The least discussed of the male sexual difficulties, and the one men are most likely to have decided means something about them. It is not a verdict on your masculinity, your desire, or your relationship.
Delayed ejaculation means that during partnered sex it consistently takes a very long time to reach orgasm, or you cannot get there at all, despite wanting to, feeling aroused and having enough stimulation. It affects somewhere between 1% and 4% of men, and the real figure is almost certainly higher, because most men never mention it to anyone.
Like every sexual difficulty it is rarely one thing. Biological factors such as nerves, hormones and medication; psychological ones such as anxiety, self-monitoring and learned patterns of arousal; and relational ones such as safety, communication and the situation you are in. Usually several at once.
A large part of the assessment is your erotic world: what turns you on and always has, what your early experiences taught you, what a genuinely good sexual experience looks like for you, and whether the sex you are actually having bears much resemblance to it. Delayed ejaculation very often lives in that gap, and it is territory most men have never had the chance to put into words.
The point of assessing it properly is not to find the cause. It is to work out which of these are contributing for you, and in what proportion, so treatment aims at the right thing.
01Medical causes
Worth excluding first, because assuming it is psychological without checking means treating the wrong problem.
What I screen for:
Medication. Antidepressants, SSRIs in particular, are the commonest cause I see. Some antipsychotics, opioids and alpha-blockers do it too
Low testosterone, and less commonly thyroid dysfunction or raised prolactin
Nerve involvement: diabetic neuropathy, multiple sclerosis, spinal cord injury, or damage after prostate or bladder surgery
Alcohol and recreational drugs, especially heavy or chronic use
Age. Ejaculatory latency lengthens naturally over the decades. That is normal, though it can tip into distressing territory alongside something else
One thing worth flagging: if you reach orgasm but little or nothing comes out, that is a different problem with a different explanation, so do say if that is what is happening.
Can antidepressants delay ejaculation?
Yes, and it is one of the commonest causes I see. SSRIs raise serotonin, and serotonin raises the threshold needed to trigger the ejaculatory reflex, so for some men orgasm takes far longer and for others it goes entirely. The effect is dose-related and varies a lot between drugs: paroxetine is among the most strongly associated, and some alternatives carry substantially less risk. It is usually workable.
Have that conversation with a doctor rather than changing things yourself. Stopping or altering an antidepressant abruptly causes withdrawal effects and can unsettle mental health that is currently stable, so it needs planning.
When should I see a doctor about this?
If it has lasted six months or more and is causing you distress or difficulty in a relationship. Sooner if it came on suddenly, changed after a new medication or after surgery, or comes with numbness, weakness or bladder symptoms.
Porn is sometimes part of it, and a great deal less often than men assume. Most men who raise it have already decided that porn is the problem, and it rarely turns out to be what is causing the difficulty. What does the damage more often is the belief itself. A man convinced his porn use is harming him carries that into sex as shame and self-monitoring, and those two are perfectly capable of producing a difficulty on their own. Plenty of men watch porn and enjoy masturbating with no effect on their sex lives at all. I do not take a moralising view of it.
Where it does matter, it is the pattern of arousal rather than the porn. If masturbating to it consistently uses an intensity, speed or type of stimulation that partnered sex can't reproduce, the body becomes conditioned to expect something sex doesn't provide. There can also be an attentional part: arousal that relies on constant novelty may not hold your focus during the slower, quieter stimulus of real sex. That is a real mechanism and a treatable one, and it is worth telling apart from the shame, because the two need opposite things.
How you masturbate matters more reliably than what you watch. It is one of the commonest causes in men under 50 and one of the most treatable. An idiosyncratic style, a particular grip, pressure or speed, or thrusting against a mattress, trains the body to that specific stimulus. Partnered sex then does not deliver a strong enough or familiar enough signal, even though attraction, arousal and erections are all working normally. Masturbating shortly before sex compounds it. None of this is a moral failing or anything to be embarrassed about.
It is a learned reflex, and learned reflexes can be retrained.
This is situational delayed ejaculation, and it is the commonest presentation I see. The fact that it works alone tells us something useful straight away: the reflex is intact, the nerve pathways work, and a purely hormonal or neurological cause becomes much less likely. So the question is what differs between the two situations, and most often the answer is that you can be in your own erotic world on your own and cannot be in it with your partner.
That is the part worth exploring rather than working around. What actually turns you on, what your erotic world is made of, how much of it you have ever been able to bring into the room with another person, and whether the sex you are having bears much resemblance to any of it. Letting yourself connect with someone who meets your erotic self is usually what shifts this, and it is a conversation most men have never had.
Alongside that, and usually tangled up with it:
The stimulation itself, where what you are conditioned to and what partnered sex provides don't match
Anxiety and self-monitoring. Watching yourself, tracking how long it is taking, reading your partner's face for boredom. That spectating pulls attention away from sensation, and the reflex needs absorption in sensation to build. The harder you try, the further it retreats
The relational conditions: whether you feel safe enough to let go, whether there is unspoken resentment, whether sex has become a performance you are delivering rather than something you are inside of
Ejaculation takes a degree of surrender. For men who are highly controlled and used to managing themselves carefully everywhere else, letting go in front of another person is precisely the difficulty.
Does it mean I’m not attracted to my partner?
No, and it is the fear I hear most often, so it is worth being direct. Attraction, arousal and the ejaculatory reflex run on different systems. Plenty of men with strong, uncomplicated attraction have exactly this pattern. If anything, caring a great deal about pleasing someone generates the performance anxiety and self-monitoring that get in the way, so the intensity of feeling can be part of the mechanism rather than evidence against it.
