Male orgasm usually has two components – an extremely pleasurable sensation, due in part to muscle contractions, as orgasm takes place, and the ejaculation of semen.
Ejaculation takes place when semen enters the end of the urethra and creates a build up of pressure, which triggers a series of co-ordinated contractions of the pelvic muscles, which forces the semen out of the body.
But, strangely, some men have trouble reaching orgasm and ejaculating during sexual activity, a condition which is known as male orgasmic disorder, retarded ejaculation, or delayed ejaculation.
Delayed ejaculation, the term I prefer to use, is defined by the American Psychiatric Association (APA) as “persistent or recurrent difficulty or delay attaining in orgasm, or the absence of orgasm, following sufficient sexual stimulation.”
So how common is delayed ejaculation? Estimates vary widely. In 2003 a study of men attending doctors’ surgeries in London reported a rate of 11%. A representative sample of American men aged between 18 and 59 years revealed that 7.8% of men had experienced delayed ejaculation for at least one month over the previous year. And a study of UK men aged between 16 and 44 found that 5.3% had been unable to reach orgasm for at least one month in the previous year. A lower proportion of 2.9% had the problem for at least six months in the previous year.
What causes such a strange condition? No-one really knows, but it has been suggested men with delayed ejaculation may have slower sexual reflexes, lower penile sensitivity, or reduced spinal nerve stimulation…but the fact is, no-one really knows.
Some authors have suggested that insufficient physical stimulation during sexual activity may be the problem. This is because men who prefer autosexual stimulation – that is, stimulation by their own hand – to any kind of partnered sex may have a physically hard way of manipulating their penis as they pleasure themselves, to which they have become habituated. This hard, even aggressive, stimulation lowers their ability to ejaculate during intercourse just because they don’t receive enough stimulation during the gentler act of lovemaking.
And some evidence suggests that intensity and ease of orgasm declines with age. The sexual organs atrophy, testosterone levels decrease, and erections are harder to achieve, all of which points to an age-related decline in the functioning of the sexual system.
Sometimes there are congenital abnormalities of the sexual glands and ducts which could lead to the inability to ejaculate. We also know that pelvic surgery may affect a man’s ability to ejaculate; in particular, radical prostatectomy often results in loss of erectile function and ejaculation. And trans-urethral resection of the prostate, an operation often carried out to resolve problems caused by the enlarged prostate gland, can cause delayed ejaculation.
Other factors associated with delayed ejaculation include vascular disease, smoking, alcohol, physical inactivity, and many drugs approved for the treatment of obsessive-compulsive disorder and depression, together with antiadrenergic, anticholinergic, psychoactive and antihypertensive drugs.
In addition, researchers have observed that almost every psychological problem known to man has been associated with delayed ejaculation! For example, a man who is ambivalent about his sexual relationship may “hold back”: not only from full emotional presence in a sexual relationship but also from sexual intimacy – this can be seen as a type of overcontrol, a way of assuming power in a difficult relationship. This assumes that men with this problem are overcontrolled and resist “letting themselves go” – in every way: psychologically, emotionally, and sexually – including the release of ejaculation.
But there again, sometimes things are not so complex, for as another author has observed, a creaking bed, thin walls, and children wandering about, may inhibit orgasm and ejaculation very effectively. So can penile pain: a phimotic foreskin, painfully stretched over an erection, or a recurrent painful torn frenulum.
In getting to the bottom of what’s going on in cases of delayed ejaculation, a doctor needs to consider whether the problem is physical or emotional. An assessment of the penis and nervous system can exclude peripheral neuropathy, autonomic dysfunction, and spinal cord pathology, as well as other physical causes.
Treatment of delayed ejaculation has often involved vigorous hand stimulation of the penis, using a lubricant, in an attempt to overcome the “block”, and “decondition” the non-ejaculatory response.
Other suggestions have included the use of masturbatory exercises, missionary position sex (which is more physically arousing to men than some other sexual positions), and the use of vibrators to increase sexual arousal. In reality, these are crude approaches which do not take account of the fear or anxiety which may be inhibiting ejaculation: fear of pregnancy and fear of sexually transmitted infections are high on this list. These all need the attention of an understanding therapist or counselor. Hypnosis may be helpful for relaxing a man and encouraging him to “let go” during sex.
In summary, retarded ejaculation treatment must address both physical, emotional and relationship factors, and therapy must be tailored to the individual’s needs.