It is okay to talk about sex, especially if you are not having a good one! Sexual activity issues are draining and sometimes lead to relationship problems, but several of them are health-related problems and able to be fixed. Here is a problem called delayed ejaculation, and of course, it can be dealt with.
What is delayed ejaculation? Delayed ejaculation is when an assigned male at birth (AMAB) ; straight, gay, bisexual or pansexual, faces either a “too-long time” prior to orgasm and ejaculation or an inability to achieve ejaculation, despite the AMAB desire to and his/their erection being normal.
This problem, which can wreck a sex life, is just as significant as premature ejaculation or erectile dysfunction. People dealing with this problem should not hesitate to consult a sex therapist, in order to have proper treatment.
Let’s explore this ejaculation problem through the science behind it. If you are the one who is experiencing it, either by yourself or with your partner, let us guide you with some advice and solutions!
Shall we begin with the general background of sexual activity? Looking through sexual intercourse in AMAB physiology, from having a sexual desire to penile erection, penetration, and then ejaculation. Every single pathology in those steps is able to disturb sexual performance and cause sexual problems and relationship issues.
These are examples of possible conditions in males that can cause sexual dysfunction at each step of sexual intercourse:
- Low sex drive, which is a wide range of causes from hypoactive sexual desire disorder, to socio cultural factors, and biological or psychological causes1
- Erectile dysfunction, is very common, especially AMAB over 40
- Ejaculation problems/ejaculatory dysfunction, which commonly consists of premature ejaculation (early ejaculation/rapid ejaculation), delayed ejaculation (retarded ejaculation), painful ejaculation, retrograde ejaculation (when semen is unable to emission through the penis during the sexual climax), and anorgasmia (unable to orgasm)2
Some of these problems cause only poor sexual performance and relationship problems, for instance, premature ejaculation does not lead to infertility (you can check out our previous article about Premature Ejaculation: https://my.klarity.health/what-is-premature-ejaculation)
However, many of them are able to cause infertility such as delayed ejaculation.
Causes of delayed ejaculation
There are a variety of mental or physical causes that contribute to delayed ejaculation;
Psychological factors: many of them can also cause premature ejaculation, for instance, relationship problems, depression, or anxiety. Here are some theories about its mechanism.3
- Insufficient sexual stimulation, such as lack of sexual arousal, can be caused by relationship issues
- Unusual masturbation frequency or style, or fantasy sexual perfection
- Disguised sexual desire disorder, which causes the patient prefers solo masturbation, rather than partnered sex
- Other fear and anxiety, unwillingness to give oneself, and cultural/religious issues
- Ageing: is a directly affecting mechanism that leads to sexual climax
- Genitourinary: some birth defects affecting the AMABreproductive system, urinary tract infection, or prostate surgery
- Neurological damage: certain nerve damage that controls orgasm, or spinal cord injury
- Consequences of other diseases: diabetic neuropathy, stroke
- Hormone-related conditions: low thyroid hormone level (hypothyroidism) or low testosterone level
Medication or substance associated
- Some antidepressants, especially selective serotonin reuptake inhibitors (SSRIs)
- Using topical anaesthetics for sexual activity
- Certain antihypertensives and diuretics
- Some antipsychotic drugs
- Some anti-seizure drugs
- Long-term, excessive alcohol consumption
Signs and symptoms of delayed ejaculation
Delayed ejaculation (impaired ejaculation/retarded ejaculation) is when a AMAB experiences difficulties in ejaculation and orgasm, which are not limited to vaginal sexual intercourse but also occur during masturbation or manual, oral, vaginal, or anal stimulation by the partner. Most AMAB have intravaginal ejaculation latency time (IELT), the amount of time it takes a AMAB to ejaculate during vaginal penetration, in the range of 4 to 10 minutes.3 Some might say delayed ejaculation is when a AMABtakes much longer time (more than 25-30 minutes), however, the things that matter are;
- He/they cannot choose to ejaculate in less than 10 minutes in all, or nearly all, sexual activity;
- Not being able to decide when to ejaculate, but desired to do so;
- Feeling upset, annoyed, or frustrated, or avoiding sexual activity.
Therefore, the issue is not when a male takes longer than others to ejaculate, but when he/they experiences negative consequences as a result. While some partners are satisfied with the extended sexual intercourse time, others may endure pain, doubt their own attractiveness, or suspect betrayal by their partner.
An AMAB with delayed ejaculation can also be presented with;
- AMAB infertility
- Marital or relationship problems
In the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition, the definition of delayed ejaculation (retarded ejaculation) requires 1 of 2 symptoms: either a marked delay in or a marked infrequency or absence of ejaculation on 75% to 100% (more than 3 out of 4) of occasions for at least 6 months of partnered sexual activity without the individual desiring delay and causing significant distress to the individual.1 However, there is still no standard tool or criteria to diagnose delayed ejaculation.3
Physicians use the information from history taking of signs and symptoms, medical, relationship, psychosocial, and sexual history, in addition to physical examination and laboratory testing (blood tests/semen analysis) or radiologic imaging, to identify the underlying causes.
Moreover, the evaluation may be determining whether the delayed ejaculation is;
- Lifelong delayed ejaculation vs. acquired delayed ejaculation,4 and
- Generalised delayed ejaculation vs. situational delayed ejaculation
regarding whether a patient faces delayed ejaculation in all circumstances or not. For example, if an AMABis unable to ejaculate only in the presence of a partner but not during his/their self-masturbation, this will be called situational delayed ejaculation and refer to specific psychological causes.
