Ask the Doctors: Delayed Ejaculation

My Good Doctors:

I have suffered from delayed ejaculation (and orgasm) since I became sexually active  in the early seventies. It is a bother to not be able to orgasm without or with a partner.

I can find very little on the net except that 1) hypnosis may be of help (how or for what the NIH website is not clear and 2) it may have a ‘relationship’ basis. I achieve a solid erection without meds.

Way back when, a professional worked with me on this.  Her training had us focusing on visualization to assist in coming.

As way of background I should say I am straight and raised in a rather conservative Christian religion.

Thank you!

Thanks for your letter. My mom hailed from the same religious background as you do — I know a little bit about it. That detail may not be completely irrelevant.

There are two things that the world of sex therapy tends to focus on when considering delayed ejaculation. There is far less attention paid to this than there is to so-called “premature” ejaculation, perhaps because so many men (and their partners) complain of the latter that it may subtly influence clinicians — the “I wish I had your problem” kind of mentality. As your own research has uncovered, one genesis of this issue is indeed thought to be emotional and situated within the context of a relationship (not necessarily not your current relationships, but an early one). If there’s any truth to that, though, other emotional elements might be worth considering, maybe even the sex messages you got from your religious background. (Catholics are usually acknowledged as having the potential of sexual issues linked to their religious upbringing, but conservative Protestant denominations certainly turn out people affected by the sexual messages of those spiritual systems, too.)

The inability to reach orgasm, whether it happens to a man or a woman (or anybody else), can be associated with control or other emotional issues, too — an inability to let go, anxiety, a lack of a sense of safety. An early fear-based genesis for some guys might be worry about getting a female partner pregnant; perhaps it’d be worthwhile for you to think back in the day to recall whether this was a substantial source of distress in your early partner-sex history.

The other thing this concern is associated with: physical stimulation. And it’s my strong guess that the majority of men with delayed ejaculation (and/or difficulty reaching orgasm, because the two things are not the same) actually have this problem, not primarily something mental. Most guys’ first sexual experiences are solo, not partnered, often involving nothing but their own hand — and while I am one of the most pro-masturbation people on the planet, it’s certainly worth saying that manual stimulation and vaginal intercourse don’t feel the same, especially if you didn’t start out masturbating with lubricant. Women who are orgasmic with masturbation often also have this issue: intercourse doesn’t feel enough like what they’re used to, and doesn’t stimulate the right places in the right way. If you can orgasm through masturbation sometimes, you may have simply taught yourself, early on, to come one way, but not others.

Whatever the genesis, your mind and body have learned this as your own normal response. If you’re going to change it, there are two main ways to try: bridging the stimulation that works for you now so as to use that erotic energy toward your goal of coming with a partner (you don’t say for sure whether you come with masturbation, so the following is for guys who definitely do); and adding to the stimulation you have to work with in the first place — getting yourself over the hump, so to speak, that you reach and do not crest with ordinary partner sex.

Bridging generally involves one of two strategies: adding strategically-timed masturbation into partner sex (intercourse for any amount of time that makes you and your partner happy; then masturbation until you feel yourself at the edge of “ejaculatory inevitability,” as we say in the trade); then intercourse again. Ideally, in this scenario, your partner is happy to encourage your masturbation, eggs you on erotically, and does not express distress at the scenario — if she does, it may not do the trick. If there are other things that are regular or important elements in your solo-sex time (porn, toys, etc.), you may want to figure out if you can bring those into partner sex also. You might also wish to try masturbation toys like the Tenga products and the Fleshlight family of sleeves, with lube, to more closely approximate vaginal intercourse compared with the sensation of an unlubed hand.

Hypnosis and visualization have a sexualized cousin: fantasy. Add mental stimulation of any kind that you and your partner can enjoy together (erotic talk, getting voyeuristic with a porn movie, exploring fantasy roles — all of these are touched on in my book Exhibitionism for the Shy, if that is of interest), or simply go to the most erotic fantasy you can when you feel yourself at all close to coming. Many people — probably most — engage in fantasy as a significant part of their sexual pattern; it’s not an extra, it might be completely integral, so don’t try to banish fantasies. Also, when you masturbate by yourself, fantasize about ejaculating inside your partner. Eroticize that scenario during solo sex.

If you do think there are unresolved and religiously-generated conflicts about sex in your psyche, it might be worth exploring some of the sex-positive spiritual belief systems out there: the Unitarians have the best sex ed program in the US, pretty much; many Pagans are very sex-positive; and of course some Tantra practitioners are very steeped in the spiritual roots of these practices — plus they tend to really emphasize intimacy. You might also like Jack Morin’s book The Erotic Mind, which addresses, among other things, religious messages that get hooked up with our adult sexual responses. Some people are turned off religion because of sex-negative messages, but then never re-wire with anything positive, spirituality-wise. This isn’t always necessary, but for some people, it appears to be very important.

Prostate stimulation is another thing that gets some guys over the edge. Try exploring intercourse while using the Aneros, a medically-designed anal device that puts pleasurable pressure on your prostate. Don’t forget the lube, and if you have never explored anal touch, don’t worry — lots of men adore this toy. (We once received an effusive thank you note from the sheriff of a small midwestern town for selling him a buttplug, which resolved a lifelong issue with delayed ejaculation–it might work for you!)

Finally, some men have had luck (during the period they’re trying to learn to re-wire themselves to orgasm with partners) by limiting their own solo erotic time. If you masturbate daily, don’t, and explore how many days of abstaining from masturbation you need to rack up before your ejaculatory pressure gets strong enough that it kicks in during intercourse. (Obviously I like the above solutions better because you get more pleasure, but this might work for you and may be an option if the other strategies don’t do it.)

Decreased serotonin may be implicated in premature ejaculation, some people think, so perhaps we also need to look at brain chemistry vis-a-vis delayed ejaculation. I’m not aware of science having caught up with this question, though, so this is a question for another, future day.

Good luck!


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Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at

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