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Question:
What could cause me to be unable to climax and ejaculate after prolonged
intercourse? This all started about six months ago.
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Answer:
by Michael A. Perelman: (05/27/2004)
There are a variety of different possible explanations for your difficulty,
which might turn out to be diagnosed as "retarded ejaculation (RE)." You need
to schedule an office visit with your primary health care provider who will do a
complete evaluation of your problem and/or make an appropriate referral for
you. However, let me take your question as an opportunity to provide some
information about RE in general.
The APA Diagnostic and Statistical Manual IV defines Male Orgasmic Disorder (RE)
as the persistent or recurrent difficulty, delay in, or absence of attaining
orgasm following sufficient sexual stimulation, which causes personal distress.
In secondary RE ,this condition occurs for a variety of reasons after a period of good sexual functioning. Some men with secondary RE can masturbate to orgasm
and others, for a multiplicity of reasons, would or could not masturbate. Some
men lose masturbatory capacity, secondary to emotional or physical trauma.
It has been well known for years that adverse sexual side effects of many drugs
cause delayed or fully impaired orgasm in men and women. This was especially
true of psychotropic medications.
In addition to psychodynamic and interpersonal causes for RE, a biological etiology should also be considered. There is strong likelihood of biological variability in the threshold of arousal necessary before experiencing orgasm. The dysfunction becomes manifest given certain external factors: medications, sexual circumstances, and intra and interpersonal dynamics, etc.
In the RE literature, multiple psychological explanations for the disorder are offered, with
unconscious aggression and unexpressed anger recurring as themes. Additionally, pregnancy fears receive emphasis, since the reason for professional referral was often the female partner's wish to conceive. Bernie Apfelbaum correctly observed that some males appeared able to achieve erections sufficient for intercourse despite a relative absence of subjective arousal. Erroneously, these "automatic erections" were taken as evidence, by both the male and his partner that he was ready for sex and capable of achieving orgasm.
In a 1994 article, I noted abusive masturbation style was a hidden cause of
frequently misdiagnosed dermatological and urological conditions. Many men with
RE engaged in stimulation that was striking in the speed, pressure, duration and
intensity necessary to produce an orgasm. I also discussed the role of
masturbation frequency, motivation, and technique in the etiology and
maintenance of sexual dysfunction, including inhibited sexual desire, erectile dysfunction, premature ejaculation, and retarded ejaculation.
In addition to idiosyncratic masturbatory style, a common immediate cause for RE is a disparity between the reality of sex with the partner and the sexual fantasy used during masturbation. This disparity takes many forms: body type, orientation, sex activity performed, etc.
I hope this information is helpful. At another point in time I will discuss some
of the treatments available to restore sexual health to those that suffer from
RE. Since the beginning of sex therapy, RE was seen as a clinical rarity and was
reported to be a difficult symptom to treat. I have treated over 100 cases
including both primary and secondary RE, with good results. So do not despair,
help is available. But first, make that appointment with your health care
provider.
**The information contained in Dr. Perelman’s response to this question first
appeared in his article "Sildenafil, Sex Therapy, and Retarded Ejaculation"
published 2001 in the Journal of Sex Education and Therapy, Volume 26, No. 1
Reviewed by Sexual Health Editorial Team
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