Delayed ejaculation: Top five facts

1. What is delayed ejaculation (DE)?
   The American Psychiatric Association defines DE as “the persistent or recurrent delay in, or absence of, orgasm after a normal sexual excitement phase during sexual activity that the clinician, taking into account the person’s age, judges to be adequate in focus, intensity, and duration.”
   
   Simply put, DE is the inability to cum when one wants to, even after enough stimulation and a strong desire to do so. The stimulation keeps flowing but ejaculation never happens, or comes so slowly that it’s exhausting for both partners.
   
   With DE, men usually have little or no problems getting and maintaining a hard-on, yet experience relatively low levels of internal sexual arousal. With strong will though, many men with DE can masturbate to orgasm, while others cannot.
2. How common is DE?
   There is little reliable research to tell us how prevalent DE is among men, so it’s a bit of guesswork. But it seems increasingly certain that the problem is more common than what we previously believed. Recent confidential internet surveys suggest that DE occurs in about 12 percent of men, in contrast with the four percent identified by sex researchers Masters and Johnson in the mid-20th century.
   
   Part of the difficulty with getting to an accurate figure is that men are usually reluctant to talk about their sexual problems, for fear of being tagged unmanly or un-masculine. However, as the subject is discussed more openly and freely, and accompanied by better research and reporting, the reported frequency of DE among men seems likely to increase.
3. Potential physical causes
   Let’s begin with drugs. Alcohol, cocaine and other drugs can temporarily cause DE, as can medication for depression or anxiety. All of them affect the level of serotonin in the brain and thus the ejaculatory reflex, making it difficult or impossible to orgasm during sex.
   
   Another common cause of DE is a history of “idiosyncratic” masturbation, i.e. masturbation that involves the use of extreme pressure on the penis, fast hand movements, ‘dry-humping’, and other techniques that are rough on the penis. Such a manner of masturbation usually begins in adolescence and from there the body is slowly conditioned to respond to sexual stimulation of only the most extreme kind. Thus, the normal stimulation provided during sexual intercourse isn’t enough to trigger an orgasm.
   
   Furthermore, any procedure, injury or disease that disrupts sympathetic or somatic innervation to the genital region has the potential to cause DE. This includes spinal cord injuries, multiple sclerosis, pelvic-region surgery and severe diabetes, among others.
4. Potential mental causes
   Any relationship issues that cause partners to feel alienated or distant from each other may cause DE. This includes any emotional restraint or reluctance to fully engage with each other sexually, resulting, perhaps, from underlying anger and resentment, or sexual shame, or guilt. All of these have the potential to dampen one’s enthusiasm for sex, preventing one from reaching the point of arousal that triggers an orgasm.
   
   In some cases, DE is caused simply by a lack of attraction for a partner. Other factors may include past traumatic events, or a strict religious upbringing in which sex was stigmatised. Fears of pregnancy, or performance anxiety, may also be contributing factors.
   
   Porn may also be responsible, especially for avid porn consumers who rely too heavily on fantasy to become aroused. This is because porn is often so outrageously stimulating, and real life sex usually isn’t capable of reaching the same intensity and excitement. Thus if one is accustomed to porn-level stimulation it will be difficult to ejaculate during actual sex.
5. What can you do?
   What you should do about DE depends on what is causing it, and the cause is usually a combination of biological, psychological, relationship and cultural factors. It is up to you, your partner and your doctor to narrow the causal factors down.
   
   If you’re taking medication for depression or anxiety and think they may be the cause of your DE, ask your doctor about different medications that may not have the same impact on sexual capacity.
   
   From there, one should begin investigating the conditions under which one is normally able to ejaculate. Current sex therapy often emphasises the importance of masturbation in treating DE. Here, men are taught – through masturbation or manual stimulation by a partner – to experience higher and higher levels of arousal through a combination of increased “friction and fantasy.”  For others, the focus is on masturbatory retraining, with masturbation serving as practice for sex with an actual partner, during which sexual fantasies are realigned so that thoughts experienced during masturbation match those occurring during sex.
   
   For DE that is most likely caused by partner issues, cooperation on the part of the partner is essential. First, efforts should be made to resolve any underlying emotional issues, then efforts should be made to increase the attractiveness and seductive prowess of the partner, i.e. discovering what most turns on the man afflicted by DE, and trying it out.
    

Do you know of anyone who suffered from delayed ejaculation? If yes, what was their experience like. You can share these experiences (even anonymously) by leaving a comment below or connecting via Facebook.