Urological Health Penis Health Print An Overview of Delayed Ejaculation Medically reviewed by facebook linkedin Medically reviewed by Richard N. Fogoros, MD on October 06, 2019 Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist. He is Verywell's Senior Medical Advisor. Learn about our Medical Review Board Richard N. Fogoros, MD Written by linkedin Written by Jesse Mills, MD Jesse Mills, MD, is a board-certified urologist trained in male reproductive medicine, and an associate clinical professor of urology at UCLA. Learn about our editorial policy Jesse Mills, MD Updated on November 11, 2019 momentimages / Getty Images More in Urological Health Penis Health Erectile Dysfunction Bladder Health Kidney Disease Prostate Health In This Article Table of Contents Expand Symptoms Causes Diagnosis Treatment Coping View All Back To Top Delayed ejaculation (DE) is a medical condition in which a man has difficulty reaching an orgasm. It should not be confused with erectile dysfunction (the inability to achieve an erection) or decreased libido (low sex drive), although both can sometimes contribute to DE. DE is not only frustrating to men but can complicate the sex lives of their partners as well. Whereas a male orgasm can normally be achieved within several minutes, DE prolongs ejaculation time by at least 5-7 minutes. During that time, the partner may lose vaginal or anal lubrication or simply lack the energy or will to sustain sex. Fortunately, there are ways to diagnose and treat DE. Some of the techniques take time but can often improve sexual function and increase the speed by which you climax and ejaculate. Delayed ejaculation is believed to affect 1% to 4% of the male population, according to a 2016 review of studies published in Translational Andrology and Urology. Symptoms Delayed ejaculation is usually self-evident, especially to those affected. In some cases, the man may feel as if he on the verge of climax but is unable to reach the point of ejaculation. At other times, there may be an erection but no sense of an approaching orgasm. The condition can range in severity, and symptoms can include: Able to ejaculate during intercourse but only under certain controlled conditionsCannot ejaculate during intercourse but can with oral sex or masturbationCan only ejaculate when aloneUnable to ejaculate Causes Delayed ejaculation may have pathologic, neurological, hormonal, pharmaceutical, or psychological causes. In some cases, there may be overlapping causes that only add to the dysfunction. Some of the causes your doctor may consider include: Pathologic causes, such as heart disease (which can lower blood pressure), diabetes, prostate problems, and urinary tract infectionNeurological causes, like stroke, neuropathy, or spinal cord injuryHormonal causes, including thyroid problems, hypogonadism (low testosterone), and Cushing's diseaseMedication side effects, including benzodiazepines like Valium (diazepam), selective serotonin reuptake inhibitors (SSRI) antidepressants, opioids like Oxycontin (oxycodone), antihypertensives (including diuretics), and certain antipsychoticsRecent prostate surgeryDrug or alcohol abuse Psychological problems can both cause and contribute to DE. Depression, anxiety, or emotional trauma can alone cause dysfunction. Religious or social taboo may interfere with your ability to enjoy sex and reach orgasm. Work stress, financial stress, or stress within the relationship are common narratives among couples experiencing DE. Stress has a cause-and-effect relationship with DE. Not only can stress contribute to DE, but the inability to achieve orgasm can build upon these negative emotions, making orgasm all the more impossible. Diagnosis Diagnosing DE is not always straightforward and simple, and there are several different definitions in use. In some of the more severe cases, it may require multiple doctors or specialists to pinpoint the cause. With that being said, a physical exam and review of your medical history may be all that is needed to render a diagnosis. If the cause is not readily apparent, the doctor may order tests to help narrow the causes. These may include: Blood tests to check for diabetes, low testosterone, thyroid disease, prostate problems or systemic inflammation suggestive of an infectionUrinalysis to look for signs of diabetes or infection in urine If the cause is believed to be psychological (and no other reasonable explanation can be found), the doctor may refer you to a psychologist or sex therapist trained in treating sexual dysfunction. If a disease, medical condition, or surgical complication is believed to be the cause, various lab tests, imaging studies, and diagnostic procedures may be performed to support or rule out the suspicion. Treatment The treatment of delayed ejaculation depends on the underlying cause or causes of the dysfunction. If DE is caused by medication side effects, it sometimes helps to lower the dose or substitute the drug with another agent. While there are no FDA-approved drugs used to treat DE, there are medications doctors will sometimes prescribe off-label if the problem is moderate to severe. These include: Buspar (Buspirone), an anti-anxiety drugPeriactin (Cyproheptadine), an allergy medicationSymmetrel (Amantadine), a Parkinson's disease medication Testosterone injections or patches may sometimes be used if hypogonadism is diagnosed. (The use of testosterone in men without hypogonadism is unlikely to help.) Erectile dysfunction (ED) drugs like Viagra (sildenafil) or Cialis (tadalafil) may be prescribed if ED is a contributing factor. With that said, ED drugs do nothing to promote orgasm outside of enhancing confidence and performance. Medical interventions may be explored if chronic conditions are not being managed, including high blood pressure, diabetes, and thyroid disease. Additionally, a psychologist or psychiatrist may help you overcome any emotional barriers that are standing in the way of an orgasm. This may involve one-on-one counseling or counseling with your partner. If the cause is functional (meaning caused by sexual practices or habits), a sex therapist may use talk therapy, toys, devices, or sexual and mental exercises to alter the way you approach sex and orgasm. Coping Delayed ejaculation is a frustrating condition for both you and your partner. Overcoming DE can take time and require commitment from both of you as a team. Central to this is open and honest communication, not only about what you are experiencing but also what is working or not working in bed. Being honest doesn't mean criticizing or hurting your partner. It is about expressing how you feel clearly ("I find this position uncomfortable") rather than telling your partner what he or she is doing wrong. Focus on the positive and don't put stress on yourself by trying to "make things right." By working together as a team, you are more likely to improve not only your sex life but your relationship as well. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Di Sante S, Mollaioli D, Gravina GL, et al. Epidemiology of delayed ejaculation. Transl Androl Urol. 2016;5(4):541–548. doi:10.21037/tau.2016.05.10 Corona G, Rastrelli G, Ricca V, et al. Risk factors associated with primary and secondary reduced libido in male patients with sexual dysfunction. J Sex Med. 2013;10(4):1074-89. doi:10.1111/jsm.12043 Morgentaler A, Polzer P, Althof S, et al. Delayed ejaculation and associated complaints: Relationship to ejaculation times and serum testosterone levels. J Sex Med. 2017;14(9):1116-1124. doi:10.1016/j.jsxm.2017.06.013 Chen J. The pathophysiology of delayed ejaculation. Transl Androl Urol. 2016;5(4):549-62. doi:10.21037/tau.2016.05.03 Abdel-hamid IA, Ali OI. Delayed ejaculation: pathophysiology, diagnosis, and treatment. World J Mens Health. 2018;36(1):22-40. doi:10.5534/wjmh.17051 Perelman MA. Reexamining the definitions of PE and DE. J Sex Marital Ther. 2017;43(7):633-644. doi:10.1080/0092623X.2016.1230161 Abdel-Hamid IA, Elsaied MA, Mostafa T. The drug treatment of delayed ejaculation. Transl Androl Urol. 2016;5(4):576–591. doi:10.21037/tau.2016.05.05 Additional Reading Chen J. The pathophysiology of delayed ejaculation. Transl Androl Urol. 2016;5(4):549-62. doi:10.21037/tau.2016.05.03 Continue Reading