Delayed Ejaculation
Delayed ejaculation is a persistent, distressing delay in reaching orgasm despite adequate stimulation, or an inability to ejaculate at all, per AUA/SMSNA guideline and DSM-5 criteria.
Symptoms
Marked delay in ejaculation (roughly 25-30 minutes or more of a distressing effort) or infrequent-to-absent ejaculation during partnered sex, present most of the time for at least 6 months.
Causes and risk
SSRIs and other medications are common causes; neurologic conditions, low testosterone, and psychological factors (including performance anxiety) also contribute. Post-SSRI sexual dysfunction, where symptoms persist after stopping the medication, is an increasingly recognized possibility.
How it is evaluated
Evaluation centers on history and exam, plus morning testosterone testing; the guideline is explicit that no oral medication has a proven risk-benefit profile for this specific condition, so treatment is individualized.
Treatment
The first step is reviewing and adjusting any contributing medications -- never stop a psychiatric medication on your own without guidance. Beyond that, treatment is behavioral and addresses underlying causes; some off-label medication options exist but come with limited evidence.
When to seek care
Delayed ejaculation itself is not an emergency. New neurologic symptoms -- saddle numbness, or bowel or bladder changes -- alongside it need emergency evaluation, since those point to a neurologic cause rather than the sexual symptom itself.