Ejaculation Difficulty during sex
It is not uncommon for men to find it difficult to come. For some men it is impossible or, if possible, is a real strain. This can be a very frustrating problem. The 
problem is technically known as retarded ejaculation.
There are two possible variants on the problem. Some men find it difficult to ejaculate whether in masturbation or in intercourse. Others find it difficult in sex, but don’t have a problem in masturbation. We consider each of these separately below.
Problems in ejaculating in masturbation and in sex
Some men are very slow to come. It is not that they last a long time because they are delaying ejaculation, they are unable to come despite their best efforts.
It may be that some of them are just at the extreme end of the normal range. Just as some men are very quick, so some men are very slow. However for some men intercourse lasts for an hour or even hours without them being able to ejaculate, despite wanting to.
It is unusual to find a physical problem in men with difficulty ejaculating. In fact we do not really understand what determines how quickly someone ejaculates.
It is sometimes possible to help someone to speed up by adjusting their technique. Increasing arousal, reducing stress and stopping men straining to ejaculate can all help. Treatment can be lengthy and there tends to be a good deal of trial and error. This is a complicated problem and needs a careful assessment in a clinic and, if necessary, an examination and further tests.
Incidentally, even in men who cannot ejaculate at all, it is usually possible to recover live sperm from them medically. This means that even with a man who is unable to ejaculate at all there is a good chance they may be able to father children.
Ejaculation problems in sex but not masturbation
Some men are quite normally quick ( a few minutes) in masturbation, but very slow or unable to come in sex. In fact this sort of problem is not uncommon. A lot of men find it difficult or impossible to ejaculate into their partner’s mouth although they may not have any problems otherwise.
If you have what is called situational retarded ejaculation – you are a normal speed in some sexual activities but very slow in others then it is almost certainly psychological in origin and treatment is usually very successful. It does, however, need specialist assessment and treatment.
The only exception to this is where a man uses very vigorous stimulation in masturbation. Sometimes men are able to apply an amount of stimulation in masturbation that they cannot possible get in oral or penetrative sex and it is this which makes the difference. Again a careful assessment is required to get to the root of the problem.
The Causes And Treatment of delayed ejaculation
It’s certainly interesting to meet a man who cannot ejaculate, whether this occurs alone or with a partner. It goes against everything that we expect about male sexuality, which is underpinned in popular culture by two major images: that of the sexually inexhaustible man who is always ready for sex, and that of the man who ejaculates prematurely because he is unable to control himself during intercourse. No wonder then, that a man with delayed ejaculation should feel bewildered, anxious and incompetent as a lover. Moreover, his partner probably also feels distressed, not just because of a lack of sexual fulfillment, but also because of the implication that he doesn’t find her attractive enough to reach climax during intercourse. And, needless to say, when a couple wish to conceive, the man’s inability to ejaculate is a problem on many levels, psychological, physical and emotional.
One of the other peculiar things about delayed ejaculation is that couples will often tolerate this condition within a relationship for years, if not decades, before treatment is initiated: the precipitating factor is often the tension within the relationship generated by the man’s inability to reach orgasm and ejaculate during intercourse or the woman’s desire to have a child. There hasn’t been a great deal of research conducted on DE because the problem is both the least well-known of the male sexual dysfunctions, and has previously been regarded as comparatively uncommon. My own research suggests that up to 10% of men in the population at large may be experiencing difficulty with ejaculation at any one time, and the reason this figure has not been understood until now is probably because of the shame associated with the condition.
One of the difficulties in understanding delayed ejaculation is that both neurobiological and psychological factors could clearly be responsible for causing it; in addition, we know very little about why men have such dramatically different ejaculatory latency times anyway – if we knew more about this, we would be well on the way to understanding the converse of DE, commonly known as premature ejaculation. Perhaps because of the historical training of sex therapists, delayed ejaculation is usually viewed as something similar to female orgasmic dysfunction: that is to say, that men who have DE do have some sexual desire and can experience erection, but they cannot reach orgasm during intercourse. This might be because they have some kind of emotional inhibition which is caused by fears around loss of control, or that they feel hostile or anger towards their partner, or that they have developed and reliance on paraphilic stimuli.
