Dear Dr G,

I feel embarrassed to put forward my questions on ejaculation this week, as I think most people would consider my condition to be a “first world problem.”

I am putting Dr. G on the spot as I have difficulty achieving orgasm during intercourse.

I am a 25-year-old, who is reasonably fit and healthy.

I have a normal appetite for sex and non-promiscuous, with only a handful of sexual partners in my lifetime.

Apart from over “self-indulgence” since the teenage years, I don’t think I have committed too many “sins” in my short period of sexual experience.

For the past few relationships, when we engaged in sexual intimacy, sad to say, I could rise to every occasion, but failed to achieve climax at all.

However, when I masturbate (which I often do), I manage to ejaculate normally, just cannot manage to reciprocate the experience when I engage in “real sex”.

Sometimes, despite twenty minutes of “marathon sex” there was still no “outcum”!

I really hope Dr. G can help me solve this problem of difficulties in ejaculation.

Can you tell me what is happening to me?

Is this related to excessive masturbation?

Is this treatable? Is this condition common?

I know it might be a dream come true for most guys to be the “marathon man” between the sheets. Truthfully, I am running out of steam and just hope to be normal in the bedroom, like any other guy. So, please help me!


Delayed Daniel

The inability or persistent difficulty for men to achieve climatic orgasm, despite normal sexual desire and stimulation is a condition recognised as delayed ejaculation or retard ejaculation.

The condition can be lifelong or acquired, generalised or situational. With lifelong delayed ejaculation, the problem is present from the time of sexual maturity. Acquired delayed ejaculation occurs after a period of normal sexual functioning.

Generalised delayed ejaculation isn’t limited to certain sex partners or certain kinds of stimulation, and situational delayed ejaculation occurs only under certain circumstances.

Under normal circumstances, a man should reach orgasm within a few minutes of active thrusting during sexual intercourse. The duration of sexual intercourse can be variable between individuals and sexual partners.

Scientific publications utilising the methods of intra-vaginal latency period (IELT) reveal that the average time for men to ejaculate is between five and eight minutes from the point of penetration.

A man who encounters delayed ejaculation, also known as retarded or inhibited ejaculation, does not typically reach orgasm unless after prolonged intercourse that may last up to 30 minutes.

The exact prevalence of Delayed Ejaculation is not well documented. According to the International Society of Sexual Medicine, such a condition is encountered by around 8% of sexually active men.

Although most men with such a condition may have delayed ejaculation only under certain circumstances; in the severe cases the sufferers cannot ejaculate at all during sex. Whichever the degree of difficulties, this often generates frustration in the relationship.

The pathophysiology of delayed ejaculation is unknown. However, the normal physiology of sexual climax is controlled by the influences of multiple “stimulatory” and “inhibitory” neurotransmitters in the brain.

These include noradrenaline and serotonin. The levels of such neurotransmitters can be affected by stress, stroke, alcohol and medications. But the exact etiology of delayed ejaculation for most men is unknown.

Psychological factors such as performance anxiety, distraction from the environment, insufficient sleep and relationship issues are thought to contribute towards such sexual dysfunction.

Well-recognised medical causes of delayed ejaculation also include hypothyroidism, pituitary disorders, prostate operation and excessive alcohol consumption.

Other common etiology may also be side effects of medications such as morphine, benzodiazepine and SSRI group of antidepressants.

According to some researchers, the other association of delayed ejaculation with masturbation is the intrinsic link of visual input of pornography.

As the excitement of “real sex” may not be comparable with the pornographic images, the threshold of ejaculation is often unachievable.

Men with delayed ejaculation observe the normal ability to perform during masturbation but fail to climax during intercourse, as the sensations felt during masturbation bear little resemblance to the experience of true sexual intercourse.

Hence the inability to duplicate the sex during masturbation may result in delayed pleasure during penetrative intercourse.

There is currently no medication approved for the treatment of delayed ejaculation. Medications used to treat delayed ejaculation are primarily used to treat other conditions, including amantadine and cyproheptadine, which are treatments for Parkinson’s Disease and allergy, respectively.

Other treatment of delayed ejaculation often involves the sex therapist advising couples to go through stages of “sexual assignment”.

The aim of the exercises is to help men familiarise with achieving orgasm through normal intercourse. Although this may sound straightforward, the idea of going through steps of masturbation in front of the partners and slowly progressing to insertional intercourse is often awkward and has poor outcome.

All-American football player and decathlete Lewis Howes once said: “There is no way to become great overnight, but in the marathon of success, it takes a lot of intention to see you through each day of the journey”.

When Dr G is put on the spot on the subject of men with delayed pleasure between the sheets, he sees a resemblance with sports as “there is no way to become great overnight, in the marathon of efforts in the bedroom, it takes a lot of love and couple exploration to see you through each experience of the sexual journey!”

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