Delayed Ejaculation

Signs and symptoms of delayed ejaculation may include the following: 

• Ejaculation that takes a significant time to achieve, often requiring 30 minutes or more of sexual stimulation
• Inability to ejaculate (anejaculation) despite the presence of an erection
• Stopping sexual activities due to the loss of erection, fatigue, partner request, or physical irritation before ejaculation has occurred
• Latency in ejaculation lasting for at least six months
• Distress about ejaculation difficulties
• Ejaculation difficulties that are not explained by physiological factors or medications

Delayed ejaculation may be diagnosed as the following: 

• Lifelong: Lifelong DE presents at the start of sexual maturity and persists over time. Often, lifelong DE results from a physiological predisposition. 
• Acquired: Someone with acquired DE may have experienced satisfactory ejaculations in the past before developing delayed ejaculations.   
• Generalized: Generalized DE is delayed ejaculation that isn’t limited to specific partners, situations, or types of stimulation. 
• Situational: Situational DE is limited to certain situations. For example, someone with situational DE may ejaculate during masturbation but not during sexual intercourse with their partner. 

Determining whether your DE is lifelong or acquired, and generalized or situational, may help you identify underlying causes and effective treatment strategies.

The causes of delayed ejaculation can vary considerably, but the following are common factors that may contribute to DE: 

• Fear: Fear may include the fear of causing physical or emotional harm to a sexual partner, fear of pregnancy, fear of sexually transmitted infections, concerns about personal perceptions of sexual performance, or intimacy fears.
• Relationship challenges: Resentment, lack of trust, and anger may interfere with the ability to achieve ejaculation. Other challenges, such as limited sexual attraction or difficulty for a partner to attain arousal, can also contribute to DE. 
• Age: Delayed ejaculation is most common amongst older adults, though anyone who has reached sexual maturity may experience the disorder. 
• Biology: Genetics, neurological factors, anatomical differences, nerve damage, infections, and hormone levels can cause DE. 
• Religious beliefs: Some religious beliefs may increase the experience of guilt or shame, contributing to DE. 
• Masturbation practices: Vigorous, frequent, or misalignment of sexual preferences during masturbation may reduce sensitivity or create a disconnect during sexual encounters, leading to DE. 
• Medications: Selective serotonin reuptake inhibitors (SSRIs), which are commonly used to treat depressive disorders, can cause delayed ejaculation. Other medications, including pain medicine, blood pressure medications, and antipsychotic medications, may cause DE in some people. 
• Alcohol and drugs: Substance use can contribute to the development of sexual dysfunctions, including delayed ejaculation. 
• Physical health conditions: Conditions like multiple sclerosis, diabetes, hypothyroidism, and spinal cord injuries can increase the risk of experiencing DE. 
• Mental health conditions: Some mental illnesses, such as major depressive disorder, may impact sex drive and the ability to reach orgasm and ejaculation. 

If you’re able to achieve orgasm and ejaculation when you’re masturbating but not when you’re with a partner, you may be experiencing situational delayed ejaculation, which could indicate challenges in your relationship, masturbation habits, or mental health. 

Alternatively, if you’re unable to ejaculate with a variety of sexual partners and sexual situations, you may be experiencing generalized delayed ejaculation. Factors like medications, physical conditions, trauma, hormones, anxiety, and older age may contribute to generalized DE.

There are various treatment options available to address delayed ejaculation, which vary based on the cause of the disorder. Effective options for reducing ejaculation latency and emotional distress may include talk therapy, new medications, changes to current medications, pelvic floor exercises, and self-care.  

Medication 

Your doctor may prescribe medications off-label to address delayed ejaculation. For example, amantadine, a drug used in the treatment of Parkinson’s disease, is sometimes prescribed for people taking antidepressants who report delayed ejaculation. In a study of 19 people with antidepressant-induced delayed ejaculation, 42% reported improvements in sexual dysfunction when taking amantadine. Other commonly prescribed off-label medications include buspirone, oxytocin, testosterone, and cyproheptadine. 

Certain medications can interfere with sexual functioning. If you’re experiencing delayed ejaculation, your medical provider can assess whether your current medications may be affecting your ability to ejaculate. Medications for depression, high blood pressure, and psychosis are examples of drugs that may cause DE. As an alternative to prescribing off-label medications to mitigate these effects, your doctor may recommend adjusting your current medications or doses to address your symptoms.  

