Taking a long time to ejaculate or orgasm during sex isn’t a common topic in locker room chat, but it’s certainly a bother. Premature ejaculation, and erectile dysfunction gets most of the media time when considering male sexual dysfunction. However, studies have highlighted the fact that delayed orgasm is underrated, and upwards of 75% of men may have problems at some point in their lives1. Furthermore, it is often a very bothersome form of a man’s sexual frustrations2. Aside from the obvious, not reliably achieving orgasm, is also troublesome to a man’s partner with pain associated with prolonged intercourse, or ‘feelings of being undesirable’ as the root of failing to orgasm. Let’s unpack some of our understanding of delayed orgasm, causes, and treatments available.

What exactly Qualifies as ‘Delayed’?

First, how long does one have to take, to take ‘too long’? Definitions vary depending on which health organization you reference, but the World Health Organization states that if you have persistent or recurrent troubles with a delay or inability of attaining orgasm with what you consider sufficient sexual stimulation (intercourse or masturbation) and this is bothersome to you- then you would meet criteria3. The important concept is that the delay to obtain orgasm is bothersome to you and your partner. If you are more of a numbers person, it takes the average man 5 and a half minutes of intercourse to ejaculate and orgasm – probably not as long as the locker room would have you believe! In medicine, to make sense of the variability we see among everyone, we often use statistics and thus standard deviations; here, if we look at the 5% of men taking the longest time to ejaculate, they tend to take 22 minutes or longer3-6.

How does one become delayed?

The bottom line is we don’t fully understand the underlying mechanisms. However, like many things in medicine, astute clinicians and researchers have made several observations and associations shedding some light on the issue. We know that among men with delayed orgasm (DO), nearly half of cases are associated with use of anti-depressant medications – specifically selective serotonin reuptake inhibitors (SSRIs), nearly one third associated with psychological stressors, a fifth with low testosterone and less than 10% due to poor penile sensation7. Hypothyroidism as well as high levels of a hormone called prolactin has also been associated with DO8.

What can you do about it?

Albeit, there are several theories of sexual processing and delayed orgasm, no one would deny the importance of having adequate sexual arousal to bring a man closer to the threshold for orgasm and ejaculation. Warming up the oven doesn’t just pertain women in bed, but men too. So, next time you find yourself in the bedroom, relax, clear your mind, and work with your partner so that both of you are excited and in the mood.

If this isn’t working for you- then the best place to go, is to see a health professional. Since this falls within a very specialized area of medicine, it is possible that your primary care physician may refer you on to a sexual medicine specialist who regularly sees men for troubles such as this. The next important step the physician may take is to screen for some of these associated conditions by asking you questions, examining you or performing some bloodwork. This is important because correcting an underlying cause may save the need for trialing other medications, and may also benefit your overall health. If you think that DO may be associated with stress in your life, or with your partner, reaching out to your primary care professional and getting connected to a sexual health professional may help get your game back on track. Among men taking an SSRI antidepressant and having troubles with DO, talk to your prescribing physician and let them know about the side-effects you may be experiencing. Your physician may consider a medication change to one with less of these sexual side effects such as bupropion. Finally, there are some medications that may be of benefit. The two most commonly used by sexual health specialists are cabergoline and the previously mentioned bupriopion. Cabergoline, in a small study found that 69% of men reported a positive improvement in their time to orgasm, and 52% reported normal orgasmic and ejaculatory function. A small study evaluating bupriopion, suggested that up to 20% of men noticed a positive improvement in orgasmic function9.

Final thoughts?

Delayed orgasm is more common than you think and probably more common than we have previously documented in medical literature. It is often associated with antidepressant use with SSRI type medications, low testosterone and psychological stressors. Men and their partners that are having trouble with delayed orgasm are often very bothered. Speaking to your physician about treatment and referral options is an important first step to addressing potential causative underlying issues or providing treatments to get your sex game back on track.

References

  1. Association AP, Force DT. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association Publishing; 2013.
  2. Paduch DA, Polzer P, Morgentaler A, et al. Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: A Prospective, Observational Study. J Sex Med. 2015;12(12):2276-2286.
  3. Jenkins LC, Mulhall JP. Delayed orgasm and anorgasmia. Fertil Steril. 2015;104(5):1082-1088.
  4. McMahon CG, Jannini E, Waldinger M, Rowland D. Standard operating procedures in the disorders of orgasm and ejaculation. J Sex Med. 2013;10(1):204-229.
  5. Patrick DL, Althof SE, Pryor JL, et al. Premature ejaculation: an observational study of men and their partners. J Sex Med. 2005;2(3):358-367.
  6. Waldinger MD, Quinn P, Dilleen M, Mundayat R, Schweitzer DH, Boolell M. A multinational population survey of intravaginal ejaculation latency time. J Sex Med. 2005;2(4):492-497.
  7. Teloken P, Nelson C, Mulhall JP. Secondary Delayed Orgasm: Patterns, Correlates and Predictors. Journal of Urology. 2012;187(4 Supplement):e562.
  8. Corona G, Jannini EA, Lotti F, et al. Premature and delayed ejaculation: two ends of a single continuum influenced by hormonal milieu. Int J Androl. 2011;34(1):41-48.
  9. Abdel-Hamid IA, Elsaied MA, Mostafa T. The drug treatment of delayed ejaculation. Transl Androl Urol. 2016;5(4):576-591.