Treatment of delayed ejaculation

Historically, treatment was to provide extra stimulation to the man’s penis during intercourse in an attempt to break down inhibition while concurrently looking at any unconscious or conscious expression of hostility or conflict in relationships to women.

Problems With Treatment

But any treatment for DE that requires prolonged and intense stimulation to the penis, since this is clearly not normal, and may indeed in some way reinforce negative associations with sexual stimulation.

If a man is more comfortable having sex with himself than with a woman, then there is a clear case for the exploration of this psychological issue in psychotherapy.

The process of uncovering and clarifying what it is that is causing a man to fail — even to refuse — to achieve orgasm and release inside a woman is regarded by many therapists as essential to understanding what’s going on.

Most men with delayed ejaculation seem to believe that they are not giving their partner enough, even though they may in reality be putting immense effort into sex. That dysfunctional attitude is a cornerstone of delayed ejaculation and clearly needs to be explored.

So how would treatment proceed these days?

One major goal is to openly encourage a man to express his feelings, to empower him to engage in relationship without fear or anxiety, and to overcome the sense that his “performance” is simply a means to please his partner.

These goals can be achieved by giving new interpretations to beliefs that a man holds around his sexuality and around relationships with women.

It has been called a “reframing” approach, where cognitive shifts can pave the way for a new kind of sexual experience.

Since the beliefs held by many men with delayed ejaculation – also known as retarded ejaculation – tend to be fundamentally similar, it’s actually quite simple to do this by using a self-help program on the Internet.

(A fact which has the advantage of avoiding embarrassment; it seems most men with delayed ejaculation prefer not to see a therapist in person: it seems men with DE find personal consultations more challenging than men with PE, although comparatively few men with that condition seek therapy either).

Alongside the psychological shifts which may be needed, any man seeking treatment for DE needs to learn how to feel and accept sensory stimulation on his body. After all, much of sexual arousal is generated by physical touch and sensory “input” to the body, rather than by mental process such as fantasy.

Certainly, sensory arousal in the body is the main route towards the point of ejaculatory inevitability for the majority of men beyond the age of 40. For men who have erectile dysfunction or erection problems, it is necessary to treat the erectile dysfunction before the delayed ejaculation.

In practical terms, an enjoyable sequence of behavioral training exercises designed to re-establish a man’s awareness of the feelings in his body can be enjoyed by both a man and his partner.

These exercises have a very powerful impact, and can shift psychological inhibitions in a dramatically short space of time — always provided, of course, that the man is motivated to overcome his delayed ejaculation, and is not holding onto the psychological blocks that may or may not have contributed to it in the first place.

All in all, we wish to leave the reader with the impression that delayed ejaculation is a condition which can be treated quite successfully, either with or without the help of a sexual psychotherapist; and there’s certainly no need for pessimism about the prognosis of the condition, or the outcome of treatment, provided, as we said before, that a man is highly motivated to overcome delayed ejaculation, probably in the context of a sexual relationship with his partner.

Definition 

At the moment, different doctors have different criteria for diagnosing the condition, and the definitions that are available depend to a large extent on subjective measurement or opinion. Also, there is no clear agreement on what is a normal ejaculatory latency (time after penetration but before ejaculation), which has hampered research into this particular sexual dysfunction.

What men and women think of as “normal” ejaculatory latency is different from country to country and – perhaps not surprisingly – between women and men even in the same country. But despite these problems of definition, the Global Study of Sexual Attitudes and Behaviors has enough information for us to conclude that rapid ejaculation affects at least 30% of men across all age groups.

And exactly what causes premature ejaculation? Like erectile dysfunction, PE is becoming more medicalized, which means that doctors are seeing it more as a condition they can cure than a psychosexual issue caused by emotional issues like anxiety. While we don’t know for sure what causes a man to lose control of his ejaculation (or never to develop it in the first place), current thinking is moving away from psychosexual ideas towards neurobiological bases.

Of course, knowing what causes men to lack control of their ejaculation will certainly help produce more effective therapies, but for the moment it has a major effect on men (and their partners) and a significant burden on their psychological well-being.

Up till now, the prevalence of premature ejaculation has been little understood, but recent research has offered a clearer picture and shows there are regional differences in the frequency of premature ejaculation among men.

