Delayed Ejaculation Causes and Treatments

Everything you need to know about this common condition

a man in bed depressed about because of delayed ejaculation

What Is delayed ejaculation?

Delayed ejaculation (DE) is when a man takes longer than usual to orgasm and ejaculate. This condition is also sometimes referred to impaired ejaculation or retarded ejaculation. But what exactly counts as a ‘too long’?

Researchers agree that if it takes you 20 to 25 minutes or more to reach orgasm while experiencing sexual stimulation, this counts as delayed ejaculation. If this is happening most of the time for an extended period; and it’s impacting negatively on your relationship and wellbeing, you might qualify for a diagnosis of this sexual disorder.

Now, keep in mind that experiencing these symptoms once or twice doesn’t necessarily mean that you have a sexual dysfunction. Most men experience delayed ejaculation from time-to-time, but only about 1 in 20 (or 5%) of men are actually diagnosed with the condition. Usually, delayed ejaculation is only diagnosed if the symptoms are causing you or your partner serious distress.

What are the types of delayed ejaculation?

Delayed ejaculation can occur in a few different forms. For example, generalized delayed ejaculation is diagnosed when a man experiences a delay in all or most sexual situations. On the other hand, situational delayed ejaculation means that the symptoms happen only under certain conditions (such as, for example, being with a particular partner).

Let’s unpack this further: most men with delayed ejaculate can climax when they masturbate, but they have trouble during sex with a partner – this is situational delayed ejaculation. Others are not able to ejaculate at all, even during masturbation, which counts as generalized delayed ejaculation.

Delayed ejaculation is also categorized by how long the man have been suffering from it: Lifelong delayed ejaculation, as you’ve probably guessed from the name, involves delayed ejaculation that happens right from the beginning of when a person reaches sexual maturity.

By contrast, acquired delayed ejaculation is diagnosed when the symptoms start suddenly, after a period of normal sexual functioning. Acquired delayed ejaculation is the condition that affects most men.

Are there any complications associated with DE?

Unfortunately, the answer is yes. delayed ejaculation is associated with difficulties such as low self-esteem, avoidance of sex, relationship issues, stress, performance anxiety and sexual frustration. Issues such as self-blame and rejection can also arise in the partner of a person who has DE.

Furthermore, prolonged sex can lead to physical pain and irritation. On top of all that, delayed ejaculation can also lead to low sex drive: this study found that 50% of men with DE also had low libido. Finally, for obvious reasons, delayed ejaculation can make it difficult to conceive.

Causes of delayed ejaculation

What causes this condition? Delayed ejaculation happens when a man has what’s called a ‘high ejaculatory threshold’. This means that he requires an unusual degree of stimulation in order to reach a climax. There are a number of factors that can cause a man’s ejaculatory threshold to be high. These are some are some of the more common causes:

Genetics

Some men are simply born with higher ejaculatory thresholds. In much the same way, genes cause some women to need more stimulation in order to orgasm. Furthermore, as men age, they often need even more stimulation to ejaculate. This can be caused by decreasing penis sensitivity over time; or due to reduced eroticism during sex (although this is not usually the primary cause of DE).

Unique masturbation style

There are certain ways of masturbation which cause stimulation that simply cannot be replicated during sex (or with oral or manual stimulation). This is one of the leading causes of delayed ejaculation. Masturbating in such a way for a prolonged period can cause delayed ejaculation as a result of habit formation.

For example, the famous Urologist, Dr Michael J Perlman, wrote that in his 20 year career of treating men with DE, the leading non-medical cause of DE is an idiosyncratic (i.e. unique) masturbation style. This usually involves using a unique speed, pressure, duration, position or focus on a particular “spot” in order to ejaculate.

Frequent masturbation

If you masturbate excessively (i.e. more than 3 times per week), this can temporarily increase your ejaculatory threshold. Then, with an increased ejaculatory threshold, your risk of encountering delayed ejaculation increases rapidly. Why? Masturbating releases sexual tension and the body then needs time for that sexual tension to re-build. Therefore, if you’re masturbating frequently, the next time you have sex (or masturbate) you’re likely to be less aroused and sensitive as you might otherwise have been.

