Men who do not ejaculate when they want, or who do not ejaculate at all used to be referred to as retarded ejaculators—hardly a gentle or an accurate term! Now they are called delayed ejaculators, but some do not ejaculate at all.

The opposite of premature ejaculation, men who last too long, or who cannot ejaculate are often frustrated, and their lovers sometimes are equally frustrated. Some women take it personally—thinking that they are not sexy enough for the man to ejaculate.

Some men have orgasms without ejaculating, although the most intense orgasms occur during ejaculation for most men. In other words, orgasm and ejaculation are not the same phenomena. Women can ejaculate from the G-Spot too, and this ejaculation is usually accompanied by intense orgasm. There is still controversy in sex research about female ejaculation—whether it exists, what to call it, and where it comes from.

It seems each generation of sex researchers and sex therapists thinks it knows the answers to these issues, but no one knows it all. Replication of studies sheds some light on what we can conclude, but sex research is still evolving.

As a sex therapist I also see men who ejaculate too quickly, which is premature ejaculation. Some of them do not show for the first appointment. I figure they came early! This problem requires its own treatment plan.

What causes delayed or nonexistent ejaculation? There are several possible causes. The man may not receive enough friction during vaginal or oral intercourse—or during anal intercourse with a woman or a man. Women can do Kegel exercises and/or other physical exercises to strengthen their vaginas so there is enough friction to ejaculate.

The way a man breathes may also affect how aroused he gets to ejaculate. Breathing deeply from the diaphragm is much more effective than shallow breathing from the chest.

In addition to friction and breathing, a man must be emotionally vulnerable—so he does not need to hold back emotionally—so he can “let go.” If a man is controlling in general, he may experience difficulty reaching ejaculation. I work with thoughts and emotions with my clients so they can let go of the need to hold back their emotions. I do this in part with cognitive behavioral therapy (CBT).

Drinking alcohol makes it harder to ejaculate, and it may affect erections too. Some men find it harder to ejaculate with higher doses of Viagra or Cialis. Some medications interfere with ejaculations and erections too. During sex therapy and couples counseling I go over this, and I recommend other modalities of treatment when I see a man. If there is a couple, I see each person separately and then together.

It is far too common for some men and women to falsely conclude that only one person has a “problem,” and only that person needs to see me. This is not clear thinking. A couple is a system, and I treat both partners with an actual treatment plan with homework and home-play to solve the problem. When a client or couple try to craft their own treatment plan, I cannot help them. I can only help those who leave the treatment plan to me.

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