What to Do If You Can’t Ejaculate: Delayed Ejaculation and Its Treatment
What to do if you can’t ejaculate, in one sentence: work out which of four problems you have — delayed ejaculation, anejaculation, retrograde ejaculation or failure of emission — because naming the right one decides the treatment. Most are reversible. Indeed the commonest trigger behind all four is a medicine you are already taking, which is why the medicine cupboard is where this article starts rather than the clinic. In practice that means three steps. First, work out which of the four it is. Then review every medicine you take. Finally, test for the handful of causes actually worth finding. Men phrase it a hundred ways in my consulting room. I cannot ejaculate. Nothing comes out. It takes forever. Sex goes on and on and I still can’t finish. Why does it take so long? Having trouble ejaculating, doctor. I have difficulty ejaculating. Having a hard time ejaculating. Trouble cumming, every time. I can’t cum. I can’t climax. Although the wording changes constantly, the problem underneath is always one of the four. I have sat with thousands of men carrying this exact worry in my Chennai clinic. Almost none said it out loud first. They booked for something else, then mentioned it at the door. Let me give you the whole thing. What it is. Why it happens. What I test. What actually works. I recorded the short version of this some years ago, and the questions in the comments have not changed since. Men want to know whether it is permanent, whether it is their fault, and whether anything can be done. The answers are no, almost never, and yes. Here is the long version. Most men carry this alone for years. Under one in eight ever asks for help. Before the detail, here is the whole picture in six lines. If you read nothing else on this page, read these. The short version In a nutshell 1 It is more common than you think In a nationwide survey of 5,331 sexually active men, 5.16% had delayed ejaculation, defined by the distress it caused (Shirai, 2025); an older clinical review put it at 1–4% (Shin, 2014). In my own clinic the proportion runs nearer 4 to 8%, which is a practice observation rather than a published prevalence. 2 Almost nobody asks for help Among men with delayed ejaculation in that survey, 58.18% wanted treatment but only 11.88% ever sought it (Shirai, 2025). Roughly one in eight. 3 Medicines are the most commonly reversible cause, and the first thing to check Antidepressants raised the odds of ejaculatory dysfunction 7.31-fold versus placebo across 19 trials and 3,973 participants (Trinchieri, 2021). 4 The antidepressants are not equal For ejaculation specifically, three stood out against placebo — clomipramine (OR 42.11), the St John’s wort extract WS5570 (OR 28.99), then paroxetine (OR 18.63) (Wang, 2025). 5 An underactive thyroid is a cheap thing to check Delayed ejaculation was far more common in hypothyroid than in hyperthyroid men (Cihan, 2021). 6 “I can finish alone but not with a partner” is a recognised pattern It has a name — situational delayed ejaculation, also called the intravaginal anejaculation phenotype (Gao Q, 2025). It is one of the most treatable versions of this. First, name it. Four problems all get called “I can’t ejaculate” This is where most men, and frankly many doctors, go wrong. Because the four look alike from the outside, treating the wrong one means nothing improves. Name which of the four you have before you treat anything. Four conditions sit behind the complaint, and they are not four parallel boxes — three of them are a hierarchy, and one urine sample moves you down it. A fifth, premature ejaculation, is the opposite problem and is included below only so you can rule it out. Read down the left column and find your own sentence. What you notice What it is called What settles it Sex lasts a very long time and you still cannot finish, or you can only finish alone Delayed ejaculation The pattern itself — you can ejaculate, just not reliably with a partner No semen released at all, ever, alone or with a partner — whether or not the orgasm feeling is there Anejaculation Nothing is released. This is where a dry orgasm starts; the post-orgasm urine splits it into the two rows below You orgasm, nothing comes out, and sperm are found in urine passed afterwards Retrograde ejaculation — the semen went backwards into the bladder Sperm present in the post-orgasm urine You orgasm, nothing comes out, and no sperm are found in that urine Failure of emission (aspermia) — the semen was never delivered into the urethra Sperm absent from the post-orgasm