WE’VE ALL HEARD of premature ejaculation, when you ejaculate within minutes or even seconds of having sex (or even just being sexually aroused), but there’s also the lesser-known reverse phenomenon: delayed ejaculation. As the name implies, delayed ejaculation is when it takes longer to ejaculate.

Before going any further, it’s necessary to differentiate between ejaculation and orgasm. Orgasm and ejaculation are two separate physiologic processes, even though they often occur at the same time or back-to-back. You can indeed have one and not the other. Sometimes, guys can have problems with both, and urologists call this delayed ejaculation. (FYI, “injaculation” is having an orgasm without ejaculating, aka “bliss without the jizz.”)

So, what causes delayed ejaculation, and how do you remedy the issue? To answer these questions, we spoke to two board-certified urologists, Michael Ingber, MD, Associate Professor of Urology at Rutgers NJ Medical School, and Jamin Brahmbhatt, MD, of Orlando Health. Here’s what the penis doctors had to say:

What constitutes delayed ejaculation (i.e., when is it a problem and classified as a sexual disorder)?

“There’s no strict definition of how long is ‘too long,’ but if it consistently takes over 20-30 minutes to ejaculate and causes distress, it could be considered an issue,” Brahmbhatt says. “The focus should be on how it’s impacting you and your partner emotionally, not just the length it takes to ejaculate.”

Ingber notes that some men don’t find taking thirty minutes to ejaculate and orgasm bothersome at all. They may actually like being able to last long comfortably. “Therefore, it is not considered a disorder,” Ingber says. “However, if it interferes with your life, causes anxiety or depression, or affects relationships, you should seek medical care from a specialist.”

What are some of the causes of delayed ejaculation?

There are several causes of delayed ejaculation—physical, psychological, pharmacological, and more. Before we break each down, let’s first address how proper ejaculation occurs.

“One must have the beginning portion of the sexual response cycle intact, specifically sexual desire (i.e., libido),” Inbger says. From there comes sexual arousal (when blood flows into the penis and causes erection). Next comes the plateau phase (sexual arousal building), and lastly, ejaculation. “Any disruption in these phases will cause delayed ejaculation,” Inger says. So, what can disrupt these phases?

1. Physical factors and health conditions: Trauma to the genitals can cause delayed ejaculation. So, too, can certain neurological disorders, such as multiple sclerosis, Parkinson’s disease, or spinal cord injuries. Diabetes and vascular disease can also cause delayed ejaculation, Ingber notes.
2. Too much masturbation: “This can lead to the penis being desensitized to other forms of stimulation (your hand feels better than a vagina),” Brahmbhatt says. “Or the frequent masturbation leads to increased stamina where it becomes easier to run a marathon in bed.” Interestingly, Brahmbhatt notes that sometimes this can cause decreased stamina, and you ejaculate too quickly; not everyone is the same.
3. Antidepressants or anxiety medications: Certain medications for depression and anxiety can have sexual side effects where you may have trouble ejaculating. “I know this because, for men with premature ejaculation (the other extreme), we use this class of meds to treat the problem,” Brahmbhatt says.
4. Whiskey dick: A few too many drinks of alcohol may be the source of your delayed ejaculation. “Alcohol is a depressant which can dampen mood and sexual desire and make it difficult to achieve orgasms,” Brahmbhatt says.
5. Psychological stress: Sex can be nerve-wracking, especially when we really like someone. It’s very easy to worry and get in our heads about not being able to ejaculate, and it becomes a self-fulfilling prophecy. For this reason, Ingber notes, “We often work hand in hand with sex therapists and psychiatrists who can assist in the diagnosis and evaluation of underlying conditions that can contribute.”

What are things you can do to help solve the issue of delayed ejaculation?

First things first, see a doctor, as delayed ejaculation could be a sign of broader health or emotional issues. “Addressing it early can improve not only your sexual health but also your overall well-being,” Brahmbhatt says.

That said, what urologists do is try to understand the primary cause.

“If there is an issue with libido or arousal, we fix and address these issues first,” Ingber says. “We then assess everything from the anatomical factors (ensuring the urinary and genital tract is intact) to making sure the nerves are intact (we have office testing to do this). We also ensure there is proper blood flow to the genitals using specialized ultrasounds and thermal imagery,” he says.

“Lifestyle changes like reducing alcohol or managing stress can also help,” Brahmbhatt says. Changing certain habits—like avoiding frequent, intense masturbation—might also improve the situation. “Additionally, sex therapy may be helpful for psychological factors as well as open communication with your partner (i.e., tackling the issue as a team can strengthen your relationship),” he says.

Are there any medications you can take?

Nothing is currently FDA-approved for delayed ejaculation. However, there are several off-label medicines urologists can give. “For example, oxytocin (AKA the ‘love hormone’) has been used before,” Ingber says. “Some anti-anxiety medicines may help, such as buspirone, and testosterone can be used to help.”

Brahmbhatt notes that if antidepressants or other psychiatric medications are causing the problem, your primary care doctor or psychiatrist (whoever is prescribing them) should work with you to either change the dosage or the medication itself.

A final note on seeking care:

Shame is often a reason why men don’t seek professional help, especially when it comes to sex-related problems. But know that you are not alone, and there’s nothing to be ashamed of. A doctor can help remedy the situation so delayed ejaculation doesn’t plague you for the rest of your life.