What is delayed ejaculation (DE)?
Delayed ejaculation (DE) is a common medical condition. Also
called “impaired ejaculation,” this condition occurs when it takes a prolonged
period of sexual stimulation for a man to ejaculate. In some cases, ejaculation
cannot be achieved at all. Most men experience DE from time to time, but for
others it may be a lifelong problem.
While this condition does not pose any serious medical
risks, it can be a source of stress and may create problems in your sex life
and personal relationships. However, treatments are available.
What are the symptoms of delayed ejaculation?
Delayed ejaculation occurs when a man needs more than 30 minutes
of sexual stimulation to reach orgasm and ejaculate. Ejaculation is when semen
is discharged from the penis. Some men can only ejaculate with manual or oral
stimulation. Some cannot ejaculate at all.
A lifelong problem with DE is very different from a problem that
develops later in life. Some men have a generalized problem in which DE occurs
in all sexual situations. For other men, it only occurs with certain partners
or in certain circumstances. This is known as “situational delayed
In rare cases, DE is a sign of a worsening health problem such
as heart disease or diabetes.
What causes delayed ejaculation?
There are many potential causes of DE, including psychological
concerns, chronic health conditions, and reactions to medications.
Psychological causes of DE can occur due to a traumatic
experience. Cultural or religious taboos can give sex a negative connotation.
Anxiety and depression can both suppress sexual desire, which may result in DE
Relationship stress, poor communication, and anger can make DE
worse. Disappointment in sexual realities with a partner compared to sexual
fantasies can also result in DE. Often, men with this problem can ejaculate
during masturbation but not during stimulation with a partner.
Certain chemicals can affect the nerves involved in ejaculation.
This can affect ejaculation with and without a partner. These medications can
all cause DE:
- antidepressants, such as fluoxetine (Prozac)
such as thioridazine (Mellaril)
for high blood pressure, such as propranolol (Inderal)
Surgeries or trauma may also cause DE. The physical causes of DE
- damage to the nerves in your spine or pelvis
- certain prostate surgeries that cause nerve
- heart disease that affects blood pressure to the
- infections, especially prostate or urinary
- neuropathy or stroke
- low thyroid hormone
- low testosterone levels
- birth defects that impair the ejaculation
A temporary ejaculation problem can cause anxiety and
depression. This can lead to recurrence, even when the underlying physical
cause has been resolved.
How is delayed ejaculation diagnosed?
A physical examination and explanation of your symptoms are
necessary to make an initial diagnosis. If a chronic health problem is
suspected as the underlying cause, more testing may need to be done. This includes
blood tests and urine tests.
These tests will look for infections, hormonal imbalances, and
more. Testing the reaction of your penis to a vibrator may reveal if the
problem is psychological or physical.
What treatments are available for delayed ejaculation?
Treatment will depend on the underlying cause. If you’ve had
lifelong problems or you’ve never ejaculated, a urologist can determine if you
have a structural birth defect.
Your physician can determine if a medication is the cause. If
so, adjustments will be made to your medication regimen and your symptoms will
Some medications have been used to help DE, but none have been
specifically approved for it. According to the Mayo Clinic, these medications include:
- cyproheptadine (Periactin), which is an allergy medication
- amantadine (Symmetrel), which is a drug used to treat
- buspirone (Buspar), which is an antianxiety medication
Treating illicit drug use and alcoholism, if applicable, can
also help DE. Finding inpatient or outpatient recovery programs is one therapy
Psychological counseling can help treat depression, anxiety, and
fears that trigger or perpetuate DE. Sex therapy may also be useful in addressing
the underlying cause of sexual dysfunction. This type of therapy may be
completed alone or with your partner.
DE can generally be resolved by treating the mental or physical
causes. Identifying and seeking treatment for DE sometimes exposes an underlying
medical condition. Once this is treated, DE often resolves. The same is true
when the underlying cause is a medication. However, don’t stop taking any
medication without your doctor’s recommendation.
What are the complications of delayed ejaculation?
DE can cause problems with self-esteem in addition to feelings
of inadequacy, failure, and negativity. Men who experience the condition may
avoid intimacy with others due to frustrations and fear of failure.
Other complications may include:
- decreased sexual pleasure
- anxiety about sex
- inability to conceive, or male infertility
- low libido
- stress and anxiety
DE can also cause conflicts in your relationships, often
stemming from misunderstandings on the part of both partners. For example, your
partner might feel that you’re not attracted to them. You might feel frustrated
or embarrassed about wanting to achieve ejaculation but being physically or
mentally unable to do so. Treatment or counseling can help resolve these
issues. By facilitating open, honest communication, understanding can often be
What can I expect in the long term?
There are many possible causes of DE. Regardless of the cause,
treatments are available. Don’t be embarrassed or afraid to speak up. The
condition is very common. By asking for help, you can get the psychological and
physical support needed to address the issue and enjoy a more fulfilling sex
Diet and DE