Treatment Options for Delayed Ejaculation

What Causes Delayed Ejaculation?

To learn more about the causes of Delayed Ejaculation (DE), read this blog first.

Can Delayed Ejaculation be Treated?

The treatment for DE is highly individualised, meaning that it is not a one size fits all approach. DE does not have an approved medication approach, and therefore treatment relies on a combination of psychological and behavioural support, as well as prescribed off-label medication. As in the case of all sexual dysfunction, it is important to consult with a doctor to explore possible biological causes.

The following information provides the current treatment options we have for DE as well as outlining the pros and cons of each.

Sex Therapy for Delayed Ejaculation:

Sex therapy addresses the underlying mental barriers such as anxiety, performance pressure, intimacy fears of relationship conflicts. Sex therapy supports individuals and couples to grow in their awareness and responsiveness to physical sensation and touch, which increases pleasure and reduces pressure and anxiety.  Masturbatory retraining or temporary suspension of masturbation is also involved in sex therapy, especially in the case of conditioned DE.

Pros:

-              Treats the root psychological and relational causes of DE

-              No physical side effects

-              Improves sexual communication

-              Encouraged a “sexual tam” which enhances sexual satisfaction

-              Re-wiring the body’s system to experience ejaculation with realistic stimulation

-              Practical, behavioural tools that can be practiced beyond therapy

Cons:

-              Can often be a slow process

-              Requires investment of time, money, emotions, and commitment

-              When partnered, it is important that there is active cooperation, patience, and understanding

-              Deeper conflicts may be uncovered

-              Changing habits can be difficult

Medication Adjustment:

In the case that DE is caused by prescription medication, it is important to consult with your doctor. There may be times where it is appropriate to adjust medication. Dosage might be reduced, a different medication may be explored, or a counteracting medication may be prescribed. Any adjustment must be supervised by a doctor.

Pros:

-              If DE is strictly medication induced, appropriately adjusting medication can be highly efficient in reversing DE

Cons:

-              This is not applicable to men whose DE is not caused by medication

-              There are risks involved in altering prescribed medication on the issue it was first prescribed for (e.g. altering antidepressants can cause a relapse in depression)

Prescribed Off-Label Medication:

There are no officially approved medications for DE. However, some doctors prescribe medication “off-label” (meaning that it is given to a patient for reasons other than the medications official purpose). This may include anti-serotonergic agents (e.g. Cyproheptadine- known as Periactin), dopamine agonists (Amantadine- known as Symmetrel), or pro-erectile medication (such as Viagra or Cialis).  

Pros:

-              These pills can have a placebo effect which boosts mental confidence, and in turn reduces anxiety

-              When blocks are caused by serotonin, these medications can override these blocks

Cons:

-              As they are off-label there is a lack of evidence for their effectiveness

-              High risk of adverse physical side effects and interference with prescribed primary medication

-              Medications do not address psychological or relational issues

Vibratory Stimulation:

If physical stimulation is inadequate, vibratory stimulation through the use of a penile vibrator can provide intense, targeted stimulation to reach the necessary threshold and trigger the ejaculatory reflex.

Pros:

-              Highly effective at triggering the ejaculatory reflex physically

-              Especially beneficial for men with age-related nerve desensitisation, or mild neurological damage

-              Can be mutually enjoyed by both partners (e.g. vibrating penis rings), or incorporated into partnered sexual intimacy

Cons:

-              If used only in masturbation and unrealistic masturbatory habits are the issue, this can further worsen DE by introducing a new, intense requirement for climax

-              It does not treat underlying psychological and biological delays

-              Some men have negative views on sexual aids which then only increase psychological barriers

Treating underlying medical conditions:

If there is a specific biological condition with the side effect of DE, treating or managing the biological condition may improve DE. For example, in the case of low testosterone, testosterone may be prescribed. If erectile dysfunction is the primary issue alongside DE, then treating the erection can sometimes improve confidence and the arousal for climax.

Pros:

-              Treating root medical causes has overall positive effects on health rather than just targeting a symptom

Cons:

-              This is only an option when DE has a clear biological root

-              Testosterone therapy carries its own set of risks

First Steps for Delayed Ejaculation:

The following suggestions are ideas that you can immediately try.

-              Vary physical stimulation during masturbation. Consciously change speed, pressure, grip and physical positioning.

-              Pleasure without pressure to orgasm. Intentionally plan sexual activity or masturbation where you explicitly rule out orgasm. Focus on arousal sensations, physical sensations, and pleasure. This can help reduce anxiety and performance pressure,

-              During partnered sex, physically stimulate until the point of ejaculatory inevitably. At this point, insert penis into your partner. When confidence is gained with this, gradually insert earlier and earlier.

Sex Therapy

Sex therapy can be highly effective for delayed ejaculation because it addresses the psychological, behavioural, and relational factors that often contribute to the difficulty. While medical care can explore possible biological causes, therapy focuses on reducing performance pressure, reconnecting with physical sensation, and addressing habits or beliefs that may interfere with the ejaculatory response.

Final Thoughts

Delayed ejaculation can feel confusing and frustrating, particularly when the desire for sexual intimacy is present but climax remains difficult to achieve. Because ejaculation involves the interaction between the brain, body, and relationship context, difficulties in this area rarely have a single simple cause.

With greater understanding, patience, and the right support, many individuals are able to improve their sexual experiences and regain confidence in their bodies. If delayed ejaculation is causing distress for you or your relationship, professional support can help explore the contributing factors and guide you toward practical strategies for change.

I offer online sex therapy across Australia, providing a confidential and supportive space to explore sexual wellbeing and intimacy concerns.

Written by Justine

References

1.        Corona G, Mannucci E, Petrone L, Fisher AD, Balercia G, De Scisciolo G, et al. Psychobiological correlates of delayed ejaculation in male patients with sexual dysfunctions. J Androl. 2006;27(3):453-458.

2.        Foley S. The complex etiology of delayed ejaculation: assessment and treatment implications. J Fam Psychother. 2009;20(2-3):261-282.

3.        Perelman MA, Rowland DL. Retarded ejaculation. World J Urol. 2006;24:645-652.

4.        Robbins-Cherry SA, Hayter M, Wylie KR, Goldmeier D. The experiences of men living with inhibited ejaculation. Sex Relat Ther. 2011;26(3):242-253.

5.        Waldinger MD, Schweitzer DH. Retarded ejaculation in men: an overview of psychological and neurobiological insights. World J Urol. 2005;23:76-81.