urine You finish far too fast Premature ejaculation The opposite problem entirely Delayed ejaculation Delayed ejaculation — also called inhibited ejaculation, impaired ejaculation or retarded ejaculation — means a persistent delay in, or absence of, orgasm following normal sexual excitement (Shin, 2014). You get there eventually, or only by yourself. Anejaculation and anorgasmia Anejaculation means no ejaculation at all, in any circumstance. Anorgasmia means the absence of orgasm itself despite adequate stimulation, whether alone, with a partner, or both. The two often travel together but they are not the same word: one describes the missing semen, the other the missing climax. A man can have anejaculation and still feel a recognisable orgasm, which is why I ask about them separately. Getting from “nothing comes out” to either retrograde ejaculation or failure of emission is the entire job of the assessment, and one urine sample does it. One term causes real confusion, so let me separate it now. Researchers use “intravaginal anejaculation phenotype” as a label for men who ejaculate perfectly well on their own but never inside the vagina (Gao Q, 2025). Despite the name, those men do not have anejaculation. They have situational delayed ejaculation, and it is one of the most treatable versions of this. Retrograde ejaculation and failure of emission Retrograde ejaculation
Early Morning Sex: Benefits, Myths, and Morning vs Night Sex
Early morning sex is sex in the first hour or two after waking, and for most men it is the easiest sex of the day. An andrologist on the real benefits, morning vs night sex, the myths that do not survive scrutiny, and when morning sex is the wrong advice.
Does Penis Stretching Work? The Truth about ‘Jelqing’
Men’s Health Blogs Does Penis Stretching Work? The Truth about ‘Jelqing’ So, you are going to love this post. Its about ‘the penis stretching exercises’. Does penis stretching work? How effective is ‘jelqing’. Can it make your organ BIG?. Watch the video below Now, the truth is a large number of men have serious problems with the size of their organ. An estimated 45% to 55% of men believe their organ is small (teenie weenieee) in terms of size. Full thanks and salutations to the porn industry, since, men tend to compare their organ sizes with porn stars while watching them do it. Moreover, they a develop a strange complex called as the ‘small penis syndrome’. Furthermore, these men compare the size of their organ with other men, while sharing common spaces in showers and toilets. I mean it really get to the head of these guys. They lose hope, they get depressed and feel their lives are over, fundamentally based on their penis size. They develop whats called as small penis syndrome. Moreover, men with this condition strongly believe and feel that they cannot satisfy their partners in bed. They believe and eventually end up with erectile dysfunction. Consequently, they avoid intimate relationships, and resort to masturbation where the element of judgement from another partner is fundamentally absent. Dr. Shah Dupesh Consultant Andrologist & Sexologist Ready to improve your Reproductive Health? Discuss your concerns in a private setting and get personalized guidance tailored to your needs. Book a Call Book a Call But the TRUTH of the matter is, their organ sizes are actually NORMAL Now, lets discuss a bit about penis size….since this is were most men have a problem. The mean average penis size ranges from about 5 to 5.5 inches when erect. But most men do not know to measure their organ. They end up comparing their size with what they see in the pro, leading to distress, anxiety, depression and a whole host of other issues. So, say you truly have a small size, does penis stretching work? Or does penis lengthening work? We hear all this humbug on these penis lengthening exercise, penis massage blah blah. However, these exercises will not increase the size of your equipment. Sorry to disappoint you. Penis stretching or Jelqing involves rubbing the organ back and forth using lubricants. This pseudoscience claims that repeated penis massage and stretches ends up causing micro tears in the deep tissue of the penis. Moreover, after the minor injuries heal, the scar tissue formed will make the organ feel and appear thicker. But, most people forget to notice that, the penile tissues are not just made of muscles. The penile tissue is made full of ‘neurovasculature’ that is, the organ is filled with blood vessels and nerves. Furthermore, it has 3 erectile tissues inside, the corpora cavernosa and the corpora spongiosum, so, stretching