A reader emails to say:
If you have any men with delayed ejaculation among your clients, please convey this information to them....
If you can break out of the conventional framework of sexual play, and open your mind to the possibility of anal stimulation, you might be opening the door to a whole new load of sexual pleasure.
This came home to me recently when I was receiving internal prostate massage for a case of enlarged prostate.
Offered by a male therapist experienced in this area, the experience was totally devoid of any eroticism whatsoever -- at least, that is, until the point where he began to massage my anus in preparation for penetration.
At this point I began to develop an erection, which was a surprise to me because I was actually experiencing no erotic arousal or attraction towards him whatsoever.
This was, in fact, quite simply a physical reaction due to the gentle massaging of my anus, which produced a rapid and significant erection.
It follows that anal massage, because it can increase your arousal, will get you nearer the point of no return, the point at which you inevitably ejaculate, and so may be helpful in allowing you to experience orgasm during intercourse.
I'd be very interested indeed to know if you
can recommend this to your readers, and if any of them find it helpful in
achieving orgasm and ejaculating during intercourse.
Indeed, I've actually seen the suggestion made by some free-thinking sex therapists, that both nipple stimulation and anal stimulation, as well as prostate stimulation, can provide an appropriate route to a high enough level of erotic arousal for a man with delayed ejaculation to ejaculate during intercourse, even if he's not previously been able to do so.
If any of you try this out and have anything to report, successful or otherwise, please let me know.
Delayed Ejaculation & Retarded Ejaculation
Delayed ejaculation and retarded ejaculation are equivalent terms. They both refer to the difficulty which a man may have when trying to reach orgasm and ejaculate during sexual intercourse.
However, it is not the desirable condition that it may seem to be. Indeed, quite the opposite, for it often causes considerable anxiety and distress to a couple, sometimes even damaging their relationship.
Delayed ejaculation (DE for short) will certainly have an impact on a couple's sexual harmony, because the persistent and prolonged intercourse that is necessary for the man to achieve ejaculation often leaves the woman feeling resentful and sore, and the man resentful and dissatisfied.
In no case will delayed ejaculation leave a couple feeling that they have had a harmonious sexual experience. It is said that DE is not an easy condition to treat.
However, the correct treatment can produce significant improvement in all cases, even though this may indicate the need for issues within the relationship to be addressed. When a couple are holding on to their psychological motivation not to change things, treatment may well be unsuccessful.
It is only with complete honesty and openness and a willingness to examine the relationship difficulties that delayed ejaculation can be easily resolved.
Many of the men who have delayed ejaculation apparently have had a strict upbringing where sexual matters were a taboo subject and may in fact been very controlled in their lives in general.
Some are very goal-orientated with high drive and have achieved remarkable things in their chosen professions. Often they are very controlling personalities although this quality may be directed inward rather than add to the people. And many men with DE have problems showing emotions and letting go.
The obvious parallel with letting go during ejaculation in sexual intercourse is significant. Other factors that have been blamed for DE include a fear of causing pregnancy, vaginal aversion (a condition where a man finds the smell, taste, and touch of the vagina repulsive), a strict religious upbringing, and even latent homosexuality.
At this point it is appropriate to emphasize that not every case of DE can be blamed on psychological or emotional issues. As mentioned above there are many medications which affect a man's ability to ejaculate.
When a man who previously had no difficulty with ejaculation begins to show signs of retarded ejaculation, the first place to look is at the medication he may be taking for other conditions. Antidepressants in particular are often a cause of ejaculation problems.
Equally a lot of men find it more difficult to ejaculate as they get older. However this is a rather different problem which will involve a man being able to ejaculate from time to time, though perhaps not every time he has sexual intercourse: this is merely a symptom of ageing and is not the same as DE which can affect men of any age.
Delayed ejaculation causes most problems within long-term relationships, especially where a couple hope to have children.
In particular, a woman may feel unattractive or even undesired if a man cannot come: many women have reported to us that they feel almost insulted when a man is not able to reach a climax during lovemaking.
This is probably the explanation as to why many men who have DE have experienced several different relationships, each of which has ended.
Having said that, cause and effect are not clear; it could be personality factors which cause the relationship to come to an end rather than delayed ejaculation; perhaps the slow arousal, orgasm and ejaculation of the man is just simply a reflection of various personality characteristics.
There is a good chance of being able to overcome all these difficulties with the appropriate psychological and physical techniques. For example, when a man no longer needs to be in control during lovemaking he will find it more easy to enjoy normal lovemaking, i.e. to reach orgasm and ejaculate inside his partner within a normal timescale.
