The Causes Of Delayed Ejaculation

 Psychological and Physical Causes

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Definition
Causes Of Delayed Orgasm
DE Occurs More and More
DE and The Social Media
Approaches To Treatment
Effective Treatment

Psychological Causes - 1
Psychological Causes - 2
Psychological Causes - 3
Conscious or Unconscious?
Prescription Drugs
Pornography and You
Neurobiology
Medication

 

Men and women in a relationship where the man has delayed ejaculation often find the problem rather distressing.

One of the key things is to identify the cause of the problem, but the reality is that this is not always very obvious. Broadly speaking, of course, causation can be divided into two categories: the psychological, and the physical.

Psychological Causes Of Retarded Ejaculation

You can read more about these here.

Ejaculatory dysfunction may be caused by historical sexual trauma.

We're talking about things like sexual abuse, repression of sexual urges caused by a childhood environment in which sex was regarded as taboo or dirty or shameful, and in which a man grew up with a psychological complex around sexual shame or guilt.

It's also possible that an abusive relationship with women in early childhood could be responsible for a man's sexual dysfunction in later life: an interesting observation about men with these problems is that they very often do not connect their historical experience with their current sexual difficulties.

Only during psychotherapy or counseling will the connection between an inability to ejaculate, vaginal aversion, and other sexual dysfunctions, including premature ejaculation, become clear.

Anger Towards Women

In my experience as a therapist, one of the things I've often found associated with ejaculatory difficulties is a high level of suppressed anger or even rage against women, and particularly in the case of premature ejaculation, a high level of anxiety and fear around sexual activity.

It's also been proposed that one of the causes of delayed ejaculation is a man's fear of making his partner pregnant.

There are other psychological explanations which are plausible but which can't be proved one way or the other.

Hostility

These include the suggestion that delayed ejaculation (DE) might be  passive aggressive hostility, where the withholding of semen penalizes the woman, punishing her for some transferential issue which originated elsewhere.

One of the best ways of identifying problems like this is in counseling or therapy when they can be teased out gradually over a period of time. The good news however, is that there are treatment approaches which do not require lengthy counseling, but which address the problem by changing things right here, right now, in "real time".

Low Sexual Confidence

As we know, many of the men who experience retarded ejaculation have a low level of sexual self-confidence, or perhaps do not regard themselves as particularly good lovers. This can be both cause and effect of the problem. It's entirely possible that a man experiences DE with a partner because he has issues caused by emotional conflicts about sex in general and women in particular.

Harsh Masturbation

However, when ejaculation only happens during masturbation, it's common for a man to have the problem because he's trained himself to achieve orgasm and ejaculate in an idiosyncratic fashion, one which usually does not involve touching the penis, but requires harsh and fast thrusting against solid objects such as the mattress of a bed.

The good news, again, is that all of these problems can be dealt with quite readily with a treatment program such as the one on this website.

Sidebar: Hypnosis may offer a solution for retarded ejaculation

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It's important to emphasize also that slow ejaculation is not the product of any kind of personality defect or abnormality.

It's actually a very common and normal condition that can sometimes result from a harsh, punitive, or unfavorable environment during childhood and adolescence.

That's why counseling is helpful: it helps to raise man's self-esteem and to enable him to establish a better relationship with his partner.

 Regrettably most men with the  condition are too embarrassed to seek help, which is another reason why we've taken the time to write a self-help program which can be used at home.

Generally, depression, anxiety, perhaps a fear of pregnancy, traumatic sexual encounters including sexual abuse, and repression of sexual urges and interests are the most common causes, due to a very repressive sexual attitude in a man's family.

Other ejaculation problems include retrograde ejaculation so this must be ruled out in a diagnosis. Having said that, RE occurs regardless of intelligence, age, race and sexual orientation.

Physical Causes

You can read more about these here.

A video which offers an alternative view: SSRI antidepressants cause slowness and delay in ejaculating.

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Penile Insensitivity

It's been suggested that slow penile reflexes may be responsible for difficulty in ejaculation.

