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Delayed ejaculation: What to do when you’re trying to conceive

Delayed ejaculation affects an estimated 1–4% of people with penises in the US. Delayed ejaculation can lead to diminished sexual pleasure and, in some cases, difficulty conceiving. However, there are a number of options to treat delayed ejaculation and get pregnant. Read on to find out what causes delayed ejaculation, how delayed ejaculation affects fertility, and which treatments can help.

Key takeaways

  • Delayed ejaculation is a condition in which it takes a prolonged period — more than 30 minutes — of sexual stimulation for a person with a penis to reach sexual climax and ejaculate.
  • Delayed ejaculation can be caused by anxiety and depression, relationship issues, and certain medications, diseases, and surgeries.
  • Treatments range from psychotherapy to pelvic floor exercises to medicinal support, depending on the cause. If delayed ejaculation is interfering with your ability to conceive, assisted reproductive technology may help.

What is delayed ejaculation?

Also called delayed orgasm or impaired ejaculation, delayed ejaculation is a condition in which it takes an extended period of time and sexual stimulation for a person with a penis to reach sexual climax and ejaculate. In some cases, they may not be able to ejaculate at all. 

The time and amount of stimulation it takes to accomplish ejaculation will vary from person to person. But often, delayed ejaculation takes enough time to cause stress for one or both partners, and may interfere with attempts to get pregnant.

Delayed ejaculation symptoms include:

  • Taking 30 minutes or more to ejaculate
  • Fatigue and/or pain due to prolonged sexual stimulation
  • Associated stress for one or both partners
  • Inability to ejaculate
  • Difficulty reaching orgasm with a partner; can only ejaculate by masturbation

According to the Mayo Clinic, there are several categories of delayed ejaculation:

Lifelong: Present from the time of sexual maturity.Acquired: Occurs after a period of normal sexual function.
Generalized: Not limited to specific sex partners or specific kinds of stimulation.Situational: Occurs only under certain circumstances, such as during intercourse (vs. masturbation).

What causes delayed ejaculation?

Causes of delayed ejaculation range from mental health conditions, like anxiety and depression, to certain medications, diseases, surgeries, and more.

Psychological causes of delayed ejaculation

Trauma: Negative past experiences related to sex or masturbation may make it harder to ejaculate.

Depression and anxiety: Research shows that pre-existing mental health conditions like depression and anxiety can trigger delayed ejaculation or its counterpart, premature ejaculation. For some, the condition worsens over time as they begin to anticipate it happening, creating a cycle of stress and anxiety.

Fear and stress: In this 2017 study, researchers listed a number of fears triggering delayed ejaculation in their subjects, which included:

  • fear of impregnating their partner
  • fear of castration and/or death
  • fear of semen loss
  • fear of losing control
  • fear of rejection
  • fear of intimacy
  • fear of hurting their partner

Non-sexual stressors may also increase the risk of experiencing the condition.

Performance anxiety: Even if you don’t normally experience anxiety on a regular basis, you could still have performance anxiety when it comes to sex, resulting in delayed ejaculation. Fear of being unable to please your partner could cause this performance anxiety.

Relationship issues: Conflict with your partner or lack of attraction are types of relationship issues that may cause delayed ejaculation. 

Poor body image: Studies link poor body image to delayed ejaculation. A 2019 study found that poor body image leading to sexual dysfunction tended to be more common in gay and bisexual men when compared to their heterosexual counterparts.

Porn addiction: If you masturbate frequently, especially with the use of porn, your risk of sexual dysfunction may be higher due to desensitization caused by overstimulation, research indicates.

Religious or cultural guilt: If you have a religious or cultural background that makes you view sex as sinful or wrong, you may have difficulty ejaculating or even difficulty getting an erection.

Medical and lifestyle causes of delayed ejaculation

Birth defects: Neural tube defects and other congenital issues affecting the male reproductive system may cause delayed ejaculation.

Injuries: Injuries to the spinal cord or the pelvic nerves that control the ability to orgasm can make it more difficult to ejaculate.

Infections: Urinary tract infections, prostatitis, or other infections that cause inflammation can lead to delayed ejaculation.

Medication side effects: There are a number of medications that may interfere with ejaculation, orgasm, or the ability to get or maintain an erection. These include antidepressants (SSRIs and SNRIs), diuretics, high blood pressure medications, anti-seizure medications, anti-anxiety medications, opiates, muscle relaxers, and antipsychotic medications. There is even some evidence that antibiotics can delay ejaculation in patients.

