Ever heard of delayed ejaculation? Most likely, the answer is no. Plenty of attention gets paid to erectile difficulties and early ejaculation, but you very rarely see delayed ejaculation discussed in the media. Delayed ejaculation is a condition where men have a hard time reaching orgasm when they’re with their partners, even though they do fine on their own. Sometimes it can take upwards of 30, 40, even 60 minutes to get there. Sometimes it doesn’t happen at all. In my sex therapy practice, I work with a lot of men who feel frustrated that they can’t have that peak experience with their partners, and ashamed believing they’re the only guys out there who aren’t trying to last longer. Here are six crucial steps to follow if you can’t orgasm with a partner. 

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1. See your doctor

There are a number of medical causes of delayed ejaculation. The most common culprit is prescription medication. Antidepressants in particular can have some of the most severe effects. Up to 37% of men on SSRIs report having a hard time reaching orgasm. Additionally, delayed orgasm can be the result of urinary tract or prostate infections, hypothyroidism, or heart disease. It’s worth making an appointment to talk to you doctor, if only to cover your bases.

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2. Evaluate your life choices

Many people like having a few drinks to ease pre-hookup jitters, but being drunk can make it much harder to reach orgasm. Recreational drugs aren’t doing you any favors either. If you only have issues when you’re high or intoxicated, or you’ve noticed that you developed problems during a particularly party-heavy time in your life, it’s time to consider some serious cutbacks.

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3. Confront shame or guilt

A number of my clients were able to realize that the reason they had a hard time orgasming was because of deep-seated beliefs. For them, having sex brought up feelings of shame, guilt, wrongdoing, and sin. If you suspect this may be the case for you, a few sex therapy sessions can do wonders.

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4. Work on mindfulness

Even if you love having sex, you may still find yourself getting distracted in the moment. Despite your best efforts, that big project you have due at work may keep popping into your mind. Maybe you feel stressed about where this relationship is going, or about the possibility of getting her pregnant. Or you could find yourself getting anxious about whether or not you’re going to be able to orgasm. If you’re stuck up in your head, you’re not going to come. It’s as simple as that. The best way to work on clearing distracting thoughts is to practice mindfulness outside of the bedroom. I frequently recommend Headspace, an app that guides you through mindfulness exercises. It will decrease your overall anxiety levels, and help you stay more focused in the moment.

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5. Evaluate your masturbation habits

Masturbation habits are perhaps the most common cause of delayed orgasm. In particular, watching porn, using the “death grip” (a very tight squeeze), masturbating too quickly, and masturbating too frequently, all make it quite difficult to orgasm with a partner. Why? Because you’re priming your body to only respond to a level of intensity that a partner can’t replicate. If you want to be able to orgasm with your partner, you have to be willing to be honest about the ways you masturbate, and make some changes. I suggest taking a two-to-four week porn hiatus, and masturbating with your non-dominant hand during that time. If you notice a difference when you’re with your partners, you’ll know that masturbation was the culprit.

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6. Enjoy yourself

Having performance issues is extremely anxiety-inducing. Unfortunately, the more stressed out you are in the moment, the less likely you are to orgasm. It’s a horrible self-perpetuating cycle. A lot of the men I work with get so worked up that they end up dreading sex. Try to break out of your rut by reminding yourself of your favorite aspects of sex, and doing them. Like it best in Doggy style? Ask her to flip over. Love the focused attention of getting a blow job? Don’t hesitate to ask for one. Want her to watch while you take care of yourself? Let her know. The more willing you are to do what works, the faster your orgasmic issues will disappear.