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Delayed Ejaculation: What can Men do if they Struggle to Ejaculate?By Danny GarrettMarch 07, 2023 7 min read Updated: March 14, 2023
All kinds of male sexual dysfunction conditions affect performance. Sadly, if left untreated, they can lead to further relationship problems for individuals and their partners.
Today, we're looking at delayed ejaculation (DE). We'll discuss exactly what it is, why it happens, and its possible treatments.
Delayed ejaculation is known by various alternative terms, including impaired ejaculation, retarded ejaculation, inhibited ejaculation, male orgasmic disorder, and inadequate ejaculation. Whichever term is used, DE regularly causes mental and emotional stress for the individual and their partner.
What is delayed ejaculation?
Delayed ejaculation (DE) is a condition where men (in this article, we assume men and males to be those with the assigned gender at birth) find it difficult to ejaculate during sexual intercourse after an extended period. In some cases, they're unable to reach orgasm or ejaculate at all, which is known as anejaculation (AE).
There isn't a standard duration for anyone to reach sexual climax
In this case, 'extended' refers to 'over 30 minutes', despite maintaining a suitable erection with an appropriate level of sexual desire.
How common is delayed ejaculation?
In the same way that many men may experience erectile dysfunction at some point during their life, the same can be said for men experiencing delayed ejaculation. An occasional case where a man fails to reach orgasm is quite normal; however, when the problem persists, it can soon become a stressful problem.
The main types of delayed ejaculation
Delayed ejaculation can be split into two categories based on symptoms and situations. The first is whether the problem has been present for all of the man's life or is a new problem; the second is whether the problem happens with all sex partners or only with specific partners or in certain situations.
Lifelong Delayed Ejaculation
Lifelong delayed ejaculation has occurred throughout the man's life, from when they entered sexual maturity.
Acquired Delayed Ejaculation
Acquired delayed ejaculation occurs after a period of normal sexual functioning.
Generalized Delayed Ejaculation
Generalized delayed ejaculation occurs with all sex partners.
Situational Delayed Ejaculation
Situational delayed ejaculation occurs only in specific situations or with particular sex partners.
What are the main symptoms of delayed ejaculation?
The main symptoms of delayed ejaculation are:
- Taking too long to climax and ejaculate during sex.
- Failing to climax before losing the ability to keep an erection.
Other factors include being unable to climax when wanted or expected or that ejaculation happens less than half the times you have sexual intercourse.
Those experiencing delayed ejaculation often find that they can climax and ejaculate through masturbation or other sexual stimulation, suggesting psychological matters rather than physical ones.
What causes delayed ejaculation?
Both physical and psychological concerns contribute to the causes of delayed ejaculation. A paper featured in the World Journal of Mens Health covers many possible psychological and physical causes of delayed ejaculation and lists many medications thought to impact the condition.
1. Psychological causes of delayed ejaculation
Both new or existing underlying mental health problems can cause delayed ejaculation. As much as we consider sex a physical act, sexual performance is intrinsically linked to how we feel and think.
All kinds of sexual dysfunction can occur when we're stressed, tired, or distracted.
For example, you may have lost confidence in your ability to pleasure your partner, suffer from performance anxiety, or be worried about your partner becoming pregnant or hurting them in some way. These types of issues can contribute to acquired and situational delayed ejaculation cases.
In lifelong cases, it may result from abuse or bonding problems in early life, feeling neglected, or other issues during childhood. In addition, some men simply cannot enjoy pleasure, while others hold religious beliefs contradicting healthy sexual activity.
As you see, psychological causes are complex, to say the least, so treatment is considered case by case.
2. Physical causes of delayed ejaculation
Physical causes of delayed ejaculation can include nerve damage, damage to the reproductive system, or a medical condition that affects either: strokes, prostatitis or other prostate trouble or removal, spinal cord injury or surgery, diabetes, or hormone changes may all affect how the body performs during sex.
Age is another leading factor, as sensitivity to sexual stimulation decreases as we get older.
3. Medication side effects
Once again, the World Journal of Men's Health features an extended list of medications that may cause delayed ejaculation. These include diuretics, anti-depressants, anti-anxiety drugs, antipsychotic meds, blood pressure medications, painkillers, and more—the list is extensive. It's a complex issue, as many different medication issues affect the ability to ejaculate with or without a partner.
4. Alcohol and recreational drug use
One commonly accepted reason behind acquired delayed ejaculation is the result of alcohol or drug use. While an occasional occurrence can happen after a few too many drinks, once in a while, extended alcohol use and alcoholism are more severe issues likely to cause reoccurring and more worrying events.
5. Changes in sexual practices and masturbation
A study by Michael A. Perelman of the NY Weill Cornell Medical Center explored the effects of masturbation on delayed ejaculation. He found that certain masturbation habits caused men to be able to achieve ejaculation only by concentrating on particular fantasies, using excess pressure or high speeds, or through a method unlikely to be duplicated during partnered sex.
