Dear Doc, I do not ejaculate during sex!

Q. Dear Doc, I read your article a few weeks ago about how long it should take to ejaculate, and I realised I may have a problem. I do not ejaculate during sex! I am 23 years old, and I don’t ever remembering it ever happening. I usually boast about being able to go for long to the point that the woman feel so tired I have to stop. It is now causing a lot of relationship issues, with girls getting upset that I don’t like them to even being told It’s cause I’m gay.

Could you please help me figure out what is wrong with me.

 

A. What you have described appears to be a condition called Delayed Ejaculation.

Whereas I am sure many men think it would be a blessing to be 'a long distance stulla, and be able to go for hours at a time at sex, this is not a good thing. In many cases, a sexual act consists of long-continued thrusting in an effort to achieve orgasm, which continues until the man either becomes exhausted or experiences genital discomfort, and eventually discontinues his efforts, or is requested to stop by their partner, who may be feeling the same fatigue and genital discomfort.

 

Delayed Ejaculation, is a condition in which there is a difficulty or inability of a man to reach an orgasm and ejaculate; and it affects around 1-4 percent of men. If a man takes longer than 30 minutes of penetrative sex to ejaculate, despite having a normal erection, he is considered to have delayed ejaculation.

 

As you confirmed, it can result in distress for both the man and his partner, having relationship problems and may lead a man to avoid sexual activity altogether, causing his sexual partner to feel less sexually attractive. It is also a major cause for concern for couples who want to start a family.

Most men will experience delayed ejaculation at some point in time of their lives, but for some men, it is a lifelong problem.

Most causes of delayed ejaculation are psychological, however, there are other medical causes.

Psychological causes of delayed ejaculation include:

- Mental health conditions such as depression and anxiety

- Relationship problems with sexual partner

- Anxiety about sexual performance

- Poor body image

- Differences between the reality of sex with your partner and your sexual fantasies

 

Medications and other substances that can cause delayed ejaculation include:

- Some antidepressants

- Certain high blood pressure medications

- Certain diuretics

- Some painkillers

- Some antipsychotic medications

- Some anti-seizure medications

- Alcohol, especially excessive alcohol use, and certain recreational drugs

 

 

Physical causes of delayed ejaculation include:

- Birth defects affecting the male reproductive system

- Injury or damage to the pelvic nerves that control orgasm

- Some infections, such as a urinary tract infection or prostatitis

- Prostate surgery, such as transurethral resection of the prostate (TURP) or prostate removal (prostatectomy)

- Diseases affecting nerves, such as diabetic neuropathy, stroke or spinal cord nerve damage, or multiple sclerosis

- Hormone-related conditions, such as low thyroid hormone level (hypothyroidism) or low testosterone level (hypogonadism)

- Retrograde ejaculation, a condition in which the semen goes backward into the bladder rather than out of the penis

- Advancing age can cause decreased sensitivity of the penis to sexual stimulation.

The cause of delayed ejaculation is more likely psychological if it only occurs in specific situations. For example, if a man is able to ejaculate normally when masturbating, but is unable to during sex with a partner.

It is important to note however, that certain types of masturbatory behavior may play a role in developing delayed ejaculation. Masturbating more than three times a week, and having a masturbation style that cannot be matched by sexual intercourse (a high speed, high pressure, or high-intensity style/form), will result in delayed ejaculation, if the sexual partner is unable to easily duplicate the learned style during masturbation.

Your primary care doctor is a good place to start when you have delayed ejaculation.

You will be interviewed in order to determine the cause, and the treatment options offered will depend on the cause. For instance, if a particular medication is the issue, an alternative drug may be prescribed, or if there is an underlying medical condition, managing it will help to resolve the delayed ejaculation.

Psychological causes of delayed ejaculation may not be straightforward to treat, and often requires professional counselors such as psychologists, psychotherapists, and sex therapists, which you can see alone, or a couples therapist if you want to inclde your partner.

There are no medications that have been specifically approved for the treatment of delayed ejaculation.