Delayed Ejaculation is far more common than most people realize. The inability or difficulty in reaching climax through sexual activity affects most men at some point in their life. Prevalence is difficult to determine because diagnosis is even more difficult. In our work, it is probably safe to say that one in four men has trouble reaching climax at some point in their lives. For some men it may be chronic, but for most men it is an intermittent issue.
The medical definition is if it takes longer than a man would like to reach climax and it causes distress to one or both partners, then most doctors would agree that he has delayed ejaculation. But again, if it takes a man 60 minutes to reach ejaculation and it does not bother him or his partner – there is no problem! As you can see, this definition is highly subjective.
Another definition which we like is if, during sexual activity, the man or his partner are focused on trying to get him to ejaculate and it is detracting from pleasure, it would be considered delayed ejaculation. This definition is a bit more flexible and focuses more on the experience and less on the outcome.
Delayed ejaculation is part of a larger body of disorders called “Diminished Ejaculatory Disorders.” One study reports that these disorders can range from “varying delays in ejaculatory latency to a complete inability to ejaculate, and include Delayed Ejaculation (DE), retrograde ejaculation (RE), anejaculation, anorgasmia and painful ejaculation.”
DE is notoriously difficult to treat. Unlike rapid ejaculation where we are trying to turn off triggers, with DE, we are trying to turn on as many triggers as possible. The requires a level of self-awareness on the part of the man. He needs to be aware of arousal levels, sensation and stimulation, sex drive/libido strengths, and an overall ability to describe what he is experiencing. Finding a cause can be time consuming.
Some common causes of delayed ejaculation are low testosterone, relationship issues, anxiety, depression, prescription medication (antidepressants, blood pressure medication, heart medication), ADHD, alcohol and drug use, boredom, performance pressure, sexual trauma/history, and even age. Sorting out the cause can take a long time and can be frustrating. Very often men are reluctant to admit that they are bored with sex or have some resentment or anger issues with their partner.
The frustration of dealing with DE itself can exacerbate the problem. The more a man or his partner focuses on trying to reach climax, the harder it can be! Self-inflicted pressure to perform is never helpful when it comes to sex! Sometimes, guilt or shame can compound the DE. It seems the possible causes of DE are endless!
Masturbation habits can affect ejaculation with a partner. Porn is often blamed for DE but there is no scientific evidence for this belief. Watching porn may lead to more frequent masturbation which may cause DE. Also, masturbation habits such as intensity of stimulation, type of stimulation, and even fantasy can have a significant impact on a man’s ability to reach climax. The porn itself has not been shown to cause DE.
Treatment begins with a thorough medical workup. Blood tests reveal hormone levels and other health issues. Mental health exams can uncover some feelings about sex, our partners, our history, our bodies, and even our penis! A thorough sexual history can often help with these aspects.
Just as with other sexual issues, treatment is usually multimodal and involves medical treatment, mental health treatment, and sexual education. Very often delayed ejaculation is a combination of the medical and behavioral issues which combine in a perfect storm. The solution then is to begin medical treatment and at the same time alter sexual behavior and the overall approach to sexual expression to accommodate climax challenges.
Our goal therapeutically is to help a man his partner focus on pleasure-based sex instead of a sexual performance which conforms to culturally imposed beliefs about sex. For example, the purpose of intercourse should be pleasure for most couples. Unless a couple is trying to conceive a child, vaginal ejaculation is completely optional. If vagina climax is leading to frustration, we simply change the focus from performance to play. Yes, we definitely want the ability to ejaculate in a partner to be on everyone’s menu. But again, this should be optional, not mandatory.
If delayed ejaculation is detracting from your sexual pleasure and connection, it’s time to address the problem.