The causes of delayed ejaculation

Debate about whether delayed ejaculation is caused by physical problems or emotional issues has been a contentious one for many decades. But even when the problem is based on some physical condition, there’s no doubt that it is always made worse by a downward spiral of anxiety and ever more likely failure to “perform”.

Back in 1988, researchers published a paper which evaluated the origin of delayed ejaculation in 400 men. They were either referred by a doctor or self referred, and initially seen by a urologist for a physical examination and a medical consultation.

The men were scheduled for two nights of evaluation in a private room at the center. They had confidential interviews by a psychologist to focus on any possible psychological factors which might be relevant to the etiology of their delayed ejaculation.

The psychological investigation focused on various factors such as the men’s psychological state, incorrect beliefs about sex or sexual activity, and the various factors in each man’s sexual relationship which might affect his ejaculatory capacity This  included poor communication, hostility, fear of rejection, and the lack of attraction to his partner. You can read all about the causes of delayed ejaculation in this book.

Diagnoses and treatment recommendations

After all the data had been collected, the urologist and psychologist reviewed the data together, so that they might establish a treatment option to be presented to man and his sexual partner. They established five categories of delayed ejaculation:

1 Purely physical – there needed to be an absence of any significant psychological or emotional factor. In addition, perhaps not surprisingly, there also needed to be the presence of some clearly identifiable disease, treatment, or drug which was known to cause delayed ejaculation.

2 Primarily physical.

3 Primarily psychological: a man’s problems would fall into this category when and psychological factors seemed to be responsible for his delayed ejaculation.

4 Purely psychological: a man’s delayed ejaculation would fall into this category when there were relevant psychological or emotional factors .

5 There was a fifth category in which the origin of delayed ejaculation was categorized as unknown: these were men in whom there was no obvious explanation, either physical or psychological, to explain the delayed ejaculation.

A small majority of men (56%) seen at the centre were in their sixth or seventh decade of life: 76.4% of men were married. In total, out of 406 men, 117 (almost 29%), were diagnosed as having physical delayed ejaculation. 161 (39.6%) were diagnosed as having psychological delayed ejaculation.

62 or just over 15% were diagnosed as having diminished ejaculatory capacity due to a physical problem that had been made worse by psychological or emotional factors. 40 men (9.9%) had primarily psychological delayed ejaculation with some physical contribution. Finally, 26 men (which equates to 6.4%) had delayed ejaculation of unknown origin.

Analysis of the men who had delayed ejaculation that were regarded as being psychological or emotional in origin revealed that only 25% of these men had delayed ejaculation under any circumstances. 22% could not ejaculate in any situation but managed to resume having intercourse after they had been seen at the centre.

Hormones

Hormonal analysis was conducted on 383 of the men. There were no significant differences between the groups when mean values were used. However, using data from men with the lowest levels of testosterone, the highest levels of prolactin, and the highest levels of estradiol, revealed that men with low testosterone had in fact significantly increased levels of delayed ejaculation.  

Also, the men who had the highest estradiol levels were more likely to be classified as having organic or primarily organic delayed ejaculation.

Video – delayed ejaculation

Treatment of delayed ejaculation

The majority of men who went through this study were advised to undergo some form of sex therapy including marriage counseling when necessary.

Although about a quarter of men in the study did not wish to pursue any further treatment, some men benefited from the investigation, while others had renewed sexual interest sparked by the evaluation process, so that sex became more pleasurable.  

Even back in 1988, frank discussions of male sexual dysfunction in the media had already begun to result in men and their partners being more likely to come into sexual clinics and doctors’ offices with complaints of changes in their sexual relationship. Read more about his here.

For men who complained of low sex drive, testosterone investigations were recommended. By the careful use of medical history taking, lack of erection could be correlated with the use of any medication such as hypertensive medication, in which case the recommendation was made that the man’s drugs should be changed or the patient motivated to lose weight.

They stated that low blood flow in the penis, diabetes, medication, prior pelvic surgery, and other factors, alone or whether in combination, would not necessarily be indicative of the fact that the man had a physical rather than psychological cause for his delayed ejaculation.

They also emphasised that it was important to establish true causality. One of the reasons for this was that some physical factors are reversible – for example, abnormally low levels of hormones, smoking, use of drugs, some vascular lesions of the penis, and some problems such as Peyronie’s disease.