this organ will cause permanent long term damage. Not just, that, their are case reports and studies that suggest that, in men who engage in jelqing or penis stretching organ damage occurs. I have personally seen patients who engage in jelqing & eventually ending up with erectile dysfunction. The last thing you want to do to yourself is self-harm by doing these things. Remember, their are about a 100 factors based on which a women will judge you. And organ size is NOT IMPORTANT. So, please do not worry about your penis size. Visit an andrologist or sexologist near you to get a correct estimate of your organ. Subscribe to our Newsletter This is because a self-estiamtion of your size, by looking at your organ from top-down will make your organ look much smaller than it actually is. In all probability, your organ size is most probably normal. As a bonus point please never use ‘penile extenders’ for stretching your organ. It will cause permanent erection problems, by either incorrect usage or by penis stretching. Penis size can be increased by other methods, like utilizing whats called as a ‘Jess extender’ OR similar devices. But, stretching techniques or stretching devices or other surgical interventions do not work. So, remember 3 things 1. Estimate your size correctly 2. Penis stretching is not required 3. Visit an andrologist for the right treatment with respect to stretching I hope you liked this short post on ‘does penis stretching work’. Pleas drop in your comments below References Veale D, Miles S, Read J, Troglia A, Wylie K, Muir G. Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: A cohort study. Sexual medicine. 2015 Sep 1;3(3):147-55. Sigalos J, Eleswarapu S, Mills J. HF01-17 PENILE STRETCHING PRACTICES THROUGH TIME AND CULTURE. The Journal of Urology. 2022 May;207(Supplement 5):e217. Related Blogs Recent Blogs Having more doubts? Consult with our doctor Consult with Dr. Shah Leave Your Comment Cancel Reply Logged in as Dr Shah Dupesh. Log out? Δ
Male Fertility Tips to Get Pregnant Fast: The 90-Day Plan
The male fertility tips that work fastest are a sequence, not a list. Book a semen analysis this week. Move to sex three times a week. Fix tobacco, weight and sleep. Then re-test at 90 days, because that is one full sperm cycle.
No Sperm When I Ejaculate? Causes & What to Do
Nothing comes out when you ejaculate? An andrologist explains the real causes of no semen on ejaculation and the exact, treatable steps to fix it.
Lump on Testicle: Causes, Self-Exam & When to Worry
Most lumps on the testicle are harmless. A soft, movable, pea-sized lump that sits separate from the testicle is almost always a benign epididymal cyst. The one to act on is a hard, painless lump felt on the testicle itself. As a practising andrologist in Chennai, I meet this fear almost every day: a man finds a “lump in my balls” in the shower and is convinced, by the time he reaches me, that it is cancer. I understand the panic. So let me settle it plainly — in roughly 8 out of 10 of the men I examine for a scrotal lump, the cause is completely benign: an epididymal cyst, a varicocele, a hydrocele, or a harmless skin cyst. There is one lump I never brush aside, and I will show you exactly how to recognise it. Book a Consultation Most lumps on the testicle are harmless – this guide shows you how to tell which kind you have. Quick Facts Most testicular lumps are benign — spermatoceles, hydroceles, varicoceles and simple cysts are well-recognised non-cancerous causes of a scrotal lump (Rubenstein, 2004). Position is everything — a scrotal ultrasound reliably tells a lump on the testicle (worrying) from one beside it (almost always benign), and cystic fluid from a solid mass (Akin, 2004). The cancer lump is hard and painless — testicular cancer most often shows up as a painless mass on the testicle itself (Singla, 2025; Chong, 2023). Even cancer is highly curable — testicular cancer is the most common solid malignancy in men aged 15–40 (~10,000 US cases a year, mean age 33), and 90–95% are germ cell tumours with excellent survival (Singla, 2025). Sudden, severe pain is the real emergency — testicular torsion needs surgery within about six hours, when the salvage rate is around 90% (Langan, 2022). Where is the lump? Position decides the diagnosis If you remember one thing from this page, make it this: position, position, position. Where the lump sits on your scrotum tells me, before any scan, what it most likely is. I run through three questions with every man who sits across from me. Is it on the skin, beside the testicle, or on the testicle itself? Pinch the