The very fact that delayed ejaculation has been known by so many names (anejaculation, delayed orgasm, ejaculatory inhibition, retarded ejaculation, and more) demonstrates the complexity of the condition, and perhaps indicates the lack of agreement in how to treat it among sex therapists.
Indeed, curing delayed ejaculation relies very heavily on the experience of the therapist, flexibility in approach, and the willingness to “think outside the box”.
We will see what that means in practice later on.
One of the key diagnostic tools for any sexual and emotional problem is the Diagnostic and Statistical Manual (DSM). But this isn’t really helpful with delayed ejaculation because the DSM puts it under the heading of male orgasmic disorder. And in fact, as you can understand from the very name of the condition, this is more a problem with ejaculation than orgasm.
However, it’s worth looking at the definition the DSM offers: “Persistent or recurrent delay in reaching orgasm, or complete absence of orgasm, despite receiving sexual stimulation that should be adequate to bring a man to climax, and which causes marked distress or interpersonal difficulty“.
I don’t really know why a definition should require the man to suffer distress or difficulty. I mean, whether he does or he doesn’t, he’s got delayed ejaculation (DE for short).
I mean, it’s not like DE is hard to spot: a man who’s making love for 30 minutes or even longer without reaching an orgasmic climax has an issue with ejaculatory delay.
He might even be masturbating for a similar length of time without coming.
Besides which, it’s inappropriate for a therapist or doctor to start judging whether or not a man’s sexual technique is adequate, and whether or not he’s receiving enough sexual stimulation, and whether or not his degree of sexual excitement is normal. But there you go. That’s what they do.
I think a much better diagnostic tool is what a man says about his own sexual performance. After all, if he’s making love for 30 minutes and he’s not coming, then he’s got delayed ejaculation.
And if he’s masturbating for an hour without ejaculating, then he’s definitely got it.
Now, I’d like you to appreciate that I’m not joking about this, because I know it has a massive effect on any couple where the man can’t reach orgasm during intercourse. It’s fair to say DE can have a much bigger impact on the woman than either premature ejaculation or erectile dysfunction.
She might, for example, believe that she’s not attractive, because the man doesn’t find sex with her exciting enough to achieve climax.
Situational and Generalized
Delayed ejaculation is an interesting condition: sometimes it only occurs with one particular partner. In that case you have to assume that the cause of this ejaculatory dysfunction is because the man doesn’t want to have sex with that partner, or – whisper it – he doesn’t even like her.
Such intermittent problems are called “situational delayed ejaculation” (or situational DE for short). When delay occurs with every partner, it’s “generalized delayed ejaculation”.
By the way, before we go any further, it’s important to appreciate that some men find quick ejaculation more difficult as they get older: whether or not you define that as delayed ejaculation is up to you.
It’s just a natural part of the ageing process, and certainly a different problem to prolonged intercourse without orgasm. That can affect men of any age.
A better, simpler way of defining the condition is to say it’s a sexual dysfunction where abnormally intense stimulation of the erect penis is necessary to achieve orgasm and ejaculation.
A moment of light relief.
Orgasm And Ejaculation Are Not The Same
We do know that orgasm and ejaculation have separate nervous pathways within the body, so in theory they are separate events.
That means that failure to ejaculate might have many causes. And indeed, it does: psychological causes, physical causes, medication causes, and psychosocial or psychosexual cause. (In case you’re wondering what psychosexual means, it means the man doesn’t know enough about sex to feel confident or competent, and the origin of his problem with ejaculating lies mostly about his inadequate sexual technique or performance. As if sex is a “performance”! But I daresay you know what I mean.)
Some people like classification: so much so that a couple of researchers have come up with 10 different types of delayed ejaculation. They say five of them are caused by physical or physiological problems, four of them by psychological problems, and one where delayed ejaculation is the result of another sexual dysfunction like low sexual desire.
But really, unless this helps treat the problem, what’s the point?
