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Why Am I Having Trouble Coming?

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Geoffrey C. Whittaker

Published 05/02/2021

Updated 01/18/2024

Men’s health is about your heart, lungs, brain and other organs, but it’s also about reproductive health. You might have learned pretty early on that poor health can equal poor erections, as well as sexual problems like infertility.

Most guys wouldn’t say “lasting too long” belongs on that list of sexual problems, but if you’ve had trouble ejaculating or can’t reach orgasm these days, you’re probably wondering why.

Before you run off to make an appointment with a sex therapist or urology expert though, it’s worth your time to read about the problem and why it could be happening. 

Below, we’ve covered possible causes of delayed ejaculation and how it can be treated, so that you can get to the finish line before it causes relationship problems and more.

Delayed ejaculation (DE) may be awesome for your quick-triggered friends, but if you're a man struggling with this issue, you’re probably not surprised to hear that it’s actually a form of sexual dysfunction. 

It’s a fairly uncommon sexual dysfunction overall — between one and five percent of men who are sexually active are affected by this condition. These men may have either lifelong or acquired delayed ejaculation.

Lifelong delayed ejaculation is when you’ve experienced the problem for as long as you can remember. Acquired delayed ejaculation, on the other hand, is a problem that developed somewhere along the line, 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.

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Performance Anxiety and & Other Psychological Causes

The psychological causes of delayed ejaculation can range pretty widely — if you think your mental health, performance anxiety, relationship issues or other “in your head” issues might be at the root of your problems, you should talk to a sex therapy professional.

Delayed ejaculation can happen due to fear of (or during) sex, or as a lack of self-esteem, but it can also be caused by losing your attraction to your partner. This can happen for emotional reasons or due to physical causes of attraction (or lack thereof), or it could even result from having sex with someone of a different gender than the one you're sexually attracted to. 

Excessive Masturbation

Masturbation is perfectly normal and even healthy. But if you’re doing it excessively, it could lead to some problems — like delayed ejaculation. This can happen if the sensation or technique isn’t easily replicated by a partner. Plus, some studies show masturbation can lead to a loss of sensitivity if your grip is a little too tight.

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:

Medication Side Effects

Turns out that some medications in charge of helping the rest of your body work optimally could make it impossible to achieve orgasm. Pain medication like opioids, antidepressants (especially selective serotonin reuptake inhibitors, or SSRIs) and antipsychotics may produce adverse reactions, including delayed orgasm, in users. 

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

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

Managing this condition usually requires getting a proper diagnosis. This can be made through a consultation with your primary care provider, who can do a full examination and take a detailed history of your symptoms. 

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

Treat Underlying Conditions

First and foremost, talking to a healthcare professional 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 another medication can help you move on from the side effects and get back to previous sexual functioning.

Psychological Treatment

For psychological issues related to delayed ejaculation, treatment methods such as cognitive behavioral therapy are great for changing negative notions about sex and re-learning sex ed. 

Masturbation habits can be retrained, sexual fantasies can be realigned 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.

Testosterone Therapy

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 an issue of your masculinity. 

Penile Vibratory Stimulation

One of the easiest ways to treat delayed orgasm is to incorporate a toy into your bedroom activities. In cases of decreased sensitivity, a vibrator can help mechanically trigger orgasms (women in your life may be able to explain this). 

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

Medications

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

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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 tell if you have DE:

  • Delayed ejaculation may be caused by a number of psychological or physical factors.

  • To help with fast-forwarding orgasm and ejaculation time, psychological activities like therapy and masturbatory retraining can be effective. 

  • Similarly, reducing or discontinuing a drug that is possibly responsible for delays could help with managing the condition.

  • Some medications could be helpful in managing delayed ejaculation, although none are specifically FDA approved for this purpose.

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

We can help with ejaculation problems like premature ejaculation, anxiety and sexual performance anxiety, depression and psychological erectile dysfunction. For more about our sexual health treatments, check out our blog and resources.

7 Sources

  1. Abdel-Hamid, I. A., & Ali, O. I. (2018). Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment. The world journal of mens health, 36(1), 22–40. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756804/.
  2. Medlineplus.gov (n.d) Delayed ejaculation. Retrieved from: https://medlineplus.gov/ency/article/001954.htm.
  3. Jenkins, L. C., & Mulhall, J. P. (2015). Delayed orgasm and anorgasmia. Fertility and sterility, 104(5), 1082–1088. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816679/
  4. Chen J. (2016). The pathophysiology of delayed ejaculation. Translational andrology and urology, 5(4), 549–562. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002008/.
  5. Is there an association between same-sex sexual experience and ... (n.d.-a). https://www.researchgate.net/publication/44699077_Is_There_an_Association_Between_Same-Sex_Sexual_Experience_and_Ejaculatory_Dysfunction.
  6. Nassar GN, Leslie SW. Physiology, Testosterone. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526128/.
  7. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Premature ejaculation: Overview. 2019 Sep 12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547548/.
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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