Inability To Ejaculate:
How It Affects Your Relationship
Sometimes a middle aged couple beset by delayed ejaculation will split up, perhaps because one partner wishes to enjoy greater sexual satisfaction and pleasure while the other is threatened by the idea of more intimacy and more sex.
And then, sometimes, a man finds he can ejaculate intravaginally with a new partner….. more easily, more often, and in more varied ways.
Perhaps because the original relationship was weighed down by unresolved sexual and emotional conflicts and historical psychological wounds in both partners.
So a couple seeking help for delayed ejaculation – or a man on his own, for that matter – need to look at many other things besides the severity of the condition; for example, whether the man’s delayed ejaculation is situational or generalized, but how much they want to solve the problem.
Sometimes delayed ejaculation can be useful in hiding deeper truths….
Introduction by Dr Neil Baum
Treatment Of DE
It’s important to remember that delayed ejaculation is an involuntary and unconscious inhibition of sexual response.
Naturally, the goal of any treatment is to stop this inhibitory process so that normal ejaculation can be enjoyed by both partners.
One approach to delayed ejaculation treatment is to use guided stimulation techniques, the object of which is to distract the man from his desire to be in control during sex.
This is an excessive level of control which he needs to relinquish. In addition, he needs to relax into sex and find a way of getting more sexual stimulation so he gets aroused enough to trigger his ejaculatory reflex.
One way to get to treat delayed ejaculation is desensitization; another is to reframe the man’s perceptions and beliefs about sexual intercourse.
Desensitization consists of a series of steps which have been specifically worked out to suit each man individually.
Each step gradually increases the level of sexual stimulation which he is receiving, so that he can become accustomed to the new situation and learn to ejaculate before he moves on to the next.
This means each time he progresses to the next level of stimulation, his inhibition is lowered.
In a real-life situation, a couple would be instructed to perform a series of sexual tasks which addressed gradually greater levels of inhibition.
So, for example, the initial request made of the man would be shaped according to his level of inhibition and his ultimate goal of intravaginal ejaculation.
A man’s complete co-operation is essential: he must be willing to monitor and report the level of arousal that he experiences in each of the steps along the treatment path.
And both the man and his partner need to be guided so that they can enjoy a lot more physical stimulation, perhaps using erotic fantasies and other tools as well, to achieve greater arousal.
In this way the man should be able to give up his need for control and respond naturally to this gradual progression of stimulation towards ejaculation. Read about progressive desensitization here.
Desensitization regimes need to be flexible, and the therapist needs to be somewhat creative. Because, for example, the man may feel threatened by the prospect of increased intimacy with his partner. Any anxiety needs to be dealt with.
For example, if a man is initially only able to ejaculate in the absence of his partner, then the first step would be to set up a situation so he could masturbate to orgasm under those conditions.
A potential next step would be to have his partner in the next room while he masturbated, then in the same room at some distance away…and so on.
However the sequence is enacted, the point is that every step in the process is planned and analyzed with the couple so that the purpose of the therapy is quite clear.
Should the initial desensitization be successful, additional steps may be planned until the man is able to reach orgasm and ejaculate with his partner, hopefully during sexual intercourse.
Helen Singer Kaplan described a so-called bridging maneuver to conclude this process, in which the female partner kneels over her partner while she masturbates him vigorously towards the point of ejaculation; just before he does so, she insert his erect penis into her vagina so that he ejaculates intravaginally.
More sexual stimulation can be provided by stimulation of the penile shaft, testicles, or his anus.
Stimulating a man’s anus is a particularly good way of increasing his level of sexual arousal during delayed ejaculation treatment.
Indeed, in many cases, having a sexual partner stimulate a man’s anus has been the final trigger that’s allowed him to ejaculate more easily.
On a more general level, a man needs “permission” to enjoy sexual arousal with his partner, so he can relax into the ideal conditions for HIM to enjoy sex.
To achieve this, he is instructed to be selfish, and to “use” his partner for his own pleasure; most men with delayed ejaculation initially regard themselves as being dedicated to the provision of sexual satisfaction for their partner.
The concept of being selfish during sex may trigger insights and observations which help a man to understand and release his inhibitions.
It’s also important that he understands he should only engage in sexual activity when he’s sufficiently aroused and excited to enjoy it; he must understand that no matter what his erection may look like, he needs to be sufficiently aroused.
(As we know, the erection of a man who experiences delayed ejaculation is often hard and long lasting, even though he may not be particularly aroused).
It’s quite likely that during an exercise like this, a man with delayed ejaculation may start to engage in negative self talk, which can both serve as a distraction and a psychological defense.
In such circumstances he should discuss with his partner what is happening, or use fantasies to increase his sexual arousal and avoid any return to a state of inhibition.
All in all, sexual therapy involves a combination of psychotherapeutic methodologies to help the man and his partner, and specifically structured exercises for retarded ejaculation treatment.
Such exercises let a man explore the unconscious hostile or aggressive defense mechanisms which delay or prevent his ejaculation.
Any other defenses such as guilt, anxiety or shame must be subject to a similar analysis.
Reframing approaches which have been developed by Bernard Apfelbaum aim at having a man accept his lack of desire, lack of interest in sexual intercourse, and his lack of arousal during sexual activity with his partner.
This allows the therapist and the man to work together to explore what enjoyable and healthy sexual activity might feel like.
It’s important not to focus exclusively on the man’s inhibitions, but to supportively and sympathetically make a man with delayed ejaculation aware of his subconscious processes.
If he is unable to “give” sexually to his partner — as in, unable to give of himself and more particularly to “give” his ejaculation — this can be reframed into an inability to take sexual pleasure from his partner, with the focus on eliminating his conscientious perfectionism, excessive control, and desire to please his partner.
This approach is best used with a man who follows the classic pattern of being unable to take, unable to be selfish, and unable to have an orgasm during intercourse purely for his own pleasure.
Changing a mindset which is about satisfying his partner means increasing his level of stimulation, and maintaining steady progress towards the point of ejaculatory inevitability.
This can overcome the inhibitions of erotic flow towards higher levels of arousal and orgasm. In other words, it can help a man get turned on and reach the point of no return!
The underlying assumption of this treatment for delayed ejaculation is that a man is desperately trying to achieve an orgasm for his partner rather than for himself.
By constantly monitoring how aroused he is, and by learning that his subjective level of arousal needs to increase progressively during sex, a man can discover how to increase the stimulation he receives, integrate it into his sexual experience, and gradually lose his inhibitions about ejaculation.
A man’s inhibitions about ejaculation may be mysterious to his partner.
When she gets that he is “trying too hard” to have an orgasm to please her, things fall into place…. when a woman understands that, she may find it easier to be more tolerant and less demanding of her man and his ejaculatory latency.