Delayed ejaculation

Delayed ejaculation is a condition in which it takes a long period of sexual arousal to reach climax and release semen from the penis, called ejaculate. Some people with delayed ejaculation can't ejaculate at all.

Delayed ejaculation can be a brief or lifelong problem. Possible causes of delayed ejaculation include certain ongoing health conditions, surgeries and medicines. Treatment for delayed ejaculation depends on the cause.

Delayed ejaculation can happen from time to time. Delayed ejaculation is a problem only if it's ongoing and causes stress or worry for you and your partner.

There's no set time that means a diagnosis of delayed ejaculation. Some people with delayed ejaculation need many minutes of sexual stimulation to have an orgasm and ejaculate. Others might not be able to ejaculate at all, called anejaculation.

In delayed ejaculation, the delay causes upset. Also delayed ejaculation might mean stopping sex due to tiredness, physical irritation, loss of erection or because the partner wants to stop.

Often, there's trouble reaching orgasm during sexual intercourse or other sexual activities with a partner. Some people can ejaculate only when masturbating. But others may not be able to ejaculate by masturbating.

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

• Lifelong versus acquired. With lifelong delayed ejaculation, the problem is present from the time of sexual maturity. Acquired delayed ejaculation happens after a period of typical sexual functioning.
• Generalized versus situational. Generalized delayed ejaculation isn't limited to certain sex partners or certain kinds of arousal. Situational delayed ejaculation happens only under certain conditions.

When to see a doctor

Your main healthcare professional is a good place to start when you have delayed ejaculation. See your healthcare professional if:

• Delayed ejaculation is an issue for you or your partner.
• You have another health problem that might be linked to delayed ejaculation. Or you take medicines that could cause delayed ejaculation.
• You have other symptoms along with delayed ejaculation that might or might not seem linked.

Some medicines, certain ongoing health conditions and surgeries can cause delayed ejaculation. Other causes include substance misuse or a mental health concern, such as depression, anxiety or stress. Often, it's due to a mix of physical and psychological concerns.

Psychological causes of delayed ejaculation include:

• Depression, anxiety or other mental health conditions.
• Relationship problems due to stress, not communicating well 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.

Medicines and other substances that can cause delayed ejaculation include:

• Some antidepressants or antipsychotics.
• Certain high blood pressure medicines.
• Certain water pills, called diuretics.
• Some antipsychotic medicines.
• Some antiseizure medicines.
• Too much alcohol.

Physical causes of delayed ejaculation include:

• Certain birth defects that affect the 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, called hypothyroidism, or low testosterone level, called hypogonadism.
• A condition in which the semen goes backward into the bladder rather than out of the penis, called retrograde ejaculation.

The following can increase the risk of having delayed ejaculation:

• Older age. With aging, ejaculation takes longer.
• Psychological conditions, such as depression or anxiety.
• Medical conditions, such as diabetes or multiple sclerosis.
• Certain medical treatments, such as prostate surgery.
• Medicines, such as certain antidepressants, high blood pressure medicines or water pills, called diuretics.
• Relationship problems, such as not being able to talk to your partner.
• Excessive alcohol use, especially long-term heavy drinking.

Complications of delayed ejaculation can include:

• Less sexual pleasure for you and your partner.
• Stress or anxiety about having sex.
• Marital or relationship problems due to a poor sex life.
• Not being able to get your partner pregnant, called infertility.

A physical exam and medical history might be all that are needed to suggest treatment for delayed ejaculation. But there might be a problem causing delayed ejaculation that needs treatment. Then you might need more tests, or you might need to see a specialist.

Besides a physical exam of the penis and testicles, you might have:

• Blood tests. A blood sample sent to a lab can check for heart disease, diabetes, hormone levels and other health conditions.
• Urine tests, called urinalysis. Urine tests look for signs of diabetes, infection and other health conditions.

Delayed ejaculation treatment depends on the cause. Treatment might include taking medicine or making changes to medicines you take. It might involve psychological counseling or addressing alcohol or illicit drug use.

Medications

If you're taking medicine that might cause delayed ejaculation, cutting the dose or switching medicines might fix the problem. Sometimes adding a medicine might help.

There aren't any medicines that are approved for the treatment of delayed ejaculation. Medicines used to treat delayed ejaculation mainly are used to treat other conditions. They include:

• Amantadine, used for Parkinson's.
• Buspirone, used for anxiety.
• Cyproheptadine, used for allergies.

Psychological counseling

Counseling can help by dealing with mental health problems linked to delayed ejaculation, such as depression or anxiety.

You might see a psychologist or mental health counselor on your own or with your partner. It also might help you to see a mental health counselor who specializes in talk therapy for sexual problems, called a sex therapist.

Ongoing delayed ejaculation can cause mental and emotional stress for you and your partner. If you have delayed ejaculation only sometimes, try not to assume that you have a lasting problem or to expect it to happen again the next time you have sex.

Also, if you have delayed ejaculation, reassure your sexual partner. Your partner might think your not being able to reach climax is a sign of lack of sexual interest.

Talk openly with your partner about your condition. Treatment often is more successful if couples work together as a team. You might want to see a counselor with your partner. This can help you address concerns you both might have about delayed ejaculation.

If you've been having trouble having orgasm, talk with your main healthcare professional. Your care professional might send you to a specialist. This might be a specialist in male genital problems, called a urologist; a specialist in the hormonal systems, called an endocrinologist; or a mental health specialist, called a psychiatrist, psychologist or social worker.

Here's some information to help you get ready for your appointment.

What you can do

Take your partner along, if possible. Your partner might be able to give information that will help in diagnosing and treating the problem.

Make a list of:

• Your symptoms, including any that might not seem linked to delayed ejaculation, and when they began.
• Key personal information, including any major stresses or recent life changes or illnesses.
• All medicines, vitamins, herbal remedies and supplements you take, including doses.
• Questions to ask your healthcare professional.

Questions to ask your doctor

For delayed ejaculation, some basic questions to ask include:

• What's the most likely cause of my delayed ejaculation?
• What tests do I need?
• Is this problem going to go away?
• What treatments are there? Which one do you suggest for me?
• I have other health conditions. How can I best manage these conditions together?
• Where can I find more information about my condition?

What to expect from your doctor

Your healthcare professional may ask:

• Do you have trouble ejaculating only now and then, or is it an ongoing problem?
• Are you able to ejaculate during sexual intercourse? Or are you able to ejaculate only when your partner directly touches your penis or when you masturbate?
• If you're able to ejaculate, how long does it take after sexual activity starts?
• Have you had changes in sexual desire or any other sexual problems?
• Are there problems with your sexual partner?
• Have you had any other sexual problems, such as trouble getting or keeping an erection, called erectile dysfunction?
• Do you drink alcohol or use illicit drugs? If so, how much?