Where something relational genuinely is contributing, unresolved conflict or a loss of erotic space between you, that still isn't an absence of attraction, and it is workable. Partners very commonly read delayed ejaculation as rejection, which adds pressure and makes it harder. Naming that cycle openly, ideally together, takes a surprising amount of heat out of it.
In most cases it can be treated. What treatment looks like follows from the assessment rather than from a generic protocol.
Depending on what turns up:
Medical: bloods, a medication review, treating any contributing condition
Behavioural: structured masturbation retraining, in graded stages, to move your conditioned pattern closer to what partnered sex provides. Often the single most effective thing where an idiosyncratic pattern is driving it
Psychosexual therapy: performance anxiety, spectatoring, and being able to stay in sensation rather than in your head. Sensate focus work is frequently useful
EMDR, where an earlier experience is still holding the pattern in place and talking about it has not reached it
Couples work: communication, taking the pressure off finishing, and moving the definition of good sex away from ejaculation as the only acceptable endpoint
Where an idiosyncratic masturbation pattern is the main driver, men often see meaningful change within a few months of consistent retraining. Where medication is the cause it can be faster.
Where something specific is keeping you braced during sex, EMDR earns its place: a humiliating early experience, an assault, a partner's reaction you have never quite put down, or shame absorbed from family, school or religion about what you actually find arousing. Reprocessing takes the charge out of the memory rather than erasing it, which is often what lets the retraining and the couples work start to move.
Experiences like those keep the body watchful, and watchfulness is the opposite of the absorption the reflex needs.
Can my antidepressant be changed?
Often, yes, and without a referral. Being both a GP and a registered psychosexual therapist means the prescription and the therapy can be handled in the same consultation. Ordinarily this work splits across two people, a doctor for the medication and a therapist for everything else, which leaves you repeating yourself and waiting on referrals while two halves of one picture are considered separately.
The routes worth considering, depending on your history and how stable things are:
Adjusting the dose. SSRI-associated delay is dose-related and a reduction is sometimes enough, provided your mood holds
Switching to something with a lower sexual side-effect profile. Bupropion, mirtazapine, vortioxetine and agomelatine are all associated with substantially less sexual dysfunction than most SSRIs. A cross-taper needs planning and monitoring but is usually possible
Adding a second medication where switching isn't appropriate. Bupropion is the best-evidenced option here
I work closely with consultant psychiatrist Dr Jamie Arkell at Central Health London, and for men with more complex psychiatric histories we can agree a plan together that protects mental health and sexual function rather than trading one against the other. If someone else prescribes your antidepressant, I will write to them and work alongside them.
Beyond antidepressants:
Reviewing other contributing drugs: some antipsychotics, opioids, alpha-blockers and occasionally blood pressure medication
Treating what is found: testosterone replacement where deficiency is confirmed properly, thyroid treatment, correcting raised prolactin, better diabetes control
Off-label options. There is no licensed medication for delayed ejaculation in the UK, and the evidence for the agents trialled, including cabergoline, bupropion and oxytocin, is limited and mostly from small studies. I will discuss them honestly, weak evidence included. They are an adjunct, never a substitute
Plenty of men need no medication at all. It is worth knowing that if a medical route is the right one, you don't have to be referred elsewhere for it.
Someone who can hold the whole picture: the medication review and the bloods alongside the conditioning, the anxiety and the relationship. I am a GP with a fellowship in sexual medicine, registration as a psychosexual therapist and a PhD in men's sexual health, so both sides get assessed in the same consultation, without a referral.
I see men of all ages, orientations and relationship structures, monogamous, open and polyamorous. Most men who come about this are relieved to find it is a solvable problem with an identifiable set of causes, rather than a fixed trait or a judgement on them.
The clinic is at Central Health London, 23 Devonshire Place, Marylebone, a quiet and discreet address a short walk from Regent’s Park. Most men arrive anxious and leave relieved. You will be welcomed by reception, offered tea or coffee, and given time to settle before we start.
A first consultation is usually an hour. We go through your symptoms, your medical and family history, and your sexual experience, relationships and lifestyle: the medical, psychological and relational picture together rather than one at a time.
I will ask you a lot of questions. You do not have to answer any of them: saying "I would rather not answer that" is a complete answer and nothing follows from it. A physical examination is sometimes useful, particularly for erection problems, and it is always optional. You stay in control of the appointment throughout.
If you have had recent blood tests, send them ahead. If not I will arrange them, and I will tell you which ones need taking before 11am.
The waiting room at 23 Devonshire Place.
Who tends to benefit most from seeing me
Men in midlife who have not engaged much with healthcare
If you are in your fifties or sixties, have no GP you know well, do not much like going to the doctor, but recognise it is time to take your health seriously, this is a reasonable place to start. I often find things that matter and have been missed.
Gay, bisexual and queer men
If you want help but are wary of seeing someone who is not comfortable talking about gay or queer sex, you can come to someone who does not need it explained, and who will not judge or shame you.
Men who want a thoughtful, whole-person assessment
Men who have tried quick fixes, or had a purely medical or purely therapeutic approach that did not help. I see a lot of men for second opinions. And men of any age and in any kind of relationship who want to understand what is going on rather than be handed a prescription.
About Dr Ben Davis
I am a GP, a sexual medicine specialist and a COSRT-registered psychosexual therapist, working at 23 Devonshire Place, Marylebone, central London, alongside NHS general practice in Hackney.
Most men reading a page like this arrived from a search rather than my homepage, so this is probably the first you have heard of me. The short version: I hold the medical, the psychological and the relational picture together in one appointment, rather than sending you to three people who each see a third of it.
