Why Am I Having Trouble Coming?

Though premature ejaculation gets more mentions in pop culture, there’s a flip side of that coin. If you’re a man having trouble coming, you may be struggling with a sexual problem like delayed ejaculation or anorgasmia. These medical conditions can cause sexual frustration, relationship problems, and overall distress.

While scheduling an appointment with a sex therapist or urologist can help you get to the root of what’s going on, we’ll share some possible causes of delayed ejaculation and what treatment options are available below.

Taking a bit longer to come from time to time is completely normal. But if it becomes a long-term issue and causes stress, a healthcare provider can help.

Delayed ejaculation (DE) is when it takes a long time to reach orgasm and ejaculate during most sexual activity. Thismay sound appealing to men struggling with premature ejaculation (PE). But, if you're a man struggling to reach orgasm or are not able to come at all,, you’re probably not surprised to hear that it’s actually a form of sexual dysfunction. 

It’s a fairly uncommon and poorly defined sexual dysfunction overall — between 1-4 percent of sexually active men are affected by this condition (some estimates suggest it affects up to 10% of men.). These men may have either lifelong or acquired delayed ejaculation.

Lifelong vs. Acquired Delayed Ejaculation

Lifelong delayed ejaculation is when you’ve experienced the issue for as long as you can remember.

Acquired delayed ejaculation, on the other hand, develops somewhere along the way or may be limited to specific partners — in other words, it doesn’t occur with every sexual experience you have.

A related condition called anorgasmia describes an inability to orgasm from sexual intercourse or any sexual activity.

The causes of delayed ejaculation or anorgasmia range from mental health conditions to endocrine (hormone) disorders to medication side effects.

Performance Anxiety and & Other Psychological Causes

The psychological causes of delayed ejaculation can vary. They can include mental health conditions like depression, performance anxiety, relationship issues, or other issues that affect mental wellbeing. If you think a mental health issue is at the root of your delayed ejaculation or anorgasmia, you should consider sex therapy or psychotherapy.

Delayed ejaculation can also be caused by losing attraction to your partner. This can happen for emotional or physical reasons.

Excessive Masturbation

Masturbation is perfectly normal and even healthy. But if you’re doing it excessively, it could contribute to delayed ejaculation. This can happen if the sensation or technique isn’t easily replicated by a partner. Plus, some studies show self-stimulation can lead to delayed ejaculation if your masturbation style is too vigorous. This is also known as death grip syndrome.

We’ve covered excessive masturbation more in our guide to masturbation, porn, and ED.

Neurological Disorders

Certain conditions related to your nerves, like the following, may delay or prevent orgasm:

• Spinal cord injuries

• Multiple sclerosis

• Nerve damage brought on by diabetes

• Complications due to adult circumcision

Endocrine Disorders

Your hormones may impact ejaculation and erectile function, which means hormonal conditions can also cause delayed ejaculation. Potential hormonal causes of delayed ejaculation include:

• Low testosterone

• Hypothyroidism: a condition where the thyroid gland doesn’t produce enough hormones, leading to symptoms like fatigue and weight gain

• Hyperprolactinemia:  a condition where there's too much prolactin in the blood, which can affect fertility, and sexual function

Medication Side Effects

Some medications in charge of helping the rest of your body work optimally could make it challenging to achieve orgasm.

Medications that may produce adverse reactions, including an orgasmic disorder, include:

• Antidepressants (especially selective serotonin reuptake inhibitors or SSRIs)

• Antipsychotics

• Diuretics

• Antihypertensives (high blood pressure medications)

• Opioids

• Antiepileptics

Living in uncertainty about reaching orgasm or constantly mentally preparing for lengthy sessions of intercourse can negatively affect your sex life. 

This is why getting the proper treatment is so important when you have trouble coming.

Managing this condition usually requires getting a proper diagnosis, which can be made through a consultation with your primary care provider, a urologist or a specialist in sexual medicine.  Your healthcare provider will take a detailed history of your symptoms and do an examination to rule out certain medical conditions that can cause delayed ejaculation. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines delayed ejaculation as a condition where a man has a significant delay, infrequent, or no ejaculation during most partnered sexual encounters for at least 6 months, causing personal distress. 

Where delayed ejaculation is confirmed, the following treatment methods may be adopted.

Treat Underlying Conditions

Talking to a healthcare provider and diagnosing underlying conditions may be your shortest path to normal orgasmic function. Treating the underlying condition may also treat delayed orgasm.

Switch Medications

Medications like selective serotonin reuptake inhibitors may affect your sexual desire and more. Switching to a different medication or lowering your dosage can help you move on from the side effects and get back to previous sexual functioning. 

Remember, you should never stop taking a prescribed medication without first consulting your healthcare provider.

Psychological Treatment

For psychological issues related to delayed ejaculation, treatment methods including cognitive behavioral therapy are great for changing negative notions about sex and building self-esteem. 

Masturbation habits can be retrained, and performance anxiety can be addressed with mindfulness and breathing techniques to put you more at ease during intercourse. 

If you and a partner both need help, online therapy for couples and interaction exercises to examine relations between partners can also help with managing delayed ejaculation.

Hormone Therapy

Conditions like low testosterone or an underactive thyroid can impact sexual performance, including the ability to reach orgasm and ejaculate. Testosterone promotes sex drive, sperm production, and fertility, so if your supplies are low, you may want to explore testosterone replacement therapy or an alternative to address the sexual side effects.

Low testosterone levels aren’t something you should be ashamed of — it’s important to remember that this is a sexual medicine issue, not something that reflects on your masculinity. 

Sex Toys

If reduced sensitivity in the penis is causing the delayed ejaculation, trying new sexual techniques or using a vibrating sex toy might help. Some research suggests that penile vibratory stimulation can be an effective treatment for up to 72% of people with delayed ejaculation or difficulty reaching orgasm.

A little extra mechanical help could be as simple as any of our recommended toys: 

• Standing O penis rings

• Thrill Ride prostate massager

• OMG Ring penis vibrator

Medications

While no medication is specifically FDA-approved to treat delayed ejaculation, a number of existing medications might be helpful and have some limited evidence of effectiveness. These include (but aren’t limited to) amantadine, bupropion, buspirone, and cyproheptadine. 

If trouble reaching orgasm happens alongside or is caused by erectile dysfunction (ED), medications like tadalafil may help improve both conditions at once.

If you’re not coming, it could be the result of physical and psychological factors, the same way the psychological factors of erectile dysfunction can prevent lift-off. 

The average sexual performance is between five and seven minutes, so many guys would see some extra stamina as a plus. However, while having impressive stamina may prolong sexual satisfaction, finding it difficult or even impossible to ejaculate following intercourse could tip normal endurance into possible delayed ejaculation.

Here’s what you need to remember if you’re trying to determine whether you have DE:

• Psychological factors may cause delayed ejaculation. To help with fast-forwarding orgasm and ejaculation time, therapy and masturbatory retraining can be effective. 

• Certain medical conditions and medications can cause delayed ejaculation. Identifying an underlying medication or discontinuing a drug may help you manage the condition. However, you should never stop taking a prescribed medication without talking to your medical provider first.

• Help is available. Seeking professional help to assist with delayed ejaculation is always advisable when you suspect you have this condition.

If you’re dealing with an ejaculation problem like delayed ejaculation, premature ejaculation, or erectile dysfunction, get advice from a healthcare provider today to see what treatments are available.