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The age-old saying “saving the best until last” certainly applies to pleasure during sex. While the build-up to orgasm can feel great, nothing compares to the sensation experienced when one finally takes place.

Contrary to popular belief, the male orgasm and ejaculation (the expulsion of semen) are two separate processes. They often occur simultaneously, but they can also take place independently. When men struggle to experience ejaculation, it may indicate the presence of a sexual dysfunction known as Delayed Ejaculation (DE).

DE involves men experiencing a delay in ejaculation or being unable to ejaculate at all.

If you’re experiencing the symptoms of delayed ejaculation, it’s natural to feel concerned and curious. This article explores delayed ejaculation, its potential causes, and what can be done about it.

What is Delayed Ejaculation?

Delayed ejaculation is an uncommon sexual dysfunction that can result in ejaculation being delayed or prevented from taking place. Naturally, the condition can cause frustration. Delayed ejaculation is considered one of the less understood and least studied male sexual dysfunctions, with an estimated prevalence of 1-4% of the male population.

For the person with the condition, the worry of delayed ejaculation may overshadow their enjoyment of sex. Equally, their inability to ejaculate may lead to feelings of inadequacy for their sexual partner.

Potential Causes of Delayed Ejaculation

Given its complexity, it may be challenging to pinpoint the exact cause of delayed ejaculation. We’ve highlighted some of the possible risk factors below.

Neurological Disorders

Individuals who experience neurological disorders may be subject to delayed ejaculation. A study investigated men who had suffered a stroke (which resulted in mild or no disabilities) and found that between 45.9% and 64.5% had reported delayed ejaculation. Other research has suggested that individuals with multiple sclerosis (MS) may also have difficulty reaching orgasm and ejaculation.

Testicular Cancer

A study which explored sexual dysfunctions in long-term testicular cancer survivors examined 539 patients after they had a testicle removed. It found that ejaculatory problems (including premature, delayed and retrograde ejaculation) occurred in 84.9% of participants.

Lack of Enjoyment

It’s possible that an individual may no longer find their sex life enjoyable. This may be due to a number of causes including a loss of attraction to a partner, or having an unfulfilled sexual desire. A lack of stimulation or sexual satisfaction may lead to difficulty ejaculating.

Drug Use

Drug use may result in ejaculatory issues. A drug used to prevent hair loss known as finasteride has been linked to problems with ejaculation. Research into cannabis use found that daily cannabis users in Australia had a prevalence of abnormal orgasm control including delayed ejaculation.

Alcohol Dependence

Frequent alcohol consumption may have a number of consequences, one of which may be abnormal ejaculatory function. Research into sexual dysfunction among individuals with alcohol dependence found that over 10% of subjects had inhibited or delayed ejaculation.

Mental Health Conditions

It’s possible that mental health issues may be risk factors for delayed ejaculation. Research has made reference to the prevalence of delayed ejaculation in individuals with depression. Selective serotonin reuptake inhibitors (SSRIs) are a type of medication used to treat depression, with delayed ejaculation said to be one of the most common side effects of using them.

Diabetes

Diabetes is a physical health condition that could be linked to difficulty reaching ejaculation. Research has identified a high prevalence of sexual dysfunction in men with type 2 diabetes, with delayed ejaculation being one of the subjects' most common dysfunctions.


Desensitization

If an individual experiences a lack of genital sensation, it may prevent ejaculation from occurring. Factors that may cause desensitization include the use of desensitizing sprays, lubricants or condoms.

Types of Delayed Ejaculation

Delayed ejaculation can be categorized into two different types: by time or contextual. We’ve explained the differences between the two below.

By Time (Lifelong or Acquired)

The type of delayed ejaculation experienced by an individual can vary depending on the timeframe surrounding the sexual dysfunction. It can typically be split into lifelong and acquired delayed ejaculation.

FORM

 DESCRIPTION

Lifelong Delayed Ejaculation

  • Lifelong delayed ejaculation means that the condition has been present throughout a person's lifetime.
  • They will have only experienced DE symptoms and won’t have experienced ‘regular’ ejaculatory behaviors.
  • An example of someone with lifelong delayed ejaculation would be a person who struggled with delayed ejaculation from their first sexual experience through to the present day.

Acquired Delayed Ejaculation

  • Acquired delayed ejaculation is used to describe the condition when an individual has experienced sexual activity with a regular ejaculatory function in the past, but delayed ejaculation has suddenly developed.
  • This may be as a result of a psychological or physical change.
  • An example of acquired delayed ejaculation would be when an individual with healthy ejaculatory function undergoes treatment for testicular cancer and loses their ability to ejaculate as a result of the procedure.

By Context (Generalized vs Situational)

Delayed ejaculation can affect individuals differently depending on the situations they find themselves in. In this case, delayed ejaculation can typically be split into generalized and situational forms.

 FORM

DESCRIPTION

Generalized Delayed Ejaculation

  • Generalized delayed ejaculation is used to describe DE when the symptoms are consistently prevalent.
  • An individual with generalized delayed ejaculation will experience the signs of the condition regardless of their situation.
  • An example of generalized delayed ejaculation would be when individual experiences delayed ejaculation regardless of who their sexual partner is or how attractive they find them.

Situational Delayed Ejaculation

  • Situational delayed ejaculation describes when an individual experiences the symptoms of DE in specific situations.
  • An example of situational ED would be when an individual with multiple sexual partners has no issue ejaculating with one partner but is unable to ejaculate during intercourse with a different partner.
  • Alternatively, an individual may find that they are able to ejaculate with no difficulty while masturbating, but are unable to when engaged with a sexual partner.

