Delayed or Retarded Ejaculation.
Occasionally, some men find it extremely difficult or impossible to ejaculate at all, even after hours of sexual stimulation. This can cause distress to the man and his partner and there is the added problem that it may be difficult for the couple to have children. It is certainly worth seeking treatment if you have this condition, although the likelihood of successful treatment will depend very much upon the circumstances of the of the individual.
What is delayed ejaculation?
Delayed ejaculation is sometimes known as retarded ejaculation. In this condition men find it difficult or impossible to have an orgasm when they are sexually aroused and stimulated even for a very long time. Usually this only occurs during sexual intercourse, since normally these men are able to ejaculate when they masturbate. However there are a few men who are unable to ejaculate in any circumstances, and this can be very distressing problem for both them and their partners.
How common is delayed ejaculation?
If large numbers of men are asked whether they have ever experienced problems having an orgasm and ejaculatory, the answer is that they give will depend on how they interpret the question. For example, medical researchers have found that as many as one in 20 men report that they have experienced difficulties with ejaculation on at least one occasion. However, less than one in 100 men probably consider that they have a real problem with retarded ejaculation which requires treatment.
What causes delayed ejaculation?
The explanation is sometimes very clear-cut. For example an injury or an operation may result in nerve damage which is clearly the cause of the problem. Sometimes medication, results in retarded ejaculation. An example of medication which causes delayed ejaculation is selective serotonin reuptake inhibitors e.g. fluoxetine, fluvoxamine,citalopram escitalopram,paroxetine and sertraline, which are antidepressants. However in most cases the explanation for delayed ejaculation is far from simple, since both psychological and physical factors, in a manner which is not yet fully understood, combine to block the ejaculatory reflex.
Why is it thought that physical factors may play a role in retarded ejaculation?
Sex therapists generally agree that psychological factors such as a person’s feelings or attitudes about sex and the contribution of their past experiences, will play a large part in causing many sexual problems. Less well understood by sex therapists and researchers is the part played by physical factors, an individual’s personality and the physiological processes that are responsible for sexual function.
For example the sensitivity of the reflex that triggers ejaculation is known to vary from man to man. In some men it is extremely sensitive and leads to premature ejaculation, and in other men it is extremely slow and leads to delayed ejaculation. It is very unlikely that this variation can be explained entirely by psychological factors. This is partly because the differences are so great between the slow and quick ejaculator’s and partly because these two types of response appear to be linked to other personality characteristics which are thought to be strongly inherited. Without holding these characteristics at least partly responsible, how else can sex therapist explain the fact that, when apparently equally worried or under stress about sex and relationships, some men react by losing their erections, some men ejaculate too quickly and other men have problems with delayed ejaculation.
What are the psychological factors that can make ejaculation difficult for a man?
A man who has problems with retard ejaculation and orgasm may, according to sex therapists, have quite rigid views about relationships and sex. Sex therapists claim that he is likely to be quite a moral person, but also one for whom sex is particularly important. Specialists in this area sometimes claim that: “above all, and because he may be particularly self disciplined, he may find it difficult to lose control of himself and his actions.”
Some psychoanalysts believe that men who find it difficult to ejaculate in a woman’s vagina are this way because they do not want to soil a woman with their semen. Personally I feel this explanation sounds rather fanciful and is probably only the case in a tiny minority of men. However sex therapists claim that it is often observed that men who have problems with delayed ejaculation with their wives or regular partners are able to ejaculate more readily when they are in a relationship that is more casual. The importance of psychological factors becomes very apparent when some men with delayed ejaculation talk about the feelings that they have when they approach orgasm during intercourse. Sex therapist report that they recall that they often seem to be consciously stopping themselves ejaculating in the vagina even though they are unable to explain precisely why they do this.
What type of accident or injury might delay ejaculation?
Any accident or surgery that results in an injury to the base of the spine can damage to the nerves which go to the reproductive organs and trigger ejaculation. If these nerves are destroyed then very little at present can be done to restore their function.
