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Delayed Ejaculation

Practice Essentials

There is a spectrum of delayed ejaculation (DE) disorders ranging from increased latency to ejaculation to absent ejaculation and including DE, retrograde ejaculation, painful ejaculation and anorgasmia.
DE  is typically self-reported. While there is no firm consensus on what constitutes a reasonable time frame for reaching orgasm, men with latencies beyond 25–30 minutes are assumed to suffer from DE.

Signs and symptoms

The history should address the following:

Sexual history (eg, repetitive pattern of difficulty in ejaculating)

Medical history (eg, lower urinary tract symptoms in elderly men)

Current medications (eg, certain antidepressants and alpha blockers can affect ejaculation)

History of injury or surgery (eg, bilateral sympathectomy at L2, high bilateral retroperitoneal lymphadenectomy)

History of alcohol and illicit drug use (including marijuana, cocaine, opioids, amphetamines, and 3,4-methylenedioxy-N-methylmphetamine (ecstasy)

Psychological factors (eg, a history of trauma, severe guilt, a fear of impregnation, hostility toward a woman, severe depression)

See Presentation for more detail.


Conditions that should be included in the differential diagnosis include the following:

Diabetes mellitus


Pain syndromes

Shortness of breath

Angina pectoris

Muscle weakness

Cigarette smoking

Excessive consumption of alcohol or the use of other recreational drugs

The following classes of prescribed medications should be considered in the differential diagnosis

Alpha-adrenergic blockers

Combined alpha- and beta-adrenergic blockers

Sympathetic nerve blockers

Antiulcer medications

Tricyclic antidepressants

Monoamine oxidase inhibitors

Selective serotonin reuptake inhibitors

Other antidepressants


Mood stabilizers

Microscopic examination of the bladder urine after a dry ejaculation is informative in differentiating between retrograde ejaculation and emission failure.

See Workup for more detail.


When pharmacotherapy for delayed ejaculation is under consideration, it is important to eliminate iatrogenic causes, including medications. Adjunctive therapies should be considered. Agents that have been used include the following:

Alpha sympathomimetics (eg, ephedrine or a combination of chlorpheniramine maleate and phenylpropanolamine hydrochloride [withdrawn from the US market])



Any psychological intervention must address both historical factors and current factors that might contribute to the present dysfunction. Historical factors that can contribute to anorgasmia include the following:

Traumatic or unpleasant past sexual experiences

Negative cognitions about sex

Current factors that can contribute to anorgasmia include the following:

Performance anxiety

Relationship problems

Stress (due to causes other than relationship difficulties or sexual problems)

Environmental factors (eg, lack of privacy or uncomfortable room temperature)

Anecdotal reports suggest that an electrovibrator applied at the lower surface of the glans penis can be an effective intervention in cases of primary male anorgasmia.

See Treatment and Medication for more detail.

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