However, what does that mean? And what does "reduced penile sensitivity" mean? When you think about it, these ideas are not particularly easy to investigate.

Sure, some work has been done with vibratory stimulation of the penis, and some evidence has emerged that men with delayed ejaculation have a slower bulbocavernosal reflux (if you even know what that is....)

However, the problem here is separating cause and effect. Incidentally, the same applies to suggestions that speed of ejaculation (or lack of it) may be associated with levels of serotonin in the brain. Serotonin is both a cause and effect of alterations in mood, but it seems challenging, to say the least, to investigate its association with ejaculation speed.

(Feeling depressed because you can't come? Or can't come because you're feeling depressed? Who knows?) 

So do we know anything at all?

YES! We do know that some physical issues like diabetic neuropathy and prostate surgery, plus other kinds of pelvic surgery, and a large number of drugs, in particular mood altering drugs and beta-blockers and alpha blockers and, oh, loads of other  medications, are 100% linked to a slowing - and a stopping - of the ejaculatory reflex.

These drugs are clear culprits when it comes to delayed ejaculation.

graphic showing the outcome of research into the relationship 
      between penile sensitivity and circumcisionMy Penis Is So Insensitive!

A large number of men claim that they have an insensitive penis.

Unless there is a clear reason why this might happen -- as in diabetic neuropathy -- it's extremely difficult to demonstrate whether or not there's any truth in this. I mean, when you think about it, how can a man know if his penis is more or less sensitive than other men's?

Of course it may be that a man thinks his penis has become less sensitive as the years have gone by, but then again, how could he possibly be sure of that?

That's an entirely subjective impression, and my own belief is that when a man claims that his penis is less sensitive than it used to be, he's probably really experiencing some kind of reduction in his emotional or psychological sensitivity to sex.

Think about this, for example: consider how very exciting it is to have a new sexual partner. After a while, the excitement of sex, even the anticipation of sex, become much less thrilling and arousing than they were in the early stages of your relationship. I think it's possible that something similar happens in delayed ejaculation. (Sex is so boring.... not that it ever was much good....)

But.... there is of course the thorny question of circumcision and how it affects penile sensitivity.

So what about a penile sensitivity test?

Age Shall Wither Them

We know that men take longer to ejaculate as they get older, but there's no evidence that this is because their penis is less sensitive. In fact, as far as I know, nobody has really explained this decline in sensitivity adequately.

(Hang on.... "age causes degeneration of the fast conduction peripheral sensory axons, which results in a number of problems including difficulty in achieving a high level of sexual stimulation, and the consequent arousal necessary to trigger the ejaculation reflex." Pardon me.)

I think is much more likely that men with delayed ejaculation don't get enough sexual stimulation during sex, or they don't respond to it rapidly enough, and they therefore don't ejaculate any time soon.

And once again, that makes me think of the way that some men masturbate: hard, fast, and furious. You just can't match that had stimulation during sex. So the body adapts to this level of stimulation, and indeed, eventually it will only ejaculate in response to such stimulation. That's what I call traumatic masturbatory syndrome.

And this woman agrees with me. (Get over your reputation, Janet. And by the way, most men with delayed ejaculation are NOT highly aroused during sex.)


Now having said all that, of course there are some cases where it's very obvious there's a physical cause such as when a man's had pelvic surgery, for example, or radical prostatectomy, or other surgical procedures that have damaged his ejaculatory capacity.

Regrettably, that includes standard operations to resolve prostate enlargement such as transurethral resection of the prostate (TURP).

But in all cases psychological explanations of delayed ejaculation are much more important.

And there's no shortage of therapists and counselors who have offered their own interpretation of DE in terms of psychodynamic process.

In case that baffles you, it means something in the unconscious mind of a man holds him back from ejaculation, inhibits his ejaculation. So Helen Singer Kaplan, for example, said that she believed some men with delayed ejaculation were over-controlled individuals who resisted letting themselves go because they basically felt hostile towards a sexual partner. Ouch. (Mind you, I kind of agree with her.)

