Delayed ejaculation also called impaired ejaculation.
This is a condition in which it takes an extended period of sexual stimulation for men to reach sexual climax from the penis.
Delayed ejaculation could be temporary or a long term problem.
Probable causes of delayed ejaculation include certain chronic health conditions, surgeries and medications.
Treatment for delayed ejaculation depends on the underlying cause.
It's normal for men to have delayed ejaculation from time to time.
Delayed ejaculation is only a problem if it's ongoing or causes stress for you or your partner.
Symptoms
Some men with delayed ejaculation need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate.
There have been no specific time that indicates a diagnosis of delayed ejaculation.
Often, men might have difficulty reaching orgasm during sexual intercourse or other sexual activities with a partner.
Some men can ejaculate only when masturbating.
Delayed ejaculation is divided into the following types based on symptoms:
Lifelong / Acquired
With Lifelong delayed ejaculation, the problem is present from the time of sexual maturity.
Acquired delayed ejaculation occurs after a period of normal sexual functioning.
Generalized / Situational.
Generalized delayed ejaculation isn't limited to certain sex partners or certain kinds of stimulation.
Situational delayed ejaculation occurs only under certain circumstances.
These categories help in diagnosing an underlying cause and determining what might be the most effective treatment.
Causes
Delayed ejaculation can result from medications, certain chronic health conditions and surgeries. Or it might be caused by substance misuse or a mental health concern, such as depression, anxiety or stress.
In many cases, it is due to a combination of physical and psychological concerns.
Psychological causes of delayed ejaculation include:
Depression, anxiety or other mental health conditions
Relationship problems due to stress, poor communication 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
Medications and other substances that can cause delayed ejaculation include:
Some antidepressants
Certain high blood pressure medications
Certain diuretics
Some antipsychotic medications
Some anti-seizure medications
Alcohol particularly drinking too much (excessive alcohol use or alcoholism)
Physical causes of delayed ejaculation include:
Certain birth defects affecting the male 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 (hypothyroidism) or low testosterone level (hypogonadism)
Retrograde ejaculation, a condition in which the semen goes backward into the bladder rather than out of the penis
For some men, a minor physical problem that causes a delay in ejaculation might cause anxiety about ejaculating during a sexual encounter. The resulting anxiety might worsen delayed ejaculation.
Risk factors
A number of things can increase your risk of having delayed ejaculation, including:
Older age as men age, it's normal for ejaculation to take longer
Psychological conditions, such as depression or anxiety
Medical conditions, such as diabetes or multiple sclerosis
Certain medical treatments, such as prostate surgery
Medications, particularly certain antidepressants, high blood pressure medications or diuretics
Relationship problems, such as poor communication with your partner
Excessive alcohol use, especially if you're a long-term heavy drinker
Complications
Complications of delayed ejaculation can include:
Diminished sexual pleasure for you and your partner
Stress or anxiety about sexual performance
Marital or relationship problems due to an unsatisfactory sex life
Inability to get your partner pregnant (male infertility)
Diagnosis
A physical exam and medical history might be all that are needed to recommend treatment for delayed ejaculation. However, if delayed ejaculation appears to be caused by an underlying problem that might need treatment, you might need further tests or you might need to see a specialist.
Tests for underlying problems can include:
Physical exam. This might include careful examination of your penis and testicles. The doctor will use light touch to make sure you have normal sensation in your genitals.
Blood tests. Your health care provider might take a blood sample and send it to a lab to check for signs of cardiovascular disease, diabetes, a low testosterone level and other health problems.
Urine tests (urinalysis). Urine tests are used to look for signs of diabetes, infection and other underlying health conditions.
Treatment
Delayed ejaculation treatment depends on the underlying cause, but it might include taking a medication or making changes to medications you currently take, undergoing psychological counseling, or addressing alcohol or illegal drug use.
Medications
If you're taking medication that might be causing delayed ejaculation, reducing the dose of a medication or switching medications might fix the problem. Sometimes, adding a medication might help.
There aren't any drugs that have been specifically approved for the treatment of delayed ejaculation. Medications used to treat delayed ejaculation are primarily used to treat other conditions.
Medications sometimes used to treat delayed ejaculation include:
Amantadine, a Parkinson's medication
Buspirone, an anti-anxiety medication
Cyproheptadine, an allergy medication
Psychological counseling (psychotherapy)
Psychotherapy can help by addressing underlying mental health problems leading to delayed ejaculation, such as depression or anxiety. It's also used to address psychological issues that directly affect your ability to ejaculate.
Counseling might involve seeing a psychologist or mental health counselor on your own or along with your partner. Depending on the underlying cause, you might benefit most from seeing a sex therapist — a mental health counselor who specializes in talk therapy for sexual problems. The type of counseling that's best for you will depend on your particular concerns.
Coping and support
If it's an ongoing concern, delayed ejaculation can cause mental and emotional stress for you and your partner. If you have delayed ejaculation only on occasion, try not to assume that you have a permanent problem or to expect it to happen again during your next sexual encounter. Remember, occasional delayed ejaculation due to stress or other temporary factors might improve when the underlying cause gets better.
