Delayed Ejaculation (DE) – Do I Have It, And How Do I Get Help?

What is Delayed Ejaculation?

Delayed ejaculation (DE) is an issue that affects about 1% of men in the United States (Hertlein et al., 2009). For some it is not a problem that it takes them longer to ejaculate, but for many men it can cause a great deal of stress as well as relationship problems. This blog post is intended to help you understand what DE is, some statistics around it, and what causes it. We also talk about  how to get treatment for delayed ejaculation; including medical treatment for DE and delayed ejaculation therapy or counseling.

Diagnosing Delayed Ejaculation

Delayed ejaculation is the delay of (at least 10 min) or inability to ejaculate when a man wishes to do so and is getting sexual stimulation. DE can be diagnosed by a medical doctor or a therapist (Hertlein et al, 2009). However, people with the issue should see a doctor to rule out medical causes for the problem. Therapists diagnose DE by using the DSM 5 criteria for the problem and seeing if the client fits them. (American Psychiatric Association, 2022). In order to be diagnosed with DE someone must have all of the following:

• Delayed or no ejaculation
• DE happens at least 75% of the time
• It has been going on for least 6 months
• DE happens during sex with a partner
• The individual actually wants to ejaculate and is not stopping on purpose
• Causes the person to be upset

DE Statistics

There are several interesting statistics around DE. Click the picture to the right for a larger version of the image. The information below was taken from (Hertlein et al., 2009).

• Delayed ejaculation affects only 1% of men in the US
• In order to get a diagnosis of DE you must have issues with delayed or absent ejaculation at least 75% of the time.
• There are two types of DE situational and general
  • General DE
    • Only happens in all sexual situations
    • General DE happens only 25% of the time.
  • Situational DE
    • Happens during specific situations such as sex with a partner
    • 75% of the time DE is situational
• DE can be acquired or lifelong
  • Lifelong is unusual, but there are no stats on how often it happens
  • Acquired is more often and it begins happening after an event or specific situation

Possible Causes of Delayed Ejaculation

There can be many reasons that someone has trouble ejaculating. These can be physical, mental, couple-based, due to the family you grew up in or due to society and culture (Hertlein et al., 2009).

Physical Causes of DE

Physical things that cause someone not to ejaculate can include, but are not limited to (Hertlein et al., 2009):

• Ability to withstand a lot of stimulation on the penis before ejaculating
• Side-effects of medications
• Pelvic injury or surgery

Mental/Emotional Things that Delay Ejaculation

Mental and emotional things that cause someone not to ejaculate can include, but are not limited to (Hertlein et al., 2009):

• Being used to masturbating to fantasies about types of sex you cannot have with your partner
• Not being in the moment during sex
• Stress

Couple Issues that Make Ejaculation Difficult

Couple issues that cause someone not to ejaculate can include, but are not limited to (Hertlein et al., 2009):

• Partner’s sexual problems
• Lots of arguing/poor communication
• Fears of intimacy

Family Problems that Can Make Ejaculation Stop or Delay

Family problems that cause someone not to ejaculate can include, but are not limited to (Hertlein et al., 2009):

• Lack of education on sex
• Taught beliefs that sex is “bad”, “dirty”, or punishable
• Sexual abuse or trauma

Society and Culture Causes of Ejaculatory Delay

Society and culture messages that cause someone not to ejaculate can include, but are not limited to (Hertlein et al., 2009):

• Cultural messages around sex and sexuality that do not fit the person
• Cultural and societal messages that the client should not want/have sex
• Macho sexual stereotypes for men

Getting Help for DE

When it comes to getting help for DE the help you can find to speed up your ejaculation depends on what is causing it to slow or stop in the first place (Hertlein et al., 2009). In general, there are several medical and therapy or counseling treatments for delayed ejaculation. Understanding what delayed ejaculation treatment is available will help you to find help quickly.

Medical Help for DE

The first thing to know when it comes to medical interventions is that no drugs are currently approved by the FDA to treat DE (Abdel-Hamid & Ali, 2018). However, doctors do prescribe several drugs off-label to treat it with some success. These drugs include oxytocin (known popularly as the cuddle hormone), pseudoephedrine and yohimbine.

Inability to ejaculate can cause fertility issues (Abdel-Hamid & Ali, 2018). No sperm = no baby. If this is the main concern that someone has then the doctor will just treat the fertility issue. Sperm can be collected in other ways for fertilization including prostate massage or catheterization, or electrical or vibratory stimulation of the penis.

Sex Therapy and Couple Counseling for Delayed Ejaculation

Sex therapy and couples counseling can help with delayed ejaculation (Hertlein et al., 2009). They are particularly helpful when they are combined, with a good couple counselor integrating sex therapy into the couple sessions. The sex therapy and couple counseling methods used depends on what is causing the delayed ejaculation. For instance, clients who are used to masturbating to certain types of images can be encouraged to use different images in masturbation and the therapist can work with the couple to bring their sex life more into sync.

It is best to do sex therapy with both members of the couple and not just the person having the ejaculation issues (Hertlein et al., 2009). This is because the sessions also help the person’s partner understand the issue and how to help. Also, it helps the therapist to understand the couple’s sexual cycle and work with them to change it when using treatments such as Emotionally Focused Therapy (Johnson et al., 2019).

My preferred method of working with this type of issue with clients is to use Emotionally Focused Therapy (EFT) with the couple and integrate sex therapy where appropriate (Johnson, 2019; Johnson et al., 2018). This allows for me to have a stable base from which to understand the issue both partners are facing from the problem, but enough flexibility to help with the DE no matter what the underlying causes are.

If you are in Ohio and interested in therapy for your issues with ejaculation, especially the problems it is causing in your relationship, contact us at Columbus Therapy and Hypnosis for an appointment.

References:

Abdel-Hamid, I. A., & Ali, O. I. (2018). Delayed ejaculation: Pathophysiology, diagnosis, and treatment. The World Journal of Men’s Health, 36(1), 22. https://doi.org/10.5534/wjmh.17051

American Psychiatric Association. (2022). Sexual dysfunctions. DSM Library. Retrieved February 1, 2022, from https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm13

Hertlein, K. M., Weeks, G. R., & Gambescia, N. (2009). Systemic Sex Therapy. Routledge.

Johnson, S. M. (2019). The Practice of Emotionally Focused Couple Therapy: Creating Connection (3rd ed).Routledge/Taylor & Francis Group.

Johnson, S. M., Simakhodskaya, Z., & Moran, M. (2018). Addressing Issues of Sexuality in Couples Therapy: Emotionally Focused Therapy Meets Sex Therapy. Current Sexual Health Reports, 10(2), 65–71. https://doi.org/10.1007/s11930-018-0146-5