lump gently. If it is in the skin of the scrotum — like a small pellet you can roll under your fingertips — it is usually a harmless sebaceous cyst. If it is a soft, distinct pea sitting above or behind the testicle but clearly separate from it, that is the classic epididymal cyst or spermatocele. The lump that earns a same-week scan is the one that feels part of the testicle itself — a firm nodule you cannot separate from the underlying egg-shaped organ. This is exactly why imaging matters. A scrotal Doppler ultrasound differentiates a testicular mass from an extratesticular one, and tells whether it is cystic, solid or complex — the single test that converts “I don’t know what this is” into a clear answer (Akin, 2004). How many lumps, and one side or both? A soft, worm-like fullness on the left side that you feel more when standing is almost always a varicocele. Generalised swelling of one whole side that lets light shine through points to a hydrocele. A single, hard, fixed nodule on one testicle is the pattern I take seriously. If you also notice a general fullness or heaviness rather than a discrete lump, read my guide on what swelling in the testicles actually indicates. The harmless lumps on the testicle (and most lumps are harmless) Let me reassure you with the actual list. The overwhelming majority of intrascrotal lumps are benign — spermatoceles, hydroceles, varicoceles, epidermoid and simple cysts (Rubenstein, 2004). Here is how each one feels in my hands. Epididymal cyst and spermatocele — the movable pea-sized lump This is the lump I diagnose most. The epididymis is the soft, coiled tube that sits behind and above each testicle, storing and carrying sperm. A small fluid-filled sac there is an epididymal cyst; when it contains sperm it is called a spermatocele. Both feel like a smooth, movable pea, sit separate from the testicle, and are painless. Hydroceles and spermatoceles are common benign adult scrotal swellings (Rioja, 2011). Epididymal cysts most often turn up in men aged 20 to 40 and tend to sit there quietly without causing harm; small, symptomless ones are simply watched, and removal is reserved for cysts large enough to bother you (Zhao, 2023). If it is not growing or hurting, I usually leave it alone. An epididymal cyst – a soft, movable, pea-sized lump that sits separate from the testicle and is harmless. Varicocele — the “bag of worms” A varicocele is a tangle of enlarged veins above the testicle, classically described as feeling like a “bag of worms,” more obvious on the left and when you stand. It is genuinely common — found in roughly 12% of men with normal semen, and far more often (around 40%) in men investigated for infertility (Chiba, 2016). A clinic-based study of men over the age of 40 reported a much higher 48% — but that is a selection-biased figure from men already attending a urology clinic for assessment, not the prevalence in the general male population, so I would not read it as “half of all men” (Besiroglu, 2019). Most cause no trouble at all. The reason I check for them is fertility: varicoceles are the commonest correctable cause of low sperm production, so if you are also trying to conceive, see my explainer on whether varicoceles cause infertility and consider a semen analysis. A varicocele – a soft tangle of enlarged veins above the testicle that feels like a ‘bag of worms’. Hydrocele — a soft fluid swelling A hydrocele is a painless collection of fluid around the testicle. It feels soft and smooth, can grow to a surprising size, and characteristically lets light pass through when a torch is held against it (transillumination). It is benign and
Can i use saliva as lube? 2 Facts on using saliva as lube
Men’s Health Blogs Can i use saliva as lube? 2 Facts on using saliva as lube Welcome to Dr Shahs Clinic, in this quick video we are going to answer the question ‘Can i use saliva as lube?’. We will explore the magic of combining sex with saliva (we will see how magical it is!). Jokes apart let move on to the more serious stuff. Doc, can i use saliva as lube?, this is probably the single most common question I get. Its not surprising. An estimated 40% of couples use lubricants (saliva, KY jelly) or otherwise some ridiculous flower scented concoctions. Don’t get me wrong though. Using lubes definitely adds to pleasure for most couples. I mean people use saliva while masturbating, partnered sex, mutual masturbation and what not? Lubes of various varieties are also put into the mix. Moreover, saliva as lube is utilized in men with erectile dysfunction and in women with vaginal dryness However, there