Delayed Ejaculation (DE) is a condition characterized by a consistent difficulty in achieving orgasm and/or ejaculation despite adequate sexual stimulation. An occasional inability to reach sexual climax is normal for men and should only be cause for concern if the condition is chronic and causes ongoing stress for a man or his partner.
What Is Delayed Ejaculation (DE)?
Delayed Ejaculation (DE) is a relatively common yet little understood sexual complaint affecting up to 4% of sexually active men.1 Men with DE find it consistently difficult or impossible to ejaculate and/or orgasm. Men typically report having DE during partnered sexual activity, however, DE may also occur during masturbation.
The length of time that it typically takes for a man to reach sexual climax and ejaculate varies widely, although the average time from penetration to ejaculation is approximately 5 minutes.2 There is no set time range in the DSM-5 criteria for what constitutes DE, making it difficult to ascertain the exact figures of men who are afflicted.
Some men with DE may experience orgasm without accompanying ejaculation and others may be unable either to ejaculate or reach a sensation of orgasmic release. Both of these situations currently fall under the diagnostic umbrella of DE. Historically, these symptoms have been clinically labeled male anorgasmia, male orgasmic disorder, retarded ejaculation, anejaculation, inadequate ejaculation, or diminished ejaculation, among others.
DE frequently co-occurs with Erectile Dysfunction (ED) and may decrease when ED symptoms are addressed.1,3 ED can cause performance anxiety, which in turn may trigger a difficulty with ejaculation when an erection is achieved.
Symptoms of Delayed Ejaculation
The main criterion for DE is a consistent inhibition of the ejaculatory reflex, with absent or reduced seminal fluid and impaired ejaculatory contractions, possibly with impaired or absent sensation of orgasm.4
Men with DE may be able to ejaculate with great effort and after prolonged intercourse or may be unable to ejaculate. Men may report prolonged thrusting to the point of exhaustion or genital discomfort. Some men may report avoiding sexual activity due to a repetitive pattern of difficulty with orgasm. Sexual partners may report feeling less sexually attractive due to their partner’s difficulty with ejaculation.
In order to meet the diagnostic criteria in the Diagnostic and Statistical Manual of Mental DisordersDSM-5 for DE, the delay or absence in ejaculation must:
- Have been present for at least 6 months.
- Be experienced during 75-100% of partnered sexual activity during that time.
- Cause clinically significant distress.
- Not be better explained by a non-sexual mental disorder.
- Not be better explained by severe relationship distress or other significant stressors.
- Not be attributable to the effects of a substance/medication or other medical condition.
DE may be specified as:
- Lifelong: Present since becoming sexually active.
- Acquired: Beginning after a period of relatively normal sexual function.
DE may also be specified as:
- Generalized: Occurring during all sexual situations, types of stimulation and with all partners.
- Situational: Only occurring during certain sexual situations, types of stimulation or with specific partners.
- DE may also be specified as causing mild, moderate or severe distress based on self-reporting.
Causes & Triggers of Delayed Ejaculation
Most causes for DE are psychological; however, biological factors should be considered and ruled out with your doctor before addressing more complex mental or emotional concerns.
Physiological contributors to DE may include:
- Aging, which can cause decreased sensitivity and decreased sexual stamina.
- Hormone imbalances resulting from low testosterone or hypothyroidism.
- Retrograde Ejaculation, when ejaculation does occur but semen moves into the bladder instead of out the urethra.
- Side effects of other medical conditions, such as:
- Stroke
- Prostate surgery
- Injury to the spinal cord
- Injury to the pelvic nerve
- Urinary tract infection (UTI)
- Multiple Sclerosis
- Advanced diabetes
- Side effects of using recreational drugs, such as:
- Alcohol
- Marijuana
- Cocaine
- Amphetamines
- Opiates
- Side effects of medications, including:
- Selective Serotonin Reuptake Inhibitors (SSRIs) often prescribed for depression
- Benzodiazepines (e.g. Valium, Klonopin, Xanax, Ativan) often prescribed for anxiety
- Diuretics (eg. Bumex, Lasix, Enduron) often prescribed to regulate blood pressure
- Opiates (eg. Vicodin, OxyContin, Percocet) often prescribed for pain management
Impacts of Delayed Ejaculation (DE) on Individuals & Relationships
DE can have a negative emotional impact on both an individual and on a relationship, including frustration and lack of sexual satisfaction. DE may be a contributing factor to infertility in some couples. DE typically does not indicate or lead to significant underlying health conditions, however, DE can cause significant psychological or relational distress.
Men experiencing DE may identify with the following repercussions of this disorder:
- Loss of self-esteem or feelings of inadequacy
- Inability to achieve an erection due to performance anxiety
- Loss of libido or desire for sex due to performance anxiety
- Anger or resentment
Men in relationships may find that:
- Frequency of sex decreases due to performance anxiety
- Loss of connection or emotional closeness occurs due to lack of sex
- Their partner experiences a loss of sexual satisfaction and/or feels inadequate
How Is Delayed Ejaculation (DE) Diagnosed?
DE is primarily based on self-report. If you have experienced difficulty with orgasm and/or ejaculation during the majority of partnered sexual experiences for a minimum of six months your doctor is likely to assign the diagnosis of Delayed Ejaculation.
Is There a Cure for Delayed Ejaculation (DE)?
While there is no cure for DE, because there is no single underlying biological cause, symptoms can often be alleviated. Successful treatment is dependent on whether there are medical or psychological factors that can be addressed and/or sexual practices which can be adjusted in such a way that symptoms subside.
Treatment of Delayed Ejaculation (DE)
Treatment for DE begins with a medical assessment for any underlying causes and addressing those factors appropriately through medication adjustments, lifestyle changes and/or sex therapy.
