Delayed Ejaculation DSM-5 302.74 (N53.11)


DSM- 5 Category: Sexual Dysfunctions


(DE) Delayed Ejaculation is a DSM -5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) sexual disorder in which a man is unable to ejaculate during sexual activity (American Psychiatric Association, 2013), specifically after 25 minutes to 30 minutes of continuous sexual stimulation ( (Case-lo, 2012 ; Nelson, 2012 ). This disorder is also known as DO (Delayed Orgasm) retarded ejaculation, or inhibited ejaculation (Nelson, 2012). Nelson (2012) noted it is the least understood of the sexual dysfunctions. There is multiple causality in DE, including sexual trauma, anxiety about sex due to fear of impregnation or religious or cultural prohibitions, (Perelman, 2009), anxiety and depression in general, prescribed and illicit opiates, medications for depression and anxiety, (Case-lo, 2012). particularly SSRI's ( Selective Serotonin Re-uptake Inhibitors) excessive alcohol use, trauma from injury or surgery, CHD ( Coronary Heart Disease), UTI's ( Urinary Tract Infections) or low levels of testosterone, thyroxin or TSH (Thyroid Stimulating Hormone) (Case-lo, 2012). For most men, DE is not linked to erectile dysfunction (Perelman, 2009). DE is a sexual dysfunction which can cause anxiety, dissatisfaction and frustration around sex, and can both contribute to and be caused by interpersonal conflicts with a partner.

Symptoms of Delayed Ejaculation

According to the DSM-5, delayed ejaculation is defined by four symptoms with a choice of seven specifiers. 1. an inability to climax during sex with a partner about 75-100% of the time, with either a delay in ejaculation or infrequent or absent ejaculation. 2. The symptoms described above have persisted for at least six months, 3., the symptoms produce marked distress in the individual, and 4. The delayed ejaculation is not better accounted for by another mental disorder, use of a medication known for causing ejaculatory delay or failure, or due to stressors within or external to the relationship. The ejaculatory delay is not considered pathological if it is due to a deliberate effort to prolong sexual activity. Specifiers include 1. the disorder is lifelong, commencing at the onset of sexual activity, or 2. acquired, starting after a period of normal sexual function, 3. generalized, in which ejaculating is delayed or not possible in either solitary or partnered sexual activity, 4. situational, in which a man can ejaculate while masturbating, but not with a partner, or during specific sex acts- e.g., oral copulation but not vaginal intercourse, and degrees of severity which include: 5. mild, 6. moderate, or 7 severe (American Psychiatric Association, 2013).


The DSM-5 notes that normal age related changes in men include loss of genital sensitivity and decline of testosterone, which can be causal in delayed ejaculation. (American Psychiatric Association, 2013). Most men, and their partners will find that increased sexual endurance is a desirable quality. It becomes problematic when it is personally distressing, and sexual activity becomes an exercise in frustration rather than an enjoyable process. For other men, it occurs in their youth, at the onset of sexual activity, or is acquired after a period of normal sexual function.


According to the DSM-5, 75% of men report always reaching orgasm during sex. The DSM-5 also notes it is the “ least common male sexual complaint”. (American Psychiatric Association, 2013). Perelman, (2009), also notes that DE is both the least common and poorly understood male sexual dysfunction (Perelman, 2009.Some sources believe the prevalence is higher than reported (Nelson, 2012) . It can be speculated that this is due to the perception that delaying orgasm is a desirable quality and a sign of sexual maturity, and self control.

Risk Factors

According to the DSM-5, The aging process as noted above, will inevitably produce predictable sexual changes, including delay of ejaculation, or ejaculatory failure (American Psychiatric Association, 2013). An IMS (Ideosyncratic Masturbation Style) may cause ejaculatory delay or failure, as sexual expectations may not be met when a partner is present. Men may masturbate with a speed and pressure which their partner may not be able to duplicate correctly. ( Perelman, 2009). Men may also fear impregnating a woman, which will produce psychic tension and inhibit ejaculation(Nelson, 2012) There is a growing body of evidence which suggests excessive exposure to pornography may reduce sexual desire, impair arousal, and otherwise produce sexual dysfunction though a stimuli overexposure and desensitization process ( Brand, Laier, Pawlikowski, Schächtle, Schöler &, Altstötter-Gleich , 2011). One will develop tolerance for sexual activity, so to speak, with increased amounts of stimulation required for performance, which an actual may not be able to provide. Men's sexual trauma is a topic which tends to be avoided and under reported, but this is another possible cause of delayed ejaculation, and other sexual dysfunctions (Case-lo, 2012). It is noted that cultural and religious prohibitions against certain sexual activities can be a contributing factor to sexual impairment, including ED (Nelson, 2012).


The DSM-5 notes comorbidity with major depressive disorder. (American Psychiatric Association, 2013).

Treatment for Delayed Ejaculation

The DSM -5 does not provide specific treatment options, (American Psychiatric Association, 2013).Treatment recommendations will vary depending on the underlying cause. If illicit drug or excessive alcohol use is identified as causal, then group or individual counseling for chemical abuse and dependency is indicated. Depression and anxiety can be addressed through CBT (Cognitive Behavioral Therapy) if a mood or anxiety disorder is causal (Case-lo,, 2012). Couples counseling may be indicated to enhance communication and resolve tensions and conflicts if this is a contributing or complicating factor. Given the consistent descriptions in the literature on the weight of intrapsychic, conflicts and repressed desires, (Perelman, 2009).psychodynamic therapy may be indicated to resolve these conflicts.

Impact on Functioning

Delayed ejaculation may complicate efforts at conception,(American Psychiatric Association, 2013), and create frustration with sexual activity, avoidance, and resultant relationship difficulties. (Nelson, 2012).

Differential Diagnosis

The SSRI's are well known for producing delayed ejaculation, or inability to ejaculate, However, this side effect typically resolves after several weeks on the medication. The DSM -5 notes a number of medical conditions that can precipitate delayed ejaculation, such as such as traumatic surgical injury to the groin or genitals, multiple sclerosis, or diabetes (American Psychiatric Association, 2013).


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders.

(5th Edition). Washington, DC.

Brand, M., Laier, C., Pawlikowski, M., Schächtle, U., Schöler, T. & Altstötter-Gleich, C. (2011). Watching pornographic pictures on the Internet: role of sexual arousal ratings and psychological-psychiatric symptoms for using Internet sex sites excessively. Cyberpsychology, behavior and social networking, 14 (6), 371-7

Case-lo, C. (2012) Delayed ejaculation: Causes, Symptoms, and Diagnosis. Healthline. Retrieved February 28, 2014, from

Nelson, C. J. (2012). Delayed Orgasm: Prevalence and Pathophysiology . Retrieved February 28, 2014, from

Perelman, MA. (2009). Understanding and Treating Retarded ejaculation: A sex therapists Perspective. ISSM. Retrieved February 28, 2014, from misinformation/news/.../understanding-and-treating-retarded-ejaculation.

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