Delayed Ejaculation – Why it is hard to come to therapy*

By Rhi Kemp-Davies (COSRT Psychosexual Therapist and Clinical Supervisor)

“Masturbation is your superpower – if gives you a chance to pay attention to what habits you’ve formed, and where your attention goes.”

The most common reason a man comes to sex therapy this issue is when he and his partner are trying to conceive, and the second most common reason is because his partner is concerned and/or would like him to enjoy ejaculation during partnered sex. The partner may also worry that they are not attractive enough, and it can fuel relationship insecurities.  

Delayed ejaculation, put simply, is when a man is unable to ejaculate at a time when he would like to. The DSM 5 classes it as a marked delay/infrequency/absence in ejaculation during partnered sex for at least 75% of the time, and for more than 6 months. The delay would be for over 25 minutes of continuous sexual stimulation.

Biological reasons

There are a lot of potential biological reasons for delayed ejaculation:
• It could be age-related (prostatic hypertrophy, or masturbating too close to partnered sex. We expect a lengthening of ejaculatory latency or a lengthening of the refractory period in older men)
• Spinal cord injury
• Stroke
• Multiple sclerosis
• Pelvic region surgery (like a prostatectomy)
• Severe diabetes
• Alcoholic neuropathies
• Hormonal differences
• A variety of medications, including treatment for balding, or anti-depressants

It is always best to get blood tests first to rule out biological issues, before focusing on psychological reasons. If something does come up in these test results, seek a referral to a urologist.

Psychological and relationship reasons

The most common psychological/relational reasons for delayed ejaculation are:
• Discrepancy between sexual fantasy & partnered sex (this is when the man’s fantasy during masturbation can’t be matched by what they can experience having sex with their partner)
• High frequency masturbation
• Idiosyncratic masturbatory style (Perelman, 1994) – to give your penis stimulation that is difficult to recreate during partnered sex
• Power struggles in the relationship
• Intimacy blocks
• Poor communication in the relationship
• Inadequate conflict resolution skills in the relationship
• Being a ‘people pleaser’, and because of this, not being able to ejaculate when you want to.

What can you do about it

There are ways in which you can help yourself if you would like to reduce the amount of time it takes you to ejaculate (or to ejaculate full stop) during partnered sex.

Masturbation

The first exercises to try are when you are on your own, which you can then move into partnered sexual interactions. Masturbation can start being used as an opportunity to start changing your relationship to penis stimulation and orgasm.

Firstly, pay attention to what you are doing during masturbation, looking at:

• What inspired you to masturbate to begin with
• What you’re thinking about, or watching
• Speed of movement
• The pressure of hand/sex toy
• The duration of your masturbation
• Your body posture/position
• The specificity of focus on a particular ‘spot’ or ‘area’

Secondly, start experimenting with different ways of masturbating – change up the speed, pressure, and if you watch porn, try masturbating without it to see what changes. Do this with curiosity and as little judgement as possible.

Masturbation is your superpower – if gives you a chance to pay attention to what habits you’ve formed, and where your attention goes.

On the flip side, one technique to help with delayed ejaculation during partnered sex is to not masturbate as often. Prolonging the time between masturbation and partnered sex can increase your threshold for ejaculation. It can help to disrupt your normal routine and increase the probability of ejaculation.

 I cannot stress how much your state of mind affects your arousal – compassion and curiosity towards yourself are invaluable. Reduce your critical beliefs about yourself as a lover.

Porn is an effective way to either get you turned on, or keep you turned on, but also be aware that by paying attention to something your watching, it can be more difficult to stay in touch with your body and arousal.

With your partner

When you have done the above, it’s time to bring it into your relationship. The involvement of you partner is important. The more compassionate, curious and willing they are, the better the outcome is.

To the partner – there will need to be a period where it becomes more about him than you, so that you can provide that supportive space for him. Then after things feel like they are changing, you can begin to balance it back out again.

What to consider

This is a suggestion of the steps to take:

Masturbate with your partner, and then in front of your partner. Your partner can then do it to you, using the same sort of technique they have seen you use.

Start with your partner giving manual stimulation and slowly move it to oral and then when you are ejaculating more often than not, move it to intercourse. These are all very different ways of being stimulated, and the two of you can learn a lot of helpful information from this.

When having intercourse with your partner, keep bringing your attention to your own sensations, and what is happening to your penis.

Outside of the penis focused aspects, you could also benefit from changing the way you initiate sex, or what positions you use.

How Therapy Can Help?

Working with a sex therapist will help you with the above, and more. A therapist can be the voice of compassion that you might not have to begin with, it will be a place to reduce your shame and embarrassment. In collaboration with a sex therapist, you will find a way that fits you and your relationship, and will help you stay accountable. You will get the chance to expand on all of the information written, with guidance, and at your pace.

*This article is focused on cisgender, endosex men

Resources:

Here are a couple of websites to help you with delayed ejaculation:

Sexual Tipping Point – https://www.mapedfund.org/

Mojo Men – https://mojo.so/

References

Laumann, E. O., Paik, A., Rosen, R.C. (1999). Sexual Dysfunction in the United States: Prevalence and predictors. Journal of the American medical Association, 281(6), 537-544.

Perelman, M.A., & Rowland, D. (2006). Retarded Ejaculation. World Journal of Urology, 25(5) 645-652 27-33

Perelman, M.A. (1994). The urologist and cognitive behavioral sex therapy. Contemporary Urology, 6(1)