Delayed ejaculation

Delayed ejaculation is the term used when a man is unable to achieve ejaculation.

Many men have this problem at least once in their lives, but are not affected long-term by it. Unfortunately, however, some men have chronic delayed ejaculation (DE) which is complete and permanent….at least, that’s what conventional wisdom suggests.

But the common effects of delayed ejaculation, which include damage to a man’s relationship, emotional stress, and lowered sexual self-esteem, are not inevitable, nor are they untreatable. Delayed ejaculation is multi-factorial, and is neither inevitable nor a sentence to a life without sexual pleasure.

Video – delayed ejaculation

Because the definition is so vague – it can mean permanent impotence, or occasional loss of erection, or anything in between – it is hard to know how many men it affects.

But the chronic form probably affects about 10% or more of the male population. It is more common in older age groups: delayed ejaculation affects about 5% of men in their 40s, and three times as many by the age of 65. Almost all men will have some experience of it by the age of 50. But it is hard to separate the psychological and the physical factors, since any event of DE causes stress and anxiety which makes the physical problems worse.

Hormone Levels and Delayed Ejaculation

Low testosterone levels cause loss of libido and erection. An excess level of prolactin, caused by pituitary gland tumor, can be a factor in reduced testosterone, but usually it is due to age.

Neurologic Conditions

Spinal cord and brain injuries cause impotence when they affect nerve impulses going from the brain to the penis. Multiple sclerosis (MS), Parkinson’s disease, and Alzheimer’s, for example.

Psychological Conditions Causing Delayed Ejaculation

All emotional problems such as depression, worry, stress, anxiety, and guilt, may all contribute to loss of sexual drive and delayed ejaculation. The classic situation is that a man experiences temporary loss of erection, but then worries that it occur once again.

This can produce sexual performance anxiety which leads to a negative spiral which leads to chronic ejaculation problems during sex. Psychological factors often reinforce physical problems.

Effects of Delayed Ejaculation

Whether the cause of delayed ejaculation is physiological or psychological, both the man and his partner will undergo intense feelings and emotions. This may include a sense of despair, hopelessness and lowered self-esteem. Sexual insecurity caused by DE can reinforce any sexual performance anxiety a man happens to be experiencing and create a further cycle of repeated failures and increasingly negative self-esteem.

To get over this, it’s necessary to accept the problem and communicate openly and honestly with one’s partner.

Sexual performance is a big part of a man’s sexual self-esteem, so delayed ejaculation (DE) can be devastating to a man’s entire sense of being.

Men with DE may well be uncertain of their masculinity and avoid sexually intimate situations with their partners; this causes more anxiety and is unnecessary because DE is often treatable. Men with DE may also withdraw emotionally and psychologically.

The psychological effects of DE can be widespread – it affects a man’s social life, his work life, and his relationship. He needs to feel secure and safe to talk about it with his partner, doctor, and therapist so he can fid the right treatment.

But of course delayed ejaculation can be hard to discuss with both health care providers and partners: women may think that initiating a discussion about the DE will induce embarrassment or even humiliation. And although you want a treatment for this challenging problem, you may not want to see a therapist. Fortunately there is a good book which may help you deal with the difficulties of not being able to ejaculate. You can find it here. And the UK verison of this self help delayed ejaculation treatment is here.

And women themselves may develop a sense of personal inadequacy, possibly believing that their man’s DE is somehow their fault (for example, they may conclude they are not sexually attractive to their partner).

It’s said that DE is usually a result of physical causes, made worse by psychological factors, but this is untrue in many cases. Such complex etiology means that treating DE may not be so simple as it first appears. And any anxiety around the situation will always make DE worse.

Treatment of delayed ejaculation

Sexual Psychotherapy

DE rooted in psychological causes can usually be overcome. And even when a physiological cause has been addressed, self-esteem problems or anxiety can impair the restoration of normal function and adequate sexual performance.

Qualified sex counselors, or sexual psychotherapists, can reduce emotional tension, increase communication, and provide realistic expectations for sex, all of which can improve a man’s sexual performance.

Psychological therapy can emphasize how men and their partners can find the motivation to change psychological expectations and modify sexual behavior.