Sensate focus can really help here. That's because when a man's objective is to focus more on his own pleasure than his partner's, and even to become more selfish in his sexual behavior, he is able to take his pleasure rather than being more concerned with whether or not his partner reaches orgasm.
Masters' and Johnson's Solution
Masters and Johnson were the first to describe a full treatment regime for DE. Basically this involved a period of abstinence from sexual activity although kissing and intimate physical contact was allowed.
The next stage was to engage in masturbation to orgasm even if this took a prolonged length of time. The third stage was to engage in sexual intercourse, where the woman inserts the man's penis into her vagina just before he ejaculates.
In essence however the best cure is psychological or emotional, one in which enables a man to be more relaxed in his approach to intimacy, as well as more in tune with his own body, and more affectionate and giving towards his partner.
If you wish to seek advice from psychotherapy or counseling organizations this is a list of those which may be able to help you. You can also obtain a list of sexual psychotherapists from the appropriate organization.
Here are some emails I've received:
I just don't know what to do. I am a 29 year old man, healthy, normal blood pressure, fit, and (I think) pretty stress-free. Yet when my wife and I make love - which we do a lot - I can pound my penis away in her vagina for ever and I just don't come. Sometimes I have become so exhausted I have had to stop for a rest. Believe me, this may sound fantastic but it is nothing of the kind.
I just can't come, and my wife is getting pretty upset about it, not because she can't have orgasms (I always make sure she is happy and relaxed through oral sex or masturbation), but because she is so concerned about what is going wrong for me. And, frankly so am I! I was always a bit slow to come, even in my college days, but then it never seemed much of a problem....now, I'm beginning to think I'm a sexual freak, not to mention the fact that I desperately want to come in her vagina and enjoy the complete act of sex and lovemaking once again.
I don't know if you would be surprised to hear that I can usually ejaculate fairly quickly during masturbation, so I know there is nothing physically wrong with me....please help...
No Ejaculation - No Baby
My wife and I have been married for eight years and we are ready to have a baby. However I am unable to orgasm during sex and that's certainly not helping matters. I am in very good physical health, 31 years old, have a normal penis, and don't have any sexually-related or other diseases. My wife is in very good physical health (30 years old), has a normal vagina, and doesn't have any sexually-related or other diseases. I can orgasm and ejaculate when I masturbate so I know my body is normal. When I do masturbate, I reach orgasm anywhere after anywhere from 10 to 30 minutes.
My wife and I have great sex, on average between 2-3 times per week and I give her multiple orgasms. She is very beautiful and very erotic. I love having sex with her, but after intercourse for 30-45 minutes straight, I just don't feel an ejaculation happening and sometimes even fake it (by using my body and vocally) because I am exhausted. My wife never seems to know the difference.
In fact, all my life with all of my sexual partners before my wife, I've had trouble reaching orgasm during sex. I have talked about it to some degree with her, but she can't accept the fact that I don't ejaculate at all. I can't stand lying to her and I really want us to have a child. Do you think I could have conditioned myself from many years, prior to meeting my wife, of having unprotected sex with many women that for fear of getting those girls pregnant, that my mind refuses to allow my body to ejaculate? Does the masturbation have an effect?
I've gone for three weeks without masturbating with no effect. I felt like I might be coming close during sex towards the end of that time period, but still nothing. Three weeks, no masturbation, sex about 10 times, and nothing. I finally caved and did masturbate. Did I ruin it? Should I abstain from masturbation entirely and just wait for it to build up and hope for the best during sex? I'm guessing this is totally psychosomatic. Do you agree? Is my guilt causing the problem? How do you NOT think about it during sex? One "will I achieve it this time?" thought during intercourse instantly kills the whole process.
Help! I have a sexual problem and it is so strange that I have never heard of it before. I don't know who else I can turn to about this issue. Hopefully, you can provide me with some advice. I started masturbating at eleven years of age. However, my technique is different from others. I put a pillow between my thighs and lie on my right side. My penis lies between my stomach and the pillow. I can achieve an orgasm by thrusting my penis against the pillow. This usually takes 4 to 10 minutes.
The strange thing is that this technique only works on my right side. It doesn't have any effect when I lay on my left side. The problem is that I cannot achieve an orgasm using the "typical" masturbation method. A hand job doesn't give me the same stimulation as the pillow.
Also, I cannot reach an orgasm during oral sex or regular sexual activity. There is just not enough stimulation. The only way I can have an orgasm is by laying on my right side and using a pillow.
My wife and I are interested in having kids. Not being able to achieve an orgasm during sex has proven to be a huge obstacle. In addition, she blames herself when she sees that I cannot have an orgasm during sex. I've told her repeatedly that the problem is with me and not her.
