Sexual Dysfunction
7 October 2025
Retrograde Ejaculation and Anejaculation
7 October 2025Delayed ejaculation is one of the least known and least researched sexual dysfunctions in men. Its prevalence in the population ranges from 1–4 per cent. The World Health Organisation (WHO) defines this condition as persistent difficulty or significant delay in reaching orgasm despite adequate sexual arousal. There is no clear "minute" limit for the diagnosis of delayed ejaculation (DE). However, it is generally considered that if ejaculation takes longer than 20–30 minutes after the penis enters the vagina, it can be classified as "delayed ejaculation".
In healthy men, the average intravaginal ejaculation latency time (IELT) (the time from penile penetration to ejaculation) is around 5–7 minutes. Anything above 20–30 minutes is statistically significantly longer than normal.
However, some guidelines require not only duration but also criteria such as personal distress and relationship problems for diagnosis. In other words, a prolonged duration that does not cause distress is not always considered a "disorder."
This condition can reduce sexual satisfaction for men and negatively impact the relationship between partners.
Causes
There is no single cause of delayed ejaculation; it usually arises from a combination of multiple factors. These causes can be classified as psychological, neurological, hormonal, surgical, and medication-related.
1.Psychological Causes
Psychological factors play a role in some cases of sexual dysfunction. Stress and anxiety in daily life, performance anxiety, communication problems with one's partner, or negative sexual experiences in the past can delay ejaculation. Depression and anxiety disorders can also suppress the orgasm reflex in men. Furthermore, self-restraint in sexual behaviour due to religious or cultural pressures is also among the causes of delayed ejaculation.
2.Neurological and Physiological Causes
Disorders affecting the nervous system can disrupt the ejaculation reflex. Diabetes, multiple sclerosis (MS), and spinal cord injuries impair the function of the nerves involved in ejaculation. With ageing, nerve transmission slows down, which can prolong the time to ejaculation. Furthermore, conditions causing nerve damage, such as peripheral neuropathy, can also affect ejaculation.
3.Hormonal Causes
Hormonal imbalances are also important underlying causes of delayed ejaculation. Low levels of the male hormone testosterone can reduce sexual desire and delay the ejaculation reflex. High prolactin (hyperprolactinemia) also makes it difficult to reach orgasm. Thyroid disorders (hypothyroidism or hyperthyroidism) can similarly affect the ejaculation process.
4.Surgical Interventions
Surgeries performed on the urogenital area can also cause delayed ejaculation. In particular, the ejaculation mechanism may change after TURP operations performed for benign prostate enlargement, radical prostatectomy, or bladder neck surgeries. Penis and testicle surgeries can also negatively affect the ejaculation process.
5.Medication Use
Certain medications can directly affect the ejaculation reflex. SSRIs (selective serotonin reuptake inhibitors) are the most well-known group of medications that prolong ejaculation time. In addition, antipsychotics, certain blood pressure medications, and alpha-blockers used in prostate treatment can also delay ejaculation.
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Symptoms
The most obvious symptom of delayed ejaculation is taking a very long time to reach orgasm during sexual intercourse. Ejaculations that take longer than normal, more than 20–30 minutes, fall into this category. In some men, ejaculation may not occur at all. This situation causes dissatisfaction in the partner and disappointment and anxiety in the man. Over time, sexual desire may decrease, and couple relationships may be negatively affected. Additionally, delayed ejaculation becomes a significant issue for couples wishing to have children.
How is it diagnosed?
The most important step in diagnosing delayed ejaculation is a detailed patient history. The doctor will ask how long the complaint has been going on, whether it occurs during masturbation or sexual intercourse, and under what conditions it increases. Medications used, previous surgeries, and accompanying diseases are evaluated. A physical examination is performed, and hormone tests (testosterone, thyroid, prolactin) are examined. If necessary, neurological tests and imaging methods are used to investigate the underlying cause.
Treatment Methods
Treatment for delayed ejaculation is not uniform; it is planned according to the underlying cause.
- Psychotherapy and sex therapy: Psychological support and couples therapy are highly effective if there is stress, performance anxiety, depression, or partner incompatibility.
- Medication adjustment: If antidepressants or prostate medications are delaying ejaculation, medication changes can be made under a doctor's supervision.
- Hormonal therapy: Appropriate medication is administered in cases of low testosterone or high prolactin.
- Lifestyle adjustments: Regular exercise, healthy eating, quitting smoking and alcohol, and maintaining a sleep routine positively affect sexual function.
- Supportive methods: Sexual therapy techniques, sensory focus exercises, or different stimulation methods may be used.