It’s the ‘least studied male sexual health problem’ yet it affects 4% of guys… so what is delayed ejaculation?

Significant advances have been made in breaking the taboo of male sexual health dysfunctions in recent years.

But while most people are aware of premature ejaculation and erectile dysfunction, doctors say there is another common problem millions of men suffer with in silence.

Delayed ejaculation (DE) – typically defined as taking at least 30 minutes of trying to reach orgasm whether through masturbation or sex with a partner – affects an estimated four percent of the male population.

According to Dr Juza Chen, a urologist from Tel-Aviv University: ‘Men with DE report less coital activity, higher levels of relationship distress, sexual dissatisfaction, lower arousal, anxiety about their sexual performance and general health issues when compared to sexually functional men.’ 

Delayed ejaculation has been dubbed the least studied of all male sexual dysfunctions by sexual health experts. 

Estimates for the number of men who suffer from the poorly-understood condition range from around four percent to as high as 10 percent globally. 

There are no set criteria for evaluating a man complaining of DE because everybody’s idea of a ‘normal’ amount of time to ejaculation is different. But 25 to 30 minutes of trying to reach orgasm is typically the threshold psychiatrists use to measure and diagnose DE. 

Despite the minimal research attention the condition gets, it can cause significant blows to a man’s self-esteem and the health of his relationship with a partner.

Dr Chen wrote in 2016: ‘The psychological and relational impact of DE is often significant in that it typically results in a lack of sexual satisfaction for both the man and his partner.’

Meanwhile, researchers in the US and the Netherlands reported that same year: ‘Like men with other sexual dysfunctions, men with [delayed ejaculation] expressed lower relationship satisfaction than controls and elevated levels of fear of failure in sexual situations, indicating a significant amount of bother or distress by their condition.’ 

Based on relatively little scientific investigation into the causes of the condition, sexual health experts believe it could have roots in childhood trauma and attitudes of shame and anxiety around sex. 

Achieving an orgasm is typically the end goal for men in a sexual encounter, BUT men with signs of a delayed ejaculation issue may struggle to reach the finish line.

Erectile dysfunction (ED) is a far more common sexual dysfunction, with around 18 percent of men 20 years and older reporting persistent inability to achieve an erection.

Some men are born with DE but in some cases, it develops at some point in a man’s lifetime, and the condition can persist for years.

Risk of DE increases with age, similar to erectile dysfunction, due to the many age-related changes the body undergoes with advanced age, such as naturally declining testosterone levels, as well as weakened pelvic muscles and deterioration of the  nerve function that helps the brain communicate with other systems in the body that lead to an erection.

Testosterone levels typically peak around 20 years old and slowly decline through the rest of adulthood.

At their highest, testosterone levels should be between 300 and 1,200 ng/dL. Once men hit their mid-thirties, testosterone levels begin declining by at least one percent per year.

There is also some growing evidence that having type 1 diabetes increases a man’s risk of ejaculatory issues.  

Mental distress, anxiety in particular, is a major force driving delayed ejaculation. A 2023 study published in the Journal of Sexual Medicine asked more than 3,000 men what they believed to be the cause of their DE.

At the top of the list was general anxiety with 45 percent of men claiming this as the cause, followed by 34 percent who attributed it to anxiety specifically about sexual performance, followed closely behind by 30 percent of men who blamed inadequate penile stimulation.

Authors of the report said their results affirmed prior assumptions about possible causes of DE, but they were expecting anxiety to play such an outsized role.

They said: ‘Specifically, anxiety and negative emotions—whether sex-specific or more general distress—received the strongest endorsements from respondents.

‘The association between anxiety and sexual performance problems has long been known, but we were surprised that it occupied such primacy in the list of reasons for DE symptomology.’

Oftentimes, treating delayed ejaculation will require the help of a mental health expert to address the root cause. 

This could result in a prescription for a selective serotonin reuptake inhibitor, SSRI, the gold standard treatment for depression and anxiety.

However, in something akin to a chicken-or-the-egg scenario, men taking antidepressant medications also seem more likely to be living with DE.

A 2009 report in the Journal of Sexual Medicine estimated SSRI users had a seven-fold higher risk for delayed ejaculation compared to non-users.

There are also a myriad of possible physical causes, such as injury to pelvic nerves that control orgasm, hormone-related conditions like hypothyroidism, past prostate surgery, or a phenomenon called retrograde ejaculation, in which the semen goes backward into the bladder rather than out of the penis.

In cases where doctors may suspect low-T levels are at play, they may opt to administer testosterone to address falling T levels as a possible cause for the condition. 

Doctors might also administer oxytocin, a hormone released when a pregnant woman goes into labor.

Oxytocin is plentiful during sexual arousal and can enhance an already pleasurable experience. 

It’s also known as the ‘love hormone,’ which plays a crucial role in bonding and feeling close to another person.

The taboo surrounding the issue of men’s sexual health has meant relatively little public awareness about issues of sexual dysfunction.

But in recent years, the stigma has begun to lift as more and more men feel empowered to bring up the topic with their primary care doctors.

This has coincided with the meteoric rise in virtual prescribing services that allow men to get prescriptions for medications to treat erectile dysfunction, such as Viagra and Cialis, as well as remedies for male pattern baldness that can arrive at their doorstep within a couple of days for as little as $10 a month.