If you didn’t orgasm during sex, did it really count? It depends on who you ask.

It’s no secret men have problems helping a woman achieve orgasm or having one themselves. But it is not widely known whether these men could be suffering from sexual dysfunction conditions known as delayed ejaculation and anejaculation.

According to the Diagnostic and Statistical Manual of Mental Disorders, delayed ejaculation and anejaculation are defined as the “persistent or recurrent delay in, or absence of, orgasm after a normal sexual excitement phase that causes marked distress or interpersonal difficulty.”

Basically, this means having penetrative sex for 25 to 30 minutes and not being able to orgasm.

READ: Wait! Men Fake Orgasms, Too?

This is the case an unidentifiable man, who reached out to Fusion to get help for his issue. For the past year, the 33-year-old Oregon native has not been able to reach orgasm when having sex with his girlfriend.

Chris McMahon, physician at the Australian Centre for Sexual Health in Sydney, wrote in his review paper for Medicine Today, “Delayed ejaculation and anejaculation are probably the least common, least studied, and least understood of the male sexual dysfunctions.”

Masturbation can also cause men to not to be able to orgasm during penetrative sex.

It is estimated between seven and 11 percent of men have these conditions, but never thought their problem could be a medical issue. When men finally do seek treatment, it can be difficult to diagnose because there are several medical, neurological and psychological factors which play a part, said Michael Butcher, a urologist at Southern Illinois University.

Butcher told Fusion people with diabetes can experience delayed ejaculation because diabetes causes neuropathic disease. The nerves responsible for an erection are different from the nerves responsible for ejaculation, meaning a man can have normal blood flow to the penis, but may not get enough stimulation to orgasm.

Many experts estimate three-quarters of cases are from psychological issues.

“Psychological inhibition of ejaculation typically occurs in young men and is the most common calls of delayed ejaculation seen in clinical practice,” said McMahon.

Experts say the psychological block can come from many things such as sexual anxiety, extreme stress or fear of sexual consequences.

“Some men are afraid they’re causing their partner pain during sex, especially if the female partner has a history of sexual dysfunction. Or they’re afraid to be a parent, or they may have issues around religion, [believing sex is wrong],” said Butcher.

Masturbation can also cause men to not to be able to orgasm during penetrative sex. Butcher says some men have masturbation techniques that make it difficult to orgasm with another person, especially if he masturbates using other objects. This is conditioning himself to only orgasm when his penis is inside something else that is not a body part.

Men with this issue are going to need to relearn how to orgasm without using their masturbation techniques.

The treatment options for delayed ejaculation are limited.

“Drug treatment of delayed or inhibited ejaculation has met with limited success,” said McMahon.

On top of that, no drugs have been approved to treat the problem. McMahon and Butcher feel this is due to lack of awareness about the disorder and men not seeking treatment for sexual dysfunction. Experts also say when men do seek treatment, they could be misdiagnosed.

“Younger men tend to delay requests for treatment until they wish to start a family. I commonly see men referred from IVF clinics for treatment. Men, in general, have a reluctance to seek treatment for any form of sexual dysfunction,” said McMahon.

Brittney Fennell

Brittney Fennell

Brittney is the Associate Editor of Jawbreaker and a writer who has goals to disrupt culture in ways unseen.