Self-reported reasons for having difficulty reaching orgasm in men with diverse etiologies.

Background: Difficulty reaching orgasm/ejaculation during partnered sex, a primary characteristic of delayed or absent ejaculation, affects about 5% to 10% of men, but the reasons underlying this problem are poorly understood. Aim: The study sought to gain insight into possible etiologies of delayed ejaculation by assessing men's self-perceptions as to why they experience difficulty reaching orgasm. Methods: We drew 351 men reporting moderately severe to severe difficulty reaching orgasm during partnered sex from a sample of over 3000 respondents obtained through an online survey. As part of the 55-item survey, participants responded to 2 questions asking about their self-perceived reasons for having difficulty reaching orgasm and selected from a list of 14 options derived from the research literature, a series of men's focus groups, and expert opinion. The first question allowed respondents to select all the reasons that they felt contributed to the problem, the second to select only the most important reason. In addition, both men with and without comorbid erectile dysfunction were investigated and compared. Outcomes: Hierarchical ordering of men's self-pereceived reasons for having difficulty reaching orgasm, including typal reasons established through principal component analysis. Results: The major reasons for difficulty were related to anxiety/distress and lack of adequate stimulation, with relationship and other factors endorsed with lower frequency. Further exploration using principal components analysis identified 5 typal reasons, in descending order of frequency: anxiety/distress (41%), inadequate stimulation (23%), low arousal (18%), medical issues (9%), and partner issues (8%). Few differences emerged between men with and without comorbid ED other than ones related to erectile problems, such as higher level of endorsement of medical issues. Typal reasons showed correlations, albeit mostly weak, with a number of covariates, including sexual relationship satisfaction, frequency of partnered sex, and frequency of masturbation. Clinical Implications: Until supplemental medical treatments for delayed ejaculation are developed and approved, a number of men's purported reasons for difficult or absent ejaculation/orgasm-anxiety/distress, inadequate stimulation, low arousal, relationship issues-fall into areas that can be addressed in couples counseling by a trained sex therapist. Strengths and Limitations: This study is unique in scope and robust in sample size. Drawbacks include those associated with online surveys, including possible bias in sample selection, limitation to Western-based samples, and the lack of differentiation between men with lifelong and acquired difficulty. Conclusion: Men who have difficulty reaching ejaculation/orgasm identify putative reasons for their problem, ranging from anxiety/stress, inadequate stimulation, and low arousal to partner issues and medical reasons.