Delayed ejaculation: what recent studies tell us - and what they still do not

Research summary | Sexual medicine | 2024–2025 | Peer-reviewed evidence

Delayed ejaculation occupies a particular place in sexual medicine. It is clinically meaningful, often distressing and frequently relationally disruptive, yet it receives far less public and professional attention than erectile dysfunction or premature ejaculation. Many men delay speaking about it, partly because the problem is difficult to name: the concern is not always the absence of desire, erection, or attraction, but the inability to reach ejaculation within partnered sexual experience in a way that feels satisfying, spontaneous, or shared.

Between 2024 and 2025, several peer-reviewed studies added important evidence to this field. Taken together, they help clarify four central questions:

How often is delayed ejaculation diagnosed and treated?
How common may it be in the wider population?
What psychological burden is associated with it?
And are there measurable neurophysiological patterns in some forms of situational delayed ejaculation?

These studies do not offer a final explanation of delayed ejaculation. No small group of studies could. But they do provide a more nuanced clinical picture: delayed ejaculation is not simply a matter of “taking too long.” It may involve medication effects, endocrine or neurological factors, patterns of stimulation, anxiety, depression, relational context, and in some cases, autonomic nervous system activity.

Good clinical thinking requires holding all of these possibilities together without reducing the symptom to only one cause.

Diagnosis and pharmacological treatment in the United States

Liao et al. - A population analysis of delayed ejaculation using a claims database: characteristics and national trends in prevalence, incidence, and pharmacotherapy

Liao and colleagues used the TriNetX Diamond Network, a large United States healthcare claims database, to examine adult men diagnosed with delayed ejaculation between 2013 and 2019. The study included men evaluated in inpatient, outpatient, and emergency settings, and focused on prevalence, incidence, and pharmacological treatment patterns.

The study identified 23,164 adult men diagnosed with delayed ejaculation across the study period. Both prevalence and incidence of diagnosed delayed ejaculation increased over time. This does not necessarily mean that the condition itself became more common; claims data cannot distinguish between a true increase in cases and greater clinical recognition, documentation, or coding. Still, the upward trend suggests that delayed ejaculation is increasingly appearing in healthcare records.

The most clinically striking finding was treatment-related. In 2019, only 19.4% of diagnosed men received any documented pharmacological treatment. The most commonly prescribed medication was testosterone, followed by bupropion and buspirone.

This should be interpreted carefully. The study documents a pharmacological treatment gap, not the full picture of care. Men who did not receive medication may have received counselling, sex therapy referral, medication review, endocrine assessment, or other non-pharmacological recommendations that were not captured in the dataset. Nevertheless, the low rate of documented pharmacological treatment suggests that many men may leave the clinical encounter without a clearly structured treatment pathway.

The prescribing pattern is also important but should not be overread. The use of bupropion and buspirone may reflect attempts to address mood, anxiety, or medication-related sexual dysfunction, but it does not prove that delayed ejaculation is primarily psychogenic. It more likely reflects the absence of a single approved, consistently effective medication for delayed ejaculation and the need for individualized treatment planning.

Clinical implication: delayed ejaculation should not end with diagnosis alone. Even when medication is not indicated, patients need a clear explanation, assessment of possible causes, and a realistic plan for treatment or referral.

Limitations: this study reflects United States healthcare claims data only. It is subject to coding variability, underdiagnosis, and the exclusion of men who never sought care. It also captures prescriptions more reliably than psychosexual or relational interventions.

Prevalence and associated factors in the general population

Shirai et al. - Prevalence and associated factors of delayed ejaculation: insights from a nationwide internet-based, cross-sectional survey on male sexual dysfunction in Japan

A nationwide Japanese survey, published in 2025 and based on data collected in 2023, offers a broader population-based perspective. Among sexually active men, the study found a delayed ejaculation prevalence of approximately 5.16%. This is important because clinical databases only capture men who present for care, while population surveys can identify men who experience symptoms but may never discuss them with a clinician.

The study found that delayed ejaculation was associated with multiple psychological, sexual, and physical health factors. These included psychotropic drug use, pelvic trauma, low partnership satisfaction, erectile dysfunction, neurological disease, obesity, masturbation frequency, and intercourse frequency.

One of the most clinically relevant findings was the treatment-seeking gap. More than half of men with delayed ejaculation reported wanting treatment, yet only a small minority had actually sought it. This is consistent with what many clinicians observe: delayed ejaculation may cause significant private distress while remaining largely unspoken in medical or therapeutic settings.

The inclusion of partnership satisfaction is especially important. Delayed ejaculation is often framed as an individual male sexual dysfunction, but its consequences are rarely confined to one person. A partner may interpret the difficulty as a sign of insufficient attraction, emotional distance, or personal inadequacy. The man, meanwhile, may experience shame, pressure, or a sense of failure. Over time, sex can become less playful and more effortful, less relational and more goal-oriented.