Delayed Ejaculation

One of the problems that men may face in their sexual relationships is delayed ejaculation. And in fact it’s interesting to see that a failure to ejaculate during sexual intercourse is something that actually happens to most men at some point in their sexual life.

Sometimes delayed ejaculation is the result of tiredness or stress, but it may also be the result of sexual boredom, the lack of attraction to a partner, or ill-health that affects a man’s libido.

Now, of course some of these problems are temporary, and a man’s sexual response will improve when the stress is removed, but delayed ejaculation can be more persistent, and men often wonder whether it is caused by psychological, emotional, or physical problems.

The answer is that actually is usually caused by combination of the two, although the emotional component is usually much more significant.

Even in cases of clear physical problems this is such an emotionally charged event that it produces a level of anxiety that acts against the likelihood of ejaculation in the future. This means that any case of delayed ejaculation needs to be examined both from a medical point of view and from a psychological point of view.

The point is that for many men it’s simply the fear and anxiety about some aspect of sex which lies at the root of consistent delayed ejaculation. In this context it’s also important to emphasize that a single man who has anxieties around sex would be well advised to avoid casual sexual encounters – these can simply confirm his anxiety and insecurity around his problems.

A much better process is to develop a full-time sexual relationship which builds intimacy slowly and gradually, so that his sexual confidence is supported and developed, rather than challenged. As in all sexual activities, good health is also important to successful sex.

Men put themselves under pressure to achieve an outstanding sexual performance. They may wish to satisfy their partner sexually before they satisfy themselves, particularly if the partner is demanding and unsympathetic, perhaps making comments on his sexual performance or physical attributes. Then, delayed ejaculation is much more likely.

A man’s experience of anxiety is likely to become a self-fulfilling prophecy, in particular if he does not have a secure relationship in which he can establish a level of emotional security about his sexual ability.

The first thing to do in all cases of delayed ejaculation is for a man to take the pressure off the situation: this may actually include temporary abstinence from sex, which can give the man space and time to control his anxiety from his sexual performance.

Sensate focus exercises are extremely beneficial for men with delayed ejaculation, and also in establishing intimacy with a partner.

When working through sensate focus exercises, it’s important that intercourse is not attempted until the man is completely able to relax into sensual touching. The object of this is to achieve pleasure for its own sake rather than to achieve orgasm and ejaculation.

Furthermore, it is also important when the woman gets to the final stage of sensate focus where genital touch is involved, that she does not focus too much on stimulation of her partner’s genitals, but maintains the experience of whole body sensitivity and sensuality.

At the point where a man has relaxed into the experience of whole-body sensuality, his partner should be able to stimulate him to ejaculation either with masturbation or oral sex. This enables the man to develop a clear belief that he does indeed have full sexual  capacity. 

It is also necessary for the man to maintain a clear involvement with touching and caressing his partner’s body, rather than focusing on whether or not he can ejaculate. A man’s expectation around his sexual performance is key here (i.e. not necessarily expecting to come every time): his partner also needs to be able to touch his body and genitals without expecting anything in particular to happen. You can see how different this is from the normal expectations that we hold of sex.

However, as a man becomes less focused on his penis, and more involved with pleasure of simply touching his partner, his level of relaxation will increase and he will be able to gain a new confidence which enables him to fully explore his sensuality and sexuality.

Cognitive-Behavioral Treatment

Two factors that seem to maintain delayed ejaculation are high-frequency idiosyncratic masturbatory behavior and the discrepancy between a man’s inner world of fantasy and the actual forms of his sexual expression with his partner.

To overcome this, a couple need to integrate his masturbation fantasies into their sexual relationship, which will not only reduce feelings of guilt but also make it easier to overcome retarded ejaculation.

And something as simple as encouraging the man to masturbate with his other hand – which may well fail to produce an orgasm – can be helpful in letting him understand how his retarded ejaculation and idiosyncratic masturbation have perhaps become an ingrained pattern of behavior.

From a cognitive – behavioral therapy viewpoint, the basic strategy is to identify inhibitions and anxieties so that the therapist and client can come up with new sexual scenarios and develop appropriate techniques to overcome them.

The aim is always to increase erotic stimulation and identify the man’s orgasm triggers, but, as we have observed already, interventions which seek to change  cognitions and produce changes in attitude are equally important. Here are some crucial aspects of this program:

Intimacy between the two partners is likely to reduce performance pressure on the man significantly; mutual pleasuring and giving will increase verbal and physical intimacy, and this will help to overcome inhibition and sexual isolation.

