Delayed Ejaculation: Symptoms, Causes & Treatments

Most people are familiar with premature ejaculation (PE). Resulting in early ejaculation during sexual activity, this medical condition is one of the most common forms of sexual dysfunction. However, far fewer people are aware of a condition with the opposite effect: delayed ejaculation.

Dealing with delayed ejaculation can be a frustrating experience. But like many other sexual health issues, you can learn how to treat delayed ejaculation. In fact, treatments for delayed ejaculation have a 70 to 80 percent success rate, though it depends on the type.

Below, we’ll explain the causes of delayed ejaculation as well as the symptoms you may notice if you’re affected by ejaculation problems, such as weak ejaculation.

We’ll also spare you the Google search of “how do you fix inability to ejaculate” with options on how to fix delayed ejaculation — from medications to psychotherapy, lifestyle changes and more.

Delayed ejaculation is a medical condition that makes it difficult or impossible to orgasm and ejaculate. Or, in certain cases, reaching ejaculation may require an extended period of sexual stimulation.

Previously called male orgasmic disorder, some men with delayed ejaculation might take longer to reach orgasm, and ejaculation can take significantly longer.

Besides taking longer to orgasm and ejaculate, men with ejaculatory disorders may find the process of orgasm and ejaculation difficult. Others might only be able to reach orgasm and ejaculate through alternative sexual experiences or acts, such as masturbation.

Delayed ejaculation has been referred to by a range of terms, including impaired ejaculation, diminished ejaculation and inadequate ejaculation.

While longer-lasting sex may sound like a good thing, the reality is that delayed ejaculation — like erectile dysfunction (ED) and other sexual dysfunction disorders — can cause stress, frustration and discomfort, both for men affected by this condition and for their partners.

It may seem like there’s one sign of delayed ejaculation, but this type of sexual dysfunction can vary in severity and cause several symptoms.

You may be affected by delayed ejaculation if you:

• Need 30 minutes or more of sexual stimulation to ejaculate. You may find it difficult to orgasm and ejaculate within a reasonable amount of time during sex with your partner or while masturbating.

• Find it difficult or impossible to ejaculate at all. Typically referred to as anejaculation, you may find it difficult to ejaculate following sexual stimulation. Anejaculation can occur with or without orgasm.

• Can only ejaculate while masturbating. Some men with delayed ejaculation find it difficult to orgasm and ejaculate during sexual intercourse but are able to orgasm and ejaculate normally from masturbation.

• Need to stop or take a break from sex. You may experience fatigue during sex due to exertion. You and/or your partner may feel physically irritated, or you might lose your erection during sex.

• Feel distress or frustration. You and/or your partner may feel distressed, frustrated or unhappy about your inability to orgasm and ejaculate. This could even cause relationship problems or tension in your sex life.

The precise symptoms of delayed ejaculation can vary. To diagnose and treat cases, most experts categorize delayed ejaculation into two categories:

• Lifelong delayed ejaculation. This form of delayed ejaculation occurs from the start of sexual maturity. Men with lifelong delayed ejaculation may have always found it difficult to reach orgasm and ejaculate.

• Acquired delayed ejaculation. This form of delayed ejaculation occurs after a period of normal sexual function.

In addition to being either lifelong or acquired, delayed ejaculation is often categorized as generalized or situational:

• Generalized delayed ejaculation. Men with generalized delayed ejaculation experience symptoms with all sexual partners and types of sexual stimulation.

• Situational delayed ejaculation. Men with situational delayed ejaculation may only find it difficult to orgasm and ejaculate in certain situations, such as with a specific sexual partner or with a particular type of sexual stimulation.

Numerous factors can play a role in delayed ejaculation causes, from psychological issues to health problems or even the use of certain medications. 

Sometimes, several factors might play a role in contributing to difficulty reaching orgasm and ejaculating.

Psychological Causes of Delayed Ejaculation

In many instances, delayed ejaculation is caused by a psychological factor, such as depression or sexual performance anxiety. 

Potential psychological causes of delayed ejaculation include:

• Fear of intimacy or pregnancy. Trepidations, like fear of intimacy or concerns about impregnating a sexual partner, may affect your ability to ejaculate and contribute to delayed ejaculation.

• Mental health conditions. Various mental health conditions are linked to delayed ejaculation, including depression, anxiety disorders and obsessive-compulsive disorder (OCD), as well as decreased sexual desire.

• Sexual performance anxiety. Even if you don’t have an anxiety disorder, it’s common to feel anxious before sex. This is referred to as sexual performance anxiety, and it may cause symptoms such as erectile dysfunction or difficulty ejaculating.

• Conditioning due to masturbation. If you masturbate frequently or watch porn often, it could contribute to sexual dysfunction, including delayed or impaired ejaculation.

• Relationship issues or lack of attraction. You may find it difficult to have a sexual response long enough to ejaculate if you lack sexual attraction to your partner — or if you feel unhappy with your partner due to a conflict.

