Delayed Ejaculation (retarded ejaculation)

"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.

What is delayed or retarded ejaculation?

The terms 'delayed ejaculation' (DE) and 'retarded ejaculation' (RE) mean the inability of a man to reach a climax inside the vagina.

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.

Writing in the World Journal of Urology in 2007, Dr Michael Perelman and Dr David 
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.

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.

What can be done for men with delayed or retarded ejaculation?

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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Starting Again: Lovers to Avoid

Starting Again: Lovers to Avoid

We're at our most vulnerable when we venture back into the dating game after a relationship break-up.

But if this is the stage you're at, take heart. You have loved before. You can love again.

First though, do ask yourself if you really are ready for another relationship.

If you still hope that your ex will come back to you, or if you still weep about the loss of that relationship on a regular basis, or if you are still furious with your past partner, then maybe you should wait a while.

My article 'How to get over being dumped' may help you. You may also find it useful to do the interactive test on self-esteem and to read the 'Self-esteem' article.

In addition, you may need more support from friends and family to help you recover after your past relationship.

It would be a good idea to have a few months discovering that single life can be fun, and you could also try to do all sorts of enjoyable things for yourself that may have been neglected during your relationship.

And if you really can't get over your sense of regret, distress or anger, you might even want to consider having some therapy.

But let's assume that you are feeling better about the past, and about yourself, and that you are genuinely ready to meet someone new. Well, it would be great if you suddenly met the perfect person who embodied everything you want – good looks, companionship, humour, love, romance and terrific sex all in one delicious package. But life is not always that kind.

And you may instead encounter people who have certain problems – and some of these individuals might be best avoided right now.

1. The selfish lover

If you have got out of a previous relationship because the sex wasn't up to much, you probably don't want to entertain the thought of a selfish lover now you are starting again.

For instance, men tell us all the time about wives or partners who demanded lots of love play, but once they'd had their orgasm used to get impatient and say: 'Hurry up and finish now.' This is very wounding for a guy.

Men have also told us how their partners have sometimes said: 'Well, if you must have sex, just do it and get it over with' while they have laid on their backs and made no attempt to be loving in any intimate way.

Obviously this is horrid for a man. So, it you're male, and starting again, you probably want to avoid any woman who is selfish and unloving or unenthusiastic in bed.

Men too can be incredibly selfish. About 20 years ago, we coined a phrase, 'the roll-on, roll-off Romeo', for males who just wanted to satisfy themselves through intercourse, but could not be bothered to indulge in the sort of love play and caresses that might satisfy a woman.

We believe that such males are a dying breed now. But if you happen to meet up with one, we suggest that you can do much better.

2. The never-on-a-Sunday lover

This is someone you might meet who is eager, and sexy and seems very keen on you but who never stays a whole night with you and who is never available on Sundays, Bank Holidays or at Christmas. The reason of course is that he or she is married.

Now, it could be that this doesn't matter to you because you are not looking for a permanent, one-to-one commitment.

After all, you may have decided that it's time for a little fun and that you're not ready for anything serious. But do remember that though you may think you just want uncomplicated sex, you might find that you fall in love with this person. And that could be painful, because he or she is not free to be with you – and might never be.

If you're suspicious, always ask him or her about their marital status. Once you know the truth, you may decide that you don't mind that this person is with someone else. But you might mind very much.

So, before you get too attached, ask yourself, truthfully, what you want from a partner. If it's a serious, committed relationship, or you're on the lookout for someone to make babies with, then avoid the never-on-a-Sunday lover.

3. The lover with a sexually transmitted infection

The most common male sex problems
 are premature ejaculation, erectile
dysfunction and delayed ejaculation.

No new partner turns up with an 'I have a sexually transmitted infection (STI)' sticker on his or her forehead, so always use condoms until or unless you know your new lover's sexual history.

Unfortunately, there are loads of adults out there who have STIs, such as chlamydia, but who simply don't know they have them.

But if individuals have something serious like herpes then they do usually know about it, and hopefully they will discuss this with you at the earliest opportunity.

Then it will be up to you to decide whether you are happy to be in a relationship with such a person, or not – bearing in mind that you will need to take safe sex precautions most, if not all, of the time.

4. The lover with a sex problem

It's no one's fault if they have a sex problem, but you might want to be aware of the sorts of difficulties you could possibly encounter, and whether or not such a relationship could still work for you.

Female sex problems

Your new female partner may have difficulties that are easily remedied, such as vaginal dryness. Or she may be shy and need some encouragement. Or perhaps she has always been unable to orgasm and this may be something you want to discuss.

More seriously, some women actually have a fear of penetration. Such females may sometimes like foreplay, and may indeed have orgasms during it, but they then feel uncomftable when any approach is made to the vagina.

This condition, which is called vaginismus, can be treated. But it has to be said that improving the situation may take quite a while, and also that in some cases the outcome is not very positive.

Other women, who may be very keen on sex, actually have pain on intercourse or painful orgasms.

Often, as you will see from the articles we have linked to, something can be done and a good sexual relationship can develop.

Male sex problems

The most common male sex problems are premature ejaculation (PE), erectile dysfunction (ED) and delayed ejaculation (DE).

If you read the relevant articles, you may decide that if a man has any of these difficulties, you can overlook them – so long as the rest of the relationship is going well.

But do be aware that if you are hoping to get pregnant, all three of these conditions can make that difficult.

PE can also be very frustrating for a woman because it can be extremely difficult for her to get any satisfaction out of intercourse.

However, there is nothing to stop a man with this condition from giving his partner orgasms through foreplay. The article above will tell you all about treatment. And if you want the relationship to last and to be a satisfying one, it would be a good idea if you and your man explored the treatment options.

Whatever your age, erectile dysfunction in your partner can be distressing for him – and for you. But nowadays, with really good drugs available, such as Viagra and Cialis, the vast majority of men can produce good erections and enjoy sex well into old age.

Delayed ejaculation is, unfortunately, not nearly so easy to deal with or treat. Basically, men with this problem find it hugely difficult, or impossible, to ejaculate into their female partners.

Initially, if you meet a man who cannot 'come' inside you, you may not be all that bothered.

In fact, you might enjoy sex with him because the chances are that he can go on and on thrusting inside you – and you might enjoy that. But men with DE are often rather buttoned-up about sex, and you might find that this becomes irritating and wearisome after a while. And also you may begin to resent the fact that he will never 'let go' in bed.

However, unless you want to become pregnant – which would be very difficult – you may decide that there are worse things than being involved with a man with DE, especially if he is a kind and loving guy.

In conclusion

Now that you are starting to date again and looking out for love and good sex, there are some problems that you may encounter. But few of them are insurmountable, and with the amount of information and advice available, you may well decide that you can cope with such difficulties.

However, having read this, you might make the decision that there are some types of lover who would be better avoided – particularly now, when you are hoping for a rather more special experience than you may have had with your ex.

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