Retraining the mind and body to react to more typical sexual situations can be implemented with the patient if they are both committed and disciplined to carry out the required exercises.
How is delayed ejaculation treated?
Treatment for delayed ejaculation depends on the reasons and diagnosis behind the issue. As discussed, the reasons for each instance are varied. They can be physical, such as a male reproductive system injury; psychological, such as diminished sexual interest; or medical, as side effects of existing drug treatments or other underlying health conditions.
Where the problem appears to be a mental health concern—such as diminished sexual pleasure—psychological counseling, or psychotherapy, is a valuable method of uncovering any underlying issues. Alternative but just as valuable options can include a mental health counselor, sex therapy, or therapeutic relationship guidance.
Undergoing psychological counseling to treat delayed ejaculation can be helpful for both partners, as failing to address the issue often results in relationship problems.
Alcohol and recreational drug abuse is another area that lends itself to specialist support for the individual. Excessive alcohol use is treated both physically and mentally, as alcohol addiction is both chemical and psychological.
Engaging with a sex therapist can help reprogram a partner where excessive stimulation has desensitized their ability to gain arousal to orgasm.
Whether overindulging in masturbation or pornography or only being aroused by unrealistic fantasies or overly sexual situations and stimulation, withdrawing from unhealthy practices may help realign their ability or through an alternative prescribed technique.
There is no approved medication available as a dedicated treatment for delayed ejaculation. However, several alternative off-label medications are regularly prescribed with limited success. From testosterone to pseudoephedrine (see table 4 of Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment for an extensive list), each type is prescribed only after carefully-considered consultation, as each treatment can produce varying side effects.
Some of the more common medications used to aid delayed ejaculation issues are:
|Amantadine||Typically used to treat Parkinson's disease.|
|Buspirone||An anti-anxiety medication.|
|Cyproheptadine||Used to treat allergies.|
Where a patient's ejaculation problems are thought to be the side effects of using existing medications, reducing the dose or switching to alternative drugs may help.
Treatment for infertility issues
Where delayed ejaculation impacts fertility and a couple's intention to have children, gathering sperm through alternative methods aids assisted reproduction.
Each case demands an appropriate solution determined by careful diagnosis.
There are various options: including penile vibratory stimulation (PVS), vigorous prostatic massage, nocturnal collection, and testicular sperm extraction. But, again, each case demands an appropriate solution determined by careful diagnosis.
Stimulation using vibrating sex toys
While sexual dysfunction cases are complex with varying underlying causes, vibratory stimulation can be considered a standalone option or an aid to medical or psychological treatments.
One study published in 2018, Genital vibration for sexual function and enhancement: a review of evidence explores how vibration is used for sexual pleasure despite the earliest uses of vibration being medical. The authors concluded that 'vibratory stimulation is a viable treatment option for premature ejaculation as well as delayed ejaculation in men without a history of spinal cord injury.'
An earlier 2007 study, Assessment of Penile Vibratory Stimulation as a Management Strategy in Men with Secondary Retarded Orgasm, also concluded that a significant increase in orgasm and satisfaction was produced by vibratory stimulation.
Stimulation through prostate massage
Another alternative method of male stimulation is via the prostate. The prostate is packed with sensitive nerves, and through internal or external stimulation, many men will experience arousal through prostate stimulation. While, so far, there is little conclusive material published about prostate massage and delayed ejaculation, the topic appears regularly regarding semen collection for people living with infertility, mainly where damage has occurred to the spinal cord or reproductive system.
Is it possible to prevent delayed ejaculation?
The Living Textbook of Medicine states that partners need a healthy attitude towards sex and sexuality, as fears and anxieties can easily affect the practice. Prevention of delayed ejaculation is possible when those anxieties and fears are managed through therapy and guidance or by adjusting medications that impact performance.
More complex physical situations require more complex solutions by having the cause of delayed ejaculation diagnosed by a suitable specialist or healthcare professional.
When should you see a doctor?
Where bouts of occasionally delayed ejaculation happen to many men, you should consult your primary care doctor when having trouble achieving orgasm becomes a regular issue. They will explore the possible reasons for any persistent delayed ejaculation problems while offering a treatment path suitable to your situation.
Delayed ejaculation typically leads to an unsatisfactory sex life. The inability to achieve orgasm through physical and psychological concerns requires delicate handling to determine the precise cause and its suitable solution.
It's a treatable issue for most, with a favorable outcome for partners wishing to return to healthy sexual activity.
However, with the right help from healthcare or psychological professionals—through medical, practical, or mental health practices—it's a treatable issue for most, with a favorable outcome for partners wishing to return to healthy sexual activity.