Delayed Ejaculation

Slow Ejaculation

Delayed ejaculation (DE) is the opposite of PE.  It is the inability of a man to ejaculate in an acceptable time frame – basically in less than 30 minutes of continued stimulation. 

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DE can be caused by a number of factors including frequent ejaculation, masturbation and/or pornography use, mental/anxiety, physical factors, medications, and inappropriate condom selection (type or size).  The treatments often work by reversing or correcting the underlying causes.

  • Masturbation and pornography are among the leading causes of DE.  For more information on how these contribute to DE, click HERE

  • Frequent ejaculation – frequent ejaculation is a common cause of DE.  In fact, men who ejaculate twice within the same day often notice that the second ejaculation has a longer latency time frame than the first ejaculation.  Simply decreasing the frequency of ejaculation can decrease latency times during sexual activity.

  • Anxiety – fear is another factor that can play into DE.  Men who fear they won’t ejaculate, fear getting their partner pregnant, or fear they’ll be rejected or even caught having sex tend to release chemicals into the blood stream that actually inhibit ejaculation pathways.  Getting appropriate treatment for anxiety disorders or simply having open and honest conversations with your partner can often alleviate fears and anxieties that lead to DE.

  • Physical factors – disorders of the reproductive system and glands as well as factors with diminished nerves signaling can cause delayed ejaculation.  In some cases, painful erections due to penile curvatures or prostatitis can offset the pleasure signals associated with sexual stimulation and may halt or impede ejaculation.  Correction of any condition that causes pain is a good first step to helping the associated DE.

  • Medications – perhaps the most common reason for delayed ejaculation are medications that increase serotonin.  These include anti-depressants (fluoxetine, paroxetine, citalopram, sertraline, venlafaxine, duloxetine,etc.), and tramadol.  In these cases, either switching to or adding an antidepressant that affects dopamine can help speed up the time for ejaculation.  Another option some healthcare providers use is to administer an old antihistamine called cyproheptadine prior to sexual activity.  Cyproheptadine is anti-serotinergic and helps decrease serotonin levels for a few hours.  Most men report that ejaculation takes much less time after taking cyproheptadine; however, for some men, their depression or anxiety symptoms can also come back.  In addition, cyproheptadine causes severe drowsiness, so it is often recommended that men who use cyproheptadine to help with delayed ejaculation have sex before bedtime so that they can sleep through the drowsiness.

  • Inappropriate fitting of condoms that are too tight can delay ejaculation.  When a condom is too tight, pressure and pain at the base of the shaft, along the shaft, and at the tip can overwhelm any sexual sensations.  Thus the nerves transmitting pain and pressure signals override the nerves carrying sexual sensations.  This mixed signals from the nerves in the penis can lead to a significant delay in ejaculation.  Men who suffer from delayed ejaculation due to condom use may find that thinner condoms and/or condoms with texture (ribbed or studded condoms) can increase stimulation.  Men typically need to ensure that the texturing (ribs/studs) are placed over the head of the penis to increase stimulation since the tip of condoms are designed to “catch” semen, not to be placed tightly over the head of the penis.  This often requires leaving some of the end of the condom (1-2cm or ½-1 inch) draping off the end of the penis.  This draped portion also gives the glans more freedom of movement within the condom during sexual activity.  For some men, condoms seem constricting and don’t allow the penis to move freely enough to have significant stimulation.  Condoms that are designed to be tight at the base and loose at the tip may improve sexual stimulation.  These more open condoms can create more friction and thus more sexual stimulation.  For men who produce little to no pre-ejaculate, sometimes placing a drop or two of personal lubricant on the tip of the penis before putting on the condom can allow more freedom of movement of the penis within the condom during sexual relations.  In men who find that condoms always seem to feel too tight, simply using a large sized condom may be more comfortable and allow more sexual stimulation. 

Images on this page from top to bottom include:

  1. PixMarket/