are some instances where you probably do not want to use saliva as lube. The best instance being ‘when trying for a child’. Saliva can basically give your sperms a knock-out punch. Studies done as early as the 1980’s have shown that saliva reduces sperm motility by 50% within just 5 mins of exposure. Not just that, by 15 mins of coming in contact with saliva, the sperm motility basically drops to zero. This is because saliva contains numerous substances that can technically ‘kamikaze’ your sperm. So, unless you are planning to use saliva as contraception method (not the best of course) you are probably better off not using saliva a lube when trying to conceive. Moreover, their are few more studies with some interesting observations. Dr. Shah Dupesh Consultant Andrologist & Sexologist Ready to improve your Reproductive Health? Discuss your concerns in a private setting and get personalized guidance tailored to your needs. Book a Call Book a Call Can saliva kill sperm? Oh yeah. Saliva is a sperm terminator In a few other studies, under the light microscope, scientist’s tried placing drops of sperm and drops of saliva beside one another. What did they find? Here again, sperm motility fell withing 5 mins of exposure and in about 15 mins the total sperm motility dropped to ‘0’. Interestingly, the sperms exhibited a kind of ‘shaking movement’ when exposed to saliva (sperms can get scared as well, have some mercy) Moreover, from the context of sexual hygiene, things get a bit more serious. Say….you are single and in a ‘not so committed’ relationship (in other words you do not know if you are going to marry the person), in these specific scenarios, you better watch out for STD’s And boy oh boy, saliva does transmit STI (sexually transmitted infections). In fact saliva can transmit a variety of sexually transmitted infections. Some common infections that can spread to your partner via saliva include 1. Herpes Simplex Virus leading to genital warts 2. Gonorrhea (by kissing and oro-genital sex) 3. Chlamydia (again by oral-penile sex) Subscribe to our Newsletter A beautiful study conducted in Australia called the HIM study has shown clearly that both Gonorrhea and Chlamydia can transmit through saliva. On an average, upon stimulation, via kissing and during oro-genital sex, saliva production in a man can reach 4-5 ml per minute (similar to that of eating food or chewing) thus aiding transmission of std’s. So should you use saliva as lube during sex? Well be careful and be damn cautious. The last thing you want is to end up with a damn STD. Trust me, it takes you out. Most importantly, I am sure you do not want your partner to end up with genital ulcers or lesions post sex. is a bit unfair right? So, exercise caution and avoid using saliva as lube. Should you definitely need to use a lube, use K-Y jelly or coconut oil as lube (more so when fertility is not a goal). I hope you found this blog post on ‘can i use saliva as lube’ informative. Please do ask your questions below. This is Dr Shah, Consultant Andrologist and Sexologist. I will see you soon with another interesting post References Chow EP, Fairley CK. The role of saliva in gonorrhoea and chlamydia transmission to extragenital sites among men who have sex with men: new insights into transmission. Journal of the International AIDS Society. 2019 Aug;22:e25354. Templeton DJ, Jin F, McNally LP, Imrie JC, Prestage GP, Donovan B, Cunningham PH, Kaldor JM, Kippax S, Grulich AE. Prevalence, incidence and risk factors for pharyngeal gonorrhoea in a community-based HIV-negative cohort of homosexual men in Sydney, Australia. Sexually transmitted infections. 2010 Apr 1;86(2):90-6. Tulandi T, Plouffe Jr L, McInnes RA. Effect of saliva on sperm motility and activity. Fertility and sterility. 1982 Dec 1;38(6):721-3. Related Blogs Recent Blogs Having more doubts? Consult with our doctor Consult with Dr. Shah Leave Your Comment Cancel Reply Logged in as Dr Shah Dupesh. Log out? Δ
Can Masturbation Cause Delayed Ejaculation?
Yes – an intense or prone masturbation style can condition delayed ejaculation. A Chennai andrologist explains why, the medical causes to rule out, and how to fix it.
Does Masturbation Cause Premature Ejaculation?
Does masturbation cause premature ejaculation? Not the act — but rushed, finish-fast habits condition a fast reflex you can retrain. An andrologist explains.
Does Masturbation Cause Erection Problems?
A Chennai andrologist explains how porn-driven and compulsive masturbation cause psychogenic erectile dysfunction with a partner, why the ‘weakness’ is Dhat syndrome, and how it is treated.