You’ve probably heard about premature ejaculation, but what about delayed ejaculation?

It’s when you have a tough time ejaculating or reaching orgasm during sex—even when you’re enjoying it. The condition affects an estimated 8 percent of guys in the United States.

Unlike premature ejaculation—usually defined as ejaculating 3 minutes or less after penetration—there isn’t a set amount of time that constitutes delayed ejaculation.

Still, you may have it if you can’t orgasm within 20 minutes after penetration, says Tobias Köhler, M.D., M.P.H., an associate professor of urology at the Southern Illinois University School of Medicine.

Statistically, that time frame is far enough away from the average guy’s norm of about 5 minutes—as reported in a study in the Journal of Sexual Medicine—to indicate a possible problem.

Sound like you? Here’s everything you need to know about why it may be taking so long to finish in bed, and how to treat the condition.

What Causes Delayed Ejaculation?

Ejaculation is a complicated process that involves your brain, nerves, and muscles in your pelvic region. Your nerves send a signal from your brain to your pelvis muscles telling them to contract and release semen.

But when your nerves aren’t communicating properly—whether from a disease like diabetes or multiple sclerosis, or from aging—that “ejaculate now” message from your brain can get lost in translation.

Some drugs can also delay your ejaculation, especially those that affect your central nervous system, says Dr. Köhler.

Selective serotonin reuptake inhibitors (SSRIs) for depression, certain muscle relaxers, and anti-smoking meds may manipulate the neurotransmitters in your brain, which can postpone your ejaculatory response.

Then there are your hormone levels: Guys with low testosterone or low thyroid hormones may be more at risk for delayed ejaculation.

Psychological issues like anxiety, depression, performance anxiety, relationship conflict, or sexual shame, or even the fear of becoming a father can also hinder ejaculation, says Dr. Köhler.

Finally, if these problems pop up only when you’re with your partner, consider the way you masturbate.

If you use an atypical technique—like rubbing your penis against a certain object, or sticking it into a vise-like device—your partner’s vagina or mouth may not be able to replicate it, says Dr. Köhler.

The Effects of Delayed Ejaculation

You might think endless sex sounds awesome, but many guys with delayed ejaculation complain that the sustained effort makes them feel physically exhausted during the act, says Dr. Köhler. In fact, that’s why a lot of them actually have to stop sex before they ever orgasm.

But delayed ejaculation can be mentally draining, too. Men can start to feel depressed or anxious that they’re taking too long to finish, which can be a self-perpetuating cycle, Dr. Kohler says.

That’s because if you stress about how long it’s taking you to get off, your body produces more of the hormone adrenaline.

And more adrenaline is bad news for your penis. The hormone can make it difficult for you to achieve an erection in the first place. Then, if you do get hard, it can delay ejaculation.

Taking too long during sex may also strain your relationship, says Dr. Köhler. If you have difficulty finishing when you’re with your partner, she may feel like she’s unattractive or not able to satisfy you, he says.

How Do You Treat Delayed Ejaculation?

Your first step is to see a urologist—preferably one who specializes in sexual medicine. Most primary care doctors aren’t going to have enough experience with this condition to treat it successfully, Dr. Köhler says.

Ask your primary care doctor for recommendations, or find a sexual health specialist in your area.

Once you find a doctor, prepare to answer some personal questions at your appointment: How’s your relationship going? How do you usually masturbate?

These conversations may be awkward, but they’ll help your doctor determine what’s causing the problem.

Depending on your answers, your urologist will most likely order a full workup, including tests for testosterone, thyroid, and blood sugar levels.

While the U.S. Food and Drug Administration (FDA) hasn’t approved any meds to treat delayed ejaculation, your doctor may prescribe drugs off-label to help. This is a legal practice that doctors often use, but it also means the drugs may lack the scientific scrutiny that comes from FDA approval of certain uses.

These include meds like cabergoline or oxytocin, which act on certain chemicals in your brain whose levels have been disrupted.

However, the most successful treatment includes both medical intervention and counselling, says Dr. Köhler. That’s where a sex therapist comes in—for both you and your partner.

Expect to dive into social or relationship issues at your appointment. These can be fuelling your stress, which may leave you struggling to finish in bed.

Your therapist will teach you ways to control those anxieties so they don’t manifest during sex, Dr. Köhler says.

And if your masturbating technique is to blame, your sex therapist can teach you how to do it in a way that’s more replicable during sex with your partner.