Last time,we discussed premature ejaculation. Today, we will look at a condition which is just the opposite - retarded or delayed ejaculation. This describes the situation where the man has difficulty achieving orgasm and ejaculating in a woman's vagina. This is an uncommon problem, occurring in less than 10 per cent of men. However, one or two men, out of a 100, will suffer from this problem regularly. The condition is also called ejaculatory incompetence or male orgasmic disorder.

Exploring the causes

A few cases of retarded ejaculation are due to alcohol and drug use. Antidepressants such as fluoxetine and drugs used in the treatment of benign prostatic enlargement are known to cause retarded ejaculation as a side effect. Certain neurological diseases will also cause the condition. However, the majority of men, who suffer from delayed ejaculation, are able to achieve orgasm and ejaculation with masturbation or during manual or oral stimulation by the partner. This indicates a psychological cause.

Psychological causes

Primary retarded ejaculation occurs in men who are unable to ejaculate in a woman's vagina. This is associated with a strict religious upbringing, fear of getting a woman pregnant, negativity and hostility towards the partner or maternal dominance. Secondary causes of this condition are less common but may occur in men who focus mainly on their performance and pleasing their partners. As a result, they are subjectively less aroused and cannot ejaculate.

Sexual therapy

Men who experience this infrequent concern should visit a health care practitioner or a counsellor for assistance. Any sexual problem must be addressed in the context of the man's overall relationship with his partner. He must be able to discuss the problem of delayed ejaculation with her freely. While he explains his feelings, he should invite her perspective of the problem. Men tend to be goal or performance-oriented during sexual relationship. As a result, they never really learn how to give or receive physical pleasure. Couples should be taught exercises that guide them to give and receive physical pleasure.

Sexual exercises

These are called sensate focus exercises. Couples take turns touching and exploring each other while expressing their feelings. They should avoid intercourse and focus on non-genital areas. The man should be expressive with his partner by letting her know what he finds to be arousing. Masturbation, in the presence of his partner, may also assist him to overcome his inhibitions. After a few days, or weeks, the couple should include mutual stimulation of the genital areas until orgasm and ejaculation are achieved while still avoiding intercourse. The final stage is the inclusion of intercourse. It is believed that this method allows the man to overcome his fear of ejaculating inside his partner.

Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email: yourhealth@gleanerjm.com.