Sex - delayed ejaculation

Alternative names
Ejaculatory incompetence; Delayed ejaculation; Retarded ejaculation

Delayed ejaculation refers to an inhibition of ejaculation. The male is unable to ejaculate, either during intercourse, or with manual stimulation in the presence of a partner.

Causes, incidence, and risk factors
Most men ejaculate within 2 to 4 minutes after onset of active thrusting in intercourse. Men with retarded ejaculation may be entirely unable to ejaculate in some circumstances (for example, during intercourse), or may only be able to ejaculate with great effort and after prolonged intercourse (for example 30 to 45 minutes).

The most common causes are psychological. Common psychological causes include:

  • A strict religious background causing the person to view sex as sinful  
  • Lack of attraction for a partner  
  • Conditioning caused by unique or atypical masturbation patterns  
  • Traumatic events (such as being discovered in masturbation or illicit sex, or learning one’s partner is having an affair)

Some factors such as anger toward the partner may be involved; however, organic causes are sometimes present. A variety of drugs (such as Prozac, Mellaril and guanethidine) may sometimes impair ejaculation. Neurological disease may also cause delayed or inability to ejaculate such as strokes and nerve damage to the spinal cord or back.

Signs and tests
If the man is unable to ejaculate in a reasonable length of time with some form of stimulation (as with masturbation), it is a good indicator that organic factors are likely to play a role in the problem.

Stimulation of the penis with a vibrator or other increased stimulatory device may determine if an underlying physical often neurological problem exists. A neurological examination may uncover other neurological defects associated with delayed ejaculation.

If the man has never ejaculated through any form of stimulation (such as wet dreams, masturbation, or intercourse) in his life, a urologist should be consulted to determine if there is a congenital or physical abnormality.

If, however, he is able to ejaculate in a reasonable period of time by some form of stimulation, he should seek sex therapy from a therapist specializing in this area. Treatment usually includes both partners.

The therapist will usually educate the couple about the fundamentals of sexual response and how to communicate and guide the partner to provide ideal stimulation, rather than trying to will a sexual response to occur.

Therapy then commonly involves a series of homework assignments wherein the couple, in the privacy of their home, engage in sexual activities that minimize performance pressure and maximize focusing on pleasure.

Typically, sexual intercourse will be prohibited for a limited period of time, while the couple gradually enhances their ability to enjoy ejaculation through other types of stimulation.

In cases where there is a problematic relationship or an inhibition of sexual desire between the couple, therapy to enhance the relationship and emotional intimacy may be required as a preliminary step.

Sometimes hypnosis may be a useful adjunct to therapy, particularly if a partner is not willing to participate in therapy. Self-treatment of this problem will probably be unsuccessful in most cases.

If a medication is believed to be the cause of the problem, the man’s physician should review other medication options. (Never discontinue a prescribed medication without consulting the prescribing physician). This may be difficult in certain instances, especially when the medication is working appropriately to solve a pre-existing medical or psychological problem.

Expectations (prognosis)
Outpatient treatment commonly requires about 12 to 18 sessions with an average success rate in the range of 70 to 80%.

A more positive outcome is associated with having a previous history of satisfying sexual experiences, a short duration of the problem, feelings of sexual desire, feelings of love toward one’s sexual partner, motivation for treatment, and absence of serious psychological problems.

If medications are the source of the problem, a full recovery should be expected if the physician is able to switch or discontinue the medication.

Marital stress, sexual dissatisfaction, inhibited sexual desire, and avoidance of sexual contact may result if the problem is not addressed and remedied.

Healthy attitudes toward sexuality and one’s own genitals helps prevent delayed ejaculation. It is also vitally important to realize that you cannot will a sexual response, just as you cannot will yourself to go to sleep or to perspire. The harder one tries to have a certain sexual response, the more it becomes inhibited.

To minimize the pressure, a man should absorb himself in the pleasure of the moment, without worrying about whether or when he will ejaculate. The partner should create a relaxed atmosphere, free of pressure, rather than create pressure with questions about whether or not ejaculation has occurred. Finally, any fears or anxieties, such as fear of pregnancy or disease, should be openly discussed.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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