Introduction

Delayed ejaculation

Delayed ejaculation (male orgasmic disorder) is classed as either:

• experiencing a significant delay before ejaculation
• being unable to ejaculate at all, even though the man wants to and his erection is normal

You may have delayed ejaculation if:

• you experience a repeated and unwanted delay before ejaculation lasting for 30 to 60 minutes
• you're unable to ejaculate at least half the times you have sex

Causes of delayed ejaculation

Like premature ejaculation, delayed ejaculation can be caused by psychological and physical factors.

Possible psychological causes of delayed ejaculation are similar to those of premature ejaculation for example, early sexual trauma, strict upbringing, relationship problems, stress or depression.

Physical causes of delayed ejaculation include:

• diabetes (usually only type 1 diabetes )
• spinal cord injuries
• multiple sclerosis
• surgery to the bladder or prostate gland
• increasing age

Many medicines are known to cause delayed ejaculation, including:

• antidepressants , particularly selective serotonin reuptake inhibitors (SSRIs)
• medications to treat high blood pressure , such as beta-blockers
• antipsychotics ,used to treat episodes of psychosis
• muscle relaxants such as balcofen, which is widely used to treat motor neurone disease and multiple sclerosis
• powerful painkillers , such as methadone (which is also widely used to treat people addicted to heroin)

Delayed ejaculation can suddenly start tohappen after previously having no problems, or (less commonly)the man may have always experienced it.

It can occur in all sexual situations, or only in certain situations. For example, you may be able to ejaculate normally when masturbating, but not during sex. When ejaculation only occurs in certain situations, there's usually a psychological cause.

Treating delayed ejaculation

Sex therapy

Sex therapy is a form of counselling that uses a combination of psychotherapy and structured changes in your sex life. This can help to increase your feeling of enjoyment during sex, and help make ejaculation easier.

Some clinical commissioning groups (CCGs) provide a sex therapy service on the NHS. Availability can vary widely depending on where you live.

You can also pay privately. Prices per session are around 50 to 80. The College of Sexual and Relationship Therapists website provides information about private sex therapists and how to find a therapist in your local area .

The relationship counselling service Relate also offers sex therapy at a number of its centres.Youll need to pay for each session.

During sex therapy, youll have the opportunity to discuss any emotional or psychological issues related to your sexuality and relationship, in a non-judgemental way.

Activities may also be recommended for you to try at home while you're having sex with your partner (you should never be asked to take part in any sexual activities during a session with the therapist).

These may include:

• viewing erotic videos and magazines before having sex to increase the feeling of stimulation
• erotic fantasies and "sex games" to make your lovemaking more exciting
• using lubricating creams, or jellies, to make the physical act of sex more comfortable and relaxing
• using sexual aids, such as vibrators, to increase pleasure

These include:

• amantadine originally designed to treat viral infections
• buproprion usually prescribed to help people quit smoking
• yohimbine originally designed to treat erectile dysfunction

These help block some of the chemical effects of SSRIs that may contribute towards delayed ejaculation.

Alcohol and drugs

Alcohol misuse and drug use can be separate underlying causes of delayed ejaculation, so addressing these problems may help.

This means the medicine shows promise in treatingdelayed ejaculationbut it hasn't been licensed for this particular use (pseudoephedrineis normally used as a decongestant).

Other main ejaculation problems

Premature ejaculation

Premature ejaculation is the most common ejaculation problem. It's where the male ejaculates too quickly during sexual intercourse. Occasional episodes of premature ejaculation are common and aren't a cause for concern.

Read more about premature ejaculation, its causes and treatment.

Retrograde ejaculation

Retrograde ejaculation is a rarer type of ejaculation problem. It happens when semen travels backwards into the bladder instead of through the urethra (the tube that urine passes through).

Read more about retrograde ejaculation, its causes and treatment.