Sometimes, Delayed Arrivals Can Signal an Ejaculatory Disorder

The concept of delayed ejaculation or delayed orgasm may not seem like a form of sexual dysfunction. "You mean I get to last longer doing something I really like? Sign me up!"

Seriously, on screens big and small, male sexual performance is often depicted in terms of prolific stamina and vigor, even though most men generally don't enjoy breaks for new camera angles and altered lighting.

However, orgasms are a big component of sexual pleasure and satisfaction for many men. While there aren't a lot of dangerous physical conditions associated with difficulty achieving orgasm for men, there could be a correlation to psychological or emotional issues in need of attention. If a man has difficulty reaching orgasm, he may have underlying issues that could be treated with talk therapy or simple mindfulness practices.

Of course, it is entirely possible to enjoy sex and intimacy without experiencing orgasm or ejaculation. Some men certainly enjoy sex romantically or recreationally without ever achieving orgasm with a partner. But experiencing orgasm together can be a source of pleasure, entertainment or even bonding for people who explore their sexuality as a pair, especially in ongoing relationships.

When climax doesn't meet expectations or hopes, a person can internalize it as being something wrong with them. This could be true for the person who has difficulty climaxing or the person's partner, who could easily think of themselves as unattractive or incapable of providing sufficient pleasure. In either case, delayed orgasm in men sometimes requires clinical attention.

Medical history might be a factor

"So, when we talk about retrograde ejaculation, it's typically easier to find a medical cause," said Brian K. McNeil, M.D., MBA, FACS, the chief of urology at the University Hospital of Brooklyn in New York. "When we're talking about erectile function, it's easier to find a cause. But when we're talking about delayed ejaculation, it's a little tough."

He explained that delayed ejaculation can stem from a person's medical history. Medications for different conditions, including depression, erectile dysfunction and even premature ejaculation, can cause delayed ejaculation for some men.

In severe cases, delayed ejaculation or delayed orgasm manifests as anorgasmia, or the total inability to achieve orgasm via stimulation or pleasure. Anorgasmia can also imply that achieving orgasm takes so much time, it becomes bothersome for the individual.

Delayed ejaculation and anorgasmia can both be linked to erectile dysfunction if the inability to achieve orgasm is tied to an inability to maintain an erection. But both can occur even when erectile function is operating at full capacity, too.

"As far as the underlying cause, there can be a lot of different contributing factors," said Petar Bajic, M.D., a urologist for the Cleveland Clinic. "One is men who have low testosterone may have more difficulty getting sufficient stimulation or maintaining a sufficiently long-lasting erection or even just difficulty reaching orgasm, period. So, there can be a hormonal component."

Bajic added performance anxiety can be a factor in delayed ejaculation or instances of anorgasmia. Delayed ejaculation can become a sort of self-fulfilling prophecy when a man's concern with being able to achieve ejaculation prevents him from doing just that, because it is a complicated process that includes physical and mental aspects.

Identifying biological factors in delayed ejaculation is important, but working with someone qualified to identify psychological components to orgasm blocks is also key. In addition to looking at hormones and physical aspects of orgasm, a sex therapist may be involved in the process of diagnosing and treating delayed ejaculation and anorgasmia, Bajic said.

Solo stimulation habits

Masturbation practices can play a role in sexual or ejaculatory dysfunction. In many ways, masturbation is a great way to learn about your own needs and desires sexually. Sometimes, however, difficulty achieving orgasm or ejaculation can be traced to a man's self-pleasure habits, including the visual stimulation he uses.

More research is needed to fully comprehend how masturbation and, in many cases, its relationship with pornography affects long-term arousal and other psychological factors. In his experience with patients, McNeil has observed instances where pornography and masturbation habits created a kind of disconnect in pleasure or the ability to achieve orgasm and ejaculate.

"There are some people who may get turned on by certain sexual scenarios that they can watch in pornography that do not mimic their real-life experiences," McNeil said.

McNeil said the conditions for arousal can change when masturbation habits facilitate it. A good analogy would be someone who decides they like spicy food, so they travel the world hunting down the spiciest ingredients they can find. Eventually, they establish a different framework for what is spicy and what isn't. The same process can happen with masturbation and arousal involving pornography use.

Conversations about coming late

It's important for men to normalize conversations, especially with their doctors, about sexual dysfunction or areas where sexual improvement is desired. Everybody deserves to pursue a healthy, satisfying sexual life, so if delayed ejaculation or an inability to orgasm with or without a partner is affecting you, it's important to address the situation.

Communication can go a long way. This may start with communication between yourself and your partner(s). Perhaps a change in routine—new positions or sexual acts are good places to start—is all it takes to reignite the flames for you. But if talking it out with a loved one or sexual partner doesn't work for you, communication with your doctor or mental health support team may be the next step.

In some cases, ejaculatory dysfunction can be connected to other health conditions, such as diabetes or prostate problems. In other instances, difficulty ejaculating or achieving orgasm may be related to mental triggers or past experiences.

"We have to become more comfortable speaking about it," McNeil said. "If you look at the incidence of sexual dysfunction, in particular ejaculatory issues, the research says, 'Oh, it affects 5 percent of men.' But I can tell you that's not true, because there are way more guys that I talk to about this issue."

Men need to become more open about the sexual dysfunction they experience and how their habits may be getting in the way of their own pleasure, McNeil said. He emphasized medical specialists and sex therapists are here to help, but they need the active participation of the patient.

"There are things we can do to help," he said. "But in order to help, we have got to get to the bottom of the issue."