A Case History
Of A Man Unable To Ejaculate During Intercourse
Rose's boyfriend, Jim, was unable to ejaculate with a partner when he came for help. His delayed ejaculation (DE) was playing heavily on his mind. When gathering the details, we established that he grew up with both parents, the older by two years of two siblings. Jim's father was the primary person he talked to about personal issues, at least until he reached puberty, and by his account they had a close relationship up to then. As he matured, things changed: certainly his sexual behavior and especially being unable to orgasm during sex were issues that he would never have dreamed of talking about. His relationship with his mother was less positive, though not damaging. Conflict and fights in the household were avoided, his father usually giving in to his mother to keep the peace.
Jim recalled that his confidence had diminished markedly at puberty when his father became more distant towards him, possibly because his father was having a sexual affair with a business partner. At 13 or so, he became depressed, and remained so for the best part of five years. He was humiliated at the age of 15 when he attempted to have sexual intercourse with a girl of 18, for he lost his erection after penetration and failed to achieve orgasm. His girlfriend condemned him as no use, for, as he bitterly reported, why would she want "a boyfriend who couldn't come"?
Even at this age it appeared he was experiencing delayed ejaculation or some combination of symptoms which looked like its precursor. He felt alienated from women, and could not confide in his mother about personal issues. He reported feeling desperate and unhappy. He found comfort in frequent masturbation, using an idiosyncratic technique which involved considerable force and left him unable to ejaculate later in life. This technique - known as "humping the mattress" - is often found in men who have ejaculatory dysfunction. During his teenage years he had a boyfriend with whom he engaged in masturbation, but even with his boyfriend he was unable to ejaculate, and this appears to have made him even more depressed. Such factors in teenage years are often precursors of DE in adult life.
Sex was a taboo subject in Jim's family. Jim used to look at girls with a mixture of fear and longing; his use of pornography to get aroused before masturbation was tempered with a feeling of guilt.
The outcome of all this was that Jim felt he could not have normal sexual intercourse, and he had given up hope of ever having a relationship with a woman, thinking that if he married he would be unable to ejaculate during sexual intercourse. Delayed ejaculation was ruling his sex life, and much of his emotional life as well. During two experiences with paid sex partners he failed to ejaculate, a sexual experience which left him even more despondent - even after an hour's intercourse he was unable to achieve orgasm, even though, as he put it, "I thrusted like I was superman."
When he arrived for therapy, hoping to find a treatment for his anorgasmia, he was in a delicate state of mind, with anxiety, self-doubt, and a feeling of despair and pointlessness around his sexual performance in general and his inability to climax during partnered sex in particular.
He had met Rose at a friend's party and they were instantly attracted to each other, though when the relationship moved from platonic to potentially sexual, he experienced considerable anxiety. Their first attempt at sexual intercourse, at Rose's encouragement, ended with Jim having a rigid erection which persisted for two hours but at no time, neither with manual or oral stimulation, nor during vaginal intercourse, was Jim able to experience normal ejaculation during sex.
This was the first time Rose had come across delayed ejaculation, so she was patient and understanding, and non-judgmental about this, but she also expressed frustration in therapy that they were not able to share the pleasure of "normal intercourse". She said that it was extremely distressing to her seeing her partner in this predicament: her self-esteem was bolstered by the thought that a man found her attractive enough to enjoy making love to her and achieve his climax while still inside her.
Rose came from a lower middle class family with social aspirations, all of which seemed to have been projected onto Rose, as the child who was most likely to go to university and achieve success is the world of academia and beyond. The family was dysfunctional in that her mother had clearly used Rose as an emotional prop during Rose's childhood, in the absence of any real emotional connection with her husband.
Although this did not discourage her, and even now she appeared to be confident she could win her father's approval before he died, there was no sign of sufficient emotional intelligence or literacy on her father's part to suggest that such a rapprochement would be made; her mother appeared to be alcoholic, severely dysfunctional, and increasingly neurotic as the years went by. Jim's DE seemed to mirror the emotional involvement of Rose's father, who, even in their intimate moments, somehow remained detached from her.
Rose had survived by using a friend's home as an alternative base during her childhood and schooldays, and this family had given her enough encouragement and support to bring out her academic abilities. She had also made a boyfriend out of, and had a sexual relationship with, the elder boy in the family, unbeknownst to everyone else, intercourse having continued for several years after they left school. Though both were over the age of consent when the relationship started, its emotional flavor was one of dominance and submission.
