Delayed Ejaculation

What it is

Delayed ejaculation is a persistent or recurrent marked delay in, infrequency of, or absence of ejaculation, despite adequate sexual desire, arousal and stimulation, causing the man distress. It is the less-discussed counterpart to early ejaculation, and although it receives far less attention, it is a real difficulty that can cause considerable frustration and distress for a man and his partner.

It varies in form: some men can ejaculate in some situations, such as with self-stimulation, but not others, such as with a partner; some experience a long delay; some cannot ejaculate at all during partnered sex. As with the other conditions in this chapter, it is diagnosed based on a persistent pattern and the distress it causes, taking account of age, since ejaculation can naturally take longer as men get older.

What it can involve

The difficulty can lead to prolonged, eventually frustrating or uncomfortable sexual activity, a sense of pressure, and distress for both partners, sometimes complicated where a couple are trying to conceive. As with other sexual difficulties, anxiety and pressure can make it worse, and the situation-specific pattern (for example, being able to ejaculate alone but not with a partner) often points toward psychological or conditioned factors rather than a purely physical cause.

How common is it

Delayed ejaculation is the least common and least studied of the male sexual difficulties, though it becomes more frequent with age and is a well-recognised side effect of certain widely used medicines. Its true frequency is uncertain, partly because it is so little discussed.

What causes it

A very common and important cause is medication, particularly some antidepressants (notably certain SSRIs), which frequently delay or block ejaculation; this is so common that any man with new delayed ejaculation should have his medicines reviewed. Other contributors include increasing age, low testosterone and other hormonal or medical conditions, nerve damage (for example from diabetes, surgery or spinal problems), heavy alcohol use, and certain other medicines. Psychological and relational factors also matter, including anxiety, specific conditioned patterns (such as particular masturbation habits that partnered sex does not replicate), and relationship difficulties. Often more than one factor is involved.

How it is diagnosed

A doctor explores the pattern and circumstances, including whether it occurs in all situations or only some, the duration, and the distress, and crucially reviews all medicines, since medication is such a common and reversible cause. Assessment also considers age, hormones, medical conditions such as diabetes, alcohol use, any nerve-related factors, and psychological and relationship contributors. The situational pattern often gives important clues to the cause.

How it is treated

Treatment depends on the cause. Where a medicine is responsible, the prescriber may adjust the dose, change the medicine, or consider other strategies, often resolving the problem. Reducing alcohol, managing relevant medical conditions, and addressing hormonal factors help where these are involved. Psychological and couple approaches address anxiety, conditioned patterns and relationship factors, sometimes including adjusting specific habits or reducing performance pressure. No specific medicine is established to treat delayed ejaculation itself, so treatment focuses on the underlying contributors. With the cause identified, particularly when it is a medicine, the outlook is often good.

Delayed ejaculation in the African context

Sexual health is rarely discussed openly here, so difficulties like delayed ejaculation are surrounded by silence, shame, and a great deal of misinformation, and men often suffer privately rather than seek help. The pressure that surrounds male performance can make the problem worse and harder to talk about. It is worth knowing that common, treatable causes are often involved, certain medicines, especially some antidepressants, alcohol, diabetes, low mood, and anxiety, so a calm medical conversation can find a real and fixable reason. Approaching it as a health matter, free of shame, is what opens the way to help.

Managing it and getting help

A calm, practical, shame-free approach works best.

• Raise it with a doctor, since common causes such as medicines, alcohol, diabetes, and low mood are treatable.
• Do not stop a prescribed medicine on your own; ask the prescriber, who may adjust it.
• Reduce alcohol, and address stress, anxiety, or low mood, which commonly contribute.
• Work with your partner as a team, with patience and open communication rather than blame, since pressure makes it worse.
• Consider seeing a clinician or therapist experienced in sexual health. Our find a therapist page can help.