What is delayed ejaculation?
Delayed ejaculation means taking a very long time to ejaculate, or being unable to, despite adequate stimulation and desire. Anorgasmia means not experiencing orgasm. The two can occur together or separately.[1]
Taking longer is not automatically a disorder. It becomes a medical issue when it is persistent and distressing for you or your partner, for example causing exhaustion, soreness, frustration or difficulty conceiving.[1]
Why it deserves care
Delayed ejaculation is discussed far less than premature ejaculation, so many men do not realise it can be helped. Some couples assume attraction has faded; some men push on until it hurts, and gradually avoid intimacy. For couples trying to conceive, it is a direct obstacle.
Separating whether the difficulty lies with ejaculation, with orgasm, or both helps a doctor find the cause and target care.[1]
How common is it?
The EAU cites roughly 1% for lifelong and 4% for acquired delayed ejaculation, while noting that evidence is limited and definitions vary between studies.[4] These figures describe populations, not individual risk.
In practice it is seen more often in men taking antidepressants, older men, and men with diabetes or neurological conditions.
Common causes
Ejaculation and orgasm depend on the brain, spinal cord, nerves and hormones working together, so several factors can interfere.[1],[2]
- Medicines are the most common cause, particularly SSRI and SNRI antidepressants, some antipsychotics, opioid painkillers and certain prostate medicines.[2]
- Neurological and chronic conditions, such as diabetic nerve damage, spinal cord injury, multiple sclerosis and pelvic surgery.
- Hormones, such as low testosterone or an underactive thyroid.
- Patterns of stimulation. Men used to masturbating with a particular grip or rhythm may find orgasm difficult with a partner, because the sensation is different.
- Mind and relationship, including anxiety, pressure to conceive, or conflict with a partner.
How a doctor assesses it
A doctor will ask whether the problem happens in every situation or only with a partner, whether ejaculation is possible during masturbation, and whether semen comes out at all, because some men reach orgasm without semen, which may mean retrograde ejaculation into the bladder. You will also be asked about any medicines started or changed around the time it began.[1],[2]
Examination focuses on the nervous system and genitals. Blood tests or further neurological tests are chosen according to the findings, such as hormone tests when symptoms suggest low testosterone.[1]
How it is managed
Treat reversible causes. If a medicine is responsible, the prescribing doctor may adjust the dose, switch to an alternative with fewer sexual effects, or change timing, while keeping the original condition well treated. Never stop medication yourself.[1],[2] Low testosterone or thyroid problems are treated on their own merits.
Adjust stimulation. For some men, masturbating less often or in a way closer to partnered sex, and adding varied stimulation with a partner, helps a great deal.
Sexual and relationship counselling reduces the pressure to “perform”, adjusts expectations and builds intimacy that is not focused only on ejaculation, which often helps the body relax and respond.[1],[3]
There is currently no medicine accepted as effective for delayed ejaculation in everyone, so care focuses on causes and contributing factors.[1] Couples wishing to conceive may also be advised on fertility options.
How we care for you at Dr. Kris Clinic
We take time to understand the details, including medicines, health conditions, patterns of stimulation and the relationship, because the cause often lies there. If a medicine prescribed by another doctor is involved, we can summarise the issue for you to discuss with your prescriber.
With training in clinical sexology, we offer direct counselling on techniques and relationships, in English or Thai. Couples who prefer joint sessions can use Kris Care Space.
Frequently asked questions
Isn't lasting a long time a good thing?
Not always. If it causes exhaustion, soreness or distress for you or your partner, it deserves care.
Can antidepressants really cause delayed ejaculation?
Yes, it is a common side effect. Do not stop them yourself; ask your prescriber about adjusting treatment safely.
I reach orgasm but no semen comes out. Why?
It may be retrograde ejaculation into the bladder, which can follow prostate surgery or certain medicines. A doctor should assess it.
Does it affect fertility?
It can. If ejaculation during intercourse is not possible, a doctor can advise on fertility options.
Delayed ejaculation and orgasm difficulties are managed by addressing reversible causes such as medicines and health conditions, adjusting stimulation and reducing pressure.[1] An open conversation with a doctor is the most important first step.
Talk to a doctor about this
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Dr. Krida Uakridathikarn (Dr. Kris)
Board-certified family physician with certificate training in clinical sexology and sexual medicine. He works at Suratthani Hospital and provides sexual health, hormone and LGBTQ+ inclusive care at Dr. Kris Clinic. Profile and CV
References
- EAU Guidelines 2026: Disorders of Ejaculation
- NICE NG222: Depression in adults—treatment and management (2022)
- EAU Patient Information: Counselling for ED (2026)
- EAU 2026: Epidemiology and Prevalence of Sexual Dysfunction
Keep reading
Main guide: Men's sexual health
Erectile Dysfunction (ED): Causes, Tests and Treatments That Work
Erections and Heart Health: Why ED Can Be an Early Warning Sign
What Morning Erections Tell You About Your HealthThis article is general education, not personal medical advice or a promise of results. Diagnosis and treatment require assessment by a doctor. Content reflects the cited sources as of the update date.