An “automatic” erection does not necessarily mean a man is ready to have sex. His subjective arousal may be too low.

A major treatment strategy is to give a man permission to enjoy sexual pleasure and to encourage him to see his ejaculation as a natural culmination of his sexual arousal.

As treatment for delayed ejaculation proceeds, a man learns to be more direct in his requests for stimulation and more straightforward in allowing himself to enjoy erotic feelings. By being more “selfish,” he will experience more subjective sexual arousal and is more likely to enjoy an orgasm during sex.

A great help in the treatment of delayed ejaculation can be multiple forms of stimulation and knowing what will trigger his orgasm. Multiple stimulation might include fantasy, testicle stimulation or playing with his partner’s breast or anal area during sexual intercourse.

Orgasm triggers are very variable from person to person, but you can find out many of them by using fantasy during masturbation. Intravaginal ejaculation must be approached gradually, with a couple only starting intercourse when they are both highly aroused.

Treatment Protocols Outlined

Two factors tend to promote and maintain retarded ejaculation: vigorous and idiosyncratic masturbation patterns and a big gap between a man’s inner world of erotic imagery and the actual reality of his sexual life with his partner.

Bringing his masturbatory fantasies into the open will help to relieve guilt and aids honest communication between the couple: if they can incorporate these fantasies into their sex life, this is likely to be helpful in increasing the man’s arousal and aiding ejaculation.

There are other simple techniques which can help a man in this situation – even something as simple as switching hands during masturbation, for example, will increase his awareness of the way in which he masturbates and how difficult he may be making it for himself to attain orgasm and ejaculation. If his other hand can’t bring him to climax, no wonder his partner couldn’t do it either!

There are many therapies which help overcome delayed ejaculation. One starting point is to examine the inhibitions and fears which may lie behind the problem and to develop sexual situations and techniques to overcome them.

Another good strategy is for the man to ask his partner for increased intimacy and eroticism. Cognitive-behavioral strategies involve a three-part combination: (1) forming a connected and close intimate sexual team, (2) enjoying comfort with sexual pleasuring, and (3) increasing the level of erotic stimulation.

1 If a man and his partner form an intimate team, the degree of performance pressure which the man feels will be a lot lower. Helping each other to enjoy pleasure is important in generating the increased level of intimacy that can overcome inhibition and a sense of separateness. This is a crucial first step in overcoming DE.

2. An erection does not mean a man is ready for intercourse. A man may need to be more aroused. A man needs to understand that he can enjoy sexual pleasure and gradually increasing arousal, and ejaculation is the expected end point of arousal.

The more direct the man can be about requesting stimulation, and the more he can enjoy erotic feelings, the more confident he will be of his ability to be sexual and the more likely he is to enjoy high levels of arousal that ill take him to orgasm. The need to be selfish, to seek out his on pleasure, is a key factor in recovering his orgasmic capacity and overcoming DE.

3. There are many ways of getting greater stimulation and greater arousal: enjoying sexual fantasies during partner sex, enjoying stimulation of the testes, perineum, anus and nipples are just some of these. Each man can discover his individual orgasm triggers.

Finally, a man who is hoping to find some effective treatment for overcoming retarded ejaculation should not initiate sexual intercourse until he’s very aroused. Fantasies can be an effective way of heightening arousal.

It’s important for each partner to ask themselves what’s at risk if the man changes the way he responds during sex. There will certainly be some consequences if the symptoms of retarded ejaculation disappear, though what they might be will be different from couple to couple.

For example, the woman might wonder if the man will search out new sexual experiences with other women; the woman might wonder if he will find her as desirable as he does now; and so on.

 These points, and others like them, can be very enlightening for a couple to discuss as they work through these issues.

When treating DE, a couple need to look at their erotic life together. One of the biggest questions is what happens to the foundations of the relationship when they start to work on their sexual issues.

If they have a boring sexual life, and an inhibited attitude to sexual experimentation, bringing some of heir hidden and dark sexual shadows into the light may make their sex lives more vibrant, flowing and exciting.

