Sex Therapy For Men With Delayed Ejaculation

Psychological Treatment 
For Men Unable To Ejaculate

The first step in treatment if you see a sex therapist is likely to involve some kind of assessment of when you can actually achieve orgasm in sex.

And here a number of typical questions that you might like to think about… questions that are relevant for the therapist and client alike!

  • Does the man experience performance pressure right from the start of intercourse or does it begin later on?
  • To what degree does the man feel himself to be “spectatoring”, that is to say detached from the sexual process in which he is engaged with his partner, and to what degree does he feel himself fully involved from moment to moment?
  • Does the man have sexual fantasies, and does he accept them without guilt or shame?
  • Does the man focus on satisfying his sexual partner, or is he also aware of his own needs and does he set out to have them fulfilled?
  • Does the man believed that his partner is interested in sex with him, or that she is just tolerating it?
  • Does the man feel any anxiety or apprehension around the prospect of orgasm and ejaculation (especially intravaginally), or alternatively with the loss of control that he may feel if he ejaculates?
  • And finally – how does the man with difficulty ejaculating masturbate? Does he use internal erotic imagery or sexual fantasies and accept these easily or try to repress them?

These questions are designed to address the issues that a man seeking a cure for delayed ejaculation may face during sex. Other deeper issues generally emerge as therapy continues.

Short Term Treatment Measures

In the short term, there is considerable benefit to be achieved from the man reducing his masturbation frequency. If he’s using hard or idiosyncratic techniques to masturbate, switching to high quality lubricants such as massage oil and gentle movements of his hand are also helpful.

However, what achieves great success are sensate focus-type exercises. These bring a couple into closer connection with their own sexuality and the intimacy that it can bring to each other. They also help produce a “relaxed” attitude to sex.

Men who have difficulty revealing their feelings may need some coaching in opening up and showing their feelings. Here’s a helpful article for women who may be reading this.

It’s important to find some motivating factor. For example, Viagra can help a man who is not experiencing good erections. This increases the prospect of satisfying intercourse and enjoying ejaculation during intercourse.

Desensitization As A Way To Reach Orgasm

Men who have difficulty ejaculating may feel a degree of sexual inhibition or disconnection.

In such instances, desensitization is a great technique. This employs a gradual approach which allows increasing experience of sexuality, intimacy and mutual touching. All of this can be done as non-anxious sexual behavior with the man’s partner.

couple making love
Are you fully engaged with sex, or are you spectatoring? (Watching yourself, a bit removed from the action?)

This may involve a graded series of exercises. It may start with a man masturbating to orgasm with his partner in the next room with the door closed. Next he may progress to masturbation while his partner is in the next room with the door open. Lastly, he may  masturbate while his partner’s present in the same room.

This process is helpful for anybody who has had difficulty with privacy or intimacy, or who has experienced invasion of their boundaries as a child. 

Clearly the caring assistance of a dedicated partner is going to be helpful in such circumstances.

It’s hard to generalize about therapeutic approaches for delayed ejaculation because each case has its own unique features. Nonetheless sex therapy for delayed ejaculation is a well-established treatment protocol.

Two Approaches To Treating DE

The Inadequate Stimulation Approach and The Desire-Deficit Approach.

In the inadequate stimulation approach, there are two different aspects of therapy.

First of all, there’s a treatment for delayed ejaculation based on behavior therapy. This assumes the man is not ejaculating because he is not receiving enough stimulation. If he was being stimulated sufficiently, this would arouse him enough to trigger the reflex of ejaculation.

The “treatment” for this has often often been harsh and vigorous stimulation of the penis to the point of ejaculation.

And secondly, there’s an approach which is basically psychodynamically orientated. This suggests that delayed ejaculation involves unconscious inhibition of orgasm because of conflicts or issues around sex. And does that mean you have to dive deep into your subconscious? No. Not really.

The desire deficit model was developed by Bernard Apfelbaum. He believed that the loss or absence of ejaculation is because of low sexual desire or arousal.

