Delayed ejaculation occurs when a man has difficulty ejaculating. It may take longer than he’d like to ejaculate, even if he has a full erection and is sufficiently aroused and stimulated. The situation can cause distress to both the man and his partner.

An estimated 1% – 4% of men experience delayed ejaculation.

Delayed ejaculation is classified as primary or secondary. Primary (lifelong) delayed ejaculation applies to men who have always had difficulty ejaculating. Men with secondary (acquired) delayed ejaculation have been able to ejaculate normally during intercourse in the past but have later developed a problem.

The disorder is considered “generalized” when it happens in any circumstance. When it happens only under certain conditions (such as with specific sex partners), it is called “situational.”

Causes

Delayed ejaculation can have physical and psychological causes. Sometimes, there are a combination of factors at play.

Possible physical causes include the following:

• Birth defects
• Side-effects from medications (especially antidepressants, blood pressure medications, and drugs for anxiety)
• Nerve damage
• Pelvic injury
• Hormone deficiencies, such as hypogonadism (low testosterone)
• Excessive alcohol or illicit drug use

Psychological factors can include:

• Depression
• Relationship problems
• Performance anxiety
• Cultural or religious beliefs that consider sex to be taboo

Men may also have delayed ejaculation when the method or intensity of stimulation changes. For example, a man who masturbates a certain way may not get the same degree of stimulation from intercourse.

Treatment

Treatment for delayed ejaculation usually involves treating the underlying issue. This may mean changing medication, changing masturbation habits, or getting help for alcohol or drug abuse.

Counseling and sexual therapy can help, too. Men can work through the psychological causes as well as the stress that results from delayed ejaculation. Often, partners attend sessions as well.

In addition, some men benefit from medications, such as cabergoline. The drug anandamide is currently being researched for treatment of delayed ejaculation.

Men who have trouble ejaculating should speak to their doctor, especially if they find the situation stressful.