This does not mean that relational dissatisfaction causes delayed ejaculation. The direction of the relationship cannot be assumed from a cross-sectional survey. But it does support the clinical view that delayed ejaculation should be assessed within the wider context of the person’s sexual life, health, medication history, stimulation patterns, and partnership dynamics.

Clinical implication: assessment should include not only ejaculation latency or orgasmic difficulty, but also medication use, erectile function, masturbation patterns, anxiety and depressive symptoms, and the couple’s sexual and emotional context.

Limitations: this was an internet-based, self-reported survey in Japan. Results may be influenced by reporting bias, cultural factors, and sampling limitations. The findings are valuable, but they should not be generalized uncritically to all populations.

Depression, sexual satisfaction, and the psychological burden of delayed ejaculation

Negri et al. - Men with delayed ejaculation report lower sexual satisfaction and more depressive symptoms than those with premature ejaculation

Negri and colleagues examined 555 men presenting to a urology clinic for a first assessment of an ejaculatory disorder: 76 with delayed ejaculation and 479 with primary premature ejaculation. Participants completed the International Index of Erectile Function and the Beck Depression Inventory.

The study found that men with delayed ejaculation reported higher depressive symptoms and lower sexual satisfaction than men with premature ejaculation. They also showed lower scores in orgasmic function and sexual desire, suggesting that delayed ejaculation may be part of a broader disturbance in sexual experience rather than a simple timing problem.

A particularly important finding was that, among men with delayed ejaculation, depressive symptoms were independently associated with lower sexual satisfaction. This association was not found in the same way among men with premature ejaculation. Clinically, this matters. It suggests that depressive symptoms in delayed ejaculation are not merely background information; they may shape the way the sexual difficulty is experienced, interpreted, and maintained.

However, this finding must be interpreted with caution. The study was cross-sectional, so it cannot tell us whether depression contributes to delayed ejaculation, results from it, or shares common underlying factors with it. A man may become depressed because of repeated sexual frustration and shame; depressive symptoms may also reduce arousal, desire, and orgasmic capacity; or both may be influenced by medication, relationship strain, health status, or other variables.

For clinical practice, the conclusion is still clear: depressive symptoms should be assessed at first presentation. Not because delayed ejaculation is “only psychological,” but because mood, desire, arousal, self-esteem, and sexual satisfaction are closely connected.

Clinical implication: screening for depression and anxiety is not secondary to sexual medicine. It is part of competent assessment, especially when the symptom is persistent, distressing, or relationally charged.

Limitations: this was a single-clinic, cross-sectional study of men seeking urological care. It cannot establish causality, and the sample likely overrepresents men with more severe or distressing symptoms. Partner-reported data were not collected.

A neurophysiological window into situational delayed ejaculation

Gao et al. - Sympathetic hyperactivity in situational delayed ejaculation: intravaginal anejaculation phenotype

Gao and colleagues studied a specific form of situational delayed ejaculation: men who were able to ejaculate during masturbation but not during partnered vaginal intercourse. The study included 67 men with situational delayed ejaculation and 65 healthy controls.

The researchers used penile sympathetic skin response, an electrophysiological measure related to autonomic nervous system activity. Men with situational delayed ejaculation showed significantly shorter response latency than controls. In neurophysiological terms, shorter latency may indicate heightened sympathetic activation.

This finding is clinically interesting because ejaculation requires a complex balance between arousal, stimulation, attention, emotional safety, autonomic activation, and reflexive bodily response. If the nervous system is in a state of excessive alertness, performance monitoring, or anxiety-driven activation, orgasm and ejaculation may become more difficult, even when desire and erection are present.

The study also found a relationship between penile sympathetic response and anxiety scores, along with elevated penile sensory thresholds and a higher prevalence of atypical masturbation patterns among men with situational delayed ejaculation. These findings align with several clinical observations: some men can ejaculate reliably under very specific self-stimulation conditions, but find partnered sex too different in pressure, rhythm, sensation, or emotional exposure.

This does not mean that sympathetic hyperactivity is the cause of all delayed ejaculation. The study concerns a narrow phenotype: men with intravaginal anejaculation who retain masturbatory ejaculation. It is best understood as preliminary evidence that anxiety-linked autonomic dysregulation may be one relevant mechanism in some situational presentations.

Clinical implication: in selected cases, treatment may need to address not only stimulation technique and relational pressure, but also anxiety regulation, bodily attention, performance monitoring, and the transition from solitary to partnered arousal.

Limitations: this was a single-center case-control study with a modest sample size and a specific delayed ejaculation subtype. The findings need independent replication before penile sympathetic skin response can be considered a validated clinical marker or treatment guide.

What these studies add to clinical understanding

Taken together, these studies support a more integrated view of delayed ejaculation. The condition cannot be understood only as a urological symptom, only as a psychological inhibition, or only as a relationship problem. It may involve several overlapping domains:

• medical and neurological factors;
• endocrine status;
• medication effects, especially psychotropic medication;
• erectile function and general sexual health;
• depressive and anxiety symptoms;
• masturbation habits and sensory conditioning;
• relational satisfaction and sexual communication;
• autonomic nervous system activation in some situational cases.