What are the diseases that may lead to retarded ejaculation?
Most of the diseases that result in delayed ejaculation will also affect penile erection and lead to erectile dysfunction. Most bodily functions work least well if a person becomes ill. Apart from acute common illnesses such as flu, which makes sufferers ill for a week or so and have the effect that sex is not surprisingly natural the last thing on their mind, there are also a large number of chronic illnesses, injuries and surgical procedures that may affect sexual performance and particularly erection:
See this link to an article about erectile dysfunction:
However, there are probably no specific illnesses that bring about a delay in ejaculation alone without also affecting erection.
Do men who have problems with delayed ejaculation ever have wet dreams?
There is very little solid evidence to support this suggestion, but it is very likely that men who have problems with delayed ejaculation will be less likely to have wet dreams. If they do have them, this probably means that their failure to ejaculate when awake has a psychological cause.
What feelings do women have about their partners who are unable to ejaculate during sexual intercourse?
One might expect that at least some women would be very pleased that their partners did not ejaculate quickly, because as a result sex may last much longer thus increasing the chance that she may have an orgasm. However if her partner is never able to ejaculate inside her, her feelings may be more confused. Some women may feel that it is their fault and may even feel rejected as a result. Just as a woman’s orgasm may be very important for a man, so his may be important to her, if only as a symbolic expression of his love and need for her. This problem of course becomes much more acute and serious if she is trying to fall pregnant and his ejaculation is rare or not happening at all. There are also some women who may be upset because they want their partner to ejaculate and get it over with.
Is it true that some men do not ejaculate during sexual intercourse because the vaginal walls do not stimulate the penis as much as the hand does during masturbation?
Just as the penis, however well designed, is not always the most effective means of bringing a woman to orgasm, so the vagina is not always the best way to stimulate a man to ejaculate. The penis of a man who takes a long time to ejaculate may require a lot of fairly vigourous and prolonged stimulation. A moist vagina in an aroused woman may not be able to provide enough of this type of intense stimulation. Also, if a man has spent a lot of his life masturbating to orgasm, he will have become used to his own particular type of stimulation and may find that the vagina is a poor substitute for his hand.
If a man feels that he has an orgasm but does not ejaculate, then what is happening?
If this happens it is almost certainly a condition known as retrograde ejaculation. What happens is that the semen carrying the sperm has passed backwards into the bladder, instead of being carried to the outside through the penis. Usually a valve closes off the bladder at orgasm to stop this happening, but occasionally as a result of surgery, an accident, disease or some types of medication, this reflex does not work. The man will still experience an orgasm but it will be a ” dry run” and he will not feel the pumping action in his penis because there is no semen to pass via the penile urethra to the outside. It is sometimes possible to treat this problem with medication or surgery, but if the problem is not treated, it does not create real difficulties unless he and his partner want a child.
Can the fear of getting his partner pregnant be a reason for delaying or stopping ejaculation?
A fear of pregnancy does appear to be one of the many reasons why a man may prevent himself from ejaculating into a woman’s vagina. One of the obvious ways of trying to overcome this fear would be to suggest that he uses a condom or that she uses a reliable method of contraception.
Can a man with no previous problems with ejaculation suddenly find it difficult to ejaculate in a new relationship?
Stress, whatever form it takes, may lead some men to delay or stop ejaculating during sexual intercourse. For example, a man who had never experienced such difficulties with his first wife found that, when he began a new relationship with a much younger woman, orgasm and ejaculation became more and more difficult until both were impossible. He went to see a sex therapist and in the course of therapy, it transpired that he had become anxious that he was unable to satisfy her need for sex every day, and because as a couple they had found it difficult to talk to each other about the problem, his body (in other words his penis) responded in a particular way. His penis responded, to tell them that something was wrong, and the result was delayed ejaculation. Once the problem had been brought into the open and been talked through, the couple agreed to have sexual intercourse less often, the man was able to relax and he again was able to ejaculate normally.
Can a single bad sexual experience upset the ejaculatory reflex?
