"How complex the human body is and how lucky are we to have people out there with the know how to tweek and fine tune it to keep it in suitable working order." - Susan
Delayed ejaculation (retarded ejaculation)
I have seen a number of males with this problem. In a little over half of these cases, the man was eventually able to reach orgasm inside his partner's vagina.
Term watch
The old term for this condition was 'ejaculatory incompetence'.
Most sex therapists now prefer to say delayed or retarded ejaculation.
To add to the confusion, you may find it referred to by other names such as:
- ejaculatory dysfunction
- ejaculatory overcontrol
- anejaculation
- inhibited orgasm
- situational retarded ejaculation.
Usually the man can achieve orgasm with masturbation, or lovelplay, but not during sexual intercourse.
Rowlands said that this disorder causes 'considerable distress, anxiety and loss of sexual confidence'.
It often has a damaging effect on a couple's relationship, particularly if the woman wants to have children.
How common is delayed ejaculation?It is the third most common male sexual disorder after impotence (erectile dysfunction) and premature ejaculation. However, it is nothing like as common as the other two.
Delayed ejaculation is not easy to treat: only 58 per cent of cases I've seen were significantly improved by treatment.
All of the successful couples were well-motivated and willing to persevere with long-term therapy.
Because this disorder is not as common as the other two main male sexual problems, there is remarkably little medical literature on this subject. Exceptions are the pioneering works of Masters and Johnson, and of Helen Kaplan and her associates in the USA.
Beware: some material which you can find on the web in 2009 is very misleading and may be designed to extract money from you for 'treatment'. Some sites confuse DE with PE.
What causes delayed ejaculation?
Many of the men tend to have had a strict upbringing and are very controlled in their lives.
Some have terrific drive and detachment, and have risen to the top of their professions. A surprising number have been in the finance industry.
Some of them readily admit to having quite controlling personalities. Very often this is directed inward rather than at other people.
Some of them readily admit to having quite controlling personalities. Very often this is directed inward rather than at other people.
They may have difficulty in showing emotions and in 'letting go'.
Other possible factors include:
- fear of causing pregnancy
- fear that the vagina is dirty
- over-strict religious upbringing
- latent homosexuality.
Is delayed ejaculation always a psychological problem?
Nearly always, but there are exceptions.
Age and climax
Quite a lot of men find it's not as easy to climax as they get older.
They have good erections, but do not always get to orgasm.
This phenomenon was first noted by US researchers Masters and Johnson.
It is not the same thing as delayed ejaculation, which first occurs in a much younger age group.
- Medication: ejaculation problems can happen suddenly in men who have had no previous difficulties, but who have been put on certain medication, particularly antidepressants. In these cases, a change of tablets will usually cure the problem.
- Excessive use of alcohol can also cause difficulty in ejaculation, as can some recreational drugs.
- Serious spinal injuries can also create major problems with achieving ejaculation. They are outside the scope of this article, but it is worth noting that men who have this type of injury can produce an ejaculation, and therefore father children, by means of electrical stimulation of the prostate area (electro-ejaculation). There have also been recent claims that high-frequency vibrators may help.
Why does delayed ejaculation cause problems?
In your youth, you may not feel that you have a problem and may well assume that other men are the same.
When you first have sex with women, you may be very popular because you can keep going for two or three hours.
But when you get into a regular relationship, especially if you hope to have children, delayed ejaculation can be a major problem.
Both the man and woman may become sore and frustrated, and the female partner often feels resentful or even insulted that her man does not ejaculate when they make love.
Not surprisingly, it is common for men with this problem to have had several broken relationships – because their partners have decided that they want somebody who can 'come'.
Sometimes the man seeks help after a divorce. More commonly, a couple may ask for treatment when they are desperate to have a baby.
Unfortunately, there is no instant cure. At present, there are no drugs that will make a man come.
But there is a good chance of putting things right through counselling, provided both the man and his partner really want to cure the problem.
Counselling
The object of therapy is to gradually diffuse the man's anxiety about giving up control so he can climax inside his partner without difficulty.
The most common method is based on the work of American experts who have developed behaviourist ways of helping the man to relax and 'let go' when he is with his partner.
Generally, the man can reach orgasm by self-masturbation and maybe through love play, but not through intercourse.
So the therapist may encourage the couple to gradually proceed to a situation where the man can ejaculate just outside his partner's vagina, and eventually go on from there to a more 'advanced' situation where he is able to cope with ejaculating inside her.
American sex experts Masters and Johnson have also devised a slightly different therapy:
- first, the couple go through a period of treatment in which actual sex is off limits, but kissing and cuddling are encouraged
- they progress to a stage where the woman, sitting astride the man, masturbates him till he reaches orgasm - even if this takes two hours or more
- finally, they move to a situation where she lowers herself onto him shortly before he climaxes.
Other treatments
Beware of people who want to give you expensive hormones, or who try to relieve you of very large sums of money.
If you search the internet, you will find claims for Chinese herbal treatment that produces a near 100 per cent success rate. This does not seem very likely.
Claims are also made for yoga and for hypnotherapy as modes of treatment.
We want to have children. What if counselling doesn't work?
If the man cannot get to the stage where he ejaculates inside the vagina, couples can be helped to conceive by:
- IVF (test-tube) techniques
- artificial insemination (AI), in which a doctor injects the man's seminal fluid into the woman.
We know of couples who have tried 'self-insemination' without medical help. This involves getting the semen by masturbation and then putting it into the vagina.
There is something to be said for this approach, but a few women who have attempted it have ended up with injuries to their cervix (neck of the womb). Do not use any sharp instruments.
There are numerous websites that have advice on self-insemination. Many of them are aimed at lesbians, but the information can be useful for any couple.
Where can I get help?
Your GP can refer you, if he knows of one.
Other organisations that can be of assistance include the following.
- A very few family planning clinics, but they're overworked these days and are unlikely to have the time to help.
- Relate has excellent psychosexual counsellors.
- Relationships Scotland does similar good work to Relate, but north of the border.
- The College of Sexual and Relationship Therapists (COSRT) is an organisation whose members are trained in sexual counselling.
- Institute of Psychosexual Medicine is another counselling organisation whose members are all doctors trained in psychosexual therapy.
- Sexual Advice Association is just an office that providesleaflets and useful addresses, but they will try to help you find a therapist.
- There are also some private clinics, but only a few have any real experience in treating retarded ejaculation.
Can delayed ejaculation be cured?
Delayed ejaculation, also known as retarded ejaculation, is a frustrating and trying condition for both partners.
With some expert help and a determination to persist with therapy, it is possible to defeat it.
But if you cannot solve the problem, and are keen to have a baby, you should consider IVF or artificial insemination – especially if your years of fertility are running out.There is some NHS help available from psychosexual clinics. Your GP can refer you, if he knows of one.
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