Of course, a big problem is that the lack of clear diagnostic criteria for normal ejaculation has hampered attempts to measure the frequency of sexual dysfunctions like early ejaculation: values between 25% and 60% are reached, depending on which criteria the researchers used. One thing we do know is that  that premature ejaculation is the most common sexual complaint among men.

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Defining normal ejaculatory latency (period between penetration and ejaculation) is difficult

Men and women’s ideas of what is normal is not consistent –  the perception of the normal period before ejaculation varies widely – between 7 and 14 minutes, with significant geographical variation.

For example, in Germany, the perceived average latency time is only 7 minutes, but in the US it is over 13 minutes. The perceived average for men in the United Kingdom, France, and Italy is around 9 minutes.

Generally, the time before ejaculation as estimated by women is similar to the time estimated by men, though slightly lower in most cases. The difficulty of agreeing what is the “normal” ejaculatory latency is reflected in the lack of a universally accepted definition of PE. The best definition is probably that of the DSM-IV diagnostic manual: persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration and before the person wishes it.

As you can see, this definition of premature ejaculation encompasses three components:

• a short period before ejaculation

a lack of voluntary control over ejaculation

• a lack of sexual satisfaction for one or both partners

Obviously these are subjective criteria, which do not provide a rigorous basis for either the definition of PE, or useful research on how to treat it effectively.

In fact, in about 45 studies undertaken between 1963 and 2000, only half contained a quantifiable measure of ejaculatory progress such as number of thrusts, or IELT, while subjectively assessed criteria, such as a man’s perceived lack of control, were reported in less than half.

Of course, most men who seek help know full well they have premature ejaculation, perhaps partly because they are so dissatisfied with their sexual performance, and partly because rapid ejaculation is so widely known to be a problem among men.

The Global Study of Sexual Attitudes and Behaviors (GSSAB) collected data from more than 13,000 men in 29 countries. Overall, approximately one third of all men seem to have difficulty with premature ejaculation.

The prevalence of premature ejaculation varies widely, though: in Latin America it was reported as 28.3%, in the Middle East, 12.4%, and in South East Asia 30.5%. These reports were based on men who said PE was a frequent problem which had persisted for a long time. These men appear to have a chronic sexual dysfunction associated with significantly lowered quality-of-life or sexual fulfillment. 

But why would the prevalence of premature ejaculation vary so much from region to region? Several reasons. For example, the level of circumcision in certain regions may be a big factor – circumcision is linked to glans keratinization and desensitization.

Then again, there are religious and cultural influences which may affect the prevalence of premature ejaculation. What is thought of as premature ejaculation may be different among Protestant and Catholic populations.

Also, rates of premature ejaculation may appear to be higher in places where sex has special cultural significance or where female sexuality is regarded as equal to male sexuality. However, in patriarchal societies where women have a lower social position, premature ejaculation may actually be seen as a sign of virility rather than a problem.

There may be a suspicion that premature ejaculation is linked to other physical conditions – not in a causative way, but because the pain and discomfort of any condition which affects overall health will affect sexual functioning, wither psychologically or physically.

In the latter case, the link may actually be no more than the fear of pain striking during sex. Arthritis and gout are excellent examples of conditions which fall into this category. For health resources on gout, in particular a great diet for gout – click here to learn more.

There is conflicting evidence about the association of race and the reported frequency of premature ejaculation. The National Health and Social Life Survey, which was conducted in 1992, looked at over 1,400 men between the ages of 18 and 59 years.

The results suggested that premature ejaculation among black, Caucasian, and Hispanic men was 34%, 19%, and 27%, respectively.

However, a more recent study suggested the figures were 21%, 16%, and 29%  respectively, although this study involved an older population of men aged between forty and eighty years.

Data from the NWLS reveals that the lack of ability to overcome premature ejaculation is not correlated with age. Indeed, the prevalence of PE is basically constant throughout the 18 – 59 age group. Overall, the GSSAB found few firm correlations for the prevalence of PE.

One which did appear was the finding that education level is negatively associated with PE. For instance, in the Middle East and Central and South America, men with no college education appeared to be twice as likely to report they had premature ejaculation as men who had received some college education.

The only other factor of significance clearly associated with premature ejaculation was infrequent sex, which is hardly surprising.

Based very loosely on an article in The Journal Of Sexual Medicine, 2005, Supplement 2: Prevalence of Premature Ejaculation: A Global and Regional Perspective by Francesco Montorsi, MD. Any errors of interpretation are solely the responsibility of this website.