Ejaculation and orgasm in men are frequently represented as overlapping processes, yet they are two different physiological events. Ejaculation is the act of emission and expulsion of semen, whereas orgasm is the transient sensation of pleasure that is frequently accompanied by ejaculation. The term delayed ejaculation (DE) is used to describe the delay of both ejaculation and orgasm. Current definitions emphasize the psychological distress caused by failure to ejaculate despite adequate stimulation and desire.

Primary vs Secondary DE

DE may be primary or secondary. Primary DE is characterized by an inability to reach orgasm and ejaculate since sexual maturity, whereas secondary DE is characterized by an inability to reach orgasm and ejaculate after a period of normal sexual functioning. In comparison to sexually functional men, men with DE often report less coital activity, higher degrees of relationship distress, sexual dissatisfaction, and decreased subjective arousal and anxiety about their sexual performance.

Variables for Delayed Ejaculation

Both biological and psychological variables can be linked to the cause of DE. Biological factors might include nerve lesions, hypothyroidism, and systemic diseases including but not limited to spinal cord damage, or multiple sclerosis. Conflicting emotions, fear, and/or anxiety that manifest during sexual activity, trauma, abuse, or previous performance issues might be listed as some of the psychological causes of DE. Other psychological variables include depression and anxiety disorders. To fully comprehend the variables leading to the condition, both physical and psychological evaluations are required. Without a thorough medical examination and a focused psychosexual history, neither pathophysiology nor psychogenic aetiology (i.e., the cause, set of causes, or manner of causation of a disease or condition) should be presumed.

Trying Idiosyncratic Masturbation

Perelman and Rowland (2006) suggested that idiosyncratic masturbation (i.e., masturbation techniques that produce stimulus intensity that is challenging to replicate in a sexual encounter with a partner), or the desire for stimuli that are not provided by the current partner (such as paraphilic interests), may also be a risk factor for DE. Considering the potential different causes, evidence from multiple domains affects the treatment for DE.

Masturbatory Retraining

As the main approach to managing DE, psychotherapy focuses on a unique examination of the personal and relationship issues affecting ejaculation. Individual work through masturbatory retraining (i.e., being introduced to an alternative style of masturbation that mimics the sensations of partnered sexual activity) can be a part of this therapy approach to DE. Considering pharmacological treatments intended to treat DE have only had modest success in research and testing, the most effective treatment currently for DE is an integrated and individually tailored sex therapy that is founded on an understanding of multiple aetiology and supports multidisciplinary cooperation.

Variety of Ejaculatory Dysfunctions

There are many different types of ejaculatory dysfunctions besides DE, such as painful ejaculation, anejaculation, retrograde ejaculation, premature ejaculation (PE), and post-orgasmic illness syndrome (POIS). Ejaculatory problems are rather common and a significant source of distress for many people and their partners. Among other ejaculatory dysfunctions, delayed ejaculation is too a complex condition and many different factors can contribute to it. Treatment for DE is often complex and requires the expertise of a qualified healthcare professional. 

If you are affected or suspect any of these conditions, you may benefit from seeing a professional for help. You can book an appointment here!

Seray Soyman is working as a Trainee Psychosexologist within the Willingness team, providing psychosexual education and sexual support sessions, as well as delivering training and workshops. She has a master’s degree in Clinical Psychosexology from the Sapienza University of Rome. Seray’s research interests are sexual communication, sex-positive behaviour, LGBTQIA+ studies, and sexual health.


Martin-Tuite, P., & Shindel, A. W. (2020). Management options for premature ejaculation and delayed ejaculation in men. Sexual medicine reviews, 8(3), 473-485.

Perelman, M. A., & Rowland, D. L. (2006). Retarded ejaculation. World journal of urology, 24(6), 645-652.
Perelman, M. A., & Watter, D. N. (2016). Delayed ejaculation. In S. B. Levine, C. B. Risen, & S. E. Althof (Eds.), Handbook of clinical sexuality for mental health professionals (pp. 150-163). Routledge.