Delayed ejaculation and anorgasmia describe the inability to ejaculate at will, so that ejaculation (and orgasm) takes much longer than desired, or does not happen at all. This might happen only with intercourse, or in all situations including masturbation. The term anejaculation describes when a man does not ejaculate after orgasm. “Orgasm” and “ejaculation” are often thought to be the same, but some men can experience orgasm even though they don’t ejaculate.
Physical causes include spinal cord injury, major lymph node surgery, diabetes, multiple sclerosis and traumatic injury to the pelvic region, when the nerve supply is affected.
Delayed ejaculation is a well-documented side-effect of some antidepressants (specifically SSRIs). While delayed ejaculation can be caused by relationship difficulties, persistent anorgasmia with no medical cause is very uncommon.
A change of antidepressant medication may be needed for men who are concerned about this side-effect. Vibrator stimulation and electrical stimulation of the penis can be used to promote reflex ejaculation in men who can’t ejaculate, but want to father a baby.
Men who are concerned about being unable to ejaculate when there is no medical reason for this difficulty may need long-term individual counselling or therapy.