Information About Delayed Ejaculation

Delayed Ejaculation Causes

Delayed ejaculation isn’t the same in all men. In the mildest form, men can ejaculate but only with great effort and after extensive stimulation, such as extremely long-lasting intercourse. Next is the intermediate form, is where men can reach orgasm and release semen but only with the most vigorous stimulation by hand in the presence of a sexual partner.

The most extreme form is where the man ejaculates very slowly or late or does not come at all. And in some cases a man can achieve climax only by self-pleasuring with his own hand, in the absence of a partner. This has been called “autoeroticism”. So what might cause of all these different forms? There are two groups of factors – the physical and the psychological or emotional. We’ll look at the physical ones first. 

Physical Causes of Delayed Ejaculation

Some prescription drugs are a significant cause of delayed ejaculation (or DE for short). Let’s say a man is depressed or anxious, and can’t come during sex. Often his slow ejaculations are not caused by the underlying emotional state – usually depression – for which the drugs have been prescribed.

In fact, it’s the drugs themselves that cause a delay in reaching orgasm or ejaculating. In particular, SSRIs, the serotonergic drugs used as antidepressants or to overcome anxiety, are associated with a tenfold increase in risk of mild or moderate ejaculation delays. Although this may be helpful in cases of premature ejaculation, men who are depressed and who ejaculate normally may find that these drugs really slow things down, or stop them coming altogether… There are more conditions that cause ejaculation problems, too. These include neurological diseases such as multiple sclerosis and diabetic neuropathy.

Equally, high cholesterol levels have been linked to slowness in ejaculation (and, for that matter, erectile dysfunction). Sometimes, when delayed ejaculation is not particularly serious, it seems to be associated with a low testosterone level and smaller testicular size. In their conclusions, the scientists suggested that although physical issues are often a cause of ejaculation problems, the most common cause of any delay in ejaculation is probably psychological. 

Research On Ejaculation Problems

Around 85% of men with ejaculation problems of this kind can reach orgasm and ejaculate through masturbation, while around 50% can achieve orgasm through sex with their partner – as long as it does not involve intercourse. (We’re talking mutual masturbation and so on rather than sexual intercourse.)

Let’s not forget that vaginal intercourse is just one form of “normal” sexual behavior! There are many ways for a couple to enjoy sexual pleasure from activities other than intercourse. And Masters and Johnson observed as long ago as the 1950s that “ejaculatory incompetence” can be a source of great sexual pleasure to the woman because it allows prolonged periods of intercourse.

That’s a good point: if a woman is able to reach orgasm with her man’s prolonged thrusting she may be delighted with her partner’s stamina, and think of him as a man who can satisfy her even though he does not attain orgasm himself. However, problems almost always arise, sooner or later, when a man cannot ejaculate during intercourse.

Sometimes a couple wish to start a family, or the woman may come to think that “if he can’t come with me, then he doesn’t find me attractive”. Now, when we’re looking at the causes, what’s very clear is that they don’t really split neatly into two groups – the physical and the emotional. Because even when there’s a physical cause, there can often be emotional factors at work.

Masturbation Style & Other Factors As Causes Of Delayed Ejaculation

  • When a young man uses an idiosyncratic style of stimulation during masturbation as a teenager or young man, he may train or “condition” himself to only come in response to very intense stimulation. This is known as traumatic masturbatory syndrome.
  • Pelvic surgery in adult life such as radical prostatectomy is high on the list of culprits for causing difficulties with ejaculation, as is transurethral resection of the prostate and bladder neck surgery. Both of those can delay ejaculation, as can other forms of pelvic surgery and spinal column trauma.
  • There are more than 20 prescribed drugs which may be responsible for delayed ejaculation. For example, almost all of the drugs licensed for the treatment of obsessive-compulsive or depressive disorders, with the exception of nefazodone and Bupropion, are known to cause ejaculatory or orgasmic difficulty. Even men who have never had any ejaculatory problems before may find that certain medications, such as antidepressants and antipsychotics, can cause ejaculation problems. Changing the medication may help.
  • Recreational drugs, including alcohol, can also cause a delay in ejaculation.
  • Phimosis and frenulum breve have been suggested as linked to the cause of slowness in ejaculating slowness. You can see these conditions in the pictures below. It’s conceivable they are indeed a factor in the origin of DE but you have to remember that many men who have these issues do not have ejaculatory delays.

Remember that long delays in ejaculation might just be one end of a normal distribution of ejaculation time in any population of men. That means premature ejaculation is normal, too – just at the other end of the spectrum.

Physical Causes Of Delays In Orgasm: Surgery, Illness and Aging

One of the interesting things about aging in men is that the sexual organs begin to work less well, it takes longer to achieve a full erection, and his erection may not last as long.

Also, by the age of 50 most men have diminished testosterone levels which can impact on levels of sexual arousal.

In addition there is a real reduction in the intensity of his physical feelings at the time of climax. That’s because the nerves responsible for orgasm and ejaculation deteriorate with age. For example, the fast conducting peripheral sensory axons are progressively lost, a change which begins in the third decade of life.

In addition collagen infiltrates the myelin nerve cell sheath, sensory receptors in the skin degenerate, and the skin atrophies. These age-related changes combine to make it harder for a man to reach his ejaculatory threshold. Other factors which impact on a man’s ejaculatory speed and responses are peripheral vascular disease, some types of psychiatric problem, diabetic neuropathy, lower penile sensitivity, reduced spinal stimulation, and a higher penile sensory threshold.

And a fundamental part of the ejaculation reflex, the bulbo cavernosus or glandipudendal reflex, seems to be missing in two out of every nine men who can’t ejaculate easily. This would make a lot of sense, of course – their ejaculations are never even triggered.

Drugs As A Cause Of Delayed Ejaculation

Neurobiology and Neuropharmacology

A paper published electronically by Marcel D. Waldinger, emphasizes that orgasm and ejaculation are caused by different nerve circuits and different neurotransmitters. And research into neurotransmitters might one day lead to drugs for treatment.

But more is known about the neurobiology of ejaculation than is known about the neurobiology of orgasm. One takes place in the body, one in the brain, so that’s not too surprising!

Work on rats has shown that rats raised in isolation do not know how to copulate and achieve orgasm by mating when they reach adulthood. If subsequently exposed to other rats, some of these rats will learn how to achieve orgasm and ejaculate; others will not.

So perhaps what we learn as we grow up is an important part of all this.

And other work on rats has shown that a couple of brain chemicals, the neurotransmitter oxytocin, and the neuropeptide opioids, may be linked to copulatory behavior. Brain opioids, for example, seem to inhibit sexual behavior.

Clearly, doing similar research in human males is rather problematic! But Waldinger suggests that neuro-receptor agonists should be researched because they may form a class of drugs which acts to alleviate delays in ejaculation in men.

Brain Imaging

Doctors have asked men to ejaculate while they are located inside a PET scanner (yes, really), and have got some interesting information about changes in the activity of the brain.

Perhaps not surprisingly, only half of the volunteers who tried this managed to ejaculate under these conditions, but what emerged quite clearly was that non-ejaculation involved much more activity in the brain cortex than did ejaculation. This activity was centered on the amygdala and left temporal areas of the brain, and it is known that these areas are responsible for controlling fear and vigilance.

No surprise, perhaps? After all, we know that fear and vigilance inhibit sexual arousal and ejaculation in almost all men. So higher than normal activity in these areas of the brain may be the cause of these ejaculation problems.

* This research was reported in the Journal of Anthology, volume 27, number 3.