This article originally appeared on Tonic US in January 2018.
Your friend has seen tons of pop culture references about erectile dysfunction and premature ejaculation, but he hasn't noticed too many plotlines about the issue he’s having: delayed ejaculation. He has noticed that it takes him a really long time to reach orgasm during both oral and penetrative sex, if he even ejaculates at all.
Your friend gets that people enjoy having sex with someone who can “last for a long time” but he has a feeling that people don’t want to have to stop mid-bone for a snack and hydration. Plus, he now spends the bulk of his sexual experiences in his head stressing about whether or not he can physically reach climax.
Delayed ejaculation can be caused by many different physical and mental health factors, says Seth Cohen, urologist and professor of urology at NYU Langone Health. “According to studies, in the United States the normal ejaculation window is seven to ten minutes of sexual activity,” he adds. “If you’re dealing with delayed ejaculation, it may take you out to 15, 20, or 30 minutes, or you just can’t ejaculate at all.”
The Mayo Clinic recommends that patients identify the nature of their delayed ejaculation in order to get to the root cause so the dysfunction can be addressed. Your friend should establish whether their delayed ejaculation has been lifelong or acquired. If the problem is lifelong, it will have been an issue since they reached sexual maturity, whereas acquired will have happened after they had normal sexual functioning for an extended period of time.
If your friend takes the Mayo Clinic’s advice, then he should also notice whether their delayed ejaculation is generalized—i.e. happens with any and all sexual activity and partners—or is situational, and only occurs under specific circumstances.
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“I wouldn't say delayed ejaculation is rare, but it’s not seen as much as premature ejaculation or erectile dysfunction,” Cohen says. Though it's normal for men to occasionally have delayed ejaculation, the real issue is when it’s ongoing and could be connected to a physical health issue, he says, or if it psychologically causes stress for the person experiencing it, or their partner.
The Worst that Could Happen
A neurological disorder or serious trauma could be what’s causing your friend’s delayed ejaculation. “If the nerves that to go to the penis or tip of penis are compromised from trauma or surgery, [or] if there is any interruption to that nerve plexus to the penis, then erections may be okay at best. But the sensation may be limited and you need that sensation for the ejaculation reflex,” Cohen says.
Another more serious, physical cause of delayed ejaculation could be attributed to lower than normal levels of testosterone. “Beyond impacting ejaculation, low levels of testosterone in men can negatively impact many things including male hormonal development, puberty, growth of testicles, libido, desire to have intimacy and erectile quality,” Cohen says.
What is Probably Happening
Your friend’s ironic sexual dysfunction is likely either psychosomatic or being caused by drug reactions. “Many antidepressants—specifically SSRIs like Prozac, Zoloft, Lexapro—increase levels of serotonin in the brain,” Cohen says. “Increased serotonin is great because it improves depressive symptoms, but [the meds] can simultaneously decrease libido and desire, while increasing sexual side effects, which can often include delayed ejaculation.”
In fact, Cohen points out, the treatment for premature ejaculation can often include putting a patient on an SSRI to intentionally have the outcome of lasting longer during sexual activity. The use of other drugs, including both stimulants and depressants, can affect the brain’s ability to perceive that it is time to ejaculate. “It doesn't matter if it's an upper or downer, drugs can mess with neurochemicals in brain, and can definitely impact ejaculation,” he says.
The psychological state of a person during sex can also have a profound impact on how long it takes them to ejaculate. If your friend has had a negative sexual experience in the past, that could definitely be causing their delayed ejaculation. “If you’re a very anxious with the person you are with, it will be difficult to ejaculate,” Cohen says. “If you have performance anxiety and are over-analyzing, it may be difficult to ejaculate, or you may ejaculate too early.”
What Your Friend Should Do
Your friend should go to a urologist, even if they believe their delayed ejaculation is psychological. That way, they can work with a medical professional to eliminate the possibility of physical issues like low testosterone or trauma.
“When a patient comes in with this issue, we go over a detailed medical history, and I see if they are on antidepressants, if they’ve had surgery in their pelvis, or have had their prostate removed,” Cohen says. “For every one of these guys who come in, I will do a hormone panel, and if they’re not within normal limits, then we will have a conversation about how to boost their testosterone.”
If there are no hormonal issues, physical trauma, drugs, antidepressants, or any other physical conditions that could be causing the delayed ejaculation, then Cohen says he’ll recommend the patient might benefit from seeing a sex therapist.
This article originally appeared on VICE US.