Editor's note: This sounds like Traumatic Masturbatory Syndrome - where a boy masturbates so hard in one way that he conditions himself to only be able to reach orgasm in that way. You can read about it here.
A Man Who Can't Ejaculate
I have a distressing question. I have met the most wonderful man. We are both 47 years old. We live in separate states and have begun a wonderful life together and we will be married soon. The problem is that he lives so far away and he has been alone for a very long time before he met me. He has been masturbating on the average of 4 to 6 times a week for many years.
Now that we are together, we have had sexual experiences together, although, we cannot be together for too long since he must return home a lot. When we are together, he gets very aroused, but there have been times when he almost reaches a climax and then cannot come. He then loses his erection, even if his penis is inside me. Sometimes he can come, and other times he cannot.
Sometimes when he loses his erection it comes back, sometimes it doesn't. I feel rejected, even though he says I turn him on. What is the problem? Is it that he has been alone for so long, and his masturbation has made him only able to please himself?
We have decided that he must stop masturbating all the time when we are not together, so he can get used to being with me. I want to marry this man, but this problem is really getting in the way. When he does come with me, it is a long and tedious work to get him to that point. Please help us with this before it too late.
Penile insensitivity and inability to orgasm
I previously suffered from partner anorgasmia [that means I couldn't come during sex]. I could masturbate and ejaculate without a problem but during unprotected vaginal sex I could last usually indefinitely. The few times where I was able to ejaculate during intercourse I had to expend so much effort as to leave myself exhausted and both my penis and partner's vagina sore.
This wasn't a problem when I was younger but as the years go by my glans seemed even less sensitive than it used to be. The urologist I spoke to told me there was nothing wrong with me physically and that I should go see a sex therapist.
Because of the quality of the sexual banter and openness within the relationship I knew this wasn't the problem. I began reading about circumcision and I learned that my situation is much more common than previously thought.
After communicating with others who had trouble ejaculating during vaginal sex I decided I to go through the arduous process of foreskin restoration. Now most of my sensitivity has returned to the point and now I am able to ejaculate during intercourse again and with much more control over when too.
All I can say is thank God for the internet because otherwise I would have believed my doctor and thought the problem was me when really it was the result of being circumcised leaving my glans to be desensitized. I suspect this might also explain some of the other guys with a similar problem.
Difficulty ejaculating is the least recognized male sexual problem. We tend to think of male sexual difficulties with sex as either coming far too quickly or as inability to get an erection. To be aroused and to be able to thrust away in a vagina indefinitely without coming is something most men would find hard to understand. So why does it happen?
There are a whole range of degrees of difficulty with ejaculation, as with many other sexual problems: some men can only come in very specific and sometimes rather unusual circumstances.
For example, one man told me he could only ejaculate if he was being dominated by a woman in high heels who was threatening to beat him: this stemmed from his mother's repressive and yet sexualized relationship with him as a child. Some men can ejaculate but experience no sensation of orgasm (this is a surprisingly common problem). Some men have an orgasm but do not ejaculate. Others simply cannot ejaculate at all. Are all these problems are related, or do they have different origins? Why would this all go wrong?
There are actually many reasons.
First, as a man gets older, it can become harder for him to reach orgasm. This is partly due to declining testosterone levels and partly due to a decrease in the sensitivity of his body to testosterone. he may also get less aroused because he is so familiar with his long-term partner.
Furthermore, when he does reach orgasm, it may all seem much less pleasurable than it once did because his muscles are less toned, the power of his ejaculation much weaker, and the pleasure given by his ejaculatory contractions much lower.
In addition, if he is ejaculating less semen - perhaps because of a prostate operation - this will diminish the intensity of his orgasm, too.
Second, any injury to the central nervous system, or damage from surgical procedures for prostate problems, or any other surgery in the region of the genitals, can affect the nerves controlling a man's sexual responses and cause ejaculatory difficulties.
Diabetes is often a culprit, because of diabetes-induced nerve deterioration. Drugs can be a problem too, both prescription medicines, especially some of those used to treat depression and anxiety, and non-prescription drugs for personal use.
Many painkillers compete with testosterone for the testosterone receptors on a man's tissues and thereby cause a decline in sexual responsiveness; and drugs prescribed for lowering cholesterol or high blood pressure can have an effect on a man's sexual drive. All in all, male sexuality can be a fragile thing.
The first questions to ask when a man is having sexual problems concern diabetes, excessive use of drugs or alcohol or injury. If none of these seem relevant then there may be an emotional component. By the way, something can be done in all cases, so if it isn't looking too bright just now, don't despair!