Differences between your expectations and your reality in the bedroom

Do you have specific sexual fantasies which you imagine regularly? These could be related to fantasies about a partner with a particular body type, a specific type of sex (think rough or kinky), or perhaps even having sex with another man. If you’re fantasizing often in this way, and the sex that you are having is quite different from your fantasy, this can set you up struggle with delayed ejaculation. This disparity between fantasy and reality is a leading cause of Delayed ejaculation.

Psychological issues

Although psychological factors are not necessarily considered to be a leading cause of DE, these factors can certainly have an effect, at times causing or worsening ejaculation time. What sort of psychological issues are we talking about here? These include:

  • Depression, anxiety and anger issues;
  • Conflict and relationship difficulties;
  • Unexpressed resentment which you hold toward your partner;
  • Simply not being attracted to your partner;
  • A hesitancy (often characterized by guilt) about being the recipient of pleasure;
  • Low self-esteem and poor body image;
  • An irrational preoccupation with ideas of getting your partner pregnant (despite the use of contraceptives), of hurting your partner, of defiling their genitals or of “running out” of your own semen.
  • A history of trauma;
  • A religious upbringing which led to feelings of shame or guilt about sex.

Generally speaking, any negative thoughts and emotions which arise during sex can be distracting enough to delay ejaculation significantly. Similarly, sexual performance anxiety can very easily trigger or worsen delayed ejaculation.

Physical issues

While physical or medical difficulties are not the most common culprit of DE, certain conditions can cause it. For this reason, it’s important to stay physically healthy and receive regular check-ups from your doctor. Physical conditions which can cause delayed ejaculation include:

  • Spinal cord injury;
  • Multiple sclerosis;
  • Surgery of the pelvic region;
  • Uncontrolled diabetes;
  • Neuropathy or stroke;
  • Excessive alcohol consumption;
  • Hormonal abnormalities (including prolactin imbalance, low thyroid, hypothyroidism and hypogonadism);
  • Medications that delay ejaculation, including certain antidepressants, antipsychotics, high blood pressure and pain medications;
  • Low testosterone levels;
  • Urinary tract (and other) infections;
  • Birth defects.

If your delayed ejaculation is caused by a medical condition, it is important to have this treated first. If the DE still persists, then alternate treatment options (discussed below) can be explored.

How do you fix delayed ejaculation?

When treating delayed ejaculation, the overall goals are to help a man lower his ejaculatory threshold and find ways to increase his arousal during sex. Below, we cover some helpful treatment tips and techniques that can help men fix delayed ejaculation.

Masturbation retraining

This involves gradually altering the way you masturbate, so that this starts to feel more like what you would experience during penetrative sex in terms of speed, friction and the point at which pressure is exerted. Imagine this as involving training exercises for delayed ejaculation, which can help you break your old habits. For some men, it’s wise to start by limiting or even abstaining from masturbation. This, in turn, will likely increase your sensitivity and arousal, and make you more likely to ejaculate when doing masturbation retraining. 

Change the way that you have sex

Speak to your partner so that you can start having sex in a way which replicates the sort of stimulation that you need to climax. For example, during masturbation you might find that you need a particular speed, rhythm or pressure in order to ejaculate. Coordinate with your partner so that intercourse can help you reach climax in this way. At the same time, try tapping into the fantasies that you would otherwise use during masturbation, as a way of increasing your arousal during sex.

Increase your psychological arousal

The goal here is to limit negative thinking patterns and find ways to be more focused on the experience of sex itself. By doing so, you can take control of DE. There are a number of treatment techniques that can help you in this regard, such as:

Sensate focus

Sensate focus is an activity that you practice with your partner, in which you use physical touch to create non-sexual forms of pleasure. This is all about using the senses (namely touch) to enjoy and rediscover the power of sexual intimacy in a low-pressure environment. The goal here is to become more comfortable and at ease with your partner, and to improve communication.

