מיקום המרפאה: רחוב לוינסקי 108, בתוך התחנה המרכזית החדשה, בקומה 5 (מעל קווי דן 4,5)

Delayed Ejaculation

The author of the article is Dr. Idan Milicher, a psychotherapist, sex therapist and family therapist.

Delayed ejaculation is a phenomenon characterized by a man’s difficulty to ejaculate. 

Some men might consider this a fantasy, not to ejaculate quickly, but in reality, men who suffer from delayed ejaculation, experience suffering. It’s like driving an amazing car to nowhere and never anywhere… Literally, the trip turns from pleasure into a nightmare.

It is unpleasant to have sex, the erection stands and burns like a torch, until something in the back almost snaps, and still not being able to ejaculate. Of course, after a while of not being able to ejaculate, there is a decrease in erection and an increase in frustration.

In the not-too-distant past this phenomenon was considered rare, but over the years we have witnessed an increased number of men complaining that they have difficulty to ejaculate. Studies today indicate that 2%-7% suffer from some level of dysfunction.

So, what exactly is delayed ejaculation? The average ejaculation time is 2 to 5 minutes from the moment of penetration. Some men ejaculate very slowly or have difficulty ejaculating during sex with a partner. This condition is called delayed ejaculation.

As mentioned, the phenomenon ranges from difficulty ejaculating in during sex to difficulty ejaculating in general, even in masturbation alone (although difficulty ejaculating in masturbation alone is very rare). 

There are quite a few men who are ashamed of the situation and as a result “pack” it in all sorts of heroic stories like I am in control, I am thinking about your pleasure, everything is in my head, and… Yada, yada, yada… All kinds of excuses to hide the difficulty. 

The causes of delayed ejaculation are many and varied:

  1. Diseases such as: diabetes, multiple sclerosis, and other diseases can impair the ejaculatory reflex. 
  2. Use of medications, especially antidepressants from the SSRI family, can impair ejaculation. In women, the response to medication might cause delayed and even make them unable to reach an orgasm.
  3. The use of antipsychotic drugs may also have an effect that will delay ejaculation, similar to antidepressants.
  4. Alcohol use and/or massive and frequent drug use, especially heavy ones. (I will not be the one to determine which ones are heavier).

Psychological reasons:

  1. Habits and patterns in the beginning of having sex. A man who practices masturbating in one way, for example friction against a mattress, will have difficulty ejaculating in another way. Alternatively, masturbating while touching the penis very strongly and massively will make it difficult to ejaculate with another “gentler” touch, such as oral sex and/or full sexual intercourse.
  2. Fear, ambivalence and guilt over ejaculating during sex. These deep feelings, which are the result of our childhood and the conflicts that have been repressed into the subconscious and have not been resolved, may manifest in adulthood in an inability to ejaculate voluntarily.
  3. Severe abandonment anxiety. A child who feared that his mother would abandon him if he did things that made him happy but did not please her. The woman, unconsciously, occupies the place of the mother. The man is afraid that she will abandon him and therefore does not allow himself to fully enjoy…
  4. Difficulty “to let go” in life in general and during sex in particular. Anxiety related to performance can also be manifested in difficulty to ejaculate. 
  5. The inability and conflict in expressing anger is manifested in holding back (literally).
  6. Delayed ejaculation as an expression of ambivalence regarding the relationship.
  7. Delayed ejaculation as an expression of the struggles for power and control within the relationship.
  8. Delayed ejaculation as an expression of a painful event such as the discovery of infidelity.
  9. In advanced age the ejaculatory reflex becomes slower.
  10. Fear of pregnancy or unwillingness.
  11. And of course, the reason is not always known.

 

The difficulty for the partner to function sexually and in regards to delayed ejaculation in particular, raises many questions for the partner. The partner may get into a whirlwind of self-questions regarding her femininity and sexuality. Many women may feel unattractive and as if they are not enough, and more than once I have come across women who have noted that while self-esteem decreases the weight goes up.

Treatment:

If there is no physical component that needs to be considered, the treatment of delayed ejaculation is conducted in two ways: 

  1. Understanding the psychological component that causes ejaculation delay.
  2. Exercises that gradually reveal the difficulty to ejaculate during sexual intercourse while performing satisfactorily. It is true that each case is deferent, but generally the man is taught to ejaculate alone, to masturbate in front of a partner, then he ejaculates with the partner and at the end of the process while having sex.

 

Having said that I will add that if there is difficulty in ejaculating several months into a sexual relationship, I would recommend seeking professional advice.

Dr. Idan Milicher

Head of the Inorganic Sexology Clinic for Men, Tel Aviv Medical Center

 

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