Psychological Aspects of Delayed Ejaculation

Possible Courses For Treatment Of Delayed Ejaculation

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. Here some typical questions that you might like to think about:

  • 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 PE 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. There are, of course, deeper issues which can be examined – such as feelings of anger or hostility towards the man’s partner – but such psychodynamically complex 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, and 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.

And what achieves great success are sensate focus-type exercises that are designed to bring the couple into closer connection with their own sexuality, the intimacy that it can bring to each other, and to develop what one could broadly described as “a relaxed” attitude to sex.

For those men who have difficulty revealing their feelings, some coaching may be needed in opening up and allowing his feelings to be seen by his partner.

Video – how to be open emotionally in a relationship

It’s important to obtain some motivating factor. For example, suppose a man is not experiencing good erections. Offering Viagra to overcome this difficulty may provide new hope around both the prospect of satisfying intercourse and the prospect of enjoying ejaculation during intercourse. Many couples find it difficult to talk about such matters, and find the prospect of emotional intimacy difficult. In such cases, self help tretament using the same sort of techniques as a therapist might employ can be a helpful approach. 

Desensitization As A Way To Reach Orgasm

In essence, for men who have a degree of sexual inhibition or disconnection, desensitization is essential. This is a gradual approach which allows increasing experience of sexuality, intimacy, mutual touching, and non-anxious sexual behavior in the presence of the partner.

This may involve a graded series of exercises, starting (for example) with man masturbating to the point of orgasm with his partner in the next room with the door closed. Progressing gradually to masturbation while his partner is in the next room with the door open. And finally masturbating while his partner’s present in the same room.

For anybody who has had difficulty with privacy or intimacy, or who has experienced invasion of their boundaries as a child, such gradual processes can overcome both emotional inhibition like guilt and shame as well as physical inhibitions such as those caused by traumatic masturbatory conditioning. 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.

There have traditionally been two models for treating Delayed Ejaculation: The Inadequate Stimulation Model and The Desire-Deficit Model.

In the inadequate stimulation model, there are two different approaches for therapy. First of all, there’s a treatment for delayed ejaculation based on behavior therapy. This assumes that the reason the man is not ejaculating is because he is not receiving enough stimulation to take him over the point of arousal at which his reflex ejaculation reaction would be triggered. 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 and suggests that the symptoms of delayed ejaculation are the result of unconscious inhibition of orgasm because of unconscious conflicts or issues around sex. This “desire deficit” model was developed by Bernard Apfelbaum, who believes that the loss or absence of ejaculation is actually the product of low sexual desire or arousal. From this viewpoint, any strategy which seeks to overcome the inhibition of ejaculation by providing harsh and vigorous stimulation to the penis is counter-productive because it increases the man’s performance anxiety and makes the situation worse.

Bernard Apfelbaum suggested that in fact 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 starting point of which will generally be that the man should accept that he and his partner have an equal right to sexual pleasure, and that it’s not his responsibility to please his partner – but it is his responsibility to ensure that he himself is satisfied sexually.

Apfelbaum’s approach has been criticized on the grounds that not all men with delayed ejaculation show what Apfelbaum described as the key diagnostic feature of delayed ejaculation – that only the man’s own touch is erotically arousing, and that his sexual orientation is autosexual (i.e. he gets pleasure from masturbation).

The fact is, many men are autosexual because this is actually the only way in which they can reach orgasm. And, as I have seen in my practice, many of them actually wish to have enjoyable sex with their partner, and feel a great deal of anxiety and pressure because of this internal desire rather than from their partner’s demands around sex.

Nonetheless, the main goal of sex therapy in either approach is to encourage any man who is experiencing this level of sexual dysfunction to be able 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).

However, deep-rooted psychodynamic conflicts may take some time to resolve, so that in clinical practice, several sessions of therapy may be essential to establish a new viewpoint which allows a man to see how he has been inhibited from sexual expression by his previous experience.

In treating delayed ejaculation, no single approach will help all men.

This means that a great deal of flexibility is required in approaching the cure. However, there are certain essential elements that you could expect to be part of any treatment. These include improving sexual techniques, that is to say becoming competent in sexual experience and lovemaking, and becoming more confident and self-accepting.

That means changing your self-image around sex (“I am a good lover and I can satisfy my partner!”) And thirdly, it also means using strategies which will promote 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.

Using these approaches, delayed ejaculation can be successfully cured in only a few months, particularly if the problem results from the fact that either partner is lacking specific information about sex. The same is true if the problem comes from anxiety, or perhaps not having a sufficiently clear focus on one’s own pleasure during lovemaking.

Another critical aspect of treating delayed ejaculation is something about behavioral accommodation: that is to say, long-term issues that cause sexual difficulties are discovered, explored, and resolved as far as possible. Sometimes the result of this is that delayed ejaculation diminishes in intensity but continues to be an issue from time to time, leaving a man able to ejaculate during lovemaking on the majority of occasions that a couple are intimate.