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The above information is not a replacement for medical advice or diagnosis. 

If you’d like to find a doctor who can address delayed ejaculation or related challenges, consider contacting a sexual health clinic or asking for a referral from your primary care provider.

Other treatment options

If you’re experiencing sexual dysfunction, you may consider working with a pelvic floor physical therapist. Once physiological causes are ruled out, this type of therapist can provide a comprehensive exam and exercises to improve pelvic floor strength, relaxation, or control.

Self-care 

Self-care may be beneficial in addition to medical and psychological care. Below are a few ways to support yourself mentally at home: 

• Mindfulness: Mindfulness is a practice of improving consciousness and awareness in the present moment. Through mindfulness, individuals may experience increased sensation, a reduced judgment of self and others, and more profound acceptance. Mindfulness techniques may be introduced during sexual therapy, but they can also be self-taught. Studies on mindfulness have found that it can improve quality of life and sexual satisfaction, promote sexual desire, and reduce performance anxiety. 
• Adjusting sexual techniques: By adjusting masturbation practices and sexual interactions, you may improve the likelihood of ejaculation. For example, if you find it easier to ejaculate from self-stimulation, you may want to try masturbation immediately before sexual intercourse or use vibrators and toys as an aid.

If you’re experiencing delayed ejaculation that impacts your relationships or otherwise causes distress, you might consider working with a licensed talk therapist. Talk therapists can discuss anxieties, fears, and shame underlying sexual dysfunction, as well as other mental health challenges that may be contributing to your symptoms. 

While talk therapy can be beneficial, some people with sexual dysfunction experience discomfort discussing intimate symptoms. In these cases, internet-based therapy, which is offered on platforms like BetterHelp, may provide a greater sense of control than in-person therapy. 

You might also consider reading books, including the following: 

• Unf*ck Your Intimacy: Using Science for Better Relationships, Sex, & Dating, by Dr. Faith G. Harper, discusses shame, trauma, consent, and sexual preferences through exercises and discussion questions. 
• Sex Without Stress: A couple’s guide to overcoming disappointment, avoidance & pressure, by Jessa Zimmerman MA, LMHC, CST, addresses emotional stress and avoidance. 

Other resources include: 

• Sensate-focused resources: Cornell Health provides a free five-step guide to sensate approaches to intimacy, which may improve presence and awareness of physical touch. 
• Support groups: Organizations, such as the Center Against Sexual and Family Violence (CASFV), offer support groups for healthy relationships, sexual respect, and trauma healing.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

Please see our Get Help Now page for more immediate resources.

Compared with other sexual dysfunctions such as erectile dysfunction (ED) and premature ejaculation (PE), delayed ejaculation is poorly researched and understood. Though few studies address the psychological factors involved in causing DE, a 2021 study published in the American Journal of Men’s Health sought to evaluate psychodynamic factors and personality traits in men with DE who seek treatment. The authors found that some personality traits may be important for positive sexual encounters, reporting that individuals with alexithymia (difficulty expressing and understanding one’s emotions) or a strong desire for control may be at a higher risk of DE. 

There is no single standard for diagnosing and treating delayed ejaculation. Instead, a 2018 review published in The World Journal of Men’s Health recommends individualized evaluation and treatment plans based on the unique cause of DE. 

Though there are no direct studies on the role of yoga in managing delayed ejaculation, recent research supports the use of yoga for addressing sexual dysfunctions, including premature ejaculation.

Holistic, individualized treatment of delayed ejaculation can successfully treat more than 75% of DE cases

Success rates for the treatment of delayed ejaculation are greater than 75%. Holistic treatment options are often used to achieve these results, including combined medical intervention and psychotherapy, according to researchers in the Translational Andrology and Urology journal.¹

¹Translational Andrology and Urology

Below are more statistics on delayed ejaculation: 

• It’s estimated that around 3% of people with an androgynal reproductive system in the US have experienced delayed ejaculation. 
• According to the DSM-5, around 25% of males report reaching orgasm in all sexual encounters. 
• 25% of DE cases are primarily driven by psychological causes.  

By working with medical practitioners, talk therapists, or physical therapists, people may successfully address ejaculation latency and related emotional distress.