All we really need to do is point out that certain drugs can cause delayed ejaculation, as can nervous system problems such as those that develop in neuromuscular degenerative diseases and diabetes, for example. And then, unless you believe in the theory of penile insensitivity, we just about covered the physical causes.
The truth is that delayed ejaculation is usually caused by emotional issues, relationship issues, or psychosexual issues.
Here’s an interesting thing: a man with delayed ejaculation usually has an erection and can make love for a long time.
Doesn’t that indicate that he’s aroused? Well remarkably enough, no it doesn’t. The truth is that many men with DE seem to be very unaroused, sexually.
And for that matter, here’s another interesting thing: a lot of people think that a ma who can make love for a long time during lovemaking is a desirable man in bed. Well, then, they might feel differently if they were making love for an hour without any sign of a climax.
So what can you do if you have delayed ejaculation?
The short answer that is — you’re not going to take any kind of medication as a solution, because there isn’t one available.
Instead, you’ll have to look at your emotional and psychosexual background. Now don’t groan….. I know you as a man might not be too keen on this kind of thing.
But the question you have to ask yourself is: “Do I ever want to come during sex?” Or maybe that should be a statement: “Do I ever want to come during sex.”
Whichever is appropriate to you, the fact is, there’s a bit of work to be done to cure the problem. That’s because delayed ejaculation emerges from a complicated mixture of psychological issues.
For instance, how anxious are you about your sexual performance? To some degree most men are, because our culture promotes an idealistic view of a man’s sexual capacity (unlimited, enduring, unfailing. That kind of crap.)
And if you’re anxious about your performance, you won’t “perform” as well as you might, because anxiety inhibits sexual responsivity and arousal.
Ironically, the same assumption (that a man can make love all night on demand with a penis of steel) prevents men with delayed ejaculation from seeking help. It’s the shame, you see.
Anyway, moving on, a sex therapist will typically put together a treatment program for delayed ejaculation based on careful inquiry into a man’s sexual experience and symptoms.
So that would include information about:
- his age
- when he first noticed delayed ejaculation occurring
- whether it’s been present all his life or only developed recently
- what is relationship status is
- his sexual orientation
- the degree of shame he feels about sexual interaction with another person
- how well he has conducted relationships with sexual partners in the past
- the kind of experiences is had within relationships
- his formative sexual experience the attitude to sex within his family
- negative and positive messages received in the family about sex
- current beliefs about how men should behave in a sexual relationship
- information about how the man’s father and male ancestors would have seen sex
- how comfortable he and they are with it
- any sexual trauma in the family or the individual’s history
- the extent to which an individual is stressed or relaxed
- whether a man is anxious or depressed, obsessive or compulsive
- whether he has the mental health challenges
- whether he has any previous sexual difficulties
- whether a man has any of those symptoms of sexual dysfunction
- what his sex life is like
- how his sex life has been in the past
- what how he sees himself as a sexual being
- what the history of the couple sexual relationship is
- the degree to which the couple can communicate easily about sex
- whether they want sexual interaction
- how common sexual interaction is in the relationship
- how sex typically works
- who initiates and leads during sexual activity
- the degree of sexual interaction – how often, how much
- how often delayed ejaculation occurs
- the kind of situations in which delayed ejaculation occurs
- whether a man feels performance pressure
- if a man experiences spectatoring or not
- how good a man is at keeping an erotic focus
- how well a couple can handle intense sexual stimulation
- whether a man has any sexual aversions
- if delayed ejaculation occurs with masturbation
- the degree to which a man uses fantasies during sexual activity
- how pleasurable he finds sexual stimulation by his partner
- how well the couple handles the woman’s sexual desire
- the degree of enjoyment or frustration that sex causes
- how often intercourse takes place
- whether the man ever ejaculates during intercourse
- if a sex a spontaneous or planned…. and so on
Well, you get the idea, I’m sure. There are many factors that might have a bearing on delayed ejaculation, and it’s necessary to tease out all of them to get a complete picture of what’s going on in a relationship. Then you can begin a treatment regime.