The strongest clinical lesson is that delayed ejaculation deserves a proper assessment. A man who reports difficulty ejaculating should not be dismissed, reassured too quickly, or treated as if the problem is merely a minor inconvenience. For some men and couples, delayed ejaculation becomes a source of shame, avoidance, resentment, and emotional distance.

The couple’s experience remains underrepresented in the recent research. Most available studies assess men individually. Yet in clinical work, the partner’s meaning-making is often central. A partner may wonder: “Is he not attracted to me?” “Am I doing something wrong?” “Why does sex feel like effort rather than intimacy?” The man may simultaneously feel watched, pressured, inadequate, or guilty. The more both partners try to “solve” ejaculation during sex, the more sex may become organized around performance rather than pleasure.

This is why delayed ejaculation often needs a couple-sensitive approach, even when individual medical or psychological factors are present. The goal is not simply to make ejaculation faster. The broader aim is to reduce pressure, understand the maintaining factors, restore erotic confidence, and help the couple recover a sexual space that feels mutual rather than evaluative.

Evidence-informed clinical considerations

Screen for depression and anxiety. Recent evidence supports careful assessment of depressive and anxiety symptoms in men presenting with delayed ejaculation. These symptoms may influence sexual satisfaction, desire, arousal, and treatment planning.

Review medication and medical history. Psychotropic medication, neurological disease, erectile dysfunction, pelvic trauma, endocrine factors, and general health status should be considered. Delayed ejaculation should not be assumed to be purely psychological.

Ask about masturbation patterns without moralizing. Some men use stimulation patterns that are difficult to reproduce in partnered sex. This should be explored clinically and neutrally, not framed with shame or blame.

Include the partner when appropriate. Even when the symptom appears individual, the consequences are often relational. Couple-focused assessment can help reduce misinterpretation, pressure, and avoidance.

Avoid promising a simple medication solution. There is no universally effective pharmacological treatment for delayed ejaculation. Treatment often requires individualized, multidisciplinary care.

Watch the neurophysiology literature. Emerging findings on autonomic nervous system activity are promising, especially in situational delayed ejaculation, but they remain preliminary.

Conclusion

Delayed ejaculation remains one of the more neglected male sexual dysfunctions. The recent evidence does not give us a single cause or a simple treatment algorithm, but it does make several things clearer.

First, delayed ejaculation is not rare enough to ignore. Second, many men who experience it do not receive, or do not seek, adequate help. Third, depression, anxiety, stimulation patterns, medication, physical health, and partnership dynamics may all be clinically relevant. Fourth, early neurophysiological findings suggest that in some situational presentations, autonomic nervous system activation may play a measurable role.

For clinicians, the task is not to reduce delayed ejaculation to either body or mind, biology or relationship. The task is to listen carefully enough to understand how these dimensions meet in a particular man, in a particular couple, at a particular moment in their sexual life.

References

Gao, Q., Yang, B., Han, Y., Dai, Y., Yu, W., & Ni, D. (2025). Sympathetic hyperactivity in situational delayed ejaculation (intravaginal anejaculation phenotype): A neurophysiological case-control study. Translational Andrology and Urology, 14(8), 2315–2324. https://doi.org/10.21037/tau-2025-348

Liao, B., Able, C., Banner, S., An, C., Nasrallah, A. A., Vu, K., Sonstein, J., Alzweri, L., & Kohn, T. P. (2025). A population analysis of delayed ejaculation using a claims database: Characteristics and national trends in prevalence, incidence, and pharmacotherapy. International Journal of Impotence Research, 37(6), 471–476. https://doi.org/10.1038/s41443-024-00937-z

Negri, F., Corsini, C., Pozzi, E., Raffo, M., Bertini, A., Birolini, G., d’Arma, A., Boeri, L., Montorsi, F., Eisenberg, M. L., & Salonia, A. (2025). Men with delayed ejaculation report lower sexual satisfaction and more depressive symptoms than those with premature ejaculation: Findings from a cross-sectional study. International Journal of Impotence Research. https://doi.org/10.1038/s41443-025-01131-5

Shirai, M., Tsujimura, A., Fukuhara, S., Chiba, K., Yoshizawa, T., Tomoe, H., Kimura, K., Kikuchi, E., Maeda, E., Sato, Y., Nagai, A., Nagao, K., Sasaki, H., & Clinical Research Promotion Committee of the Japanese Society for Sexual Medicine. (2025). Prevalence and associated factors of delayed ejaculation: Insights from a nationwide internet-based, cross-sectional survey on male sexual dysfunction in Japan. Sexual Medicine, 13(4), qfaf072. https://doi.org/10.1093/sexmed/qfaf072

Editorial note: This article is an independent professional research summary written for educational purposes. It does not constitute medical advice, diagnosis, or treatment. Individuals experiencing sexual health concerns should consult a qualified healthcare professional, sex therapist, or sexual medicine specialist.

                                                                © 2026 by Shabnam Sadigova