Delayed Ejaculation (DE)
As the saying goes, what goes up must come down, and the penis is no exception. However, some men face the “rising” issue of delayed ejaculation (DE)—an umbrella term that describes an orgasm that takes longer-than-usual to achieve, or may not happen at all. Historically, incidences of DE were relatively rare compared to other male sexual problems, such as erectile disorder or premature ejaculation. Today, there are new factors contributing to DE’s increased prevalence.
Orgasm and ejaculation in men are two separate processes that often happen at the same time. However, when talking about men and “orgasm,” ejaculation is assumed to be part of the equation.
This Good in Bed mini-guide is based on a conversation with Dr. Michael A. Perelman, a sex therapist and co-director of the Human Sexuality Program at Cornell Hospital in New York City.
Table of Contents
Factors contributing to the rise in cases of delayed ejaculation.
Having an erection, but not being sufficiently turned on to reach orgasm.
Emotions his partner might experience.
Delayed ejaculation caused by feelings of guilt and shame.
How “holding back” emotions can lead to delayed ejaculation.
Delayed ejaculation as an indicator of a larger health issue.
Link between delayed ejaculation and frequent masturbation.
Delayed ejaculation and faking orgasm.
Delayed ejaculation and its affect on a relationship.
What type of expert to see for help.
First and foremost, millions of men of all ages are now taking SSRI-based anti-depressants such as Prozac, Zoloft or Paxil. These drugs not only have the side effect of delaying orgasm and ejaculation but, in many cases eliminate it altogether.
Rapid proliferation of Internet porn also plays a role in the rise of delayed ejaculation. The reason is that easy access to porn has made frequent masturbation among men more common. This can lead to an increase in the time it takes to reach orgasm and ejaculate during real sex. The result: With so many varieties of porn at their fingertips, men who get in the habit of having a steady flow of sexual novelty and intense visual stimulation, have a more difficult time reaching peak levels of sexual arousal with their real-world partners.
Also, men with delayed ejaculation may get physiologically aroused when with a partner, but they are mentally disconnected and cannot focus enough climax. These psychological causes can include: Not wanting to get a woman pregnant, bottled-up anger, and control issues. Recently, there has also been an increase in delayed ejaculation among men who are anxious about the economy, often related to job loss and financial stress.
Medication that treats erectile dysfunction such as Viagra, Levitra and Cialis often reduce the amount of stimulation required for a man to achieve an erection. However, it causes some men to erroneously think they are sufficiently turned-on when in fact they are not. The reason is they have a physical sign of being sexually excited (an erection), but they are not emotionally and psychologically aroused.
We often think of men getting erections merely from the thought of sex, let alone physical touch. Partners generally think, “If he has an erection, he wants to have sex. If he is not hard, then something must be wrong.” The same is true for orgasm. If he does not climax, the partner may take it personally. In these instances, it is not uncommon for a partner to question their own attractiveness, feel angry and resentful, or experience a range of other emotions.
Psychosocial and cultural factors often play a significant role in cases of delayed ejaculation. For example, religions that are extremely structured and strict in their views related to sexuality (those in which masturbation and/or sex outside of marriage is forbidden or discouraged), generally prevent people from learning about and experiencing sexual pleasure. Ultimately, this can hinder a person’s sexual self-expression when they feel it is appropriate to become sexually active. Or, their shame and guilt can inhibit them from truly immersing themselves mentally and emotionally in the experience of sex. Some of these men will even develop odd masturbation styles that require more friction than usual, and they end up training themselves to reach orgasm through a masturbation pattern that is very different from what it feels like to be stimulated by a partner.
Control issues frequently play a role in delayed ejaculation. Generally speaking, there are men who have trouble letting go and experiencing pleasure in various aspects of their life—including their sex life. Or, they have sex to be able to brag about the number of partner they have had, but in the end they are not really immersed in the sensuality of the sexual experience. There are also some men who do not use their mind to enhance arousal, and always rely on routine types of touch to get turned-on. They might not even be aware they are mentally disconnected or know that their enjoyment of sex could be different. As these men age and start to deal with erectile problems, they may turn to drugs such as Viagra or Cialis. Ultimately, medication is not enough because the critical missing piece is the ability to be mentally immersed in the experience of sex, and forge a sexually intimate connection with their partner.
