Delayed or Retarded Ejaculation
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When A Man Can't Ejaculate, Is It Because Of Inhibition Of Sexual Impulses Or Lack Of Sexual Desire?

There are two basic theories to explain why a man might not be able to ejaculate the first involving inhibition of sexual impulses, and the second involving a lack of sexual desire (a "desire deficit").

Helen Singer Kaplan came up with the inhibition model, and Bernard Apfelbaum came up with the desire deficit model. And the treatment strategies for these two theories are very different.

Kaplan's method of treating retarded ejaculation was to encourage the man to ejaculate intravaginally by using strong stimulation of the man's penis, gradually bringing him nearer and nearer to his partner's vagina, before finally having him ejaculate inside her.

This has been criticized as "aggressive". And indeed it is.

Yet an approach which simply consists of trying to understand the psychological forces at work in the man's subconscious might also be criticized because delayed ejaculation is partly a couple's problem, not the man's alone.

So any effective treatment program requires a suitable combination of approaches which work together effectively.

The first thing that a sex therapist might suggest is "guided stimulation techniques".

Techniques To Achieve Ejaculation When A Man's Unable To Ejaculate

But first....

A video worth watching if you suffer form the inability to ejaculate

If delayed ejaculation is an unconscious process, caused by something that inhibits the man's sexual responses, one approach to solving his ejaculatory difficulty is to find a way of enabling him to drop his excessive control.

And also increasing the sexual stimulation he's receiving so he can reach the point of ejaculatory inevitability.

The first option to do this is to use a desensitization process that helps him ejaculate intravaginally.

And this might be combined with guided stimulation exercises using sexual play and sexual fantasy which take the man's mind off his fears of failure and reduce his performance anxiety.

A graded series of desensitization exercises might start from a man's existing sexual capacity which might be, for example, masturbating on his own in private and lead up towards the goal of intravaginal ejaculation.

Desensitization has to be done creatively. So, for instance, if a man is only able to ejaculate without his partner present, then the first step may literally be that: self-stimulation to the point of ejaculation in the absence of his partner.

The next natural step would be to have his partner somewhere in the house, an adjoining room, perhaps, and then finally in the same room.

Of course the man has to have a high level of sexual arousal throughout the process, so techniques to increase this, and to reduce his anxiety, are essential.

A couple could use as many steps as they need to allow the man to finally feel comfortable with the idea of ejaculating his partner's presence, and from there might move to sexual stimulation by the sexual partner until the man is near to climax.

At this point, the "bridging maneuver" can be used. This involves the man receiving stimulation until he's close to orgasm and ejaculation, and then promptly inserting his penis into the vagina, where he experiences his orgasm.

Sexual stimulation of the nipples, anus, prostate or testicles can help achieve this.

Diagram of the prostate location should you feel moved to try prostate stimulation.

Because the man needs to feel comfortable with what's going on, he is often instructed to be "selfish" and experiment with sexual techniques, to ensure he feels comfortable in "using" his partner only for the purpose of sexual gratification.

There is lots more information about how this technique can be adapted to use at home successfully in the treatment program.

One of the key factors, though, is that the man should only engage in sexual intercourse when he is adequately aroused (i.e. likely to have an orgasm).

Remember, low arousal is one of the characteristic features of delayed ejaculation.

A great approach to treatment is to combine desensitization exercises with some kind of approach that reframes the man's beliefs and attitudes towards sex.

So, for example, this might be about getting a man to acknowledge his true feelings around sex (for example, does he really want to have sex with his partner?) and also around his lack of sexual arousal (what really turns him on?)

But it's also important to deal with fundamental aspects of delayed ejaculation like the belief that a man should be "more giving" to his partner during intercourse.

All the other faulty myths and false beliefs that men hold around sex can inhibit their sexual expression and ability to ejaculate.

That means one objective of any treatment program must be to draw these out, examine them, and reframe them into more realistic beliefs and ideas about sex.

So, for example, if a man believes that he is unable to give sufficiently to his partner during intercourse, he may be encouraged to see that the problem is actually that he's unable to take his own pleasure in sexual interactions with his partner.