Other therapist believe that the origins of DE lie in idiosyncratic masturbation during teenage years which condition the penis and the sexual reflexes within the nervous system of an individual to respond only to hard and vigorous stimulation of a kind which cannot be achieved during sexual intercourse. In addition, the therapist Bernard Apfelbaum has come up with an intriguing and provocative theory which suggests that men with delayed ejaculation are in fact not really sexually aroused, but that the autonomic functioning of his sexual reflexes leads to hard and long lasting erections with which he attempts to please his partner. Unsurprisingly, there are several treatment approaches to DE, and it’s clear that the same approach may not be appropriate in every case. It’s not always necessary to explore a man’s early sexual experiences, or his beliefs around human sexuality. Or it may mean exploring the historical origins of shame and guilt around sexuality, or it may mean exploring the man’s ability (or lack thereof) to communicate with his partner on sexual issues – often in the area of his feelings, wishes and expectations around sex.
It may be that, for example, that a man is unable to say no to his partner’s sexual (and other) demands and feels resentful while engaging in sexual intercourse, because of a compulsion to please her even at the expense of his own wishes and desires. Today there are no drugs which can be used to treat delayed ejaculation, and it’s extremely unlikely that there will be any developed in the near future. As a result, it’s been claimed that the treatment of DE requires particular support and ingenuity on the part of the therapist. I wouldn’t take such despondent view of the likely outcome of therapy, because a skilful combination of sex therapy, psychotherapy and behavioral therapy can usually produce dramatic improvements in the vast majority of cases. That’s the basis of the treatment program on this website, which appears to be successful for around 96% of the men who seriously apply the techniques described.
The Basics of Delayed Ejaculation
Of course we all know that erectile dysfunction and premature ejaculation have received huge amounts of attention in recent years, culminating in the development of phosphodiesterase inhibitors such as Viagra which allow men to overcome physically induced erection problems, and a huge focus of attention on premature ejaculation, a condition which is pretty much come out of the closet, and about which discussions are now almost socially acceptable. It’s an interesting fact that delayed ejaculation is still comparatively unobserved and poorly understood.
This might be partly because people believe the condition is uncommon (which, as I’ve already suggested, is far from true), but it may also be based on the fact that the condition is regarded as difficult to treat – this also appears to be untrue when treatment approaches are tailored to the man concerned. So let’s start with the definition.
A large number of terms have been used to label delayed ejaculation, including inhibited orgasm, anorgasmia, ejaculatory incompetence, and so on. But essentially delayed ejaculation is simply a long delay in reaching orgasm, or the complete inability to reach orgasm, after normal sexual excitement and sexual activity that would be expected to produce orgasm. Now of course not all men require the same level of stimulation to reach orgasm: but this definition, although vague, does not cause too many problems: any man who can sustain vigorous thrusting during intercourse for 30 minutes without approaching the point of orgasm, or indeed even if he does approach the point of ejaculatory inevitability but does not ejaculate, can be said to have delayed ejaculation. Like PE, those who have it, know it.
What Are the Characteristics of Delayed Ejaculation?
Well, first of all, it’s involuntary. That’s to say the man isn’t holding back his orgasm consciously. He may have DE from the very first airings of his sexual interest, in which case it is called primary DE, or he may find that it develops in later years after some initial sexual experience, in which case it’s called acquired or secondary DE. More interestingly, the difficulty that a man has with ejaculation may occur in every sexual situation, or it can be situational, in other words occurring only with particular partners or in particular situations.
Some men who have delayed ejaculation will find that they can masturbate normally while others cannot; some men will find they have nocturnal emissions while others do not. But basically the thing that unites all men with this condition is that the flow of erotic energy from sexual desire through sexual excitement and on to the final stage of orgasm is somehow inhibited or blocked. There’s no question the most common form of delayed ejaculation is the inability to reach orgasm during sexual intercourse. Often a man can reach orgasm during masturbation or even by manual and perhaps oral stimulation from his sexual partner, but he’s unable to do so during intercourse.
Men can function anywhere on a sexual spectrum covering the whole range of ability around reaching orgasm, from being able to climax during masturbation to a complete inability to achieve climax even after vigorous and prolonged thrusting during intercourse. In most cases, sexual desire is normal and a man’s ability to have an erection is quite normal. It’s also important to understand that delayed ejaculation isn’t helpful to a couple’s relationship: there is an assumption in certain quarters that prolonged thrusting can bring women to orgasm through vaginal stimulation, and while this may well be true, the fact is that the majority of couples where the man has difficulty ejaculating are marked by tension and stress, low self-esteem on the part of the man and woman, and often by soreness and irritation of the genitals that develop due to prolonged intercourse which ceases to be pleasurable.
