More About The Emotional and Psychological Factors
Delayed ejaculation is one of those tricky conditions that appear to defy both explanation and definition.
Over the years it’s been known as ejaculatory incompetence, male orgasmic disorder, inhibited orgasm, ejaculatory inhibition and a few other terms as well.
And if you’ve worked in the field, as I have, you might be forgiven for thinking that this variety of names reflects some confusion in the minds of doctors and therapists who try to treat it.
You see, the thing is there are many ways to refer to “delayed ejaculation”, which reflects difficulty in both agreeing what it is and the best approach to treatment.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM V, fifth edition, categorizes delayed ejaculation as follows:
Accoording to the DSM-5, it’s defined by four symptoms with a choice of seven specifiers.
- An inability or difficulty in achieving orgasm during sex with a partner about 75 – 100% of the time, with either a delay in ejaculation or infrequent or absent ejaculation.
- If the problem has persisted for at least six months.
- And the symptoms produce marked distress in the individual.
- Also, the problem must not be better accounted for by another mental disorder, or by use of a medication which causes ejaculatory delay or failure, or stress within or external to the relationship.
- The ejaculatory delay is not considered pathological if it is due to a deliberate effort to prolong sexual activity.
- Lifelong, starting from the onset of sexual activity.
- Acquired, beginning after a period of normal sexual function.
- Generalized, in which ejaculation is impossible in solitary and partnered sexual activity.
- Situational, in which a man can ejaculate while masturbating, but not with a specific partner or in specific sex acts or situations.
- Degrees of severity include mild, moderate, or severe.
But in practice, of course, things are not quite so complicated. Most men with delayed ejaculation know that they have a problem simply because they cannot reach orgasm and ejaculate in a timely fashion during sexual activity.
(Even here one can see that the expression “in a timely fashion” suggests there is an element of subjectivity about how long orgasm and ejaculation should take during normal intercourse. Which, of course, there is….)
Perhaps a better way of assessing a man’s difficulty with ejaculation is the amount of effort and struggle a man has to put into sexual intercourse to be able to reach orgasm and ejaculate.
Objectively, even this is unsatisfactory, because as you may already know, delayed ejaculation can be lifelong or acquired later in life, it can be generalized (occurs with all partners and in all situations) or situational (occurs only in certain situations), and it can be due to either psychological or physical factors.
But, if you have to put a lot of effort into coming, sex is not relaxed, and you last longer than average, you know you have an issue…. and the average time between penetration and ejaculation is less than 7 minutes. (And in fact more like 3 minutes in some countries.)
One of the complications which is frequently mentioned in the context of delayed ejaculation is the fact that it can be caused by substance abuse or prescription medications.
Clearly the treatment routine for such conditions is going to be very different to the treatment for lifelong delayed ejaculation, and indeed for acquired DE when this is not the result of substance abuse or prescription medication.
Orgasm & Ejaculation Are Different Things
A further complication is that orgasm and ejaculation are mediated by different nervous pathways, and so are separate events. A man may ejaculate independently of orgasm, and equally he may reach orgasm with no ejaculation.
DE consists of an absence of both orgasm and ejaculation, and that is one of its defining features.
In some ways, much of this debate is mere pedantry because, as I observed above, men who have difficulty reaching ejaculation will be in no doubt that they have a problem!
However, pedantry? Well, it’s been suggested by Metz and McCarthy that proper diagnosis and treatment of delayed ejaculation depends on a doctor or a therapist being able to distinguish 10 types of delayed ejaculation.
There are, so it’s claimed, ten physical or physiological problems that can cause difficulty with ejaculation, namely, physical illness, physical injury, physiological conditions, side-effects of drugs, and lifestyle issues such as alcohol consumption; there are four psychological causes of DE, namely, psychological problems, emotional problems, relationship distress, and a deficit in psychosexual skills.
Arguably, the tenth type of delayed ejaculation is a mixed problem where delayed ejaculation is associated with low sexual desire or a sexual partner’s difficulty in enjoying intercourse.
The possibility that the sexual partner is associated in some way with the origin of DE clearly means that treatment is most likely to be successful when both the man and his partner are involved in solving the problem.
Video: How To Discuss Sex Problems With Your Partner
Some experts have suggested that DE is almost like inhibited sexual desire, in the sense that some men can’t develop enough sexual desire or interest to generate sexual arousal, while others can’t fully enjoy the level of sexual arousal they do experience.
