Delayed or absent ejaculation is a condition in which a man takes 25 minutes or longer to ejaculate or is unable to ejaculate at all. The condition can be inherited or the result of a secondary cause. Delayed or absent ejaculation often causes significant distress to the individual and their sexual partner.
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What Is Delayed or Absent Ejaculation?
Delayed ejaculation (DE) happens when a man regularly takes an especially long time to ejaculate. DE also encompasses the related disorder of absent ejaculation (AE), called anejaculation, which happens when a man can’t ejaculate at all. DE can also cause a reduction in the volume, force, and sensation of ejaculation.
Ejaculation is the physical act of semen being released from the genitals. Orgasm is a pleasure sensation that results from hormonal changes in your brain. Though they normally occur at the same time, ejaculation and orgasm are separate experiences, and may happen without the other. If these experiences do not occur simultaneously, it may indicate a secondary cause of DE or AE.
Though there is a wide range of what is considered “normal” sexual behavior, most men climax within a few minutes of intercourse. The time it takes for most men to ejaculate during sex is known as ejaculatory latency and is estimated to be four to 10 minutes; men with delayed ejaculation may take 20 to 25 minutes or longer to ejaculate.
Men with DE often do not have problems achieving or maintaining an erection, but find it difficult or impossible to ejaculate and orgasm, even with sufficient sexual stimulation. No amount of sexual stimulation may help men with AE to reach orgasm.
The condition can be a short-lived or lifelong problem; it can also occur all the time or only in specific situations. The causes of delayed or absent ejaculation vary but may be due to chronic health or mental health conditions, certain medications, surgeries, or trauma to the sex organs. It also appears to worsen with age.
DE can cause significant distress and relationship problems. Sometimes men only experience DE in the presence of a partner but do not have difficulty ejaculating during solo masturbation.
Treatment for delayed or absent ejaculation depends on the cause of the problem and how long it's been going on.
Doctors do not yet have a strong understanding of DE and AE because they are the least studied of male sexual dysfunction disorders. While the actual prevalence of DE and AE is unknown, it is thought to be a rare condition, affecting 1% to 5% of sexually active males.
In men taking medication to achieve and sustain an erection, DE or AE may occur as the erection may be due to the medication rather than sexual arousal.
Delayed ejaculation is a recognized mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Men with DE tend to have more general health issues than sexually functional men.
What are the types of delayed or absent ejaculation?
DE is considered primary when it is the result of an inherited disorder. Acquired or secondary DE occurs as a result of something else, such as a surgery or medical condition.
How common is delayed or absent ejaculation?
Acquired DE seems to be more common than primary DE, but more research on the prevalence of this disorder needs to be done.
What causes delayed or absent ejaculation?
The causes of delayed or absent ejaculation vary and can be physical and/or mental. Due to the complex nature of this disorder, its cause is often attributed to a combination of factors.
Physical causes include:
- Aging.
- Birth defects of the male reproductive system.
- Blocks in the ducts that semen passes through.
- Complications from surgery, including circumcision.
- Diabetes.
- Genetic factors.
- Hormone issues, such as low thyroid or low testosterone.
- Infection or inflammation of the prostate or pelvis.
- Injury.
- Medications, especially antiseizure drugs or antidepressants.
- Nerve damage.
- Nervous system diseases, such as Multiple Sclerosis, stroke, or a spinal cord injury.
- Urinary tract infections.
- Use of alcohol and/or narcotics.
Mental causes include:
- Autosexual orientation, meaning that a person prefers masturbation over sex with a partner.
- Cultural or religious taboos that result in an inhibition of normal sexual function or significant guilt or shame around masturbation or sexual orientation.
- Depression or tension.
- Difficulty asserting oneself in a sexual relationship or encounter.
- Diminished libido.
- Fear, including fear of pregnancy, loss of control, abandonment, rejection, intimacy, or hurting a partner.
- Hostility and anger towards a partner.
- Insufficient arousal or sexual stimulation.
- Obsessive-compulsive disorder.
- Performance anxiety.
- Poor self-confidence.
- Relationship problems, such as problems bonding or communicating.
- Sexual orientation — DE seems to occur more commonly in homosexual men than in heterosexual men.
- Unusual, particular, or high-frequency self-masturbation habits.
- When the fantasy differs from the sex partner.
Delayed or absent ejaculation risk factors
DE tends to get worse with age.
Other risk factors include:
- Chronic illnesses, such as diabetes and MS.
- Excessive alcohol use.
- Blood pressure medicine or antidepressants.
- Mental health issues, such as depression and anxiety.
- Relationship problems, such as anger or poor communication skills.
Complications of delayed or absent ejaculation
DE isn't a life-threatening condition, and, by itself, doesn't lead to any serious physical illness, but the complications can be difficult to manage.
These complications include:
- Avoidance of sexual intimacy.
- Decreased arousal.
- Difficulty conceiving or infertility.
- Low self-esteem.
- Performance anxiety.
- Sexual dissatisfaction.
- Significant stress on relationships.
Delayed or absent ejaculation can be very difficult emotionally for a man’s sexual partner. The prolonged penetration needed to achieve ejaculation can cause physical pain. It may also cause a partner to question their own attractiveness or their partner’s loyalty.
What Are the Signs and Symptoms of Delayed or Absent Ejaculation?
Symptoms of delayed or absent ejaculation include:
- Difficulty ejaculating 75 to 100% of the time for at least six months.
- Difficulty or inability to reach orgasm, the psychological experience of pleasure associated with ejaculation.
- Inability to ejaculate at all.
- Significant psychological distress and frustration.
- Taking 20 to 25 minutes or longer to ejaculate during self-masturbation or sexual activity with a partner.
When should I see a doctor about delayed or absent ejaculation?
It’s normal to have DE or AE from time to time, just like it’s normal to have erectile dysfunction sometimes during your lifetime. However, if you have been experiencing difficulty ejaculating within 25 minutes for six months or longer and it is causing distress or physical discomfort to you or your partner, you should talk to your doctor.
How Do You Diagnose Delayed or Absent Ejaculation?
There is no test for DE or AE. Your doctor will listen to your symptoms and conduct a physical exam. They may order blood and urine tests to rule out issues like infections and hormone imbalances. Your doctor will also ask you questions about the history of your condition, such as whether it occurs in partnered and/or solo sex, how long it has been going on, your masturbatory habits, and your feelings about sex.
How Do You Treat Delayed or Absent Ejaculation?
Treatment for delayed ejaculation (DE) depends on what is causing the problem. Once doctors find the cause, they are better able to resolve the issue.
The most common methods for treating delayed ejaculation are:
- Breathing techniques and mindfulness to reduce sexual anxiety.
- Changing the style, frequency, or nature of masturbation habits and sexual fantasies.
- Prescribing, switching, or adjusting medications — Some drugs for diseases such as Parkinson’s have been helpful for men with DE or AE.
- Psychological counseling.
- Rehabilitation treatment for drug or alcohol use.
- Sex education and/or use of the sexual tipping point model.
- Sex therapy.
- Surgery.