Other men, however, had irreversible delayed ejaculation, and the team suggested their expectations of treatment should be managed, and treatment adapted accordingly. The authors noted that one of the problems for men who had delayed ejaculation, a condition noted for its devastating personal consequences, would be that they were motivated to seek simple and permanent solutions that would make them feel neither guilty nor responsible.

They concluded, in the light of the knowledge available to them at the time, that such patients could best be served by counseling and re-education about the realities of sexual function.

off youreallywanthim.com 12/3/23

Definition Of Delayed Ejaculation

The simplest definition is the one set out by Marcel Waldinger (in Handbook of Clinical Sexuality For Mental Health Professionals, second edition, edited by Stephen B Levine).

In this he says delayed ejaculation means a man finds it difficult or impossible to reach orgasm and ejaculate despite receiving adequate sexual stimulation, having a hard erection, and experiencing the desire to achieve orgasm.

But is it this simple?

(Read more about delayed ejaculation here.)

Some men will struggle to ejaculate during intercourse, some during masturbation either by their own hand or by a partner’s hand, some during oral intercourse, and some during sexual intercourse.

Sometimes DE occurs in all situations… sometimes in specific ones.

Marcel Waldinger also makes the point that ejaculation may be delayed with all partners, in all sexual situations, and at all times – in which case the definition is of generalized delayed ejaculation (DE for short).

And sometimes, a man may have difficulty ejaculating only with a particular partner in a particular situation, in which case the condition is defined as situational DE.

So, for example, a man may be unable to orgasm and ejaculate inside his partner’s vagina, but he may be perfectly able to do so during self-pleasuring.

Or he may be able to ejaculate during sex with one partner but not another. Or even during sex with a man but not with a woman.

And then there’s perhaps the most obvious example of this, that a man may be able to ejaculate with one particular female partner but not with any others.

It is also possible for situational problems to occur from time to time, but not all the time, so a man finds himself able to ejaculate with one woman on certain occasions but not on others.

Another intriguing aspect of this problem is the fact that sometimes a man may be able to reach orgasm and ejaculate when he has a particular sexual stimulus – a fetish object, or a specific sexual fantasy, perhaps.

(This is probably about being more turned on in the presence of specific stimuli, and may even be a good way for a man with delayed climax to help himself reach orgasm – i.e. to find out what turns him on and then to incorporate this into sex play with his partner.)

It’s important to remember that DE is actually an involuntary condition. In other words, a man appears to have no choice about it – his body does something involuntarily. He cannot avoid the problem.

As such, it may be seen as similar to female orgasmic dysfunction, although it’s also been described as a process that disconnects the two phases of normal male ejaculation – emission and ejaculation.

As observed above, DE can be lifelong or it can be an acquired condition that develops later in life, and it can also occur in every sexual encounter that a man engages in, or it may just occur in certain situations.

Given this variability, it’s hardly surprising that there has been a lot of debate and even argument about how to define it.

However, what we do know is that the most common form of this problem is coital anorgasmia – which is, in the opinion of some authors, the only form of difficulty with ejaculation which should be defined as “delayed ejaculation”.

Even something as simple as a latex fetish or wearing a condom may help a man come – it all depends what turns him on. Anal stimulation and nipple play can be helpful here.

Coital anorgasmia means anorgasmia during sexual intercourse (which could serve as a complete definition in its own right).

In general a man can enjoy normal orgasm through masturbation, but not during sexual intercourse.

Although there are variations on this pattern, it’s fair to say this is reasonably common.

Another interesting observation is that a man’s erectile function is generally not affected, at least initially, although prolonged experience of anorgasmia may eventually produce erectile dysfunction.

How Common Is Difficulty Ejaculating?

There is a definite lack of data on the epidemiology of delayed ejaculation, but the few data that are available strongly suggest that it is more common than people have realized in the past. 

In one study, the US National Health and Social Life Survey, as many as 8% of men responding to the survey questionnaire admitted the experience of being unable to achieve orgasm during a period of at least two months in the previous 12.

In men aged 70 to 79 years old, delayed ejaculation is said to reach a frequency (prevalence) of 12%.

Even so, DE is most probably the least common sexual dysfunction. For comparison, premature ejaculation is reckoned to affect anywhere between 30% and 50% of men, possibly more.

As you might guess, there are many theories regarding the origin of DE.

Some of these are based on theories and observation, and aren’t backed up by good evidence or any reliable kind of empirical data.

This is a common problem with sexual dysfunctions in general, and this problem in particular, and the unfortunate outcome of such a lack of hard facts means there is no generally accepted and defined choice of treatment protocol.