Similarly, the reasons for his need to have excessive control over his own emotional and physical release during intercourse can be examined and reframed. Is this a bigger issue of a need to be in control generally?

The partner should be involved in this because she often believes that the man's delayed ejaculation is somehow a form of rejection.

In fact, when a woman can understand that her man is actually trying too hard to have his own orgasm for her benefit, she's much more likely to be sympathetic and ready to assist with treatment.

Continued in the next column.

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Cognitive behavioral approaches

These tend to combine features of both the inhibition and the reframing approach to treatment as described before in the left hand column of this page.

We know a lot of men with the inability to ejaculate use high-frequency and hard masturbation methods, and we know a lot of them also find it hard to translate their own inner world of erotic fantasy and imagery into the reality of sex with a partner.

To overcome these problems, it's possible for a couple to integrate the man's masturbation fantasies into their sexual activities, which tends reduce guilt and increases the likelihood of a man reaching orgasm.

Simple tricks can be very enlightening: if a man simply switches hands while masturbating, he may immediately see much more clearly the kind of stimulation he needs to reach orgasm and ejaculate.

For example, if he can't masturbate to orgasm with his own left hand, then it's hardly surprising that his partner also fails to do this for him!

So from a cognitive behavioral point of view, the basic strategy to treatment is to identify the man's inhibitions and fears and develop sexual scenarios and techniques that help to overcome them.

When they are explored, some might lose their power, others might be accepted and worked around. The point is that the man and his partner can change their sexual behavior and find "orgasm triggers" that excite the man enough to reach orgasm.

These orgasm triggers are very important. Some common ones include nipple stimulation and anal stimulation.

Make sure your partner knows what excites you during sex!

In addition, targeting faulty beliefs and encouraging a change in attitude towards sex is just as important.

This may involve something as simple as showing the man how to ask his partner for increased intimacy and different types of sexual experience, or something as sophisticated as exploring the beliefs about sex that inhibit the man's arousal.

When a couple manage to work together effectively on curing retarded ejaculation, the likelihood of success is much greater.

Mutual involvement in sexual pleasuring is an essential element of any treatment strategy, as is better communication: the level of verbal and physical intimacy between the partners is always improved with better communication, because good communication overcomes emotional isolation and sexual inhibition.

As I've said before, one of the main things about getting over problems with the inability to ejaculate is ensuring that you and your partner are communicating effectively about what's going on in the relationship in general, and sex in particular.

Another factor to be aware of is that when men "automatically" get an erection, it doesn't necessarily mean they're ready for intercourse.

To understand that an erection doesn't necessarily mean a man is aroused, and that he need not immediately engage in sexual intercourse when he gets hard is really important.

Both partners can be selfish in enjoying sexual stimulation and experiencing and savoring the eroticism of their interaction. This "selfishness" which is more about him ensuring he gets his needs met tends to increase the man's arousal and makes it more likely he's going to achieve orgasm.

This can be encouraged by knowing what will trigger his orgasm: various possibilities include discussing fantasy during intercourse, testicle stimulation, stimulation of nipples or anal area.

Orgasm triggers tend to be very different from person to person but can be easily identified by the man during masturbation before being brought into sex with a partner.

There are many other important questions that need to be asked as well. For example, what underlies the man's delayed ejaculation?

Sidebar: Physical causes of delays in orgasm

What factors are hidden beneath the surface? You may wish to consider what's at risk for the man and his partner if he gains normal sexual function.

In other words, what are the consequences for him and for his partner if the symptoms of delayed ejaculation disappear, and what the consequences if they remain?

There are many subconscious fears and other emotional feelings attached to sexual behavior. For example, if the man was to gain normal sexual function, his partner may be worried what might happen.

Would he, for example, want to catch up on his missed sexual experience with other women? If he was able to ejaculate in a timely fashion, would that perhaps expose the fact that his female partner didn't enjoy sex or was anorgasmic (unable to achieve orgasm)?

These are the sort of questions that need to be exposed and dealt with during therapy and treatment, because left unattended, they can often prevent a successful treatment outcome.

Updated August 11, 2016