This could mean any strategy which involves harsh and vigorous stimulation to the penis is counter-productive. Why? Because it because it increases the man’s performance anxiety and makes the situation worse.

Bernard Apfelbaum suggested the right approach was to uncover and deal with any psychological issues that were causing the man to be inhibited sexually or making him fail to enjoy or enter into sexual relationships.

Apfelbaum also suggested that the sustained hard erections that occur in (some) men with delayed ejaculation are not necessarily a sign of his high level of sexual arousal.

Apfelbaum’s approach emphasizes the importance of the man taking responsibility for his sexual functioning. The  man should accept that he and his partner have an equal right to sexual pleasure. However,  it’s not his responsibility to please his partner. It is his responsibility to ensure that he himself is satisfied sexually.

Apfelbaum’s approach has been criticized. Not all men with delayed ejaculation show what Apfelbaum described as the key diagnostic feature of retarded ejaculation. This is that only the man’s own touch is erotically arousing. Apfelbaum described this as an autosexual orientation (i.e. he gets pleasure from masturbation).

If sex with yourself is better than sex with a partner, why not stick to self-pleasuring?

The fact is, many men are autosexual because this is the only way in which they can reach orgasm.

And, as I have seen in my practice, many of them wish to have enjoyable sex with their partner. They feel a great deal of anxiety and pressure because of this situation. 

Nonetheless, in either approach our aim is to encourage a man to openly express his feelings, to become more sexually aroused, and to bypass what he experiences as demands for a particular kind of “sexual performance” (as in, perhaps, making the woman orgasm during sex).

Deep-rooted psychodynamic conflicts may take some time to resolve. In clinical practice, several sessions of therapy may be essential. That way a man can establish a new viewpoint which allows him to see how he has been inhibited from sexual expression by his previous experience.

This means that a great deal of flexibility is required in approaching the cure. However, there are some essential elements in any treatment.

These include improving sexual techniques and becoming more confident and self-accepting as a sexual man. That means changing your self-image around sex (to, for example, “I am a good lover and I can satisfy my partner!”)

Also, it also means finding ways to enjoy a better relationship with your partner, both sexual and non-sexual.

Such techniques also improve intimacy and allow mutual expression of love and affection within the relationship. Sex education, and instruction on how to make love in a way that satisfies both partners is usually helpful.

Back to delayed ejaculation

Using these approaches, delayed ejaculation can be successfully cured in only a few months. This is also true if the problem comes from anxiety, or from not having a sufficiently clear focus on your own pleasure during lovemaking.

Another critical aspect of treating delayed ejaculation is “behavioral accommodation”. That is to say, long-term issues which cause sexual difficulties need to be discovered, explored, and resolved as far as possible.

Sometimes delayed ejaculation diminishes in intensity but continues to be an issue from time to time. A man may be able to ejaculate during lovemaking on the majority of occasions that a couple are intimate.

A suitable case for treatment

Exploration of biological, psychological, and genetic reasons why a man might be experiencing difficulty orgasming is esssential. 

For example, if a man is in getting too little stimulation during lovemaking, additional stimulation may increase his arousal.

This might include nipple stimulation, anal stimulation, or the use of a vibrator. This could be applied on the perineum, the base of the penile shaft, or other sensitive areas. Some men have found these approaches to be very helpful in speeding up arrival at orgasm.

You can see a couple of well-known sex pundits talking about vibrators for men in the video below. These tools may make a man’s climax slightly faster but it may still have a tendency to dawdle slowly and linger along the way!

Other problems with retarded ejaculation

Any medication which might be interfering with the man’s sexual responses should be stopped, or an alternative prescription found. Many prescriptions medications can delay ejaculation.

Treatment benefits in the longer term will far outweigh the inconvenience now, even if treatment goes slowly or takes a long time.

Anxiety and obsessive-compulsive characteristics are major aspects of delayed ejaculation. They may create the problem, or compound it, so any technique that reduces anxiety is helpful.