This boy had, by all accounts been "good at sex", which appeared to mean that he had been a sexual partner who cared little for her needs, but he was certainly able to ejaculate when he wished during sex, and was able to last longer in bed or shorter as he wished: certainly he had not been experiencing ejaculation problems, and it was this relationship which had given Rose her expectations of sexual intercourse in general, and ejaculatory latency in particular. She occasionally compared her partner's performance with her teenage lover's sexual ability.
Rose masturbated frequently, and reached orgasm on about half of these occasions, though she felt inhibited about doing so in front of her sexual partner. She described sex as "pleasant enough" and "sometimes good", especially when she could give her partner the pleasure of orgasm - sex in fact seemed to be a vehicle for her to express her love to her partner and offer him what she regarded as a man's greatest pleasure. In return, she regarded a man's ejaculation as an expression of his love and attachment. Her husband's difficulties during sex therefore seemed to serve as a signal that Jim did not love her as much as she loved him.
The first stage of the treatment program involved classic sensate focus exercises to enhance intimacy, re-establish connection, and regenerate trust between the partners. This worked well in soothing the anxiety of the two partners towards sex with each other, in particular allowing them to establish a higher level of comfort with each other's bodies. Indeed, Jim's feelings of disgust around the appearance of the female genitals significantly reduced, and Rose's inhibitions about allowing Jim to see her naked dissipated somewhat, to the extent that they reported spending considerable time embracing naked in bed each evening. This was an indication that treatment was likely to be successful.
Of course, any relationship may experience difficulties which suggest that the intimacy levels between the partners should somehow be higher. The lack of intimacy always comes down to the same thing - that the partners do not have enough invested in each other's well being. They do not spend enough time, or enough energy, looking out for each other, and the resentment this causes will always affect the health of the relationship. Oddly enough, techniques used by the pick-up artists community can help any relationship - these techniques are not just for men looking to get into a relationship. Go here to read one of these programs - The Tao of Badass, by Joshua Pellicer.
To remedy an intermittent erection problem which Jim reported, he was given a prescription for Viagra. This enabled him to overcome the erection problem, which appeared to be the result of his anxiety about his delayed ejaculation, and further enhanced the intimacy between the couple in that they engaged in a dialogue about what was going on between them. In particular, they asked for sexual psychotherapy to work out the role of Jim's desire to explore his fantasies of domination and submission in his sexual life with Rose.
Both partners became aware of their complementary scripts around sexual behavior, and Jim's reliance on this element of sex play for his arousal reduced significantly; his fear of failure and performance anxiety, especially around his ability to satisfy his partner (a recurrent theme, which he defined as "my ability to give her an orgasm") was also reduced by therapy.
The consequence of this was that Rose perceived Jim as being a partner committed to being able to come during sex: but she reported that though he "worked hard" at giving her an orgasm and attempting to enable her to reach orgasm during intercourse, she did not feel that he was psychologically present, or at least as not as present as she would like their lovemaking.
The next stage of therapy was to tackle Jim's idiosyncratic masturbatory patterns: desensitizing his penis to hard and traumatic masturbatory practices took time, but he persevered and was eventually successful (the therapy which he used is described in detail on the page about treatment of delayed ejaculation).
As the couple's enjoyment of sensate focus exercises increased, along with their level of intimacy and sense of connection, they expressed a wish to move on to erotic interaction in general and intercourse in particular. Although the physical act of penetration was not difficult, Jim still was still unable to orgasm during sexual intercourse and his delayed ejaculation was evidence of increased aversive sexual behavior on the part of both Jim and Rose: Jim reported feeling disgust with the female genitals, and expressed a wish to tie up his partner before sex. (Although he studiously avoided mentioning Rose in this context, it seemed clear that being able to act out this fantasy would have facilitated his sexual arousal.) Jim appeared to be using his fantasy to boost his arousal sufficiently to overcome his fear and aversion to the female genitals.
Rose, by contrast, found it challenging to be passive during sex; she wanted to be active, to please her partner and give him an orgasm while he was enjoying intercourse. The presence of retarded ejaculation was of major significance for Rose, and she imagined it to be a sign that Jim was not really interested in her.
Since both the erection problems and the intimacy problems faced by the couple had been reduced somewhat, the final hurdle of the delayed ejaculation was now tackled, with a treatment program of gradual desensitization.
Delayed ejaculation treatment ]