Lasting a long time sounds like a boast until it isn't. Delayed ejaculation describes a marked delay in ejaculation, or an inability to ejaculate at all, that you don't want.1 Sex can turn into an exhausting effort, partners may wonder whether they're the problem, and couples trying for a baby can find it gets in the way.
It's a poorly defined and uncommon form of male sexual dysfunction. There's no agreed cut-off time and no gold-standard test, so the diagnosis rests on your history.1 A joint US urology and sexual medicine guideline describes it simply as difficulty achieving sexual climax.2
Some men can ejaculate alone but not with a partner, or with one kind of stimulation but not another. Those details matter, because they help a clinician work out whether the cause looks physical, psychological, situational or a mix.1
What causes delayed ejaculation?
Usually several things at once. Physical factors such as ageing, prostate conditions, hormones and certain medicines combine with psychological and relationship factors.
Reviews describe DE as multifactorial, with both physical and psychosocial contributors, and the exact mechanism still isn't known.1 It becomes moderately more common with age, and acquired cases can follow conditions such as an enlarged prostate or specific drug treatments. Hormones also seem to influence how long ejaculation takes, although that evidence comes from small studies.3
Medicines deserve a look. Drugs that raise brain serotonin, such as SSRI antidepressants, delay ejaculation, which is exactly why they're used for premature ejaculation.4 In a man who didn't have a timing problem to begin with, the same effect can tip things too far.
- Medicines that raise serotonin, including some antidepressants
- Ageing
- Prostate conditions and their treatment
- Hormonal factors, including testosterone
- Psychological and relationship factors
How is delayed ejaculation diagnosed?
Mostly through a conversation rather than a test. A clinician will ask when it started, whether it happens in every situation, and what medicines you take.
Because there are no agreed diagnostic criteria, your history is the key tool.1 Expect questions about solo versus partnered sex, desire, erections, mood, alcohol and drug use, and any surgery or illness. Blood tests may be used to look at hormones or blood sugar.
It's worth knowing the difference from retrograde ejaculation, where you do reach orgasm but little or no semen comes out because it travels backwards into the bladder. That's a separate problem with different causes.
How is delayed ejaculation treated?
Treatment targets the cause: reviewing medicines, treating an underlying condition, psychosexual therapy, or other approaches. No drug is formally approved for DE.
The AUA/SMSNA guideline notes several psychological, behavioural and medication options, but none has regulatory approval in the US for DE, so any drug use is off-label.2 A specialist review likewise found no approved drug therapy and recommended treatment tailored to the cause.1
Don't stop a prescribed medicine on your own. If you suspect an antidepressant or another drug is involved, ask the prescriber about alternatives or adjustments; there's often more than one option.
Can men with delayed ejaculation still have children?
Often, yes. Fertility specialists have several ways to collect sperm when ejaculation during sex isn't happening.
Options described in reviews range from penile vibratory stimulation and collecting night-time emissions to electroejaculation and retrieving sperm directly from the epididymis or testis.1 A semen analysis is usually part of the work-up.
Common questions
Is delayed ejaculation the same as not being able to orgasm?
They overlap but aren't identical. Orgasm and ejaculation usually happen together but are separate processes, and research has often blurred the two, which is one reason DE is poorly understood.3
Is delayed ejaculation common?
It's considered uncommon, particularly compared with premature ejaculation.1 It does become somewhat more likely with age.3
Should I see a doctor about delayed ejaculation?
Yes, if it's persistent and bothering you or a partner, or if it started after a new medicine or procedure. A GP can review your medicines and refer you to a urologist or psychosexual therapist if needed.
Read more on this
Sources
- Abdel-Hamid IA, Ali OI. Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment. World J Mens Health. 2018;36(1):22-40. PubMed
- Shindel AW, et al. Disorders of Ejaculation: An AUA/SMSNA Guideline. J Urol. 2022;207(3):504-512. PubMed
- Di Sante S, et al. Epidemiology of delayed ejaculation. Transl Androl Urol. 2016;5(4):541-8. PubMed
- Levin RJ. Revisiting post-ejaculation refractory time-what we know and what we do not know in males and in females. J Sex Med. 2009;6(9):2376-89. PubMed
Not medical advice. Written by Eric Stephens from the research cited above; not reviewed by a doctor. If something worries you, see a GP.