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Delayed Orgasm

Symptoms, Causes, and Treatment of Delayed Orgasm

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Updated November 20, 2008

Delayed orgasm refers to the experience of not being able to reach orgasm following adequate sexual stimulation within a time that is pleasurable or agreeable to you. Some people will experience delayed orgasms occasionally at specific times in their lives, while others experience it more consistently over time. Delayed orgasm isn’t the same as having no orgasm; it specifically means that one happens, but it takes “too long.” That said, because there is no “normal” amount of time it should take to have an orgasm, there is no single definition of how long is too long. One way to think about delayed orgasm is that it’s a problem if you (or to some extent if your partner) experience it as a problem.

Compared to other clinically defined sexual dysfunctions, delayed orgasms are not very well understood or researched. The term delayed orgasm doesn’t appear in the DSM, where sexual disorders are cataloged for clinicians, but a description of the experience can be found in DSM diagnoses for Male Orgasmic Disorder and Female Orgasmic Disorder, defined in both cases as:

"persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase."

More recently, in 2004 a group of researchers and clinicians proposed revised definitions for women’s sexual dysfunctions, including the following definition of Women’s Orgasmic Disorder:

"Despite the self-report of high sexual arousal/excitement, there is either lack of orgasm, markedly diminished intensity of orgasmic sensations or marked delay of orgasm from any kind of stimulation."

Delayed Orgasm in Men and Women

Even though the experience of delayed orgasm may feel similar for men and women, the medical and clinical literatures treat them differently. One reason for this is that it is more common for women to have delayed (or absent) orgasms because of lack of stimulation, a cause that is almost never attributed to men.

Another difference in descriptions of delayed orgasms between men and women relates to ejaculation. In men, the term delayed orgasm and delayed ejaculation are often used interchangeably, even though orgasm and ejaculation in men are separate events and the DSM does distinguish the experience of ejaculation with orgasm from ejaculation without orgasm. Because female ejaculation is neither commonly agreed upon nor well documented in the medical literature, it is not mentioned in the context of delayed orgasm for women.

Causes of Delayed Orgasm

Delayed orgasm may be caused by physical or psychological conditions, and they may be caused by some treatments for conditions. Causes of delayed orgasm can include:

  • Insufficient arousal which can come either from not enough physical stimulation, a lack of mental stimulation, or a combination of both.
  • Medications, particularly SSRIs used to treat depression. A recent study of over 1,600 men found that taking SSRIs was associated with a 10-fold increase in risk of delayed ejaculation.
  • Medical conditions that have an influence on hormone production in the body, including Hypgonadism and Hypothyroidism.
  • Disabilities including spinal cord injury, multiple sclerosis, and epilepsy have also been associated with delayed orgasm.
  • Relationship factors can also cause delayed orgasm including expectations from a partner and having a partner who has orgasm difficulties.
  • Other psychological factors including external stressors and an inability to focus on sexual thoughts or feelings can result in delayed orgasms.

Treatment for Delayed Orgasms

The treatment for delayed orgasms depends on the cause of the problem. If you are experiencing delayed orgasms and you don’t think it is related to isolated stress or medications with known sexual side effects, you should consider seeing a physician to start by ruling out physical causes. If it is discovered that the cause is related to a medical condition or medication you are currently taking, several options exist including finding alternate medications and hormone replacement.

Individual and couples therapy, possibly with a sex therapist, can also be a very effective way of treating delayed orgasm when it is caused by either psychological or relationship factors. Sex therapists are skilled at working with couples to find a way for both partners to have their sexual needs met and therapy could include both talking about your sexual values and relationship and specific homework exercises related to how you have sex.

Sources:

  1. American Psychiatric Association. Diagnostic and Statistical Manual - Text Revision (DSM-IV-TR™, 2000) Washington, DC: American Psychiatric Association. Accessed November 5, 2007.
  2. Balercia, G., Boscaro, M. Lombardo, F., et. al. “Sexual Symptoms in Endocrine Diseases: Psychosomatic Perspectives” Psychotherapy and Psychosomatics Volume 76, No. 3 (2007): 134-140.
  3. Basson, R., Leiblum, S., Brotto, L., et. al. “Revised Definitions of Women’s Sexual Dysfunction” Journal of Sexual Medicine Volume 1, No. 1 (2004): 40-48.
  4. Corona, G., Mannucci, E., Petrone, L., et al. “Psychobiological Correlates of Delayed Ejaculation in Male Patients With Sexual Dysfunctions” Journal of Andrology Volume 27, No. 3 (2006): 453–458.
  5. Rosen RC, Lane RM, Menza M: Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacology 1999; 19:67–85
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