Mindfulness meditation

Mindfulness meditation is a technique that trains a person to focus on the present moment without judgement. When applied to sex, Mindfulness can make you more aware of and connected to the physical sensations that arise. This is backed by science. A recent study showed that mindfulness meditation successfully helped both men and women reach climax in good time.

Cognitive behavioral therapy (CBT)

CBT trains a person to identify faulty thinking patterns which then give rise to feelings of discomfort and anxiety which can contribute to delayed ejaculation. Through CBT, you’ll be empowered to replace these thoughts with patterns of thinking that help fix delayed ejaculation.

Resolve internal conflicts

Many people have psychological conflicts or thinking patterns which contribute to sexual dysfunction. For example, some men are overly preoccupied about pleasing their partners and feel that it would be selfish for them to experience pleasure themselves. Others experience, for example, worries about getting their partner pregnant (even when using contraceptives). Addressing these internal conflicts is important for fixing delayed ejaculation.

Couple’s therapy

We mentioned above that delayed ejaculation can be caused by tension in a relationship, which often builds as a result of unexpressed feelings of resentment, amongst other things. Additionally, if you’re experiencing ongoing conflict with your partner, it’s important to address this in order to improve your sex life.  Couple’s therapy provides a safe space in which to work through these relationship problems. With better communication and increased intimacy, you’ll be empowered to overcome DE.

Sexual education

Proper sex education is an important component of solving delayed ejaculation. When you know the facts about the condition, this can help reduce performance anxiety. It can also be reassuring to learn that this is a common problem experienced by many – it doesn’t necessarily speak to any fault of your own.

See a psychologist or a sex therapist

Many of the techniques that we mentioned above can be practiced alone, perhaps with additional guidance from self-help books and other online resources. Others, however, may need a bit of extra input from a trained professional. You can do therapy alone or with your partner (i.e. couples therapy). It’s also a good idea to see a psychologist if you have any other underlying psychological difficulties, such as depression or anxiety. 

Switch medications

Certain medications have delayed ejaculation as a side effect. These include antidepressants like fluoxetine (Prozac) and Escitalopram (Lexapro); high blood pressure medication such as propranolol (Inderal); certain antipsychotics and certain pain medications. Do not make any changes to your medications without speaking to your doctor first. With their guidance, you may be able to change the dose of switch to a medication that helps you fix difficulties with delayed ejaculation.

Delayed ejaculation medication

Currently, there are no pills or medications designed to make a man climax faster. However, there are some medications which are used to help men with DE because of their side effects. These include Cyproheptadine, Cabergoline, Buspirone and Amantadine.

However, it’s important to know that there is little to no proper scientific evidence showing that these drugs treat delayed ejaculation. Also: contrary to some popular belief, erectile dysfunction drugs such as Cialis and Viagra don’t help delayed ejaculation.

There are some websites which offer natural home remedies, supplements and vitamins to treat delayed ejaculation. There isn’t any proof for the efficacy of these products and you should watch out for anything that doesn’t have the FDA’s approval. Also keep in mind that some of these treatments can have dangerous side effects and/or interactions with other medications.

Takeaway

Delayed ejaculation is a common condition, affecting as many as 5% of men around the world. This is a form of sexual dysfunction which can take a serious toll on your relationship, sex life and overall wellbeing. There are multiple possible causes of this condition, so it’s important to think carefully about your individual experience in order to get the right treatment. Fortunately, there are many effective ways of treating delayed ejaculation. In this article, we have covered everything that you need to know about fixing delayed ejaculation. Take back control today.

About Oreoluwa Ogunyemi, MD

Urologist and Health and Wellness Coach

Dr. Ogunyemi is a medical doctor, trained urologist and a health and wellness coach. She received her medical degree from the David Geffen School of Medicine at UCLA. Her professional background and love of writing, allow her to efficiently synthesize complex and detailed research, making it accessible to a broader audience.

She serves as a medical writer for the Between Us Clinic.