Do you find it difficult, or impossible, to ejaculate, even when you can maintain a good erection and enjoy sex with your partner?
Perhaps you never ejaculate during sex, but don’t have a problem when you’re on your own? Or maybe you’re able to with one partner, but not with another?
If any of these seem familiar then it could be that you suffer from a form of delayed ejaculation.
What is delayed ejaculation?
The British National Health Service website, who refer to the problem as delayed ejaculation or male orgasmic disorder, provide the following definition:
- 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
And the US-based Mayoclinic refer to it as follows:
Some men with delayed ejaculation need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate. Or, they may not be able to ejaculate at all (anejaculation).
What is anejaculation?
Anejaculation is when a man’s prostate gland and seminal ducts are unable to release semen.
It’s important to note that anejaculation isn’t the same for all guys though; there are in fact different types and different causes.
According to urologicalcare.com, it can be defined as follows:
Anejaculation is the inability to ejaculate semen despite stimulation of the penis by intercourse or masturbation. The causes can be psychological or physical and anejaculation can be situational or total.
Confusingly then, there are different names used by different countries and healthcare practitioners, including:
- Delayed ejaculation / Retarded ejaculation / Impaired ejaculation
In this article I’ll be using the word delayed ejaculation or anejaculation throughout.
Lifelong or acquired?
Some men will suffer from delayed ejaculation from the time they reach sexual maturity. For others, they may have a period of normal sexual functioning – which could last years – and then develop the problem.
Different types of anejaculation
To add to the confusion, there are in fact different subtypes to be aware of as well.
1. Total / complete anejaculation
In this case, the man is unable to ejaculate in any situation – whether it be during masturbation or sex. And within this type, there are 2 further distinctions:
A) Anorgasmic anejaculation
Men with anorgasmic anejaculation will neither reach orgasm nor ejaculate.
B) Orgasmic anejaculation
Men with orgasmic anejaculation will have orgasms, but still won’t release semen.
2. Situational delayed ejaculation or anejaculation
Some men find they are able to orgasm and ejaculation in certain situations, but not in others, for example:
- He might be able to ejaculate normally at home, but in a sex clinic be unable to, perhaps due to stress and pressure.
- He might ejaculate when masturbating, but be unable to during penetrative sex.
- He may be able to ejaculate with one partner, but not with another.
It’s important to distinguish delayed ejaculation from a rarer condition called retrograde ejaculation. In retrograde ejaculation, semen travels backwards into the bladder rather than coming out through the urethra.
Guys with retrograde ejaculation will still experience orgasms usually, and it’s not a dangerous condition health-wise. However, it does mean it’s not possible to have a child through normal means.
A urine sample soon after climaxing would be needed to distinguish between retrograde ejaculation and complete anejaculation.
There can be many causes of delayed ejaculation, such as chronic health conditions, surgery and medication. Substance abuse and mental health conditions, such as depression, anxiety or stress can also play a role.
Some of these can be successfully treated, either with professional help or self-help. And in some cases there may be a combination of physical and psychological causes that need to be addressed.
There are various possible physical causes, including:
- Nerve damage to the spinal column
- Parkinson’s disease
- Multiple Sclerosis
- Diabetes (typically type 1)
- Infection, such as a urinary tract infection
- Injury to the pelvic nerves responsible for ejaculation.
- Prostatitis, prostate surgery or removal
- Surgery to the abdomen, bladder or testicles.
- Low serum testosterone levels
- Low thyroid hormone (hypothyroidism)
- Hormonal therapy for prostate cancer
- Increasing age
- Partial blocking to the uretha
Several different medications can cause delayed ejaculation, such as:
- Antidepressants. In particular the type known as SSRIs, which include Prozac, Lexapro, Zoloft, Paxil and Celexa. Interestingly, SSRIs are sometimes prescribed to help men with premature ejaculation exactly because they have this delaying effect
- Medication for high blood pressure, such as beta-blockers
- Some diuretics
- Certain anti-psychotic medication for mental illness such as schizophrenia or bipolar disorder
- Some anti-seizure medications
- Too much alcohol
- Some recreational drugs
- Strong painkillers, such as methadone or tramadol
Psychological causes / sexual inhibition
- Problems in the relationship
- Worrying about pregnancy or sexually transmitted diseases
- Guilt due to religious or cultural taboos
- Strict upbringing
- Sexual trauma during childhood
- Anxiety about getting semen on the partner
- Poor body image
- Education about sex, e.g. difference between sexual fantasy and reality of sex with a partner
- Lack of communication about what works for you
- Only masturbating in a particular way, leading to inability to ejaculate any other way
Even in the absence of a clear physical cause or medication, a combination of physical and psychological causes may be at the root of the problem, for example:
- Perhaps you’re growing older, drink too much alcohol, are very stressed generally or suffer from depression.
