Causes

Delayed ejaculation can result from medications, certain chronic health conditions and surgeries. Or it might be caused by substance misuse or a mental health concern, such as depression, anxiety or stress. In many cases, it is due to a combination of physical and psychological concerns.

Psychological causes of delayed ejaculation include:

• Depression, anxiety or other mental health conditions
• Relationship problems due to stress, poor communication or other concerns
• Anxiety about performance
• Poor body image
• Cultural or religious taboos
• Differences between the reality of sex with a partner and sexual fantasies

Medications and other substances that can cause delayed ejaculation include:

• Some antidepressants
• Certain high blood pressure medications
• Certain diuretics
• Some antipsychotic medications
• Some anti-seizure medications
• Alcohol — particularly drinking too much (excessive alcohol use or alcoholism)

Physical causes of delayed ejaculation include:

• Certain birth defects affecting the male reproductive system
• Injury to the pelvic nerves that control orgasm
• Certain infections, such as a urinary tract infection
• Prostate surgery, such as transurethral resection of the prostate or prostate removal
• Neurological diseases, such as diabetic neuropathy, stroke or nerve damage to the spinal cord
• Hormone-related conditions, such as low thyroid hormone level (hypothyroidism) or low testosterone level (hypogonadism)
• Retrograde ejaculation, a condition in which the semen goes backward into the bladder rather than out of the penis

For some men, a minor physical problem that causes a delay in ejaculation might cause anxiety about ejaculating during a sexual encounter. The resulting anxiety might worsen delayed ejaculation.