Delayed Ejaculation: Longer lasting is not always better


Delayed ejaculation — formerly known as retarded ejaculation — is a condition in which it seems like an extended period of sexual stimulation is required for orgasm (climax) and ejaculation. Treating delayed ejaculation depends on the underlying cause (chronic health conditions, surgeries, and medications).

It is only a problem if it is distressing to you or your partner. It is most common for delayed ejaculation to be a temporary problem.


Men need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate. There is no specific time that indicates a diagnosis. The delay must cause distress or frustration, or if you have to stop sexual activity due to fatigue, physical irritation, loss of erection, or a request from your partner.

The symptoms include several factors:

  • Lifelong vs. acquired. So, this means the problem began from the time or very early on in adolescence and occurs after a period of normal sexual functioning.
  • Generalized vs. situational. This isn’t limited to a specific sex partner(s), act, or under specific circumstances.

These categories help identify any underlying causes and determine what might be the most effective treatment.

When to seek help

Your primary care provider is a good place to start if:

  • It’s an issue for you or your partner
  • You have another known health problem that might be linked, or you take medications that could be causing the problem
  • You have other symptoms that may or may not be related

What is the cause?

Certain medications, chronic health conditions, and surgeries can cause delayed ejaculation. Also, drug and alcohol misuse, abuse, or addiction. Often underlying mental health disorders such as depression, and anxiety can cause delayed ejaculation. Often delayed ejaculation can also cause depression and anxiety which creates a self-perpetuating problem.

Mental health-related factors of delayed ejaculation include:

  • Depression, anxiety, or other mental health conditions
  • Relationship problems due to stress, poor communication, or other concerns
  • Anxiety about performance
  • Poor body image
  • Cultural or religious taboos
  • Also differences between the reality of sex with a partner and sexual fantasies
    • Pornography use
    • Masturbation pattern

So what medications and substances that can cause delayed ejaculation include:

  • Psychiatric Medications
  • Blood pressure medications
  • Seizure medications
  • Alcohol and opioid use

Lastly, here are several medical causes of delayed ejaculation include:

  • Certain birth defects affecting the male reproductive system
  • Pelvic nerve injury
  • Infections
  • Urologic surgery
  • Neurological diseases
  • Endocrine (Hormone-related conditions)

It is common for men to feel anxious or depressed regarding any sexual dysfunction, especially something like delayed ejaculation. For some men, a minor physical problem that causes a delay in ejaculation might cause anxiety about ejaculating during a sexual encounter. The resulting anxiety might worsen delayed ejaculation.

General Risk factors

Several other things can increase a man’s risk of having delayed ejaculation, including:

  • Older age — as men age, it’s normal for ejaculation to take longer
  • Temporary Psychological conditions, such as depression or anxiety (even related to life events, new job, loss of job, the birth of a child, meddling in-laws)
  • Acute and chronic medical conditions and surgical recovery phases
  • Relationship problems, such as poor communication with your partner, or recovering from or engaging in infidelity

What happens if I do nothing?

Complications of delayed ejaculation can include:

  • Possible less sexual pleasure for you and your partner
  • Stress or anxiety because of sexual performance
  • Marital or relationship problems due to an unsatisfactory sex life
  • Inability to get your partner pregnant (male infertility)

Furthermore, the most common and effective treatment involves talk therapy and behavioral interventions homework which are done in the privacy of your own home.

About Metro Medical Direct

Dr. Raymond Zakhari is the owner and operator of Metro Medical Direct and provides Telehealth and in-home visits. He also provides in-home alcohol and drug rehabilitation. Book an appointment here and check out the rest of this site for more information about concierge medicine.

Also, check out Dr. Ray’s Podcast The Psychology of it All here. Also available on Apple Podcasts.