What is delayed ejaculation (DE)?
- Delayed ejaculation (DE) occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate.
- DE has multiple causes, including anxiety, depression, neuropathy, and reactions to medications.
- No drug has been specifically approved for DE, but medications used for conditions such as Parkinson’s disease have been shown to help.
Delayed ejaculation (DE) is a common medical condition. Also called “impaired ejaculation,” this condition occurs when it takes a prolonged period of sexual stimulation for a man to ejaculate.
In some cases, ejaculation cannot be achieved at all. Most men experience DE from time to time, but for others it may be a lifelong problem.
While this condition does not pose any serious medical risks, it can be a source of stress and may create problems in your sex life and personal relationships. However, treatments are available.
Delayed ejaculation occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate. Ejaculation is when semen is discharged from the penis. Some men can only ejaculate with manual or oral stimulation. Some cannot ejaculate at all.
A lifelong problem with DE is very different from a problem that develops later in life. Some men have a generalized problem in which DE occurs in all sexual situations.
For other men, it only occurs with certain partners or in certain circumstances. This is known as “situational delayed ejaculation.”
In rare cases, DE is a sign of a worsening health problem such as heart disease or diabetes.
There are many potential causes of DE, including psychological concerns, chronic health conditions, and reactions to medications.
Psychological causes of DE can occur due to a traumatic experience. Cultural or religious taboos can give sex a negative connotation. Anxiety and depression can both suppress sexual desire, which may result in DE as well.
Relationship stress, poor communication, and anger can make DE worse. Disappointment in sexual realities with a partner compared to sexual fantasies can also result in DE. Often, men with this problem can ejaculate during masturbation but not during stimulation with a partner.
Certain chemicals can affect the nerves involved in ejaculation. This can affect ejaculation with and without a partner. These medications can all cause DE:
- antidepressants, such as fluoxetine (Prozac)
- antipsychotics, such as thioridazine (Mellaril)
- medications for high blood pressure, such as propranolol (Inderal)
Surgeries or trauma may also cause DE. The physical causes of DE may include:
- damage to the nerves in your spine or pelvis
- certain prostate surgeries that cause nerve damage
- heart disease that affects blood pressure to the pelvic region
- infections, especially prostate or urinary infections
- neuropathy or stroke
- low thyroid hormone
- low testosterone levels
- birth defects that impair the ejaculation process
A temporary ejaculation problem can cause anxiety and depression. This can lead to recurrence, even when the underlying physical cause has been resolved.
A physical examination and explanation of your symptoms are necessary to make an initial diagnosis. If a chronic health problem is suspected as the underlying cause, more testing may need to be done. This includes blood tests and urine tests.
These tests will look for infections, hormonal imbalances, and more. Testing the reaction of your penis to a vibrator may reveal if the problem is psychological or physical.
Treatment will depend on the underlying cause. If you’ve had lifelong problems or you’ve never ejaculated, a urologist can determine if you have a structural birth defect.
Your physician can determine if a medication is the cause. If so, adjustments will be made to your medication regimen and your symptoms will be monitored.
Some medications have been used to help DE, but none have been specifically approved for it. According to the Mayo Clinic, these medications include:
- cyproheptadine (Periactin), which is an allergy medication
- amantadine (Symmetrel), which is a drug used to treat Parkinson’s disease
- buspirone (Buspar), which is an antianxiety medication
Low Testosterone can contribute to DE and low testosterone supplements could help fix your DE issue.
Treating illicit drug use and alcoholism, if applicable, can also help DE. Finding inpatient or outpatient recovery programs is one therapy option.
Psychological counseling can help treat depression, anxiety, and fears that trigger or perpetuate DE. Sex therapy may also be useful in addressing the underlying cause of sexual dysfunction. This type of therapy may be completed alone or with your partner.
DE can generally be resolved by treating the mental or physical causes. Identifying and seeking treatment for DE sometimes exposes an underlying medical condition. Once this is treated, DE often resolves.
The same is true when the underlying cause is a medication. However, don’t stop taking any medication without your doctor’s recommendation.
DE can cause problems with self-esteem in addition to feelings of inadequacy, failure, and negativity. Men who experience the condition may avoid intimacy with others due to frustrations and fear of failure.
Other complications may include:
- decreased sexual pleasure
- anxiety about sex
- inability to conceive, or male infertility
- low libido
- stress and anxiety
DE can also cause conflicts in your relationships, often stemming from misunderstandings on the part of both partners.
For example, your partner might feel that you’re not attracted to them. You might feel frustrated or embarrassed about wanting to achieve ejaculation but being physically or mentally unable to do so.
Treatment or counseling can help resolve these issues. By facilitating open, honest communication, understanding can often be reached.
There are many possible causes of DE. Regardless of the cause, treatments are available. Don’t be embarrassed or afraid to speak up. The condition is very common.
By asking for help, you can get the psychological and physical support needed to address the issue and enjoy a more fulfilling sex life.
Off-label drug use
Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. A doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for you.