Dr Cindy Pan sheds some light on the issue of delayed ejaculation that until now has been left in the dark

While the commonest male sexual problem is coming too soon (premature ejaculation) there are those who suffer the opposite problem – delayed ejaculationa – whereby despite normal libido and adequate stimulation a man has difficulty ejaculating or orgasming. He may not be able to climax at all or, in less severe cases, he may be able to do so but only after prolonged intercourse, in the order of half to three quarters of an hour or more.
Orgasm during masturbation may be unaffected. If the occurrence of delayed ejaculation is merely transient or occasional there is little need for concern as this is quite common and may be perfectly normal. If on the other hand the problem is increasingly frequent, chronic or even lifelong, medical attention is warranted.

Is it all in the mind?

There are psychological, environmental and relationship-based issues that may cause or influence the condition. Anxiety, stress, relationship conflict, environmental distractions, uncomfortable situations or circumstances or lack of sleep could all trigger or exacerbate delayed ejaculation.

Is it physical?

There could be physical medical issues such as neurological, urological, hormonal or cardiovascular problems that could affect ability to orgasm too. Some medications – typically certain anti-depressants and blood pressure medications – have been known to cause delayed ejaculation as a side effect. Alcohol excess may also have this effect, as may various other recreational or illicit drugs. The problem can cause relationship problems and lead to mutual sexual dissatisfaction, not to mention chafing, annoyance and frustration.

The solution?

The remedy will of course depend somewhat on what are identified as being the major causal factors. Seeing a urologist (or possibly a endocrinologist, neurologist or cardiologist) may be beneficial if the underlying issues are predominantly physical, whereas seeing a sex therapist or relationship counsellor may be more relevant if the problem is more psychological or relationship-based. Start by seeing your GP; you can talk it through and look at your options. Your GP can refer you accordingly and manage and oversee your progress and overall health and well-being. Most importantly, don’t be too shy or ashamed to admit you have a problem.
Many men with delayed ejaculation choose to ‘fake it’ and some couples get to the point where they are seeing fertility specialists before the underlying cause for failure to conceive is revealed or ‘discovered’. There is no shame in having delayed ejaculation but suffering in silence and faking it means your problem is unlikely to be resolved, which most would say really is a shame.