- It could be that a physical or other medical cause created the problem temporarily. That can cause anxiety that it will keep happening, which becomes a vicious circle. Even when the original cause is long gone, the anxiety now fuels it.
- You may not communicate well with your partner about what really works for you. It may be that you know exactly what will help you ejaculate, but you don’t feel comfortable talking about it.
Treatment for delayed ejaculation very much depends on the type and the cause. The first step to take is to visit your doctor or physician. They can rule out any physical causes and recommend the most appropriate treatment.
It may be that dealing with an underlying cause clears up the anejaculation too. For example, dealing with an infection such as prostatitis or changing your medication.
Your doctor can also help you understand counselling options if you have situational anejaculation and/or they think the problem is psychological.
In some cases, such as after prostate surgery, treatment to return normal ejaculation may not be possible.
In this case, thinking about sperm retrieval if you want to have children, or helping you to cope with the problem or referring you to therapy may be the best options.
Treatment for fertility purposes
For men who wish to have children, there are options to retrieve sperm for the purpose of artificial insemination if necessary.
The first line method is penile vibratory stimulation (PVS). If this doesn’t work, options such as electroejaculation and surgery may be considered.
In 2014, a study by researchers at the University of Miami found that the PVS method was successful in 77% with spinal cord injury.
Psychogical or sexual counselling
If the cause is psychological, then it may be helpful to speak to a therapist to find a way to help you deal with it.
Whether you think it’s best to go alone or with your partner is up to you, but it’s worth thinking about which might be most appropriate.
In particular, if you’re having relationship problems generally, and delayed ejaculation is a new development, it could be a sign that working on your relationship problems is needed.
How successful is treatment? 2 opposing views
An interesting piece of research looking at delayed ejaculation treatment in the United States was published in the journal of Urology in 2015.
They asked 94 members of the Sexual Medicine Society of North America, of which 73% were urologists, about their patients.
Here are some of their findings:
- 89% of practitioners felt that delayed ejaculation was moderately (61%) and severely bothersome (28%) to the patients.
- Medication the patient was taking was thought to be the most common cause.
- Psychological factors were not often seen as the underlying cause, but counselling was often a treatment option if the first choice of treatment didn’t work.
- 60% of patients didn’t respond well to treatment.
- The main medication treatment choices were: Carbergoline (36%), Buproprion (28%), Oxytocin (15%), Cyproheptadine (13%) and others.
They conclude in their research that there’s a wide range of causes – as we’ve already looked at in this article – and that treatment is rarely successful.
Despite the gloomy outlook presented though, do remember that some men are successfully treated.
And contrary to their findings, in an in-depth article written for the International Society of Sexual Medicine website, Michael A. Perelman offers a more optimistic statistic:
While anecdotally viewed by urologists as a difficult-to-treat sexual dysfunction, some sex therapists have reported good success rates, in the neighborhood of 70-80%.
Self-help and communicating with your partner
There are several self-help techniques to try, especially if your problem is one of taking a long time to ejaculate or only happens in certain situations. These won’t apply to everyone, of course, but you might find them helpful:
- Reduce your alcohol intake.
- If you have relationship problems, take the first steps to working on them. Perhaps consider marriage counselling.
- If you find you need a particular movement or type of stimulation, talk to your partner about it. Perhaps you can teach them how to do it to you, or get them involved in other ways while you do it yourself.
- Stop watching pornography for a while, especially if you find your love life doesn’t reflect it.
- Try changing the way you masturbate, especially if you masturbate in a very fast or hard way. Go Slower, gentler and use lubricant to masturbate in a way that imitates sex. Fantasize about your partner when you do and avoid watching pornography.
Do you suffer from delayed ejaculation, and if so, what type? What treatment have you tried, or are thinking of trying?
Feel free to share your story and views below. I know that other readers often appreciate appreciate hearing the thoughts of others in the comments on this site.