Delayed Ejaculation Diagnosis

As we alluded to earlier, delayed ejaculation is uncommon and understudied. This combined with the wide range of potential causes means that diagnosing the condition may prove challenging. Research on the diagnosis of DE notes that there is no gold standard for the diagnosis of delayed ejaculation. However, it noted a process consisting of 3 areas: history, clinical examination and investigations that may be helpful during diagnosis. Each step has been expanded on (albeit not exhaustively) in the table below:

AREA

 DESCRIPTION

History

  • Checking if an orgasm is present without ejaculation, which may indicate retrograde ejaculation (when ejaculation takes place internally)
  • Duration of sexual intercourse before thrusting is stopped and why it’s stopped. For example, loss of erection, fatigue or partner request
  • How much the condition is emotionally affecting the individual and their partner
  • Whether the symptoms have always been present or have been acquired and if the symptoms occur generally or in specific situations
  • The individual's ability to get and maintain an erection, in addition to how frequently they engage in sexual intercourse
  • The presence of other sexual dysfunctions, history of mental health difficulties and history of pelvic pain

Clinical Examination

  • Questionnaires to assess erectile function, such as the International Index of Erectile Function (IIEF)
  • Examination of genitals (penile/testicular size & any abnormalities)
  • Rectum examination to measure an individual's prostate size
  • Measuring an individuals response to testicular squeezing

Investigations

  • Blood tests
  • Examination of prostatic secretion and urine to explore possible infections
  • Scans to assess the anatomy of the pelvic region
  • Urine examinations to rule out cancer of the bladder

How is Delayed Ejaculation Treated

As with diagnosis, the treatment of delayed ejaculation may be complicated. The appropriate treatment path will depend on a variety of factors, including the cause of the condition, the patient's medical history, and associated risks. We’ve highlighted some of the potential treatments for addressing delayed ejaculation.

Psychological Intervention

Delayed ejaculation might be occurring because of a psychological factor such as depression. Naturally, psychological intervention may be used in an attempt to treat the condition. Techniques such as mindfulness-based interventions have been said to improve orgasmic function.

Changes to Sex Life

If you believe that you are experiencing delayed ejaculation due to a lack of fulfillment from your sex life, making a change may be what’s needed to improve your ejaculatory function. Such changes may include introducing new techniques to the bedroom, using sex toys or communicating your sexual interests to a partner.

By making changes to your sex life you may find that you start enjoying sex more and subsequently notice improved ejaculatory function.

If you feel uncomfortable with this, sex therapy for couples may help to create a safe space to communicate your needs to your partner.

Changing Medication

If your doctor believes that you’re experiencing the symptoms of delayed ejaculation as a result of medication, they may find an alternative option.

Individuals who are taking medication for non-critical illnesses such as hair loss prevention may make the decision that their ejaculatory function takes higher priority than stopping their hair loss. If you are considering making changes to medication, always do so under the guidance of a medical practitioner.

Changing Lifestyle Habits

Delayed ejaculation symptoms may be present as a result of an individual's lifestyle habits. As mentioned in the causes section, some of these may include alcohol dependence or cannabis use. As part of your treatment, you should disclose any potentially harmful lifestyle habits to your medical professional who may be able to advise on the impact of these on your sexual function. 

Delayed ejaculation symptoms may be present as a result of an individual's lifestyle habits.

For example, if it’s believed that an alcohol dependence may be contributing to ejaculation issues, your doctor may suggest refraining from using alcohol to assess its impact on your delayed ejaculation.

What can you do to cope with DE?

Sexual dysfunctions can be difficult to deal with and delayed ejaculation is no different. Given that delayed ejaculation is fairly uncommon, it may feel isolating for individuals suffering from the condition. We’ve highlighted some points that may make it easier to cope with the symptoms of delayed ejaculation.

Diagram of Advice on How to Cope with DE

Communicate with Your Partner

If you have a trusted partner, explaining the condition to them may feel like a weight off your shoulders. Communication may also make it easier for them, without it your partner may feel that your lack of ejaculation is a reflection of their sexual performance. By sharing the issue with your partner, you can reassure them that the ejaculation difficulty isn’t caused by them and work through the condition together.

Seek Medical Help

Don’t keep the symptoms to yourself. As soon as you believe there’s an issue with your ejaculatory function you should consult a doctor. They will be able to advise on the best steps to diagnose and treat your condition. Seeing a mental health professional may also help you address any psychological issues that have arisen as a result of DE. Seeking medical help will offer reassurance that you’re on the road to recovery.

Use a support network

Delayed ejaculation may feel like an isolating condition, but utilizing a support network may help you feel better equipped to cope with it. Some ideas for a support network can include your partner, friends, family, men’s health support groups, and online communities. You can confide as little or as much information as you feel comfortable offering. Knowing you have people to turn to during tough times may make it easier to cope with DE.

Summary

Delayed ejaculation is a sexual dysfunction in which an individual experiences a delay or the complete absence of ejaculation. The condition itself is complex, given it’s understudied and low in prevalence. Individuals may experience DE as a result of psychological or physiological causes. The symptoms of DE may be lifelong, or occur at a specific point in an individual's life and the condition may present itself generally or be limited to specific situations.

Diagnosing the condition may prove complex and treatment options will vary on a case-by-case basis.

A thorough evaluation of an individual's history followed by a clinical examination and further investigations may be used during diagnosis. Although this article is intended to be informative, it cannot be considered a substitute for professional medical advice. If you believe that you are experiencing delayed ejaculation, you should consult a doctor for a professional opinion.

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