Men with DE often show exaggerated concern for their partner as a way of hiding the things they fear. Changing the focus of attention from the couple’s conflicts with each other onto each partner’s own conflicts and fears can be very illuminating!

It’s exciting to discover new erotic worlds, but it can also be scary and lead to defensiveness, fear and guilt. A man overcoming delayed ejaculation should be aware of which of his own sexual fears have been sheltered by his sexual problems.

A very effective way of getting to the bottom of a person’s unmet or unexpressed wishes or desires is to have them imagine being completely self-centered in sex, with no need to think of the partner. What then would be an ideal sexual scenario?

Lifelong or chronic delayed ejaculation is more common than most men realize. It’s also different for each man who has it: a different combination of factors has caused it, a different approach to treatment will cure it.

There are two basic models of treatment for male anorgasmia. These are called the “inhibition model” and the “desire deficit model.” Don’t worry about these terms, they are just scientific language for some simple ideas…..

Inhibition Model

The so-called inhibition model and the approach to treatment which comes from it was promoted by the famous sex therapists Masters and Johnson, and Helen Singer Kaplan.

This approach to curing ejaculatory dysfunction assumes that a man is not receiving enough sexual stimulation – in either quality or quantity – to reach his orgasmic threshold, his point of no return, also known as the point of ejaculatory inevitability, so he is not able to ejaculate.

Obviously, the implication here is that if the level of sexual stimulation can be increased above his ejaculatory threshold, then he will be able to ejaculate – though the problem is that his ejaculatory threshold may be so high as to make this impossible.

Is this a case of inadequate stimulation or a high stimulation threshold?

These are actually quite different things when you consider them: for example, the high stimulation threshold concept behind delayed ejaculation might mean that a man’s delayed ejaculation comes from inhibition of his orgasmic capacity because he is consciously or unconsciously expressing deep rooted hostility and anger towards women.

Inadequate stimulation might also result from a man having an insensitive penis, or penile nerves, perhaps because he learned to masturbate as an adolescent with an idiosyncratic technique such as thrusting his penis against the mattress without using his hand.

Obviously the conclusion behind this line of reasoning is that treatment methods for DE might either have the aim of increasing sexual arousal through intense stimulation or they might aim to interpret and resolve conscious and unconscious impulses and neurotic defense mechanisms; or they might, of course, aim at both these objectives.

If a man has a lot of anxiety around sex and especially around his sexual performance as a lover, then any treatment approach which aims to increase stimulation thresholds – for example by rough and powerful manual stimulation of the penis – as a treatment for DE may actually have the side-effect of increasing a man’s anxiety even further (after all, the problem is the result of performance anxiety in the first place).

This any kind of aggressive approach to curing the desire disorder, or overcoming a high ejaculatory threshold, is likely to be counter-productive. It certainly sounds counter-intuitive to suggest a scheme like this for a man whose symptoms are probably rooted in anxiety anyway.

The desire deficit model

In sex therapist Bernard Apfelbaum’s view, DE speaks of  arousal and desire deficits which need to be understood, therapeutically approached, and clarified so that a man can take responsibility for dealing with the unconscious conflicts which have caused his delayed ejaculation in the first place.

Apfelbaum described this as “counter bypassing”, and suggested that treatment for delayed ejaculation should explore with a man his lack of desire for sexual intercourse and his lack of arousal which leads to his inability to ejaculate during sex.

It is a fact that most men with such sexual dysfunctions are firmly convinced they are withholding something from their partner and that they should be more giving; this implies that changing a man’s attitude and separating his distorted beliefs around sex in general and DE in particular are a main component of this treatment approach.

When a man has delayed ejaculation, he may often have a long-lasting erection, which he can maintain for hours – but this is not a sign of his arousal.

Indeed, many men in this situation have very low desire: they do not actually want to have sex, they do not desire their partner, but they feel at the same time compelled to have intercourse to please their partner.

This ejaculation problem is very often partner-specific, and the fact that a different partner, as in our case history, results in a lessening of the symptoms is indicative that we need to expand the range of therapies beyond aggressive stimulation of the penis to overcome the desire deficit.

Having said that, there are problems with Apfelbaum’s approach. Other therapists have observed that many men with ejaculation problems show features of affective disorders, obsessive-compulsive disorders, paraphilia, anxiety disorders, and even various personality disorders.