Other, simpler, explanations include a man's fear of pregnancy, or fear / resentment about becoming a father, or anything else, combined with a man being unable to communicate this to his partner.

Or, even simpler, if young children are present, maybe the man feels inhibited about having sexual activity in their presence.

Or maybe he's just emotionally withdrawn from his partner. A lot of men do, you know. Especially when they had a bitch of a mother....

All of these, and no doubt many more things too, could stop a man ejaculating.

 

schematic diagram of the ejaculation reflex in menNervous Pathways Associated with Ejaculation

Even when a man who is experiencing delayed ejaculation has enjoyed sufficient sexual stimulation that in the "average" man would trigger orgasm and ejaculation, he will simply not be able to achieve climax.

Conventionally, of course, climax is divided into two parts: orgasm and ejaculation.

We speak as if the two are very closely linked, so that a man who fails to reach orgasm generally won't ejaculate, and vice versa.

This is a working assumption that is adequate for an assessment of the problem, although it's technically incorrect since the two events are both mediated by different parts of the nervous system, and they can both occur independently of each other.

To be more specific, orgasm is associated with emotional sensations and feelings in the mind, which are interpreted as extremely pleasurable.

There may also be muscular contractions and spasms in the body. The reason for this is the release of oxytocin and endorphins which occurs at the moment of orgasm.

Some men with DE may find that they can only reach orgasm through stimulation by their own hand during masturbation, while others may find that they can occasionally reach orgasm during intercourse with a partner.

It's hard to understand how such problems could arise, but understanding that orgasm and ejaculation are actually separate processes can help clarify it.

As we mentioned before, orgasm is an experienced of the mind which is interpreted by the brain as a very pleasurable experience.

Ejaculation is an unconscious reflex response which is triggered by sufficient sexual stimulation being applied to the genital region, so that the nerves which are responsible for the reflex of ejaculation reach a threshold of stimulation that triggers the emission and release of semen.

Clearly the phenomenon of dry orgasm -- which means an orgasm where no semen is released -- has a bearing on delayed ejaculation.

The question that arises from this is why men who have this problem don't usually experience the sensations of orgasm as we know that it's not necessary for the ejaculatory response to take place before a man can move into the orgasm phase of his sexual response cycle.

Of course all men experience orgasm differently, and it's true that even in the same man the experience is different from time to time.

Nonetheless, we know that orgasm generally involves similar features in all men: it involves contraction of certain body muscles, including the pelvic musculature and other body muscles, that have built up tension during the excitement phase of sexual arousal. All of this tension is released in the moment of orgasm.

All of these sexual responses, including the ejaculatory response, is mediated by the interaction of the sympathetic and parasympathetic nervous system. The sympathetic and the parasympathetic. What we call the sympathetic nervous system is associated with activity, while parasympathetic nervous system is associated with relaxation and recovery.

The interplay of these two involuntary nervous systems is highly relevant to any discussion of the etiology of DE. For example, in order for a man to develop an erection the smooth muscle fibers of the internal cavities of the penis have to relax: only then can blood flow into the penis in sufficient quantities to generate an erection.

The structure of the male pelvis showing structure responsible for seminal emission

diagram of the male pelvis showing structures responsible for ejaculation

 

The control of this process is under a complicated network made up of the nervous system, the circulatory system, and hormonal influences, all of which are initially dependent on the relaxation of these muscle fibers induced by the parasympathetic nervous system.

However both orgasm and ejaculation are controlled by the sympathetic nervous system, as is the phenomenon of relaxation and recovery which is commonly become known as the "afterglow".

Ejaculation itself is divided into two parts, emission, which is under the control of parasympathetic nervous system, where seminal fluid is released from the seminal vesicles into the base of the urethra in preparation for ejaculation proper, which is controlled by the  sympathetic nervous system.

But these generalizations are indeed just that: there's no better example of this than the fact that a man can reach orgasm during sleep when no physical sexual stimulation has taken place.

Last updated: January 22 2016