Management and treatment for delayed ejaculation
First and foremost, before considering any treatment options, we have to understand and accept it as a medical condition that can be managed scientifically. Empathy, good communication, and support are the crucial keys.
It would be nice if you went to the GP, urologist, or specialist in sexual medicine with your partner. She/he/they might be able to provide useful information for diagnosing and further management.
You can also prepare some questions about treatment options or the prognosis of the conditions.
Possible treatment options are listed below.
- “Sex therapy”, are forms of psychosexual counselling to deal with underlying causes related to mental health problems or relationship issues.5 In the UK, we can access the services provided by the College of Sexual and Relationship Therapists, or other relationship counseling services
- Substituting the medication that might be the cause of delayed ejaculation, for instance, SSRIs, with other antidepressants. This must be consulted with the physician who is responsible. Or else, some drugs can lower the effects of SSRIs
- Testosterone replacement therapy; only in patients with delayed ejaculation and testosterone deficiency4
- Pharmacotherapy: there is still no approved drug for delayed ejaculation, in spite of there being some potential drugs, i.e., pseudoephedrine
- Alcohol or illegal drug uses: must be counselled for cessations
- If infertility issues co-occur, reproductive specialists must be consulted for possible sperm collection procedures, such as the collection of nocturnal emissions, prostatic massage, prostatic urethra catheterization, penile vibratory stimulation, probe electroejaculation, and other surgical sperm retrieval techniques
These are the risk factors the condition;
- Ageing - as natural that when a male gets older they have a longer time to ejaculate
- Psychological causes or mental health conditions, i.e., depression or anxiety
- Medical, or physical causes, such as diabetes, multiple sclerosis, or spinal cord injury
- Post-medical treatments, such as post-prostatic surgery patient
- Medications: SSRIs, antihypertensive, or diuretics
- Relationship problems: lacks communication between partners is the important issue
- Alcohol use and heavy drinking in long-term
Some are modifiable and some are not, but you can always seek help from sexual medicine experts, such as sex therapists.
Your sexual health can be deteriorated by ejaculation problems, which lead to the conditions below.
- Infertility. A patient should consult with physicians or sexual medicine experts
- Decreased sexual pleasure for a couple or sex partners
- Stress with sexual performance, leading to anxiety or other mental health problems
- Marital or relationship problems, because of unpleasurable sex life
Can delay ejaculation be prevented
Of course, we can, by eliminating or controlling the risk factors, such as;
- Empathic communication about sex life between the couple, which leads to comprehensive problem-solving and healthy relationships;
- Consultation with a physician about medications or medical interventions which could be a risk of delayed ejaculation, and looking for support or alternative interventions;
- Mental health support and sex therapy, or psychosexual counseling; and
- Avoiding long-term alcohol consumption (which could prevent many health issues as well!)
How common is delayed ejaculation
A certain number of prevalence is still lacking, due to uneasiness to get a consensus on the definition of certain ejaculation problems internationally.3 Therefore, it is believed to be under-reported all over the world.
Reports in 2005-2006 state the rough number to be 1% (lifelong delayed ejaculation) to 4% (acquired delayed ejaculation) of sexually active AMAB.6 This depends on medical conditions and race as well.
When should I see a doctor
Feel free to consult your GP or sex therapist if you have some of these issues;
- Delayed ejaculation is causing problems or issues for you and your partner;
- With this information provided, you may have some known health conditions, or take medications that might be related to delayed ejaculation; and
- Some other symptoms occur along with delayed ejaculation that might or might not seem related, such as bloody semen.
As we can see, sex is not only affected by emotions or desires but also by health issues that we may not be aware of. Delayed ejaculation is not so common in the general population; however, it can lead to a catastrophic relationship, mental health issue, or life complication. Communication is a first but worthy step to empathizing with one another, then it is fine to seek help from health experts to take care of your health, sexual health, and relationship.
- DSM-5 - an overview | ScienceDirect Topics [Internet]. [cited 2023 Jun 15]. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/dsm-5
- ICD-10-CM [Internet]. [cited 2023 Jun 15]. Available from: https://icd10cmtool.cdc.gov/?fy=FY2023
- Abdel-Hamid IA, Ali OI. Delayed ejaculation: pathophysiology, diagnosis, and treatment. World J Mens Health [Internet]. 2018 [cited 2023 Jun 15];36(1):22. Available from: https://wjmh.org/DOIx.php?id=10.5534/wjmh.17051
- Shindel AW, Althof SE, Carrier S, Chou R, McMahon CG, Mulhall JP, et al. Disorders of ejaculation: an aua/smsna guideline. Journal of Urology [Internet]. 2022 Mar [cited 2023 Jun 15];207(3):504–12. Available from: http://www.auajournals.org/doi/10.1097/JU.0000000000002392
- Erectile dysfunction (Impotence) [Internet]. nhs.uk. 2017 [cited 2023 Jun 15]. Available from: https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/
- Di Sante S, Mollaioli D, Gravina GL, Ciocca G, Limoncin E, Carosa E, et al. Epidemiology of delayed ejaculation. Transl Androl Urol [Internet]. 2016 Aug [cited 2023 Jun 15];5(4):541–8. Available from: http://tau.amegroups.com/article/view/10793/11774