Ironically, another unhelpful aspect of this condition is that there is a widespread myth that men who can make love for a long time, men who have great staying power, as it were, are in some way extremely desirable as lovers.
The truth is, of course, that men who have difficulty ejaculating may feel very inadequate, both in terms of sexual functioning, and in terms of their sexual self-confidence.
How Common Are Male Orgasm Problems?
We know that delayed ejaculation is a condition which is under-reported. One survey, the National Health and Social Life Survey, reported in 1994 that 8% of men between 18 and 59 had an episode of delayed ejaculation lasting for at least two months in the previous 12 months.
My experience as therapist over the last 12 years suggests that the percentage of men experiencing difficulty in achieving ejaculation is actually rather higher at around 12%, but one thing’s for sure: it isn’t the rare condition that everybody once believed.
Many therapists believe that they have come up with a particularly appropriate or successful model of treating delayed ejaculation, but I tend to think that what they’ve done is actually come up with a treatment that addresses the problem for a particular category of men, who most likely share some similarities both in cause and effect.
You certainly can’t adopt a “one size fits all” treatment approach to delayed ejaculation.
The reason being that in almost all cases, the problem with ejaculating is the outcome of a combination of the man’s emotional and psychological history, his physiology, his relationship and cultural upbringing, and his family environment during childhood.
You might think that treatment would be impossible if we had to look at all these aspects of a man’s life, but in actual fact it’s often a lot simpler than you might expect.
Now, having said that, if problems with ejaculation are the product of physical causes such as a man’s abnormally slow bulbo-cavernosal reflexes, or lowered sensitivity in the penis, then clearly there may not be a great deal that can be done about it.
The same is true if it’s caused by prostatectomy, transurethral resection of the prostate, or bladder neck surgery.
But we’ll leave those cases to the medics, because they should be easily identifiable, and most men who have had these operations will be able to associate their delayed ejaculation with their surgery. Hopefully the same is true of men who have suffered spinal-cord injury, multiple sclerosis, or diabetes.
Now, I don’t subscribe to the belief that almost any psychological condition or sexual or emotional experience can be the culprit where delayed ejaculation is concerned.
If the cause isn’t immediately obvious, further exploration of a client’s psychological issues or relationship dynamics will often produce evidence of certain critical factors.
It’s certainly no use making some kind of general statement that, for example, delayed ejaculation is caused by things like anxiety, fear of pregnancy, or fear of “absorption” by women. Even if this is true, it explains nothing about why a man can’t ejaculate!
The most likely explanation for delayed ejaculation is either that a man has “trained” his body and mind to respond to very intense stimulation, such as that received during hard masturbation, or that he is not receiving enough stimulation to reach the point of ejaculatory inevitability.
Now, this might happen when a man is out of touch with his own sensory experience during sexual activity with another person. (This article was written for women but is just as true for men as well.)
What this means in effect is that he simply can’t let go of his desire to be in control, can’t surrender to sexual stimulation, and perhaps also can’t relinquish a sense of responsibility for his partner’s pleasure.
We know that most men with delayed ejaculation have difficulty reaching orgasm and ejaculating during sexual intercourse, so another possibility is that there might be some kind of arousal issue with the partner (i.e he’s not turned on by her).
That’s particularly likely when you see a man who is able to ejaculate during masturbation but who can’t do so with a partner.
This means that maybe a man simply prefers his own sexual touch – it arouses him. By contrast, when he’s with a partner, he can’t relax, and while he gets an erection, it’s a purely an “automatic” response, and doesn’t indicate a high level of sexual arousal.
So this psychological explanation suggests a man is unable to give up control, or that a man can’t come to terms with the necessary process of losing control of himself during sexual activity — after all, orgasm and ejaculation are moments where one has to relinquish emotional and psychological control almost completely.
We do know that is difficult for men who have a rather hard and fierce masturbation style to talk to their partner about the kind of stimulation they need to reach the point of ejaculation. (Certainly not a level of stimulation they get during sexual intercourse.)
We also know that difficulty in communication can be a feature of many relationships where the man has delayed ejaculation.
And what about the role of anxiety? Well, we know that anxiety certainly causes premature ejaculation, because emotional arousal acts on the nervous system in much the same way as sexual arousal. That’s to say, it takes a man towards the point of no return faster.