Interventions can include:
Medication Reassessment
Conditions such as high blood pressure, depression, anxiety, and chronic pain are often treated with medications which may cause DE as a side effect. Your doctor may be able to prescribe a similar medication which does not cause DE.
Medication
Currently there are no medications which directly treat DE. If you have an underlying hormone imbalance such as low testosterone or hypothyroidism, your doctor may refer you to a specialist and/or prescribe hormone replacement therapy.
Other medications are occasionally prescribed off-label, meaning they are not FDA approved to treat DE, but a prescriber may choose to prescribe them because they believe they are beneficial. These include:
- Buspirone (Buspar)
- Cyproheptadine (Periactin)
- Amantadine (Symmetrel)
Lifestyle Adjustments
Poor sleep hygiene and insomnia can be contributing factors to the body feeling depleted and unable to achieve orgasm. Discussing basic adjustments to your routine with a doctor or sex therapist, such as moderating caffeine and artificial light, can improve sleep and help to alleviate DE symptoms.
Regular use of substances such as alcohol, marijuana, cocaine, amphetamines or opiates may cause DE as a side effect. Moderating or eliminating substance use under doctor supervision may help to alleviate the symptoms of DE.
General stress can contribute to the body feeling depleted and unable to achieve orgasm. Identifying the causes of stress with a doctor or sex therapist, and making any possible adjustments to reduce stress levels, may help to alleviate the symptoms of DE.
Masturbation Adjustments
Assessing the style and frequency of masturbation with a certified sex therapist and adjusting technique appropriately may alleviate symptoms of DE. “Idiosyncratic masturbation,” when a man becomes accustomed to a specific rhythm, pressure and/or type of visual stimulation that is not easily mimicked in partnered sex, can contribute to DE; frequency of masturbation of over 3 times a week can also reduce the ability to orgasm. Both of these masturbation habits can be shifted behaviorally, potentially reducing symptoms of DE.
Sexual Technique Adjustments
If orgasm and ejaculation occur easily with masturbation but not during partnered sex, one of the most common interventions for a couple is to begin sexual interactions with masturbation. Penetrative sex is then initiated when the man with DE is close to orgasm, increasing the likelihood of a timely ejaculation.
As a couple practices this method, the period of time before orgasm during penetrative sex can gradually be extended. Sexual aids such as vibrators may also be added to penetrative sex in order to increase sensation. For best results with techniques such as these, seeking the help of a certified sex therapist is recommended.
Counseling
Sex therapy can be sought as an individual who is experiencing sexual symptoms or as a couple impacted by DE in a male partner. A sex therapist will take a detailed sexual and psychosocial history to assess for psychological factors contributing to sexual dysfunction.
The clinician will explore the onset and context of the symptoms being experienced, especially any changes in the situations or cues that have triggered ejaculation in the past. They will then likely offer coaching on mindfulness and behavioral techniques that either an individual or couple can explore.
Co-occurring psychological conditions, such as mood disorders, will also be assessed and treated. Counseling can provide an effective adjunct to any other treatment for DE, as performance anxiety and relational difficulties are common issues resulting from DE symptoms.
How to Get Help for Delayed Ejaculation (DE)
DE is sometimes treatable through medication adjustments or a medical assessment for lifestyle factors such as alcohol consumption or recreational drug use. Treating underlying psychological factors can be tricky and are best addressed with a certified sex therapist.
If you are consistently unable to achieve orgasm with ease, speak with your doctor about whether your symptoms are clinically concerning and what treatment approach might be appropriate. A Primary Care Provider (PCP), General Practitioner (GP), or Urologist all are suitable providers to consult with on ejaculatory issues. While it may be embarrassing to bring up the topic of sexual problems, don’t let that keep you from seeking care.
Your doctor will assess whether medical treatment would be helpful and whether referrals to other medical providers should be made. It’s important to ensure that there are no underlying medical conditions, hormone imbalances, or side effects to current medications before treating the psychological components of DE.
However, even if the ejaculatory issues are treatable through medication adjustments or a reduction in substance use, anxiety or relational distress can often develop as a side effect to the primary problem. Often, psychological counseling can be helpful to address the overall issue and achieve consistent sexual satisfaction.
When consulting a therapist for the psychological treatment of sexual issues, make sure that your mental health practitioner is AASECT (American Association of Sexuality Educators Counselors and Therapists) certified. “Sex therapist” and “sex therapy” are not protected terms, meaning that anyone can call themselves a sex therapist in their marketing.
Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex specific psychological issues.
Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy rates in your area. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180, and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.
You can find an AASECT certified sex therapist here.
Living with Delayed Ejaculation: Coping & Managing Symptoms
If you or your partner is suffering from DE, make sure to:
- Talk honestly with your partner(s) about sexual issues in order to reduce performance anxiety and collaborate on strategies to change your sexual experience.
- Consult with a medical professional to rule out any underlying medical issues.
- Consult with a certified sex therapist to develop a plan around lifestyle, sex and masturbation which is tailored to your specific needs.
- Remember that DE is treated most effectively when assessed and addressed as soon as possible.
- Acquired DE brought on by stressors, medications or other medical issues may be overcome without continuous treatment. Lifelong DE symptoms may require ongoing attention in order to promote orgasmic release.
Delayed Ejaculation Statistics
- Lifelong DE affects approximately 1% of sexually active men and acquired DE affects approximately 4% of sexually active men, although these figures may be low due to the vague medical definition of this disorder.1
- DE increases in prevalence with age6to a reported incidence of 35% in men over 70.7
- The frequency of DE increases when Erectile Dysfunction (ED) is present and may decrease when ED issues are addressed.1,3
