Delayed ejaculation: What causes it?

It takes me a long time to reach orgasm, sometimes 45 minutes or longer, which is very frustrating. What causes delayed ejaculation, and is there anything I can do about it?

- Jim / Minnesota

Answer

The difficulty in ejaculating that you describe is known as delayed ejaculation. Men with delayed ejaculation may be unable to ejaculate or may only be able to ejaculate after prolonged — 30 minutes or longer — intercourse or manual stimulation. This can be a frustrating problem for both partners.

Medical causes of delayed ejaculation include:

• Trauma to the pelvic nerves, which control orgasms, such as from injury or pelvic surgery
• A side effect of certain medications, including some antidepressants
• Excessive alcohol use or illicit drug use
• Neurological diseases, such as stroke or nerve damage to the spinal cord

However, the most common causes of delayed ejaculation are psychological. These may stem from concerns about performance or cultural or religious taboos. Another psychological cause is conditioning resulting from certain masturbation patterns. For example, a man who is used to masturbating with a very fast motion may find it difficult to climax with the slower process of intercourse.

A medical history and thorough physical or neurological exam can determine if delayed ejaculation is due to an underlying medical condition or a side effect of medication. Treatment of delayed ejaculation depends on the underlying cause but may include:

• Sex therapy with a therapist who specializes in this area, if the cause is psychological
• Changing medications, if the cause is thought to be a side effect of medication
• Discontinuing use of alcohol or illicit drugs

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