Neurological disease: Stroke, diabetic neuropathy, and multiple sclerosis are neurological diseases that can cause nerve damage, leading to delayed ejaculation.

Surgeries: Certain surgeries, like transurethral resection of the prostate or prostate removal, may lead to the condition.

Hormone conditions: Hormone disorders like hypothyroidism and hypogonadism (low testosterone) may contribute.

Alcohol and drug use: Excessive alcohol consumption can make it difficult to ejaculate or maintain an erection, a condition colloquially known as “whiskey dick.”

In a survey on cannabis use and its effect on sexual function, frequency of cannabis usage was unrelated to sexual problems in women, but men who used cannabis daily were more likely to report inability to reach orgasm.

Retrograde ejaculation: Retrograde ejaculation, or dry orgasm, is a condition in which the semen is pushed back into the bladder rather than out of the penis. It can cause delayed ejaculation or no ejaculation at all.

Aging: With age, the risk of experiencing delayed ejaculation goes up. Studies show that around 6% of men over 50 report ejaculatory impairment.

How to treat delayed ejaculation

There is no one way to treat delayed ejaculation. If the condition is due to recreational drugs, excessive alcohol, or porn, cutting back or abstaining from these habits may resolve the problem. If it’s a side effect of prescription drugs, you can talk with your doctor about switching to another medication.

In some cases, a therapist or couples counselor may be able to help you address the psychological issues contributing to sexual dysfunction. Therapy for delayed ejaculation has a success rate of over 75%. If you see a sex therapist, they may offer suggestions on sex devices or tips on how to communicate better with your partner. 

Delayed ejaculation treatment may include Kegel exercises, which can help you control sexual function. Kegels involve squeezing and releasing pelvic floor muscles. Kegel exercises are often associated with vaginal health, but can be just as important for people with penises. (Wondering where your pelvic floor muscles are? Next time you’re peeing, stop the flow of urine, then start again. The muscles in use are your pelvic floor muscles.)

There are no FDA-approved medications for delayed ejaculation, but some doctors prescribe medications — such as oxytocin, testosterone, bupropion, and cabergoline — off-label to help a patient achieve ejaculation more easily. In some instances, the erectile dysfunction medication tadalafil (Cialis) has also helped those with difficulty ejaculating.

How can delayed ejaculation affect the process of trying to conceive?

Delayed ejaculation can make it more difficult to conceive in a number of ways. Conceiving naturally requires sexual intercourse to the point of ejaculation, and often requires sex often and on a schedule.

Taking too long to “cum” may lead someone to stop having sex before ejaculation, either because they’re tired, sore, or feel embarrassed. It can also mean that a couple avoids sex in the first place, for fear that they may not be able to “complete the act.”

Is delayed ejaculation related to infertility?

Like premature ejaculation and erectile dysfunction, delayed ejaculation can cause infertility if it prevents you from being able to successfully deposit semen into the vagina.

Is delayed ejaculation associated with sperm health issues? It’s possible. Some of the causes of delayed ejaculation can also affect fertility. For example, hormone conditions like hypothyroidism and low testosterone can contribute to ejaculatory dysfunction as well as low sperm count.

Tips for trying to conceive with delayed ejaculation

Delayed ejaculation does not mean it’s impossible to conceive. If counseling, medical intervention, or other treatments do not resolve the issue, your doctor may suggest using assisted reproductive technology (ART)  such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

If you are able to ejaculate through masturbation, you can provide sperm this way for the procedure. If not, sperm can be retrieved surgically through testicular sperm extraction or testicular sperm aspiration.

Sperm freezing

If you are experiencing delayed ejaculation, or can only ejaculate through masturbation, consider freezing your sperm. If you may try to conceive with IUI or IVF, freezing your sperm is a great way to ensure your carefully timed fertility treatments can move forward, even if you’re not able to produce a “fresh” sample on the day of the procedure.

Keep in mind that ejaculatory dysfunction can happen to anyone, and the risk increases with age. Freezing your sperm provides you with a back-up plan, no matter what the future brings.

In the past, freezing your sperm entailed a trip to a clinic or sperm bank to deposit sperm in a “collection room.” For a person dealing with delayed ejaculation or performance anxiety, that experience can make the process stressful and difficult. Legacy’s at-home sperm freezing kit allows you to provide your sample from the comfort and privacy of your home and send it directly to the lab through the mail.

Not sure if your sperm is healthy and viable? Start with an at-home semen analysis.

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