Why Can’t I Come? Coping With Delayed Ejaculation

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.

Different names

Confusingly then, there are different names used by different countries and healthcare practitioners, including:

  • Anejaculation
  • 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.

Retrograde ejaculation

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.

Causes

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.

Physical causes

There are various possible physical causes, including:

  • Nerve damage to the spinal column
  • Stroke
  • 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

Medications

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

  • Anxieties
  • Stress
  • 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

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.

Your views

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.

24 comments

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  1. Finding a solution

    It’s kinda of irritating when the medical profession doesn’t have the answer for a problematic medical condition such as delayed ejaculation, or retarded ejaculation. I’ve dealt with what’s classified as severe DE all of my 44 years of existence. I had no idea it even had a name until an ex-girlfriend decided to research why I couldn’t have an orgasm during sex. I’ve achieved an orgasm during intercourse maybe two to three times in my life. That sensation was amazing and I’ve attempted to find it several times after to no avail. The amount of time and stamina needed to achieve an orgasm those 2-3 times was exhausting. I have no problem achieving an orgasm through masturbation, but it’s still at least 45 minutes to an hour or better for it to happen. The psychological factors, conditioned masturbation techniques and frequency of self sexual gratification isn’t the cause. It’s the sensitivity sensation that’s being hindered or some other chemical imbalance that causes the final release not to occur. The pharmaceutical related DE lends additional evidence that it’s a chemical imbalance causing the lack of sensation needed to climax. They’ve assessed that the orgasm happens in the mind, while the release of sperm is the resulting body function. That’s not accurate at all. Yes, the mind plays a key role, but I challenge you to watch or think about the sexiest situation you can dream up. Tell me if you have an orgasm without any stimulation to your penis. Even for premature ejaculation something has to touch their penis before they orgasm. Might not take much physical stimulation, but I guarantee that some form of physical contact occurred. It also wasn’t masturbatory techniques or frequency of masturbating either. I was sexually active at a young age, which is where I actually discovered masturbation. I’ve also quit masturbating for better than 3 months trying to achieve an orgasm from vaginal, oral and anal penetration. I’m heterosexual so attempting with another man has no excitement value to even obtain an erection. Living with DE you do question your sexual preference. Sadly, this condition is only experienced by a small percentage of men. Which results in a very small amount of actual studies and each study begins with the determination that it’s psychological or caused by the person afflicted. You can attempt the mind games, but you better be physically fit and willing to exude the amount of stamina required. That’ll work a few times, until you just simply get tired and resort back to masturbation for the final climax. Sex still feels amazing, you just won’t have the typical orgasm that others enjoy. The hard parts always attempting to make your partner understand that it’s not their fault, or to play it off like you’re fixed or some other reasonable explanation for not producing sperm when faking an orgasm. I’ve gotten really good with my explanations, who says a woman is the only one who can fake it. There are a few drugs that show promise and I plan to explore them. Just like about all other medication, they come with side effects. But, side effects are always individualized to the chemical makeup of the person taking them. I’ll report my finding here after exploring each.

    1. Ethan Green

      Hi there
      Thanks for sharing your experience with such honesty. It was interesting, though obviously sad, to read and I can understand why it would frustrate you so much. Have you tried various different ways of stimulation that might be more uncommon as an experiment? And what are the meds you’re planning on taking? It would be great to hear back from you once you’ve tried them.
      Ethan

  2. I am 40 years of age I happened to got married to a young lady early this year. During our first night I realized that, she was a virgin and her Virgina is very tight that I had to used stimulant in the first place. I could vividly recalled that night she bleed so much that really scared me. The following day we consulted our family doc and council us accordingly. Thereafter, I began to experience some itches around the cap of my penis and we were told that perhaps my spouse had an infection which the doc also recommended some drugs for us. We actually got good results but nevertheless, she always complain about pains whenever I tried to penetrate her though is less presently. My major concern is I don’t normally ejaculate the way I used to some couple of days back. And sometimes I had to sweat profusely before I did so. The issue is seriously disturbing me and my wife at present please doctor what is the way forward. Because I am even using some herbs now which I don’t see their impact

