Delayed Ejaculation: Symptoms, Causes and Treatment

Woman in bed with man and checking the clock.

Delayed ejaculation is a condition in men where prolonged sexual stimulation is required to achieve an orgasm and release semen (ejaculate). Some men who experience delayed ejaculation may not be able to ejaculate at all.

Delayed ejaculation can be a short-term or long-term condition. Certain medical problems, medications, and surgical procedures can all be potential causes of delayed ejaculation. The best method for the treatment will depend upon the underlying cause.

It is not uncommon for men to occasionally experience delayed ejaculation. However, if it occurs on a consistent basis, or is a source of stress for you and/or your partner, then it can be definitely be a problem.

Signs and Symptoms

For men who have delayed ejaculation, some may need to be sexually stimulated for half an hour or more before they can achieve an orgasm and ejaculate. Others may be entirely unable to ejaculate (a condition known as anejaculation).

However, there is no exact time frame that determines a diagnosis for delayed ejaculation. Rather, if you are experiencing frustration or stress over the delay, or need to stop sexual activity because of tiredness, physical discomfort, being unable to maintain an erection, or at your partner’s request, then you are likely experiencing delayed ejaculation.

Additionally, some men are only able to ejaculate when masturbating. It is often difficult for them to achieve an orgasm with a partner through sexual intercourse or other sexual activity.

Depending upon the symptoms, delayed ejaculation can be divided into the following categories:

Situational or generalized – Situational delayed ejaculation is when the delay occurs only in certain situations. On the other hand, generalized delayed ejaculation will occur regardless of sex partners and type of sexual stimulation.

Acquired or Lifelong – Acquired delayed ejaculation develops later on, when sexual function was previously normal. However, with lifelong delayed ejaculation, the problem is present right from the outset of sexual maturity.

By using these categorizations, a healthcare professional will better be able to diagnose the underlying cause of an issue and determine the best treatment.

When Should You See A Doctor?

If you are experiencing delayed ejaculation, seeing your primary care physician would be an appropriate first step. Make an appointment to visit your doctor if:

  • You or your partner is having a difficult time due to delayed ejaculation.
  • There is a known medical condition that may be linked to delayed ejaculation.
  • You are taking medication that could be contributing to the problem.
  • Other symptoms besides delayed ejaculation are present, even if they appear unrelated.

To diagnose delayed ejaculation, a physical exam and your medical history may be all that’s needed by your doctor. If there is indication that the delayed ejaculation is due to an underlying health condition, further testing may be required or you may need to visit a specialist.

Testing for underlying issues can include:

Physical Exam – This will likely include examining your testicles and penis.
Blood Test – Your doctor might request a sample of your blood to be analyzed at a laboratory to test for signs of underlying conditions, such as diabetes, cardiovascular disease, or low testosterone.
Urinalysis – Your urine may be tested in order to detect signs of diabetes, infection, and other health issues.

Delayed Ejaculation Causes

Certain medicines, ongoing medical conditions, and surgical procedures can all potentially cause delayed ejaculation. Other causes could be due to substance abuse or mental health issues, including depression, stress and anxiety.

It is also not uncommon for the cause to be due to a combination of both psychological and physiological problems.

There are a number of potential physiological causes for delayed ejaculation, such as:

  • Birth defects involving the male reproductive system.
  • Surgery or injury to the pelvic nerves associated with orgasm.
  • Certain types of infection, for example a UTI (urinary tract infection).
  • Surgical procedures involving the prostate gland.
  • Neurological diseases and nerve damage due to diabetes or spinal cord injury.
  • Hormonal imbalances, including those caused by hypothyroidism and low testosterone production.
  • Retrograde ejaculation, a condition where the semen travels back into the bladder instead out through the penis.

Some of the following types of prescription medications and other substances may lead to delayed ejaculation:

  • Antidepressants
  • High blood pressure medications
  • Diuretics
  • Antipsychotics
  • Anti-seizure medications
  • Alcohol (especially heavy alcohol use)

Some of the psychological reasons behind delayed ejaculation can include:

  • Mental health issues, such as depression and anxiety.
  • Stress, lack of communication, and other issues that can cause relationship difficulties.
  • Sexual performance anxiety.
  • Poor body image.
  • Guilt over cultural or religious beliefs pertaining to sex.
  • Contrast between imagined sex with a partner and actual sexual encounters.
  • Addiction to pornography.

Additionally, a man having some minor physical problem that results in a delay in ejaculation could develop anxiety during a sexual encounter that might actually worsen the condition.

Treatment

You may be offered a variety of treatment options by your doctor, but treatment for delayed ejaculation will depend upon the specific cause. It might involve taking a prescription drug, altering any medication you may already be taking, receiving psychological therapy, or dealing with any alcohol or drug-use issues you may have.

Medications

There are currently no approved prescription medications that specifically treat delayed ejaculation. Even so, some healthcare providers will prescribe certain drugs for off-label use.

These medications are normally used to treat other conditions, but may have limited success with treating delayed ejaculation. Examples of these drugs include:

  • Cyproheptadine, an antihistamine to treat allergies.
  • Buspirone, for the treatment of anxiety.
  • Testosterone injections, to treat low T levels.
  • Cabergoline, medication that supports dopamine levels.
  • Amantadine, a drug used to treat Parkinson’s disease.
  • Oxytocin, a hormone produced by the body during an orgasm, and helps strengthen contraction of the uterine muscles.

It’s important to remember that these medications are not specifically intended for the treatment of delayed ejaculation, and may or may not be of any help.

Additionally, if delayed ejaculation is preventing you from having children, your doctor may suggest methods for retrieving sperm for use in artificial insemination.

Psychological Therapy

Your doctor may recommend that you undergo psychological counseling or sex therapy, either one-on-one or with your partner, depending on the situation.

Psychotherapy can be helpful by addressing any underlying psychological difficulties contributing to delayed ejaculation. These can include problems like depression, anxiety, or specific psychological issues that directly impact your ability to ejaculate, such as porn addiction.

You might find that you are most benefitted by seeing a sex therapist, who is a counselor that specializes in therapy for sexual issues. Your particular needs will determine the type of counseling that is best for you.

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