So what about the causes of delayed ejaculation? What, you may ask, do we know about that?
It’s a very good question, and it’s occupied a lot of clever people for many years. Even so, strangely enough, the answers are not entirely clear, but we do have some ideas. And since I’ve never been afraid to bring ideas where knowledge is lacking, let’s see what they are!
Natural Human Variability
To start with, the speed with which men reach orgasm during any kind of sexual activity varies from man to man. Some men are very quick to come, and some are very slow, and some can’t ejaculate at all. So this dysfunction could be seen as part of the natural variability in the whole population. No doubt to some extent that’s actually true. After all, we know that some men never experience premature ejaculation: even from the first time they make love they appear to have excellent ejaculatory control. Others struggle with rapid ejaculation for life, and appear to be completely unable to delay it. But the idea of a natural variation in the population certainly isn’t the whole story.
But Surely Delayed Ejaculation Is Natural?
One of the questions that comes up from me is why we think it’s such an unnatural condition. I guess in a way the answer is obvious: sex is meant to end with the man ejaculating, because that’s the way Mother Nature planned it. The idea is to get the woman pregnant. But humans aren’t as simple as most mammals. We have a highly developed brain, and within that brain, a mind that we use to process all kinds of thoughts, feelings and behaviors.
And one of the things we tend to do as a species is to put people who are different from ourselves in some way in a different category. So, many years ago, women who couldn’t reach orgasm during sex were called “frigid”. And that’s a very disparaging term. I wonder if the sense I have of “retarded” ejaculation as a disparaging term has anything to do with this sense of “difference”?
There’s certainly no question that men who can’t ejaculate are seen in some way as having a “problem”, whereas women who can’t come during intercourse are seen as normal, even if they were once called frigid. Nowadays there is certainly a widespread acceptance of female anorgasmia during intercourse. (As it happens, quite rightly, because only about 15% of women reach orgasm during sexual intercourse.)
So what’s all this mean? Well, it’s a good question, but I think the root of this whole thing is our inherent sense that delayed ejaculation somehow goes against the natural order of things. But among men who have it, there’s no question of them wanting to be like this. I’m sure every man with delayed ejaculation would appreciate being able to ejaculate easily.
Yet, having said that, and bearing in mind your highly complex mind, I’m wondering right now if you can see how your attitudes to sex affect the way you respond to a sexual partner? For example, is it possible that some men – you, perhaps – actually prefer to have sex with themselves to sex with a partner? And when they have sex with a partner, maybe they simply don’t get very aroused, and therefore they can’t ejaculate. It’s an interesting idea, but if it’s true, then why do men in this situation have a hard and long lasting erection? Isn’t that a sign of arousal?
One of the key people working in the field of ejaculatory problems is Bernard Apfelbaum, who came up with the idea that men with delayed ejaculation might simply prefer sex with themselves to sex with a partner: in other words, that their orientation was “autosexual”.
Bearing in mind the wide range of human preferences, that seems to me to be entirely plausible. And then the question would be – well, OK, but why does a man who’d simply prefer to be sexual with himself seem to be so aroused with a sexual partner? We’ll look at this in more detail on the section on psychological causes of this sexual dysfunction.
Another therapist called Helen Kaplan suggested that the reason men couldn’t ejaculate was because there was some kind of emotional block stopping them doing so. We know that emotions can interfere with sexual arousal, so this is quite a plausible explanation as well.
But is it true, and if it is, what sort of emotions are we talking about? Well, the most obvious suggestions here are things like anxiety, anger, emotional conflict about women, perhaps a lack of trust at a very deep level in women, and such like. These are all things that could give rise to a man’s inability to “open up” emotionally in the way that’s necessary for the completion of sexual activity (orgasm and ejaculation, in case you were wondering!).
That might sound bit strange to you, but then again, if you’re a man who’s been wounded by women, either in childhood, or in adulthood, you probably do have a sense of whether or not your level of trust is high enough to be able to enjoy sex fully with them.
You see, the thing is that we all carry a huge amount of unconscious information, beliefs, and emotions that have a massive impact on everyday life. The irony is that much of this isn’t conscious — in other words we’re simply not aware of it. So if you’re a man who has trust issues with women, you may not be aware of the impact that they have on your sexual relationship.
Equally, if you’re a man who was abused by women in childhood, you may have a massive fear of being “taken over” or absorbed or repressed (or almost anything really) by women or the feminine, and if you do that’s going to have a very negative impact on your ability to engage in an intimate relationship with a woman. Yes?
And it can be even simpler than that: suppose, for example, that you’re a man to whom control is incredibly important. To feel safe, you have to be in control. Well, ejaculation and orgasm are the times in our lives where we’re just about as vulnerable as we get. You have to let go of control to be able to reach orgasm and ejaculate.
So if you’re frightened of losing control, or for that matter if you’re frightened of your partner seeing you at your most vulnerable, it’s quite likely that you will have some kind of difficulty with ejaculation. And again, we’ll look at these in more detail on the page dealing with the psychological and emotional causes of delayed ejaculation.
But Before We Go On – What About The Physical Causes Of DE?
You might recall I mentioned above the possibility that male orgasmic disorder is simply a reflection of the natural variability of ejaculation speed in the human population.
If so, the question arises about what can a man in this situation can do to make things a little bit, shall we say, faster? One obvious answer would be find some way of getting more aroused before or during sex. And we will look at that later on, too, when we talk about possible approaches to treatment. But there are some other physical causes which go beyond any kind of natural variation in the population.
For example, low testosterone has an impact on men and their sexual responsivity, and in particular on their ejaculation speed. So if you have a low sex drive and delayed ejaculation, you might want to see a doctor who knows something about male hormonal issues…. just to get checked out and make sure that if you need testosterone supplementation, you get it. That applies particularly to men over 50 who very often experience low levels of testosterone.
Another common cause of ejaculatory dysfunction is prescription drugs. You may find that drugs as simple as painkillers like tramadol delay your ejaculation. We certainly know anything that acts as a sedative, inhibits sympathetic arousal in the sympathetic nervous system, or raises serotonin levels in the brain, can definitely impact ejaculation speed (impact it adversely, that is – at least if you take too long to come already!)
The drugs which tend to do that include antidepressants and other mood altering drugs, such as drugs designed to relieve anxiety, as well as other drugs like antihypertensives, alpha blockers and beta-blockers.
Equally potent inhibitors of ejaculation are diseases of the nervous system such as Parkinson’s disease, multiple sclerosis (MS), and so forth. The fact that such conditions can affect ejaculation means that men with ejaculatory difficulties who to go to a doctor for help will often receive a complete medical checkup….just to make sure there’s nothing physically wrong with their health.
What else? Well, surgery can cause delayed ejaculation. Any surgical procedure that damages the lumbar sympathetic ganglia or any nerves associated with the ejaculatory reflex, or any surgery on the prostate gland and pelvic area, all have the possibility to impact ejaculation. In the case of prostate surgery, TURP or transurethral resection of the prostate, causes retrograde ejaculation, although orgasm is normal.
Male sexual response has two parts to it: it has an erection reflex, and it has an ejaculatory reflex. Regrettably, for all you men out there with retarded ejaculation, the latter seems to be more sensitive to problems than the erection reflex.
One of the most important causes of delayed ejaculation is traumatic masturbatory syndrome, which means that a man has learned to masturbate in a way that has conditioned his body to respond only to very hard stimulation of the penis – sexual stimulation of perhaps the most extreme kind. Often this involves thrusting against the mattress, or masturbating with an extremely tight grip on the penis during self-stimulation. Once again, we will look at these in the section on the physical causes of delayed ejaculation.