Situational Retarded Ejaculation

I'm looking for information on the ability to achieve orgasm with some partners but not others. Patient checks out phsically and problem is psychogenic. Patient is able to achieve orgasm with strangers and prostitutes but cannot ejaculate by any means in a normal relationship. Patient has been unable to ejaculate with his wife at all during their 13 year marriage.

Sensate Focus therapy has failed in this case. Looking for a less demand oriented therapy.

go to this link, scroll down past the ads at the top of the page and you will find a detailed explanation of this problem.

http://www.the-penis.com/premejac.html

Men with this problem usually have a very high orgasmic threshold. This can be caused by atypical masturbation patterns. A man who is used to the feel of his own hand and grip strength feels understimulated my vaginal or oral sex with a partner. Vaginal intercouse especially can be a problem and many men with this dysfunction complain their penis feels numb during intercourse.

Some men can only have an orgasm under certain circumstances and with certain people. The excitement of a new partner or certain unusual sex practices may be the only way these men can reach thier orgasmic threshold.

Sensate Focus therapy has proved ineffective in the treatment of male anorgasmia because it puts even more performance pressure on a patient who already feels enormous pressure to ejaculate with his partner. Indeed these men are usually so eager to please that even though they don't feel a sufficient level of arousal during partner sex, they can achieve and maintain erections that can last up to an hour.

Allowing the patient to express his unaroused state during intercourse can be a potent method of starting a treatment program. He must be able to express negative emotions towards his partner and all pressure to perform must be removed.

Dr. Greene,

I would think the reason your patient is able to reach orgasm with prostitutes and strangers has to do with performance anxiety. These women expect nothing from him and he knows it, and is therfore able to relax enough to let go.

Sex within a relationship is seen as a demand to give pleasure and the patient is overcome with anxiety- sometimes without even realizing it on a concious level. These men are usually sensitive and attentive lovers spending much time making sure the partner is happy and ignoring their own needs. Orgasm in itself is a selfish act and these men have difficulty being selfish within a sexual relationship.

Sometimes a treatment stratedgy of distraction can be used to take the man's mind off his partner. Video pornography has been very successful in treating these patients. The man watches the video during intercourse and this helps to stop him from engaging in the spectator role with his partner and he ceases to constantly monitor her level of arousal.

Surrogate therapy has an excellent cure rate with anorgasmia/retarded ejaculation but tends to be expensive and is not widely available.

In my practice I have found that the root cause of retarded ejaculation not caused by drugs, diabetes, or other physiological problem is usually extreme low self esteem. Many of these men
will enter into marriage or relationships not out of strong feelings or sexual attraction, but rather they seem to hook up with any woman who shows interest. Once the relationship begins to solidify, the man starts to realize he is not sexually attracted to his wife/girlfriend and this can cause his sexual dysfunction. In other words, the low self esteem gets him into situations that then result in a low sexual desire for the partner. Because he feels he must perform no matter what, he gets an erection, but is unable to ejaculate. With women he does find sexually attractive or is truly in love with, his orgasmic threshold is normal. However, in a long term relationship where interpersonal difficulties or boredom set in, the symptoms of R.E. can return.

In regards to male anorgasmia it is clear that it is an arousal disorder.
In treating these patients, finding the root cause of the patients low desire can be the key to successful therapy. It may be a lack of self esteem has gotten him into a relationship were he may not be sexually attracted to his partner or he may be in a long term relationship gone stale where he no longer feels sexually sttracted to his partner. It is very common that these men never have any ejaculation problems with masturbation (especially while viewing pornography) or with prostitutes. In both cases he picks the object of his own sexual arousal for sexual purposes only and so is able to easily ejaculate. When the retarded ejaculator percieives sex as demanding (as in a comitted relationship) and he feels an enormous responsibilty to pleases his partner, he becomes anxious and performance anxiety can set in. The harder he tries to concentrate on pleasing his partner, the harder it is for him to become aroused enough to ejaculate.

Masturbation can cause RE. If a guy starts masturbating early an doesn't have alot of sexual partners in his life through his teen years and perhaps his 20's, he can get so used to the feel of his own hand that regular partner sex will not feel "right" and he will not get stimulated enough.

If he watches porn while masturbating, especially every day, then he tends to get dissapointed with the real thing. I was going to say unless he gets into bed with his favorite porn star. But even if THAT were to happen the difference between the fantasy and the real thing might cause him some dissapontment. Maybe not at first.... but let's say he had an ongoing serious relationship with her. Chances are the lack of feeling and the real vs. fantasy thing would ultimately cause his RE to rear up it's ugly head once more.

IF the guy has a partner or is expecting to find one, the best thing to do is to stop masturbating for the duration of the relationship. This may or may not help depending how ingrained the masturbation style and the connection between porn fantasy and orgasm is.

Even after halting masturbation, if he still can't ejaculate then we are into a psychological problems like the ones mentioned above by the other posters. In those cases, sex therapy is required.

Male Anorgasmia/Retarded/Inhibited Ejaculation.

Bernard Apfelbaum's Counterbypassing therapy works very well in these cases (see Principals and Practice of Sex Therapy) providing a surrogate partner is used. This therapy with a partner in a long term relationship however, usually does not succeed because the partner's ego can become shattered should the retarded ejaculator be allowed to voice his feelings during intercourse (especially true in the high percentage of cases of this dysfunction where the patient is not sexually attracted to the partner) With a surrogate it is much easier for the patient to complain about his unaroused state. Even if the problem has been caused by atypical masturbation habits, Counterbypassing can still work in conjunction with teaching a less strident masturbation style.

Allowing the patient to be the "taker" rather than the "giver" during intercourse has proven to be a dramatic breakthrough for these men who are usually consumed with low self esteem, guilt and performance anxiety.

Allowing them to take control of the sexual encounter and not to worry about the pleasure and feelings of the (surrogate) partner allows these men to relax and concentrate on their own pleasure. Then can then be reprogrammed to take this mindset into their regular sexual relationship(s)

I also agree that retarded ejaculation is fundamentally a problem of low desire. The fact that many of these men have no prolem reaching orgasm during masturbation or with prostitutes proves this.

I believe that R.E. will be in the early decades of the 21st century what erectile dysfunction was in the latter part of the 20th- and hopefully, like E.D. a treatment for this serious and debilitating sexual dysfunction will be found not in the realm of psychotherapy (which has had little success) but in pharmacology. Boosting desire is the drug companies' new holy grail and I believe it won't be long before a drug comes out that will allow men to boost their arousal even with a partner who they may not be particularly attracted too- a common problem in long term baby boomer marriages.

RB

below is a link to one of the better websites dealing with RE. It talks a bit about the arousal problem but doesn't follow up. Instead it regurgitates the old M&J saw about masturbating in front of your partner. This of course is ridiculous if the low arousal is being caused by lack of attraction to the partner. The poor guy would end up pumping away at his penis for an hour, probably tearing the penile skin in the process and in the end he would have the same problem as with vaginal intercourse- no ejaculation.

For RE caused by performance anxiety this site might be of some help.

http://www.sexnews.org/features/Feature ... icle_id=48