Our sexual health is a barometer of our overall health, and delayed ejaculation can be a sign that something else is not functioning properly. For this reason, it is important to distinguish between something related to the chemistry and biology of the body itself, and additional factors like medication, illness, injury or surgery that can disrupt healthy functioning.
For men who take prescription drugs, it is important to pay particular attention to potential side effects. This is especially true of anti-depressants that raise serotonin levels. Men do not have to choose between sanity and a sex life, but it is important to address the issue with an experienced prescribing doctor. Also, as men age, it is common for their prostates to swell and to interfere with urination. As a result, alpha-blockers are commonly prescribed, leading to DE.
When a man masturbates, he is often applying significantly higher levels of pressure and friction than real intercourse provides. So, he may get used to a different kind of physical feeling. Additionally, age can exacerbate the situation, as it is perfectly natural for older men to experience longer refractory periods (the time between erections), but also an increase in the time it takes to reach orgasm and ejaculate.
As a result, there are a lot of men who can only get past the point of no return via oral sex, or manual stimulation (usually their own). The bottom line: If a man with delayed ejaculation is masturbating more frequently than he’s having sex with his partner, then it can be helpful to take a masturbation-break.
Contrary to conventional wisdom, men can fake it, and often do without detection. It is actually pretty easy when he is using a condom. Even if a man is having sex without a condom, he can likely come up with an excuse like, “Well I came, there just wasn’t a lot.” In general, it takes about two minutes for a man to fully lose an erection after he ejaculates. When a guy fakes his orgasm and ejaculation, it is easy to be fooled since it is natural to have some time before his penis becomes flaccid.
Not talking about delayed ejaculation-with a partner, doctor, or therapist—can negatively affect each partner and the relationship. Men with delayed ejaculation may feel anxious about their sexual performance, have low self-esteem, and face other emotional consequences. Partners may question their own attractiveness, feel angry and resentful, or experience a range of other emotions.
The good news is that talking about delayed ejaculation is not as difficult as talking about erectile disorder or premature ejaculation, as guys with DE are able to get erect as well as last longer—two sources of male pride. It is easy to get the conversation going by saying something outside of a sexual situation like, “Hey, I feel like you are a little disconnected during sex, or that you’re not enjoying being with me as much as you could. Is there something on your mind? When he asks “What do you mean?” a partner can say, “Well I have noticed it takes you longer to reach orgasm or that you can only get there in certain ways. What can I do to help?”
By understanding delayed ejaculation and being aware of the factors that might cause it, couples can be on the same page, strengthen their relationship and get back to enjoying an intimate sexual connection.
It can take a lot of courage to seek help for delayed ejaculation. Some men may get help on their own, and others may go with their partner for support and to work through the issue together.
If a man thinks something may physically be wrong, it can be helpful to see a doctor. Making an appointment to see a urologist to do some general tests can help narrow down or rule out the cause.
If the cause may be psychological in nature, it's helpful to see a sex counselor or sex therapist. In general, sex counselors and sex therapists tend to get specific training about sexual issues that sabotage sexual satisfaction. It is important to find a counselor or therapist who is certified by the American Association of Sexuality Educators, Counselors and Therapists (AASECT). As, experts with this certification have had training related to both relationship issues and sexual concerns.
A sex coach can also help individuals and couples. They tend to work on issues in the present, and through communication and home activities help get to the root of the issue providing education, support and guidance for an individual or couple to set and reach their goals. In regard to DE, when the cause is not deeply psychological in nature, coaching can be helpful. Since many people can call themselves a "coach," it is best to find one that has a graduate or doctoral degree in human sexuality and certification from AASECT as a sexuality educator, counselor or therapist.
Following is a quick reference guide for the various academic degrees and licenses a mental health professional might obtain:
- Psychologist: Usually has a PhD, PsyD or EdD in psychology or other mental health specialty.
- Social Worker: An MSW pr PhD in social work.
- Counselor/Therapist: An MA or MS in clinical psychology, counseling, mental health, or sexology.
- Psychiatrist: An MD in psychiatry, generally licensed to prescribe medication. Some, not all, psychiatrists are trained to provide therapy, in addition to prescribing medication. Many people see a psychiatrist in conjunction with a therapist.
- Sex coach: Ideally has a M.A., M.S., or Ph.D. in human sexuality.