Why can I get hard but not climax?

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.

mayoclinic.org - Delayed ejaculation - Symptoms and causes - Mayo Clinic

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Overview

Delayed ejaculation — sometimes called impaired ejaculation — is a condition in which it takes an extended period of sexual stimulation for men to reach sexual climax and release semen from the penis (ejaculate). Some men with delayed ejaculation are unable to ejaculate at all. Delayed ejaculation can be temporary or a lifelong problem. Possible causes of delayed ejaculation include certain chronic health conditions, surgeries and medications. Treatment for delayed ejaculation depends on the underlying cause. It's normal for men to have delayed ejaculation from time to time. Delayed ejaculation is only a problem if it's ongoing or causes stress for you or your partner.

Symptoms

Some men with delayed ejaculation need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate. Other men might not be able to ejaculate at all (anejaculation). But, there's no specific time that indicates a diagnosis of delayed ejaculation. Instead, you are probably experiencing delayed ejaculation if the delay is causing distress or frustration, or if you have to stop sexual activity due to fatigue, physical irritation, loss of erection or a request from your partner. Often, men might have difficulty reaching orgasm during sexual intercourse or other sexual activities with a partner. Some men can ejaculate only when masturbating.

Delayed ejaculation is divided into the following types based on symptoms:

Lifelong vs. acquired. With lifelong delayed ejaculation, the problem is present from the time of sexual maturity. Acquired delayed ejaculation occurs after a period of normal sexual functioning. With lifelong delayed ejaculation, the problem is present from the time of sexual maturity. Acquired delayed ejaculation occurs after a period of normal sexual functioning. Generalized vs. situational. Generalized delayed ejaculation isn't limited to certain sex partners or certain kinds of stimulation. Situational delayed ejaculation occurs only under certain circumstances. These categories help in diagnosing an underlying cause and determining what might be the most effective treatment.

When to see a doctor

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Your primary care doctor is a good place to start when you have delayed ejaculation. See your doctor if:

Delayed ejaculation is an issue for you or your partner

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Causes

Psychological causes of delayed ejaculation include:

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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.

Risk factors

A number of things can increase your risk of having delayed ejaculation, including: Older age — as men age, it's normal for ejaculation to take longer

Psychological conditions, such as depression or anxiety

Medical conditions, such as diabetes or multiple sclerosis

Certain medical treatments, such as prostate surgery

Medications, particularly certain antidepressants, high blood pressure medications or diuretics

Relationship problems, such as poor communication with your partner

Excessive alcohol use, especially if you're a long-term heavy drinker

Complications

Complications of delayed ejaculation can include:

mayoclinic.org - Delayed ejaculation - Symptoms and causes - Mayo Clinic

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