In such cases, DE itself is very likely to be a sign of inhibited arousal and desire in a partner-specific context, but backed up by a profound intrapsychic or interpersonal psychopathology that needs effective treatment.

Apfelbaum also suggested that in cases of slow or non-existent ejaculation, only the man’s own touch is erotically arousing, which makes him autosexual (i.e. masturbatory) rather than heterosexual or homosexual.

However, it’s possible to see idiosyncratic masturbation as the simple expression of the fact that a man can only reach orgasm through masturbation rather than a sign that he only finds his own touch arousing – though of course the latter statement might also be true.

In other words, DE is not necessarily a sign of auto sexuality, or autoeroticism, and this will be especially true when a man is clear that he wishes he could ejaculate during sex, and when he is clear that this wish comes from his own desires rather than his desire to please his partner or from an externally imposed standard which dictates that ejaculation during orgasm is the goal of sexual intercourse.

However, there is no clear division between different approaches in the treatment, and any treatment which is effective in opening up the subconscious drives and inhibitions which affect a man’s sexual relationship with his partner is a worthwhile endeavor.

Open expression of feelings, awareness of lack of arousal, and the ability to indulge one’s own desires rather than focus on the needs of one’s partner, are all clearly highly desirable objectives, whether within or without the framework of delayed ejaculation treatment.

In therapy, this process is facilitated by offering or stimulating different interpretations of beliefs held by the man and his partner around sex and intercourse in particular.

This is of course a kind of reframing approach which allows men and their partners to “see things in a different light”, a kind of decontamination of the beliefs which the man holds.

There may be some powerful insights which have an impact on the cognitive level almost immediately – others, more deeply rooted in the unconscious, may take longer to change. Surrogate therapy with specially trained partners has also been helpful too.

What all this tells us is that the overall approach to treatment need not be limited to one modality. All treatment approaches reflect some reality for one man or another with delayed ejaculation.

Apfelbaum and Kaplan look at different sides of the same coin: on the one side, the unconscious aggression and hostility that makes a man experience low arousal with his partner; on the other, feelings of guilt, shame, a tendency to excessive giving during sex, and so on. Both of these approaches can be useful with different patients.

Masturbation and Sex:
Reaching Orgasm Is Not Always Easy

Many men with delayed ejaculation are able to ejaculate more easily when they are masturbating alone.

You may think this implies that delayed ejaculation is caused by relationship issues or difficulty with a sexual partner.

However, why blame the relationship or the people in it?

Fact is, if a man can’t ejaculate during oral sex, intercourse, or even masturbation by a partner, but he can come when he masturbates by himself, it could be that none of these activities provide a high enough level of physical stimulation to get him sufficiently aroused to ejaculate?

Traumatic Masturbation

Aha! So, a man may have learned to apply hard pressure to his own penis while masturbating on his own. And, that’s not what sex with a vagina is like…. that’s much softer….

That’s right. The penis can be conditioned to respond only to very high levels of stimulation. Think here of an adolescent boy furtively masturbating by thrusting his erect cock on or into his bed.

So perhaps many cases of delayed ejaculation are caused by a man using harsh, firm, or high-frequency pressure during masturbation.

If he doesn’t get this level of stimulation during sexual activity with a partner, then you’ve pretty much discovered the cause of his inability to ejaculate. 

And the cure will lie in retraining his body, his penis and maybe above all, his mind, to respond to much more gentle stimulation of the kind that can bring about an orgasm during sexual activity.

Surely Slow Ejaculation
Is More Complicated Than That?

Therapists and counselors tend to take the view that the relationship is often the cause of the problem.

But is this kind of therapy the appropriate solution for delayed ejaculation?

Well, it can be. I’ve seen many couples where a gradually increasing level of hostility has reduced intimacy to the point where the couple no longer enjoy sex, and the man even resents it.

And if you resent sex, why bother ejaculating? Why would you give your partner the obvious sign of your sexual pleasure – orgasm and ejaculation? You could simply make your feelings clear by not coming during sex with your wife or girlfriend. 

To start with, communication is needed. A couple who have sex but don’t talk stand little chance of communicating in a way that might open a path to resolving the man’s delayed ejaculation. Or, for that matter, his hostility, anger, or whatever he may be feeling. 

