How To Help A Partner With Delayed Ejaculation
By Dr Dean Knoll
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By Dr Dean Knoll
What are the most common ejaculatory dysfunctions? As the name suggests, ejaculatory dysfunctions occur when a man has problems ejaculating. This can occur even when the man is completely aroused and has a full erection. There are generally 6 categories of ejaculatory dysfunction. They are premature ejaculation, delayed ejaculation (also historically known as impaired ejaculation), anejaculation, retrograde ejaculation, perceived ejaculate volume reduction, and decreased force of ejaculation.
Delayed ejaculation (DE) is probably the least common and least understood of all male ejaculatory disorders. In general, DE is reported at low rates in the literature by urologists and sex therapists. However there is an increase in the reporting of the incidence recently and the prevalence appears to be moderately and positively related to age, which is not surprising because ejaculatory function as a whole diminishes as men age. So how do we diagnose it and what can we do to treat it? Read on to learn how to help a partner with delayed ejaculation.
DE occurs when a man has difficulty ejaculating. It may take longer than he’d like to ejaculate, even when he is fully aroused, erect, and sufficiently stimulated. The situation can cause distress to both the man and his partner. While some reports indicate that 22 minutes or more to ejaculate is considered delayed, exact numbers do not represent a hard and fast rule for a DE diagnosis. In fact, ejaculation that occurs within a shorter or longer period may still be considered delayed if it is distressing to a man or his partner.
DE has been reported to affect about 1 - 4% of the male population. DE is classified as primary or secondary; primary (lifelong) DE, with an incidence of around 1%, applies to men who have always had difficulty ejaculating, men with secondary (acquired) DE, with an incidence of around 4%, have been able to ejaculate normally during intercourse in the past but later developed a problem. The disorder is considered “generalized” when it happens in any circumstance. When it happens only under certain conditions, such as with specific sex partners, it is called “situational”.
DE can have a psychological or biological cause. There can also be an overlap between the two. However, more commonly, DE occurs after a period of typical function. Through a detailed medical and sexual history and a physical examination, a provider (usually a Urologist) can often determine the cause of a man’s DE. A focused psychosexual evaluation is critical and typically begins by differentiating this sexual dysfunction from other sexual problems and reviewing the conditions under which the man can ejaculate.
Biological (physical) causes of DE can be related to changes in the man’s pelvic reproductive anatomy, neurological disorders, endocrinological changes, and certain medications. Some birth defects affect the male reproductive anatomy as would pelvic region surgery such as the removal of the prostate in a person diagnosed with prostate cancer. Diabetes, particularly uncontrolled, aging, neurological diseases, such as stroke, spinal cord injury, and multiple sclerosis all can affect normal neurological function and create DE. Other biological causes are hormone changes in testosterone and/or thyroid levels, illicit drug use, excessive alcohol intake, and side effects of medications used to treat depression, high blood pressure, and anxiety.
Multiple psychosocial factors have been offered as a cause of DE. Depression, unexpressed anger, and/or unconscious aggression along with relationship problems may be a recurring theme that contributes to DE. Fear of pregnancy has been emphasized along with cultural or religious beliefs that consider sex to be taboo are other possible etiologies for this condition. Sexual performance anxiety surrounding the inability to ejaculate may draw the man’s attention away from erotic cues that normally serve to enhance arousal and therefore deter from climax and ejaculation.
So when should you see a healthcare provider about treatment for DE? If it has been a lifelong problem or has developed in the last 6 months you should always seek help. Treatment for DE usually involves treating the underlying issue. If a prescribed medication, like an SSRI antidepressant drug, is creating a problem, then finding an alternative prescription with a doctor’s guidance can usually solve the problem. Lifestyle changes may effectively treat DE, such as limiting alcohol consumption in excess drinkers, decreasing or eliminating illicit drug use, and modifying diet to better control diabetes mellitus. Medical management by a doctor of abnormal testosterone and/or thyroid levels can help treat this condition as well.
The management of DE requires providing the person with accurate information and removing blame and use of sensate focus to reduce sexual performance anxiety. Sensate focus is a technique used to improve intimacy and communication between partners around sex, reduce sexual performance anxiety, and shift away from ingrained, goal-oriented sexual patterns that may not be serving a couple. A major aim of the exercise is for the partners to let go of their expectations and judgments of mutual touching, and instead focus solely on the sensory aspects of touch like temperature, texture and pressure. Sensate focus has also been described as mindful touching, or non-orgasm/non-arousal focused touch.
If idiosyncratic masturbatory practices are contributing to DE, masturbation retraining to a style more resembling the sensations of penile-oral, penile-vaginal, or penile-anal intercourse may be useful.
Penile vibratory stimulation is a potentially inexpensive and convenient first-line treatment to increase sexual friction and provide the stimulation necessary to restore orgasm and ejaculatory capacity. Some medications prescribed by one’s healthcare provider may help improve the symptoms of DE when used off-label. None have been specifically approved to treat it yet. Drugs with some reported benefits include oral erectile dysfunction drugs, i.e. Viagra, Cialis; cyproheptadine, amantadine, buspirone, cabergoline, and oxytocin.
Sex therapy can be helpful if one is struggling to reach ejaculation. Sex therapy is a form of talk therapy that helps address a range of concerns like sexual identity, intimacy challenges, and even sexual taboo issues. Other issues like anxiety, anger, and depression can be addressed. Counseling involves seeing a psychologist or mental health counselor specializing in this area on your own or along with your partner. Sex therapy most often involves both partners. During sex therapy, one will have the opportunity to discuss any emotional or psychological issues related to one’s sexuality in a non-judgmental way.
Activities may be recommended to try at home while having sex with their partner. These may include viewing erotic videos and magazines before having sex to increase arousal and stimulation, erotic fantasies and sex games to make lovemaking more exciting, using lubricant creams or gels to make the physical act of sex more comfortable and relaxing, and using sex toys like vibrators to increase pleasure. Why not try one of our Pepper lubricants? Or a new and exciting toy that can help with erectile stimulation?
DE can be a lifelong or acquired condition. It can have a physical or psychological cause or a combination of both that needs to be recognized and managed. If it’s an ongoing concern, DE can cause mental and emotional stress for a person and their partner. Communicate openly and honestly with your partner about this condition so that your partner does not think that your inability to ejaculate is a sign of diminished sexual interest. Understanding the underlying causes of someone's condition is one way to help a partner with delayed ejaculation. A combination of medical and/or psychological management can help improve this very stressful condition and improve overall sexual health to bring back the fun between the sheets.