There's a list of physical problems and drugs which can cause ejaculation problems at the bottom of the page.
The emotional causes of retarded ejaculation
When a man cannot reach climax and there are no physical problems stopping him, he may be preventing himself, consciously or unconsciously, from ejaculating. This may be hard to believe, but the evidence bears it out.
Many emotions, some of which may be so suppressed that a man is unaware of them, can contribute to anorgasmia. For example, fear of being unable to satisfy a woman can be a big element of the problem.
So can fear of not living up to her expectations; fear of coming too quickly; fear that his partner will leave him, and so on. The other big culprit is anger, where ambivalent feelings exist towards a partner in a relationship - for example where both love and hate are components of a couple's feelings for each other.
The strangest aspect of many of these stories is that the men concerned have resorted to faking orgasm to try and get themselves out of their difficulties.
In many cases they will wear a condom so that the absence of flowback (seepage of semen from the vagina after intercourse) does not give them away.
However it is done, a faked orgasm introduces another destructive element into the problem, and further erodes communication between the two partners about the issue. This is not surprising, because men very often see these issues as something they should solve by themselves.
There are all kinds of male assumptions about masculine strength and weakness here: many men see it as as a failing if their penis will not get hard, thrust away, and ejaculate on demand, and they are not inclined to discuss what they see as their failings with their partner!
So the first part of a cure for non-ejaculation is good communication between the partners. Good communication not just about sexual difficulties, but about emotional issues as well.
If a man is having trouble ejaculating because he is angry about his partner's lack of sexual responsiveness, or because he senses her suppressed resentment about sex (being seen as a sex object, perhaps, and not appreciated for herself), or even at his failure to ejaculate, it can be incredibly difficult to approach the issue frankly and openly.
Some men simply do not know how to communicate emotional matters, while others have an inbuilt resistance to doing so because they see such discussions as weak or unmanly.
Other men may fear hurting their partner by speaking frankly, or may perhaps anticipate her anger if she interprets what is being said as blaming her for the problem. There is no simple route to emotional openness, especially if you have never learnt how to communicate your feelings and thoughts.
Counseling may help here, of course. But many men refuse even this option, at least up to the point where the very survival of their relationship may be threatened.
Perhaps the most common psychological reason a man has this problem is that he resents the balance of power or influence around sex in a couple's relationship.
Many men and women still cling, maybe even unconsciously, onto the belief that the man must lead the way in sex, or that a woman is less sexually responsive than a man, and that her orgasm and sexual pleasure are something that he must "give her" - and, by implication, therefore, that if he cannot give her an orgasm, or even sexual pleasure or satisfaction, then he has failed as a lover, and perhaps as a man.
There is also a great deal of pressure on men to see themselves as sex machines, with a hard penis ready in an instant to make love.....but the truth, of course, is that male sexual desire can be as delicate as female sexual desire.
But unless a man is emotionally mature and the couple are in a loving, trusting relationship, he may find it difficult to express his self-doubts and feelings. And this all assumes that there is no unexpressed resentment or anger eating away at the relationship, which unfortunately is rarely so in cases of DE.
Such anger can take many forms, and can have many causes. In one case, a man who could not ejaculate was angry at his partner because she was more successful in her career than he was in his.
She spent a lot of time away from him, and he complained that the only time they had together was when they were making love.
It seemed almost as though his non-ejaculation was an attempt to hold onto her for longer...or maybe a way of punishing her for not spending more time with him? In many many cases, couples with difficulties of orgasm are angry, resentful, ambivalent or have some other underlying emotions affecting their relationship.
When a man cannot come during intercourse, it may be a problem with every woman he has sex with, or only with one particular partner. The latter condition is called "partner-specific anorgasmia".
Men who experience anorgasmia or retarded ejaculation admit to feeling hostile or turned off by their female partners, yet they have astoundingly long lasting penile erections, and they can often have intercourse vigorous and long lasting enough for the women to experience multiple orgasms.
If the problem is partner-specific, and a man can have normal intercourse with another partner, then the cause of the ejaculatory difficulty would seem to be a relationship issue.
By contrast, if the man can ejaculate through masturbation yet cannot have have an orgasm with any woman he has sex with then the problem lies in his attitude to sex and women.
Partner-specific anorgasmia is sometimes a sign that a man either dislikes, or resents, or feels hostile towards, or has emotionally rejected his partner, or that he does not wish to impregnate her, or that he wishes to deny her the pleasure of seeing him achieve orgasm through intercourse.
A manin this position often seems compelled to try and satisfy his partner, even when he doesn't experience her presence or touch as sexy or stimulating. He works hard to give his partner an orgasm, yet his own pleasure is low on his list of priorities.
