Delayed ejaculation occurs when a man requires an extended period of sexual stimulation (22 minutes or more) to orgasm and ejaculate.

While some men may need 30 minutes or more of sexual stimulation to reach orgasm, the median intravaginal ejaculatory latency time (IELT) is 5.4 minutes. This means that men who reach orgasm after 22 minutes of sexual activity fall just below the 98^th percentile of ejaculation times, which may qualify them to be diagnosed with delayed ejaculation.

Nevertheless, these numbers do not represent a hard and fast rule for a delayed ejaculation diagnosis. In fact, ejaculation that occurs within a shorter period of time may still be considered delayed if it is distressing to a man or his partner, or if it requires significantly more time than a man’s previous “normal.” Conversely, if a man takes more than 22 minutes to ejaculate during sexual activity, but it is not bothersome to him or his partner, this would not be considered delayed ejaculation.

Therefore, several other variables need to be explored to determine whether a person has delayed ejaculation. For example, a health care provider may ask the patient if they ever need to stop sexual activity due to being too tired or too sore to continue, or due to a request from a sexual partner. Additionally, they may ask if there are some situations in which the patient can ejaculate in a timely manner and others in which they cannot (e.g., masturbation versus partnered sex, while having sex with some sexual partners but not others, etc.)

Asking the patient about whether the problem has been present since their first sexual encounter or if it has developed over time can help established if the delayed ejaculation is primary (lifelong) or secondary (acquired).

Although the treatment for delayed ejaculation often depends on what is causing it, penile vibratory stimulation can be an easy and accessible treatment option for patients to start with.

Some medications, such as the antidepressants called selective serotonin reuptake inhibitors (SSRIs), can negatively impact a person’s orgasmic function. If these medications are making it harder for a patient to reach orgasm, they should speak to their health care provider about changing medications or modifying the dosage.

Since poorly controlled diabetes can contribute to delayed ejaculation, managing diabetes may improve symptoms. Similarly, treating low testosterone with testosterone replacement therapy may help. Lastly, speaking with a sex therapist and/or resolving any underlying relationship issues with a sexual partner may help a person address any mental or emotional barriers that are exacerbating the problem.

References:

Jenkins, L.C., & Mulhall, J.P. (2015). Delayed orgasm and anorgasmia. Fertility and sterility, 104(5), 1082-1088. DOI: https://doi.org/10.1016/j.fertnstert.2015.09.029