Can't ejaculate

Dear Troubled Spikey One and Frustrated,

You both seem to be experiencing a similar scenario, but each of you “cums” from a different perspective — one of you is troubled by a difficulty to ejaculate with your partner, and one of you is frustrated by your partner’s difficulty to ejaculate with you. Clearly, you're not alone in your concerns! That being said, there may be a number of approaches that can be taken to bring ejaculation back into your sexual activities, depending on the reason for the problems. 

When it takes a very long period of sexual stimulation for someone with a penis to ejaculate, this is called delayed ejaculation (DE). This may look like 30 to 45 minutes of sexual activity before the individual ejaculates, and sometimes they may find themselves unable to do so. Folks who can't ejaculate at all may be experiencing anejaculation.

There are a number of possible causes for DE. Troubled Spikey One, you're right in suggesting that there could be a psychological element, but there are also a number of other physical and external contributors to consider when trying to get to the bottom of your or your partner’s DE.

Some of the non-physical causes include:

• Conditioning to a certain sensation through masturbation
• Mental health conditions, such as depression or anxiety
• Relationship stress or poor communication with partner
• Performance anxiety
• Low self-esteem or negative body image
• Cultural or religious pressure/expectations
• Difference between sexual expectations and reality

Trouble ejaculating may also be due to certain types of medications or substances, such as:

• Certain antidepressants
• Some medications for high blood pressure
• Some diuretics
• Certain anti-psychotic medications
• Certain anti-seizure medicine
• Alcohol (drinking excessively or alcoholism)

Finally, there are a number of physical causes that may cause someone to have trouble ejaculating:

• Older age
• Birth defects that affect the reproductive system
• Injury to the pelvic nerves that control orgasm
• Infections
• Prostate surgery
• Neurological diseases
• Hormonal conditions such as hypogonadism or hypothyroidism
• Retrograde ejaculation, in which the semen goes into the bladder instead of out through the urethra

Lists adapted from Mayo Clinic.

Speaking with a health care provider about these potential causes may help highlight the cause of the DE. 

Both of you mention struggling with DE in your current relationships, so it might be worth examining the communication between you and your partners, inside and outside the bedroom. Do either of you have a fantasy you would like to explore? Have you shown each other the way you like to be touched? Is there tension or stress coming from other areas of your relationship that might be affecting you? Sometimes sex can be a space of expectations and pressure to perform; try letting go of the idea of how things “should” go and just exploring what you both enjoy. Additionally, have you tried incorporating sexual activities in which ejaculation or orgasm aren't the goal? This may be a time for you to explore your sexuality with your respective partners without adding pressure to ejaculate. You can check out the Sexual Variety category of the Go Ask Alice! Sexual & Reproductive Health archives for some more ideas. As long as they're consensual, there are no rules about when, how, or in what order you may find your sexual activities to be most enjoyable!