Personality Plays A Part

Even if a man doesn’t feel any hostility, anger or any other negative emotion towards his partner, he might be a bit slow to ejaculate by nature.

That’s because one particular type of personality is prone to delayed ejaculation. This personality type appears to be of a man who

• is somehow detached from his own “process of sexual arousal”,
• is frequently unaware of how aroused he is during sexual activity
• regards sexual activity as a duty for which he is responsible
• regards himself as responsible for his partner’s pleasure
• believes that the woman’s pleasure must come first and is the priority during sex
• often, whether consciously or not, regards himself as the “workhorse of sex”, laboring away (often against all the odds) to bring sex to a successful conclusion for him and his partner.

I also see many partners of men in this situation being a bit passive around sexual issues. It’s almost like they think their man is somehow responsible for their sexual pleasure. (As opposed to the obvious fact that they are responsible for their own orgasm.)

And men who have this personality profile tend to have a lack of awareness of their own level of sexual arousal.

In fact, often they don’t really know much about sex, or they haven’t had much sexual experience …

Often there seems to be some kind of lack in their sexual experience. To compensate, they link their internal process of sexual arousal with the external process of engaging in intercourse with a partner.

Simply put, this means that their own erotic world somehow doesn’t function as a source of sexual arousal and pleasure. They are left in a sort of sexual “limbo” where they are trying to have sex without all the emotional and physical experience. The mental processes which are necessary for sex to be an enjoyable and intimate experience are missing or incomplete. I hope that makes sense.

How often do husbands have trouble ejaculating during sex?

It’s not at all clear how many men experience slow ejaculation, because very few men with this condition seek help or are willing to speak about it. 

This is in stark contrast to premature ejaculation. Men with PE tend to discuss it with partners, doctors, researchers and friends. The social stigma of being quick off the mark is much lower than that of being slow to “pop your cork”, it seems….

The most reliable research available suggests that the frequency of delayed ejaculation in the population is about 10%.

This comes from a survey of men visiting their family doctors in London. The reason that some estimates are much lower than this is probably the high level of embarrassment, shame, and inadequacy of men with delayed ejaculation tend to experience.

But ejaculation problems are completely natural – and common. And if you look around the internet you will soon see many questions from women whose boyfriends can’t ejaculate during sex, and from woman after woman whose husband has trouble ejaculating during intercourse… on and on it goes….

Summary!

You can see how a man might have difficulty with ejaculating with when he feels inhibited, can’t get aroused, doesn’t feel turned on, or because he’s concerned about some aspect of sex.

Such fear might include other people hearing the noises of lovemaking, or fear about the consequences of sex (pregnancy), or anxiety about his ability to pleasure a woman, or his sense of failure in bed, or his lack of confidence, or…. well, you name it.

A lot of experts believe that premature ejaculation is a similar response to stressful events during sex. It’s certainly a response to a high level of anxiety around sex, which has the effect of catapulting a man’s arousal sky high, far too quickly. Coming far too soon as a result.

Delayed ejaculation, or even a man simply having some trouble ejaculating with wife during sex, speaks to me of an emotional distance between the man and partner. It hints at emotional separation, withdrawal, and isolation. And all of that suggests this may be a relationship where two people are not intimate or communicating well.

By that, I mean they are NOT communicating about what they are truly thinking and feeling. 

How To Ejaculate

Generally speaking, you’re going to find that a man isn’t particularly aroused when he suffers from slow ejaculation (with the possible exception of the physical causes mentioned above).

So all kinds of ideas have been suggested to increase arousal These include the use of vibrators to increase sexual stimulation, nipple stimulation, anal stimulation, prostate massage, and so on.

All of these things are aimed at increasing a man’s level of sexual stimulation and so his level of arousal.

And because porn is very arousing, it’s also been suggested that viewing porn might be helpful. However  while viewing erotic films together may increase arousal, there are dangers of using porn – disassociation from real life partners being one of them. 

So what’s the cure? Well, as far as I’m concerned, it’s about re-establishing intimacy between a couple on both the physical and the emotional level.

Emotional intimacy comes from open, honest, clear communication from an authentic place. Physical intimacy comes from a whole series of exercises which are described in the treatment program on this website. See the top right hand corner of this page for a link to the treatment program.