• Feelings of guilt due to religious or cultural conviction. If you have a religious or cultural background that makes you view sex as sinful or inappropriate, it could affect your ability to orgasm and ejaculate.

• Traumatic events. Traumatic events related to sex or masturbation — such as worries about your partner’s sexual life or a negative past experience with sex — might make it harder to orgasm and ejaculate.

Physical Causes of Delayed Ejaculation

Sometimes, delayed ejaculation is linked to a physical factor, like nerve damage or the use of a certain type of medication.

Potential physical causes of delayed ejaculation include:

• Use of certain medications. Some medications, such as antidepressants, may affect your ability to orgasm and ejaculate, resulting in delayed ejaculation. Prescription drugs associated with delayed ejaculation include antidepressants like SSRIs (selective serotonin reuptake inhibitors), diuretics, high blood pressure (hypertension) medications, anti-seizure meds and antipsychotics.

• Alcohol consumption. How does alcohol affect a man sexually? It’s associated with a long list of sexual performance issues, including ED. Drinking alcohol frequently or excessively could cause delayed ejaculation.

• Nerve damage. Damage to the pelvic nerves responsible for controlling your ability to orgasm and ejaculate — also known as neurological ED — can cause delayed ejaculation. Nervous system conditions and neurological issues that can cause nerve damage include stroke, multiple sclerosis and diabetic neuropathy. A spinal cord injury or pinched nerve may also lead to delayed ejaculation.

• Retrograde ejaculation. This condition causes semen to release into the bladder instead of outward from the penis. With retrograde ejaculation, you might be able to reach orgasm but ejaculate a very small volume of semen — or no semen at all.

• Pelvis surgery. Some prostate surgeries, such as prostate removal or transurethral resection of the prostate, may cause delayed ejaculation.

• Hormone conditions. Conditions like low testosterone or hypothyroidism (underactive thyroid) could affect your sexual performance and ability to reach orgasm and ejaculate.

Several delayed ejaculation treatment options are available. For some guys, treatment of delayed ejaculation can involve medication, while others may benefit from therapy, such as sex therapy or relationship-focused therapy.

Medications

Unfortunately, there aren’t currently any FDA-approved medications for delayed ejaculation treatment.

This means a urologist or other healthcare provider may recommend using a medication off-label to treat delayed ejaculation symptoms.

• Testosterone

• Cyproheptadine

• Cabergoline

• Bupropion

• Amantadine

• Reboxetine

• Lisdexamfetamine dimesylate

• Oxytocin

• Yohimbine

• Pseudoephedrine

• Cyproheptadine

• Bethanechol

• Buspirone

• Ephedrine

• Midodrine

While the list of medications associated with treating delayed ejaculations is extensive, not all have proven effective in testing.

Like any medication, these off-label treatments for delayed ejaculation may cause side effects:

On the other side, though, if your delayed ejaculation is caused by an existing medication, your healthcare provider might recommend switching medications or reducing your dosage.

Therapy

Several forms of therapy may be helpful for treating delayed ejaculation, including psychotherapy for underlying conditions or sex therapy. If a relationship issue is causing delayed ejaculation, seeing a sex therapist may involve working on your relationship and intimacy with your partner.

You can work with a therapist in person or try online therapy with professional counselors.

Lifestyle Changes

If your delayed ejaculation is caused by a lifestyle factor, such as heavy alcohol consumption or lack of intimacy with your partner, making changes to your lifestyle might help.

• Communicate with your partner. Delayed ejaculation can be a result of performance anxiety. If you have sex-related worries, try talking openly with your partner to ease anxiety and make sex more relaxing and enjoyable.

• Seek treatment for alcohol or substance use disorder. Alcohol and drug use may contribute to delayed ejaculation and other sexual dysfunction issues. If you have an alcohol or drug use disorder, consider seeking treatment.

While it’s one of the less common forms of sexual dysfunction, delayed ejaculation can happen to some guys. But there are ways to treat this men’s health condition, especially if you know the underlying cause.

Here’s what to remember: 

• Delayed ejaculation is an inability to ejaculate or having trouble ejaculating, even with enough sexual stimulation.

• Causes of delayed ejaculation can be physical, such as the use of certain medications, heavy alcohol consumption, nerve damage or surgery.

• This medical condition can also be psychological when sparked by mental health issues, fear of intimacy, past trauma or sexual performance anxiety.

• Treatment usually consists of therapy, lifestyle changes and, in some cases, medication.

• Currently, no medications are FDA-approved specifically for delayed ejaculation, but a healthcare provider might prescribe one off-label.

Delayed ejaculation is just one form of sexual dysfunction. If you’re struggling with erectile dysfunction or premature ejaculation — two of the most common sexual issues affecting men — seek advice from a medical professional.

A healthcare provider can recommend one of several available erectile dysfunction medications or premature ejaculation treatments.