A man who feels inhibited in talking to you about his inability to ejaculate may want to get professional help instead.

Getting help with delayed ejaculation (DE)

There’s some helpful information about DE here. That may help a lot. And you may also want to get some counselling. So to put this into context, lifelong or chronic delayed ejaculation is more common than most men realize. It’s also different for each man who has it: a different combination of factors has caused it, and a different approach to treatment will cure it.

There are two basic models of treatment for male anorgasmia. These are called the “inhibition model” and the “desire deficit model.” Don’t worry about these terms, they are just scientific language for some simple ideas…..

Inhibition Model

The so-called inhibition model and the approach to treatment which comes from it was promoted by the famous sex therapists Masters and Johnson, and Helen Singer Kaplan.

This approach to curing delayed ejaculation assumes that a man is not receiving enough sexual stimulation – in either quality or quantity – to reach his orgasmic threshold, his point of no return, also known as the point of ejaculatory inevitability, so he is not able to ejaculate.

Obviously, the idea here is that if a man’s level of sexual stimulation can be increased above his ejaculatory threshold, then he will be able to ejaculate. However, what if his ejaculatory threshold may be so high as to make this impossible? Is this a case of inadequate stimulation or does it mean he has a high stimulation threshold?

These are actually quite different things when you think about it. For example, the high stimulation threshold concept might mean that a man’s issue with delayed ejaculation comes from some inhibition of his orgasmic capacity. Maybe he is consciously or unconsciously expressing resentment or anger by withholding his orgasm.

On the other hand, inadequate stimulation might also result from a man having an insensitive penis or penile nerves. Perhaps he learned to masturbate as an adolescent with an unusual technique such as thrusting his penis against the mattress without using his hand.

Obviously this line of reasoning suggests that treatment methods for DE might either

• aim to increase sexual arousal through intense stimulation;
• or they might aim to interpret and resolve conscious and unconscious impulses and neurotic defense mechanisms;
• or they might, of course, aim at both these objectives.

Video – treatment for delayed ejaculation

If a man has a lot of anxiety around sex (and especially around his sexual performance as a lover), then increasing stimulation thresholds may simply increase a man’s anxiety even further. After all, the problem is the result of performance anxiety in the first place.

So any kind of harsh treatment (increased physical stimulation, for example) is likely to be counter-productive. It certainly sounds counter-intuitive to suggest a scheme like this for a man whose symptoms are probably rooted in anxiety anyway.

The desire deficit model for dealing with delayed ejaculation

In sex therapist Bernard Apfelbaum’s view, DE suggests there might be some deficit of arousal or desire. These deficits which need to be understood and therapeutically investigated. That way, a man can take responsibility for dealing with the unconscious conflicts which have caused his delayed ejaculation in the first place. (You can read more about this problem in this book.)

Apfelbaum described this as “counter bypassing”. He suggested that treatment for delayed ejaculation should explore a man’s lack of desire for sexual intercourse and his lack of arousal. After all, it is these which lead to his inability to ejaculate during sex in the first place.

Some men with delayed ejaculation do indeed feel they are withholding something from their partner. They feel that they should be more “giving”. This implies that changing a man’s beliefs around sex in general and his difficulty ejaculating in particular are important in treatment. 

When a man has delayed ejaculation, he may often have a long-lasting erection, which he can maintain for hours – but this is not a sign of his arousal.

Indeed, many men in this situation have very low desire: they do not actually want to have sex, they do not desire their partner, but they feel at the same time compelled to have intercourse to please their partner.

However, some therapists have observed that many men with ejaculation problems may also experience some degree of obsessive-compulsive disorders, paraphilia, anxiety disorders, and even various personality disorders. In such cases, DE is not just caused by inhibited arousal and desire in a partner-specific context. It is also backed up by other psychological issues that could benefit from therapy.

Apfelbaum also suggested that in cases of slow or non-existent ejaculation, the man only finds his own touch erotically arousing. This suggests he is “autosexual” (i.e. masturbatory) rather than heterosexual or homosexual.

But what if idiosyncratic masturbation simply means a man can only reach orgasm through masturbation? it may not be a sign that he only finds his own touch arousing (though of course the latter statement might also be true).

In other words, DE is not necessarily a sign of autosexuality, or autoeroticism, and this will be especially true when a man is clear that he wishes he could ejaculate during sex. 

However, in practice there is no clear division between different approaches in the treatment of delayed ejaculation. Any treatment will probably open up the subconscious drives and inhibitions which affect a man’s sexual relationship with his partner.

From this point of view, the open expression of feelings, awareness of lack of arousal, and the ability to indulge one’s own desires rather than focus on the needs of one’s partner, are all clearly highly desirable objectives. And that is true both within and without the framework of professional therapy. 

Video – healthy selfishness during sex

A final word about professional therapy

In therapy, the facilitator will offer or stimulate different interpretations of the sexual beliefs held by the man and his partner around sex and intercourse. This is a kind of reframing approach which allows men and their partners to “see things in a different light”, a kind of decontamination of the beliefs which the man holds.

There may be some powerful insights which have an impact on the cognitive level almost immediately – others, more deeply rooted in the unconscious, may take longer to change. Surrogate therapy with specially trained partners has also been helpful too.

What all this tells us is that all treatment approaches reflect some reality for one man or another with delayed ejaculation. Apfelbaum and Kaplan look at different sides of the same coin: on the one side, the unconscious aggression and hostility that makes a man experience low arousal with his partner. On the other, feelings of guilt, shame, a tendency to excessive giving during sex, and so on.