There are many case histories reported in which a single distressing experience appears to have been responsible for causing a block or delay in ejaculation. Sex therapists refer to this as traumatic learning.
The well-known sex therapists, Masters and Johnson, have described a case in which a husband and wife were disturbed by the children at a critical point during their love-making when the man was just about to ejaculate. He was so upset by this that he was unable to climax again until he had had treatment by a sex therapist. A similar experience was reported by a young couple who were disturbed by a policeman when they were having sexual intercourse in a parked car. Fortunately delayed ejaculation caused by this kind of experience usually responds very well to treatment.
What kind of treatment is used to help men who have problems with delayed ejaculation?
Delayed or retarded ejaculation is not easy to treat, and because it is quite rare, there are not many reliable medical reports on success rates for the various types of treatment that are available. At present, very little, can be done to change the physical make up of a man that makes him likely to delay his ejaculation. However, if a sex therapist takes a careful medical history, this may well provide valuable clues about a man’s psychological make up. To give an example: since the role of his partners so important, any information about the way in which the man views his partner, whether as primarily a mother, mistress, daughter, wife or prostitute, may help the sex therapist to identify some of the causes of the problem. Once these causes have been identified, then they can be shared by the sex therapist, with the couple, and the greater understanding of what has caused the problem, may help them to develop a more successful and fulfilling sex life.
Put very simply, this is how talking therapy or psychotherapy works. It is an essential first step in the treatment of delayed ejaculation and many other sexual problems. Sooner or later, however, a more practical approach may be required and this second stage is known as behaviour therapy.
Which type of behaviour therapy is used to treat men who have delayed ejaculation?
It is known that most men with delayed ejaculation are able to masturbate themselves to orgasm. It may take them longer than is usual, say 10, 20 or even 30 minutes, but they usually get there in the end. If, however, they have never been able to ejaculate even during self masturbation, it is very important that, if possible, they attempt to achieve this before they involve their partner in the treatment.
If ejaculation proves to be very difficult or even impossible, when they attempt to masturbate themselves, then this may be due to one of the following reasons:
- If they are able to have an orgasm but do not ejaculate, they probably have a condition known as retrograde ejaculation (see above).
- They may have had an injury to the spine, spinal-cord or an operation that has affected the nerve supply to the penis, or they may be taking some medication which hinders or prevents ejaculation.
- They may require so much physical stimulation that masturbation by hand does not provide sufficient arousal and stimulation. Or they may need additional psychological stimulation which is not available in self masturbation.
Retrograde ejaculation can sometimes be treated successfully, and an alternative medication that does not prevent orgasm can often be prescribed. Unfortunately, there is very little that can be done to repair damaged nerves. If a lack of adequate physical stimulation is thought to be the problem, then a vibrator designed for use on the penis, one that is one that is shaped like an artificial vagina, usually powered by batteries, or better still a body massager powered from the mains may provide sufficient stimulation to lead to ejaculation.
Once that he is able to masturbate to orgasm, then it is possible to reassure the man that his body is working satisfactorily and normally. He should then continued to practice self masturbation as often as he is able with the aim of speeding up ejaculation, so that he is able to have an orgasm within three or 4 min if possible.
Those men who find it difficult to masturbate to until they ejaculate and orgasm or those who may need up to or more than 30 minutes of vigourous and stimulation before they “come” should experiment:
- They should try to lose themselves in exciting erotic fantasies or use sexually arousing pictures or videos.
- Try drinking a moderate amount of alcohol. Not too much.
- Use KY Jelly, a cream or suitable lubricant when they masturbate.
- Attempt masturbating in in as many different situations and positions that they can think of. For example standing in front of a mirror, lying on their stomach, in the bath, in the shower or whatever turns them on.
The next step in treatment of delayed ejaculation is for the man to involve his sexual partner.The treatment plan is for him to practice masturbation until he is able ejaculate with her being present. Different couples will want to experiment at this phase to establish the most effective way. One example of a method taught by sex therapists is for the man to start by masturbating in the dark, possibly with his sexual partner lying a little distance away in the room. Every time they practice she should move a bit closer to him until he is able to actually ejaculate on her body. One suggestion is for her to help him become aroused and ejaculate by “talking dirty” or by acting out some of his sexual fantasies.
