Delayed Ejaculation

Written By Adriana Guarderas

If you are a man who experiences difficulty reaching orgasm or delayed ejaculation, please know that you are not alone!

Approximately 5-10% of cisgender men experience difficulty reaching orgasm or experience delayed ejaculation during partnered sexual acts. (1, 4, 9) Delayed ejaculation can mean that the person is unable to ejaculate after sufficient arousal and stimulation or ejaculates infrequently enough to the point that it causes the individual psychological and emotional suffering and worry. (12)

Common Causes of Delayed Ejaculation

Anxiety (Including Performance Anxiety): Men who experienced high levels of stress and difficulty “dropping” into their bodies and the moment of the sexual encounter, essentially being present to their pleasure and sensations, were more than 2.5 times more likely to experience delayed ejaculation than men who did not experience the challenge of being present and “in the moment.” (1) Cisgender men are more likely to experience anxiety related to performance than cisgender women, sometimes believing before sex starts that they will “fail” in the sexual act, which in turn can increase the chance that they may experience delayed ejaculation due to the anxiety that they are experiencing at that moment. (7)

Life Stressors: Life stressors, such as the loss of income from being laid off, stress due to a high workload, or stress due to the upcoming birth of their first child, can contribute to a man developing delayed ejaculation. (2, 5) A man who is experiencing life stressors may be unable to become aroused enough to experience orgasm or ejaculation due to being in “his head” and ruminating over the stressful life events. (5)

Pornography: Some men, due to “out of control” porn use to the point that they may feel as though it’s problematic in their lives and affecting their relationship(s), can experience delayed ejaculation due to their pornography use. (14) Although some cisgender men experience decreased arousal due to the use of pornography, the correlation between the use of pornography and experiencing delayed ejaculation is inconclusive. (10) Since the studies have been inconclusive as a whole, porn use and its potential being a factor for delayed ejaculation should be examined on a case-by-case and individual basis.

Physical Aspects: Although psychotherapists cannot treat physical conditions, since they are not medical doctors, you can discuss the emotional effects of health conditions or how medication side effects affect your mental and emotional well-being.

  • Medication: Some medications, like selective serotonin reuptake inhibitors and SSRIs, can have sexual side effects, such as delayed ejaculation. (1, 6, 16) Men who are over the age of fifty are more prone to experiencing sexual side effects from medications prescribed for anxiety and depression, such as SSRIs; the decreased sexual desire can contribute to experiencing delayed ejaculation. (3)

  • Physical Health: Men who experience delayed ejaculation are more likely to have health concerns or challenges that contribute to the physical difficulty of achieving orgasm or ejaculation. (5) Men with an increased likelihood of experiencing delayed ejaculation had health concerns, such as “high blood pressure and cholesterol, diabetes, obesity, and mood disorders.” (5) In addition to delayed ejaculation, men with the above conditions also reported a decreased sex drive as compared to men in the same study who did not have the same health conditions. (5) Additionally, if the man is above the age of fifty, he may also experience decreased sexual desire for many factors due to reduced penile sensitivity and cardiovascular disease. (3, 8)

What Can Help?

Talking with your Primary Care Physician or Psychiatrist: Getting regular checkups and consulting your primary care physician or licensed medical specialist to address health concerns affecting other aspects of your well-being is essential! Our bodies are critical to our well-being, and seeing if there is a physical or hormonal cause of delayed ejaculation is necessary to try to rule out and attempt to figure out what is happening. Although it can be a nerve-wracking conversation, please feel free to discuss concerns regarding how medical conditions or medication side effects are affecting your sex life with your primary care physician or psychiatrist (or another prescribing clinician).

Mindfulness: Increasing mindfulness can improve your sex life, including creating more satisfaction and pleasure, decreasing performance anxiety, and assisting with delayed ejaculation. (15) Mindfulness essentially entails being present in the moment, dropping into what is happening for you right then and there - what are you feeling in your body? Are you warm? Is the blanket soft? What do you see? What do you smell? Practicing mindfulness can increase our gratitude and self-compassion; it can give us the space to recognize how we are feeling, give ourselves grace, and become more grounded. It can increase our connection with our partners (s) and ourselves.

The Right Therapist: Finding a therapist with whom you feel open and safe to discuss your concerns is vital! One study showed that when it came to worries regarding sexual well-being and sexual concerns, including delayed ejaculation, 20% of clients mentioned their concerns to their therapist, whereas 70% of the people interviewed wanted to talk to their therapists and wished that they had when they had the chance. (13) It’s the responsibility of the therapist to check in with the client and do their best to create a comfortable and safe environment; if they don’t happen to ask directly, you, as the client, should feel comfortable talking about what’s bothering you and if delayed ejaculation is causing you distress, it’s worth bringing up in your session! That said, not everyone is the right fit, and that’s okay! You will trust one therapist over another or feel more comfortable, which is perfectly understandable. Additionally, finding a therapist who has training in sex therapy or is a certified sex therapist is great; ideally, that means that they will have more sensitivity and training regarding sexual issues and concerns.

