The terms delayed ejaculation’ (DE) and retarded ejaculation (RE) mean the inability of a man to reach a climax inside the vagina. Some men with delayed ejaculation need 30 minutes or more of sexual stimulation to have an orgasm and ejaculate, or they may not be able to ejaculate at all (anejaculation). In the most common form of delayed ejaculation, a man can t reach orgasm during sexual intercourse — but can ejaculate with oral or manual stimulation of the penis. Some men can ejaculate only when masturbating Delayed ejaculation can result from certain chronic health conditions, surgeries and medications like antidepressants, certain high blood pressure medications, diuretics, antiipsychotic medications, ALCOHOL — particularly drinking too much, Illegal drugs, including marijuana. Or, it may be caused by substance abuse or a mental health concern, such as depression, fatigue, poor communication with the partner, anxiety or stress, cultural or religious taboos, relationship problems due to stress. In many cases, delayed ejaculation is due to a combination of physical and psychological concerns. Treatments and If it s an ongoing concern, delayed ejaculation can be a source of mental and emotional stress for a man and his partner. If you have delayed ejaculation only on occasion, try not to assume that you have a permanent problem or to expect it to happen again during your next sexual encounter. Remember, occasional delayed ejaculation due to stress or other temporary factors may improve when the underlying cause gets better. In addition, if you experience occasional or persistent delayed ejaculation, remember your sexual partner. Your partner may think your inability to reach climax is a sign of diminished sexual interest. Your reassurance that this is not the case can help. Communicate openly and honestly with your partner about your condition. Treatment is often more successful if couples work together as a team. You may even want to see a counselor with your partner. This can help you address concerns you both may have about delayed ejaculation and can be an effective treatment To find the best treatment for you, we will first need to determine whether your delayed ejaculation is due to an underlying medical condition, a psychological issue or another concern. Delayed ejaculation treatment depends on the underlying cause but may include taking a medication or making changes to medications you currently take, undergoing psychological counseling, or addressing alcohol abuse or illegal drug use. Psychological counseling (psychotherapy) Psychotherapy can help by addressing underlying mental health problems leading to delayed ejaculation, such as depression or anxiety. It s also used to address psychological issues that directly affect your ability to ejaculate. It may involve seeing a psychologist or mental health counselor on your own, or along with your partner. Depending on the underlying cause, you may benefit most from seeing a sex therapist — a mental health counselor who specializes in talk therapy for sexual problems. The type of counseling that s best for you will depend on your particular concerns At present, there are no drugs that will make a man come. But there is a good chance of putting things right through counseling, provided both the man and his partner really want to cure the problem. The object of therapy is to gradually diffuse your anxiety about giving up control so that you can climax inside his partner without difficulty. The most common method is to relax and let go when you are with your partner. Generally, you can reach orgasm by self-masturbation and maybe through love play, but not through intercourse. So I will encourage you and your partner to gradually proceed to a situation where you can ejaculate just outside his partner s vagina, and eventually go on from there to a more advanced situation where you are able to cope with ejaculating inside her. Another effective therapy: first, the couple go through a period of treatment in which actual sex is off limits, but kissing and cuddling are encouraged then progress to a stage where the woman, sitting astride the man, masturbates him till he reaches orgasm - even if this takes two hours or more finally, they move to a situation where she lowers herself onto him shortly before he climaxes. Medications Medication may be a treatment option, particularly if you re taking an antidepressant that s causing the problem. Sometimes reducing the dose of a medication or switching medications may help. In some cases, adding a medication may do the trick. Most medications used to treat delayed ejaculation are used primarily for other conditions. Prevention Because it can happen for a number of physical and psychological reasons, there s no one strategy for preventing delayed ejaculation. But taking these steps may help: Limit or avoid the use of alcohol, Don t use illegal drugs such as marijuana. Stop using tobacco. Exercise regularly. Take steps to reduce or better manage stress. Get enough sleep. Get help for anxiety or depression.