    1. Ethan Green

      Hi Jaafar
      It might take longer than a couple of days to fully recover from the infection, so don’t worry. If she is vert tight, then you need to spend longer on good foreplay, and use lubricant too.
      Ethan

  3. Fernando

    Hi, my name Is Fernando, from México, recently i have heard about the nofap technique, they Say that porn and masturbation Is the Main problema, they say that ir you don’t watch porn and masturbate for a little more than 1 month you Will be cured, that can be truth?

    1. Ethan Green

      Hi Fernando
      I don’t think you can be 100% sure that one month without them will definitely cure you. But I think it has a good chance of helping. So I would say try it, but keep your expectations reasonable!
      Ethan

  4. I have had this problem all my life, since not ejaculating the very first time I had sex. It helped to end my marriage, as well as several relationships after. I have been to lots of specialists, been assessed medically etc. No one has had a cure for me. Luckily I am now with a wonderful woman who has helped it to not be an issue any longer. Although the problem persists, we have found one way around it. First thing in the morning, while she is still asleep, I penetrate her in the spoons position. I can usually ejaculate within 10 minutes (usually she is awake by then!) Despite this success, I have never ejaculated during normal ‘awake’ sex in our five year relationship.

    1. Ethan Green

      Hi there
      Thanks for your comment and for sharing your experience. That’s a really interesting way of dealing with it! I’m not sure if it says anything, or could be passed on to others. Perhaps the peace and privacy helps somehow. Great that you found someone who is happy to work with you to find a solution though!
      Ethan

  5. I am 72 and have enjoyed a problem-free sex life until very recently when I have been unable to reach orgasm either through intercourse or masturbation. I can achieve an erection with or without Viagra. I wonder if this purely an ‘age thing’!? The only medication I am taking is Atorvastatin 40mg and an aspirin, for about 4 years now.

    1. Ethan Green

      Hi James
      I’ve seen reports that statins can cause delayed ejaculation for some men. Perhaps ask your doctor about the Atorvastatin?
      Ethan

  6. Hi, I have d same issue.. whenever I have sex with my girlfriend,it can take up to an hour and I still don’t cum, I really feel bad and to her it’s as though I’m punishing her. I don’t know what to do to cum faster… I really need help please.

    1. Ethan Green

      Hi Zion
      Sorry to hear you have this issue. There’s not much I can do to help other than suggest trying the ideas in the article. If she’s having a hard time dealing with it, then it might be worth doing some reading together. Find an article that shows it’s not necessarily your fault, and that it’s not you punishing her.
      Ethan

  7. My wife and I are in a friendship marriage, not a lover’s marriage, if tat makes sense. We have an excellent friendship, but have not been lovers for a very long time. Roughly a year ago a lady and I became deeply romantically involved. We see each other a few times a month since we live in different cities. We honestly love each other incredibly deeply on all levels. Making love is a result of our love. Its not that we like each other because of sex. We are both totally open with each other about everything including our bodies and the topics around love making. She openly shows enjoyment of love making to me, a desire for me, and allows me to do the same regarding her. When we see each other, we cannot help but make love, over and above doing a lot of talking and just a lot of other things. Unfortunately, on many occasions I suffer from delayed ejaculation to the point where we give up. Other times I do climax and ejaculate. Sometimes she lets me masturbate while she encourages me in some physical way until I ejaculate. Other times, as I said, we just give up, even though my whole being screams “I want to climax!” and of course she wants that for us too. She openly expresses her enjoyment of seeing or recognizing when I climax, and she almost always orgasms, either during intercourse or some other way. The delayed ejaculation does not bother her (unless I go on too long and she starts to hurt), it seems, but it does bother me. I want it to stop. We are both just inside of 50 years of age, healthy, active, and positive in our outlook on life. Any comments? No religious reprimanding required.

