Overview

Delayed ejaculation — sometimes called impaired ejaculation — is a condition in which it takes an extended period of sexual stimulation for men to reach sexual climax and release semen from the penis (ejaculate). Some men with delayed ejaculation are unable to ejaculate at all.

Delayed ejaculation can be temporary or a lifelong problem. Possible causes of delayed ejaculation include certain chronic health conditions, surgeries and medications. Treatment for delayed ejaculation depends on the underlying cause.

It's normal for men to have delayed ejaculation from time to time. Delayed ejaculation is only a problem if it's ongoing or causes stress for you or your partner.

Symptoms

Some men with delayed ejaculation need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate. Other men might not be able to ejaculate at all (anejaculation).

But, there's no specific time that indicates a diagnosis of delayed ejaculation. Instead, you are probably experiencing delayed ejaculation if the delay is causing distress or frustration, or if you have to stop sexual activity due to fatigue, physical irritation, loss of erection or a request from your partner.

Often, men might have difficulty reaching orgasm during sexual intercourse or other sexual activities with a partner. Some men can ejaculate only when masturbating.

Delayed ejaculation is divided into the following types based on symptoms:

  • Lifelong vs. acquired. With lifelong delayed ejaculation, the problem is present from the time of sexual maturity. Acquired delayed ejaculation occurs after a period of normal sexual functioning.
  • Generalized vs. situational. Generalized delayed ejaculation isn't limited to certain sex partners or certain kinds of stimulation. Situational delayed ejaculation occurs only under certain circumstances.

These categories help in diagnosing an underlying cause and determining what might be the most effective treatment.

When to see a doctor

Your primary care doctor is a good place to start when you have delayed ejaculation. See your doctor if:

  • Delayed ejaculation is an issue for you or your partner
  • You have another known health problem that might be linked to delayed ejaculation, or you take medications that could be causing the problem
  • You have other symptoms along with delayed ejaculation that might or might not seem related

Causes

Delayed ejaculation can result from medications, certain chronic health conditions and surgeries. Or it might be caused by substance misuse or a mental health concern, such as depression, anxiety or stress. In many cases, it is due to a combination of physical and psychological concerns.

Psychological causes of delayed ejaculation include:

  • Depression, anxiety or other mental health conditions
  • Relationship problems due to stress, poor communication or other concerns
  • Anxiety about performance
  • Poor body image
  • Cultural or religious taboos
  • Differences between the reality of sex with a partner and sexual fantasies

Medications and other substances that can cause delayed ejaculation include:

  • Some antidepressants
  • Certain high blood pressure medications
  • Certain diuretics
  • Some antipsychotic medications
  • Some anti-seizure medications
  • Alcohol — particularly drinking too much (excessive alcohol use or alcoholism)

Physical causes of delayed ejaculation include:

  • Certain birth defects affecting the male reproductive system
  • Injury to the pelvic nerves that control orgasm
  • Certain infections, such as a urinary tract infection
  • Prostate surgery, such as transurethral resection of the prostate or prostate removal
  • Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord
  • Hormone-related conditions, such as low thyroid hormone level (hypothyroidism) or low testosterone level (hypogonadism)
  • Retrograde ejaculation, a condition in which the semen goes backward into the bladder rather than out of the penis

For some men, a minor physical problem that causes a delay in ejaculation might cause anxiety about ejaculating during a sexual encounter. The resulting anxiety might worsen delayed ejaculation.

Risk factors

A number of things can increase your risk of having delayed ejaculation, including:

  • Older age — as men age, it's normal for ejaculation to take longer
  • Psychological conditions, such as depression or anxiety
  • Medical conditions, such as diabetes or multiple sclerosis
  • Certain medical treatments, such as prostate surgery
  • Medications, particularly certain antidepressants, high blood pressure medications or diuretics
  • Relationship problems, such as poor communication with your partner
  • Excessive alcohol use, especially if you're a long-term heavy drinker

Complications

Complications of delayed ejaculation can include:

  • Diminished sexual pleasure for you and your partner
  • Stress or anxiety about sexual performance
  • Marital or relationship problems due to an unsatisfactory sex life
  • Inability to get your partner pregnant (male infertility)

June 05, 2018
References
  1. Sexual dysfunctions. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org/. Accessed Feb. 25, 2018.
  2. Wein AJ, et al., eds. Disorders of male orgasm and ejaculation. In: Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed May 7, 2018.
  3. Ferri FF. Ejaculation and orgasm disorders. In: Ferri's Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Feb. 25, 2018.
  4. Abdel-Hamid IA, et al. Delayed ejaculation: Pathophysiology, diagnosis, and treatment. World Journal of Men's Health. 2018;36:22.
  5. Sadowski DJ et al. A review of pathophysiology and management options for delayed ejaculation. Sexual Medicine Reviews. 2016;4:167.