And even those it occasions where a man can reaches climax inside his partner can be less than satisfactory because of the struggle he may have to achieve that outcome. Indeed, it is probably true to say that most men with this particular sexual dysfunction regard sex as hard work, and not as a very enlightening or satisfying experience.
Often boredom or the failure of erection or the loss of lubrication on the part of the female partner is the signal for the end of intercourse. Things are complicated when the woman feel some kind of responsibility for the fact that the man can’t reach the normal climax of sexual activity. Her feelings of guilt, shame or anger will be even more pronounced if the man isn’t able to reach orgasm in any way with her, only being able to bring himself off through masturbation when he is alone. Such orgasmic inhibition can cause extreme sexual difficulties and place an enormous burden on any relationship. It’s no surprise, therefore, that many men with delayed ejaculation feel very unhappy, particularly when it’s a long-standing problem. Often men with DE engage in sex just because their partner wishes them to, or to reassure themselves that they actually are masculine and sexually competent. It’s not unknown for men with delayed ejaculation to fake orgasm, or experience erectile dysfunction, loss of desire or an aversion to sex.
How Common Is Delayed Ejaculation?
There is very little data to tell us how common it is. Researchers have suggested that between three and 8% of men have some form of DE: my own work on the Internet and with men in person suggests that the figure is much higher: I put it at around 10 or 12%.
A Typical Case History
A Simple Treatment Approach To Delayed Ejaculation
The basic treatment approach to delayed ejaculation is a simple one. For men who have never been able to ejaculate, and that includes men who have not been able to ejaculate during masturbation on their own, an individual sensate focus program can be extremely helpful. (It’s a program that is very similar to the one used for women who are unable to reach orgasm.) One of the most important principles in such program is that the therapist must make an assumption that there is some kind of inhibition blocking the man’s orgasm, and that during any attempt to ejaculate, it is possible to reinforce disinhibition. Treatment must therefore accommodate the tendency of the man involved to become more inhibited as he feels himself getting close to orgasm.
During the sessions of gradual self stimulation, the focus should not be on reaching orgasm, or rather, the man’s attention is diverted from the achievement of orgasm when he feels close to climax – this is done by simply stopping stimulation. This simple mechanism allows sexual arousal to build up without any interference from whatever inhibition is causing the delayed ejaculation. The end result of such processes typically that man will reach orgasm ejaculate unexpectedly: and the benefit of this is that subsequent inhibition is always much reduced.
It’s easy to speculate why this might be so, but the most likely reason is that the man has experienced natural ejaculation with no adverse emotional or physical consequences. In any event, the gradual approach to stimulation needs to continue after the first ejaculation until the man has established sexual confidence and the ability to feel positive about his own sexual arousal. In therapeutic practice, it is often found that men with delayed ejaculation actually vary considerably in the ease with which they can overcome the problem. Some therapists report that younger men who have an inability to ejaculate are the easiest to help, most likely because they actually have less established patterns of sexual behavior and seek treatment earlier than the majority of men. It’s important to note that any therapist who is working with men with delayed ejaculation need to understand the parameters of a man’s difficulty in reaching climax. For example, it may be that the problem only occurs in the presence of a particular sexual partner, the man is able to ejaculate normally when he masturbates on his own, or it may be that he can ejaculate on his partner outside the vagina, but that he is unable to ejaculate internally.
Another indicator of the nature of the problem would be whether a man gets wet dreams (nocturnal emissions), because the presence of such emissions in a man who can’t ejaculate when he’s with a partner suggests some kind of emotional inhibition. In addition, it is also necessary to establish whether the man is using any medication which might be responsible for interfering with orgasm and ejaculation. Another variation, which is seen less frequently, but does occur from time to time, is a dry orgasm, in which orgasm occurs without ejaculation. This implies that seminal emission component of the ejaculatory reflex is missing, which may be induced by drugs or some kind of neurological problem, unless there is evidence of retrograde ejaculation in the form of cloudy urine being passed after orgasm.