This means there is a lot of hidden anger and a lot of guilt floating around somewhere in the relationship. Such men may even act as though their orgasm was designed to satisfy the woman's needs and desires rather than their own.
These men can get an erect penis even when their level of desire for their partner is very low: so low, perhaps, that other men's penises would not even stir in the same situation.
But they often feel their penis to be "numb" or insensitive, incapable of producing the gradually increasing arousal and sensation necessary to stimulate arousal and orgasm. In other words, they are not turned on, and their desire is low.
However, when masturbating, these men may find their penis is sensitive and they enjoy the sensations of touching it themselves. They enjoy the ever-increasing sensitivity and arousal that leads to orgasm and ejaculation.
One of the strange things about partner specific anorgasmia or retarded ejaculation is that the man concerned can masturbate to orgasm successfully.
In fact, many of these men admit that they really prefer masturbation by their own hand to intercourse. (There may be many more men like this who avoid sexual partners altogether and are therefore never identified as anorgasmic during intercourse.)
Perhaps this is because only when free of the compelling need to satisfy his partner, can a man like this enjoy his own touch, his own sexuality, and his own orgasm.
About 35% of men who are treated for retarded ejaculation will say that they like their own touch on their penis better than that of a partner because "after all, who would understand it better than me...I've been doing it all my life!"
Men who think like this may also feel guilty that they actually may prefer their own stimulation to being with a partner, and so they lock themselves into a cycle of ever more desperately wanting to please their partner but resenting the feeling that they "have" to do so.
The goal of the "normal", by which I mean "traditional", therapy for this problem is a form of progressive desensitization.
To cut a long story short, this involves him masturbating to orgasm many times, but each time he does so, his wife or partner is more closely involved in the process, until eventually he is able to put his penis inside her and ejaculate in her vagina.
The crucial aspect of this treatment, on which it relies for its success, is the intensity of the level of stimulation of the man by his partner, and his ability to switch off his critical faculties and lose himself in his sexual fantasy.
The more stimulation, the better, is how the logic goes, so often the suggestion is made that the man uses porn to increase his arousal, or has his female partner dressing up or using sex toys or talking dirty or whatever turns the guy on.
It will not, however, have escaped your notice that this method make no mention of the need to resolve the relationship issues that may lie at the root of the sexual problems.
[Another variation of retarded ejaculation - emission but no ejaculation
In some cases - a very few cases - a man will achieve an erect penis, be able to enjoy intercourse, and feel himself enter the emission stage of ejaculation - the part where semen is expelled into the upper passages of the penis - but fail to achieve the powerful expulsion phase of ejaculation, which is the part of the ejaculatory response where powerful contractions of the muscles around the penis expel the seminal fluid with the accompanying sensations of physical pleasure and emotional release. According to sexual therapist Helen Kaplan, men with this challenge are often over-critical of themselves, and concerned about their performance. Treatment has been the same as for retarded ejaculation - as described above.]
The conventional treatment outlined above often seems quite cruel - at least to the guy's penis!
The manual stimulation that is an essential part of the treatment is often aggressive and forceful, since this roughness may be necessary to stimulate his ejaculatory reflex.
And even where the problem only exists with one partner, the man who cannot have orgasm during sex is often seen as being at fault, even though it may well be perfectly reasonable for him not to want sex, or to experience some negative feelings towards his partner.
It may, in fact, be relationship therapy that is needed, not sex therapy! It's a strange fact, though, that this treatment does sometimes work: at least, it restores the guy's ability to ejaculate in a vagina.
This treatment has also been criticized because it demands so much of the man - that he almost be made to give up his orgasm - and this from a man who may be having sexual difficulties in the first place because he resents having to give so much to his partner, whose role in the relationship may be passive and unassertive anyway.
Many a man like this experiences sex as a continuous demand for performance, but has no way to experience himself as being used.
Instead, he has flashes of disgust and/or hatred for his partner. He may also feel disgusted with his own ejaculate, as expressed by a fear of soiling his partner with it. This may be a sign of his turned-off state.
People in a sexual situation but not aroused often have disgust reactions that disappear when they are aroused.
(See Principles and Practice of Sex Therapy, ed., Sandra Leiblum, pub., The Guilford Press, 2000.)
Another difficulty is that the rough and intensive masturbation necessary to get the man to the point of his orgasm and the insertion of his penis into her vagina are heavy demands to place on the female partner who may be resentful and frustrated about her partner's inability to ejaculate.
These demands may be made worse if she knows only too well that the man is simply not aroused by her, a fact that she will sense if it is true. None of this seems like a recipe for a happy resolution of the problems.
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