References

  1. Carvalheira, A., & Santana, R. (2016). Individual and Relationship Factors Associated With the Self-Identified Inability to Experience Orgasm in a Community Sample of Heterosexual Men From Three European Countries. Journal of Sex & Marital Therapy, 42(3), 257–266. https://doi.org/10.1080/0092623X.2015.1010677

  2. de Pierrepont, C., Brassard, A., Bécotte, K., Lessard, I., Polomeno, V., & Péloquin, K. (2022). Sexual activity based fears during pregnancy, sexual function and dyadic adjustment in couples who are expecting their first child. Journal of Psychosomatic Obstetrics & Gynecology, 43(2), 107–113. https://doi.org/10.1080/0167482X.2022.2052844

  3. Driscoll, J. J., & Hughes, A. A. (2022). Sexuality of Aging Adults: A Case Study Using Narrative Therapy. Contemporary Family Therapy: An International Journal, 44(4), 373–380. https://doi.org/10.1007/s10591-021-09589-3

  4. Mahar, E.A., Mintz, L.B. & Akers, B.M. Orgasm Equality: Scientific Findings and Societal Implications. Curr Sex Health Rep 12, 24–32 (2020). https://doi.org/10.1007/s11930-020-00237-9

  5. McCabe, M. P., & Connaughton, C. (2014). Psychosocial Factors Associated with Male Sexual Difficulties. The Journal of Sex Research, 51(1), 31–42. http://www.jstor.org/stable/43701748

  6. Milosavljević, J. Z., Milosavljević, M. N., Arsenijević, P. S., Milentijević, M. N., & Stefanović, S. M. (2022). The effects of selective serotonin reuptake inhibitors on male and female fertility: a brief literature review. International Journal of Psychiatry in Clinical Practice, 26(1), 43–49. https://doi.org/10.1080/13651501.2021.1872647

  7. Peixoto, M. M., & Nobre, P. (2016). Automatic Thoughts During Sexual Activity, Distressing Sexual Symptoms, and Sexual Orientation: Findings from a Web Survey. Journal of Sex & Marital Therapy, 42(7), 616–634. https://doi.org/10.1080/0092623X.2015.1113583

  8. Ross, J. (2024). Identifying and Assessing Sexual Dysfunction: Strategies for Counselors. Journal of Mental Health Counseling, 46(1), 2-18. https://doi.org/10.17744/mehc.46.1.01

  9. Rowland, D. L., McNabney, S. M., Teague, L. G., Padilla, S. M., Bacys, K. R., & Hevesi, K. (2023). Description of and Relationships among Potential Variables Supported for the Diagnosis of Delayed Ejaculation. Sexes, 4(1), 40. https://doi.org/10.3390/sexes4010005

  10. Rowland, D. L., Morrow, A. L., Hamilton, B. D., & Hevesi, K. (2022). Do Pornography Use and Masturbation Frequency Play a Role in Delayed/Inhibited Ejaculation during Partnered Sex? A Comprehensive and Detailed Analysis. Sexes, 3(1), 115. https://doi.org/10.3390/sexes3010010

  11. Rowland, D. L., Moyle, G., & Cooper, S. E. (2021). Remediation Strategies for Performance Anxiety across Sex, Sport and Stage: Identifying Common Approaches and a Unified Cognitive Model. International Journal of Environmental Research and Public Health, 18(19), 10160. https://doi.org/10.3390/ijerph181910160

  12. Rowland, D. L., Padilla, S., Kӧvi, Z., & Hevesi, K. (2023). Self-reported reasons for having difficulty reaching orgasm in men with diverse etiologies. Sexual medicine, 11(3), qfad030. https://doi.org/10.1093/sexmed/qfad030

  13. Selice, L., & Morris, K. L. (2022). Mindfulness and Sexual Dysfunction: A Systematic Research Synthesis. Journal of Sex & Marital Therapy, 48(4), 323–342. https://doi.org/10.1080/0092623X.2021.1991536

  14. Southern, S. (2017). Reflections on Sexual Health: Fraught Intimacies and Ethical Choices. Sexual Addiction & Compulsivity, 24(3), 129–139. https://doi.org/10.1080/10720162.2017.1363602

  15. Valderrama Rodríguez, M. F., Sánchez-Sánchez, L.,C., García-Montes, J. M., & Petisco-Rodríguez, C. (2023). A Scoping Review of the Influence of Mindfulness on Men’s Sexual Activity. International Journal of Environmental Research and Public Health, 20(4), 3739. https://doi.org/10.3390/ijerph20043739

  16. Zeiss, R., Malejko, K., Connemann, B., Gahr, M., Durner, V., & Graf, H. (2024). Sexual Dysfunction Induced by Antidepressants—A Pharmacovigilance Study Using Data from VigiBaseTM. Pharmaceuticals, 17(7), 826. https://doi.org/10.3390/ph17070826

Adriana Guarderas adrianaguarderas.com
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