When he has been able to ejaculate with her close by, the next step is for her to start to masturbate him to orgasm. The success of this will vary from couple to couple. This may prove to be easy or it may take some considerable time. They may try masturbating him together, using both his and her hands on his penis. Slowly his hand can then be moved away and she can then masturbate his penis with her hand alone.
When this last step has been reached and he is able to ejaculate with his partner masturbating him, then they are ready to experiment with sexual intercourse. Either he or she should masturbate him, and start with he should aimm to ejaculate just between the lips of her vulva. The next step is is to place the tip of his penis at the entrance of the vagina and masturbate in this position so that he ejaculates just inside her. Each time they try this, he should attempt to ejaculate deeper and deeper inside her vagina.
Another way is for him to masturbate himself almost to the point of orgasm and then quickly penetrate the vagina so that he ejaculates well inside her. To ‘come’ inside the vagina for the first time, however it is achieved, is a significant step for him, and things may become easier after that.
If a block still persists and ejaculation in the vagina continues to present difficulties, a return to talk therapy may be required. Then another attempt can be made to bring any remaining fears and conflicts to the surface.
Another way of trying to bypass these blocks to ejaculation during intercourse is to try distraction techniques. Whatever blocks are responsible for a man’s inability to ejaculate, be they psychological or physical, there is no doubt that sometimes they can be modified by sexual novelty, spontaneity or, indeed, by any situation that contains an element of the unexpected. This kind of sexual experience is possibly everyone’s fantasy, but for a man who is not able to ejaculate, any scenario that will arouse, distract and focus his concentration away from his fear of failure has a chance of success. Obviously in order to succeed, whatever is tried should, as far as possible, be unrehearsed and, up to a point, unpredictable. Here are a few suggestions:
- Make love under a shower or in the bath
- Have sex in the open air or in a car (ensuring some degree of privacy)
- Have intercourse fully clothed and spontaneously
Sometimes the treatment outlined above does not work. This may be because the ejaculation reflex requires so much stimulation that normal intercourse is just not able to provide sufficient stimulation. Alternatively, it may not work because the man has special psychological needs that have to be satisfied before he can ejaculate. If he feels, for example, that ejaculating inside a woman is an insult to her and an assault on her femininity, that it is in some way dirty, these feelings will obviously influence his ability to ‘come’ inside someone he loves and respects.
If the difficulty he experiences in combining sex and love cannot be resolved by psychotherapy, he may need to experiment with other relationships, particularly with women who he does not hold in high regard. For example he may learn to ejaculate for the first time by obtaining ‘relief’ from a masseuse in a massage parlour. In the past I remember one patient in his 50s who had never ejaculated in his life, either during masturbation or during sexual intercourse, but he did so on his first visit to a sauna where the masseuse was able to masturbate him to orgasm. Sometimes such unconventional methods can work better than all the best professional advice put together. If by experimenting with these types of relationships, he can learn to ejaculate regularly during intercourse, he may finally be able to transfer this success on to a more valued relationship.
Does behaviour therapy work?
Because delayed ejaculation is a relatively rare problem, there is a paucity of information available on the success rates after treatment. Masters and Johnson claimed successes in over 75% of their patients with this problem, but nothing like this level of success has been achieved by other sex therapists. In the United Kingdom a success rate of 25% has been quoted as probably a more realistic expectation.
Is there any form of medication that will help treat delayed ejaculation?
Medication has been tried, but generally it has not been very successful. Therefore at present it does not form part of sex therapist’s treatment armoury.
Delayed ejaculation may be difficult to treat, but premature ejaculation is definitely treatable with a very high rate of success. The best treatment advice and programme available today is the Ejaculation Trainer programme, by Matt Gordon. Click on the link below to discover more immediately.