Dear Dr Ren,
After reading your column about PE (premature ejaculation), I thought you might be able to help me with the opposite problem. I can’t come with a partner!
This used to mean that I just came last, but over the years it is becoming more difficult to reach orgasm at all when I’m having sex with a boyfriend. It’s easier with hookups, and with masturbating I’m okay, but after a while with the same guy, nothing pops my cork. Once he notices, I become a “cause,” with him trying to make me come, and me trying, too. Eventually, I avoid sex and leave feeling inadequate and guilty.
Is there something I can do to turn this around? I want to be normal!
Dear Never Premature,
You are describing what we called RE (retarded ejaculation) or DE (delayed ejaculation). It affects about three percent of men and is defined as “repeated delay in achieving, or the complete failure to achieve, ejaculation, despite receiving the level of sexual stimulation which would normally trigger it, and where the man cannot control the timing of his ejaculation.”
Men with DE usually complain of little or no difficulty attaining or maintaining erections, in spite of which they don’t feel particularly aroused. And, although PE and DE are on opposite sides of the coming spectrum, the problem with both is your focus on the timing of ejaculation rather than on the pleasure you could be experiencing.
DE can be caused by, or a side effect of, SSRIs (antidepressants) and other drugs such as blood pressure medication, antipsychotics, diuretics and even some painkillers.
There also seems to be an undeniable connection between strict religious orthodoxy (and attendant cultural sexual shame) and DE.
Some factors associated with masturbatory habits encourage DE, such as a death grip or idiosyncratic style or position, differing from what would be associated with the sensations of partnered sex.
Health concerns can also contribute, including type 1 diabetes, neurological illnesses, multiple sclerosis, bladder or prostate surgeries, low testosterone and plain old aging.
Underlying relationship issues (wrong sex/wrong partner) sometimes also prevent men from being willing or able to “let go.”
Concentrating on performance rather than pleasure doesn’t help either.
Retarded ejaculation, then, is best understood as a response to the interaction of biological, psychological, relationship and cultural factors. Check with your healthcare provider to eliminate physiological or drug-related causes before assuming the problem is in your head or your hand.
Once you become aware of your “problem,” anxiety may draw your attention away from the erotic cues that would normally enhance your arousal. Men with RE often fail to experience sufficient erotic stimulation to reach the point of ejaculation. Remember, getting hard isn’t the problem; getting off is.
Men with DE are usually sensitive and attentive lovers who concentrate on their partners’ responses and ignore their own. Focusing on your own fantasies and desires helps you respond to your own arousal.
What to do?
Remember the impact of erotic cues — look at your lover and/or watch arousing porn during sex.
If partnered sex doesn’t feel as good as solo sex, try switching up how you wank. Change hands, lessen your pressure or alter your pace to approximate sex with your lover.
Assess your relationship. Familiarity decreases arousal, so keep your intimate relationships fresh and innovative.
Just as I suggested for the guy who came too fast, you need to lose the stopwatch and concentrate on pleasure. Embrace intense desire. Stop trying to come and simply enjoy your sensations. Be a little selfish.
The “cure” comes when you learn your particular erotic turn-ons and indulge them sufficiently to increase your physiological arousal with your partner.