    1. Ethan Green

      Hi Paul
      Thanks for sharing your experience here. I saw your other comment asking what happened to this one. As you can see, it wasn’t deleted; it just sometimes takes me a long time to reply due to the large number of comments I get on this site, other commitments, and as it happens just this week being on holiday!
      Anyway, are you taking any medication at all? Do you drink a lot of alcohol? These are two things to rule out. Apart from that, age might be a factor in making your orgasm less predictable. It might be a case of accepting that you won’t always ejaculate, and being fine with it – if she’s ok with it, then perhaps learning to be ok with it yourself too. And have you tried other things together? Are there positions or styles of sex that are more likely to work for you?
      Ethan

      1. Ethan,

        Thank you for your response and explaining why the delay happened.

        To answer your questions: No, I do not take any prescription medications. The most medications I take are the occasional headache tablet, or cold prevention supplement, or if I should get a sore throat or cold, some over the counter remedy. I am a very healthy person. I also do not smoke (I used to smoke, but quit cold turkey in 1998), and I drink a glass of wine or a beer once in a while, perhaps a drink a week, if that much. When I do not climax, it leaves ME real frustrated, even though the love making itself is wonderful. Its just that because it is so wonderful, I want/need it to end in climax. I have had days where we made love more than once during the day and I climaxed both times, and then the others occur where no matter what, I can get right to the edge of climaxing, but it just will not happen.

        1. Ethan Green

          Hi Paul
          No problem. Well, as I said before, perhaps it’s a case of accepting that it just won’t always happen. Try to take the pressure off yourself, and relax more, and see if that helps. Sorry I don’t have any more advice for you!
          Ethan

  8. My husband and I have been dealing with delayed ejaculation for some time and recently stumbled across a blog that has really helped us. We now have him on an ejaculation schedule so he comes weekly on Sundays and is not allowed to orgasm from sex unless he does it naturally. After three months, he is now doing it naturally much of the time.

    There are a few sites with information, just search for ejaculation schedule.

    1. Ethan Green

      Hi Angie
      Thanks for sharing this advice. I’ll take a look at that concept in more depth!
      Ethan

  9. My issue may or may not be unique so posting here for feedback. I can only obtain an erection with medication (sildenafil or cialis) … cialis has a longer half life so I can get an erection the next morning but cannot ejaculate more than once within a 24 hour period of time … confused by what’s going on.

    1. Ethan Green

      Hi Greg
      Unfortunately, one possible side effect of drugs like cialis is delayed ejaculation. Have you spoken to your doctor about it to get their advice?
      Ethan

  10. My boyfriend has the same issue. We’ve tried many things (switching between oral and intercourse, different positions), but nothing and what worked yesterday usually does not work tomorrow (sex usually takes over 2 hrs if we don’t give up or have somewhere to be and sometimes we just give up too tired.). He has a congenital birth defect and had a mechanical valve inserted about 10 years back and is on daily medication (blood pressure, anticoagulant and another one.) Also, due to this he was more prone to watch porn and masturbate by himself or many years. I’m looking for any advice.

    1. Ethan Green

      Hi Nala
      Has he spoken to his doctor about it, or do you think he’d be willing to? He could ask if the medical condition or any medication he’s taking could cause it. You could also check online together to see if any of his meds are known to cause it, and if there are alternatives he could ask for. As per the article, he could also consider therapy. And perhaps try the other tips in the article to see if they have any effect.
      Ethan

  11. Hi, interesting article. I have exactly this problem, and sometimes last for so long my girlfriend tells me to stop because it’s hurting. That really sucks because I often feel like I will come eventually, but just need to keep going. I think maybe it’s situational because my ex could get me off in much less time. idk though because that was ages ago.

    1. Ethan Green

      Hi Danny
      That must be frustrating for both of you. Are you able to continue through other means though? Perhaps if you feel you just need a little more time, you could spend longer on foreplay, and also go to manual stimulation before she gets to the point of it being too much.
      Ethan

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