Psychological Causes of Delayed Ejaculation
Lasting a long time in bed may not sound like a problem. Until it is.
There is certainly such a thing as lasting too long, which can be a sexual dysfunction known as delayed ejaculation, where it takes an extended period for a man to climax and ejaculate. That timeframe can vary from man to man, but experts generally consider delayed ejaculation as requiring more than 30 minutes of stimulation to ejaculate.
Some men with delayed ejaculation are not able to ejaculate at all, known as anejaculation. Others only ejaculate through masturbation. Delayed ejaculation can be very frustrating and distressing for both the man and his partner. For a female partner, if she climaxes long before the man, her vaginal lubrication can dissipate, and sex can be uncomfortable or even painful.
While delayed ejaculation can be attributed to an array of potential physical causes, such as thyroid or neurological disease, the cause is often psychological. Potential psychological or emotional causes of delayed ejaculation include:
- Depression, anxiety and stress
- Feeling angry, resentful or uncomfortable with a partner
- Feeling guilt or shame about sex
- Strict religious upbringing or cultural taboos
- Family-of-origin messaging
- Lack of sex education that's not fear-based
- Body image concerns
- Not feeling safe in their body or in sync with their partner
- Fear of disease or pregnancy
- Sexual performance anxiety
- Intrusive thoughts or self-judgments
- Sexual trauma
- Lack of communication with their partner
Regardless of the type of psychological cause of delayed ejaculation, treatments are available. Don't hesitate to seek help from a qualified sex therapist, who can provide the support necessary to address the problem and work toward a more satisfying sex life.
Sex is often goal-oriented in that the goal is an orgasm, according to sex therapist Robyn Flores, a doctoral candidate and licensed marriage and family therapist who provides client care in Texas and Colorado for Respark Therapy.
"If they're not getting there fast enough, they start judging themselves and getting frustrated," Flores said. "That doesn't help the process along; it actually impedes it."
If a man is not communicating with his partner during sex or he's changing positions or always trying something new, frustration can set in, she said.
"I've had patients where the partner will actually start taking it personally, and that's a whole problem in and of itself," Flores said. "It's like, 'Oh, I'm not hot enough for you.' That's the partner's issue; it's not his issue. It's the other partner judging, which is often worse than judging ourselves."
'Deconstructing the messages'
When Flores first sees a client struggling with delayed ejaculation, she conducts a complete sexual history and investigates their first sexual experience.
"Was it positive, negative or neutral? I think a lot of people think, 'Oh, an innocent first time.' Sometimes, it's not. Sometimes, it's a rape or nonconsensual situation," she said.
Flores believes it's important to meet them where they are in their historical context.
"We spend most of our time in therapy deconstructing the narratives that they have around sex and deconstructing the messages that they received from religion or their family of origin," she said.
Flores counsels patients on emotional regulation, or the process by which we exert control over our own emotional state. This could involve rethinking the situation to reduce anxiety and focusing on reasons to relax.
Flores helps them build stress-tolerance skills, practice mindfulness and examine any shame they may be experiencing. The man often feels guilty for his delayed ejaculation because he's not providing his partner with the experience they want, she said.
Sloan, a licensed marriage and family therapist at Austin Concierge Therapy in Austin, Texas, usually asks the man to bring his partner to the therapy sessions so she can give them a heads-up as to what she's working on with the client.
If the delayed ejaculation stems from the fear of pregnancy, Sloan talks about birth control and the possibility of a vasectomy if they're not interested in having children. Birth control and vasectomies make a huge difference because they take away the pregnancy fear and may even resolve the delayed ejaculation, she said.
Take it step by step
If it's a case where the man cannot ejaculate at all during sex but can when masturbating, Sloan tells him to close his eyes and imagine he's with his partner.
"You've got the familiarity of your own body touching yourself, but you want to start to link that pleasure with your partner," she said.
Sloan suggests the patient include his partner in the self-pleasuring process by having them put their hand on top of the man's while he masturbates. After that is successful, proceed to only the partner's hand. Then try it during sex.
"It's literally just cognitive behavioral stair-stepping, going very slowly toward where you want to get to," Sloan said.
Flores wants her clients to leave their sex therapy sessions feeling empowered.
"I want them to be able to advocate for themselves and I want them to embrace their sexuality," she said. "Take their power back from whatever moment in their past took it away from them."
A urologist's perspective
To Martin Kathrins, M.D., a glaring sign that delayed ejaculation is psychological is when a man is able to ejaculate through masturbation within the time he prefers but not when he's with a partner.
"It's probably stress-related during the time that he's intimate with his partner," said Kathrins, an assistant professor of surgery at Harvard Medical School and a urologist at Brigham and Women's Hospital in Boston. "Coping strategies are what's needed, and that's when the sexual therapists come in. I think for that problem, in particular, [therapy] can be quite helpful."
However, if the man is having the issue long term and with different partners, Kathrins generally recommends going the pharmacotherapy route, using one of the number of drugs available to treat delayed ejaculation. He mentioned cabergoline, oxytocin, buspirone and cyproheptadine. However, because no drug is approved by the Food and Drug Administration for the specific treatment of delayed ejaculation, they are prescribed "off-label."
'Coping strategies are what's needed, and that's when the sexual therapists come in.'
One of the leading causes of delayed ejaculation is iatrogenic, meaning it's caused by treatment such as medications, Kathrins said. Selective serotonin reuptake inhibitors (SSRIs), which include antidepressants such as Zoloft and Prozac, are notorious for causing delayed ejaculation.
"We can educate the patient about the risk of that, and maybe instruct them to discuss with the prescribing physician other non-SSRI alternatives," he said.
After all the physical causes of delayed ejaculation have been ruled out, Kathrins said it then becomes a diagnosis of exclusion.
"We still focus on the situational nature of the problem in trying to really zero in on when the problem is occurring and when it started," Kathrins said. "What was his relationship status at the time this was going on? Those are all clues that there's a psychogenic problem. As a physician, I want to identify any readily or more easily correctable causes."