Dear Dr G,

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

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

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

I understand the theme of the month is about ejaculatory disorders.

I feel embarrassed to put forward my questions, as I think many would consider this to be a “first world problem” since I have a great deal of difficulty achieving orgasm during intercourse.

In my past few relationships, when we engaged in sexual intimacy, I could rise to every occasion but failed to achieve climax at all.

However, when I masturbate, I manage to ejaculate normally.

I just can’t seem to replicate the experience when I engage in “real sex.”

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

I really hope Dr G can help me solve this problem of difficulty 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!

Regards,

Marathon Man Matthew

UNDER normal circumstances, a man should reach orgasm within a few minutes of active thrusting during sexual intercourse. The duration of sexual intercourse can vary between individuals and sexual partners. Scientific publications utilising the methods of IELT (Intra-Vaginal Latency Period) reveal that the average time for men to ejaculate is between five to eight minutes from the point of penetration.

A man who encounters delayed ejaculation, also known as retarded or inhibited ejaculation, typically does not reach orgasm unless after prolonged intercourse that may last up to 30 minutes. The inability or persistent difficulty for men to achieve a climactic 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.

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, strokes, alcohol, and medications.

Well-recognised medical causes of delayed ejaculation also include hypothyroidism, pituitary disorders, prostate operations, and excessive alcohol consumption. Other common aetiology may also be side effects of medications such as morphine, benzodiazepines, and SSRI group antidepressants.

Psychological factors such as performance anxiety, distraction from the environment, insufficient sleep, and relationship issues are thought to contribute to such sexual dysfunction. 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 for ejaculation is often unachievable. Typical 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 allergies respectively.

Other treatments for delayed ejaculation often involve a sex therapist who advises couples to go through stages of “sexual assignment.” The aim of the exercises is to help men familiarise themselves 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 outcomes. 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 severe cases, the sufferers cannot ejaculate at all during sex. Whichever the degree of difficulty, this often generates frustration and is bothersome in the relationship.

The 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 mysterious world of marathon men with delayed pleasure between the sheets, he sees many resemblances of sex with sports, as “There is no way to become great overnight; in the marathon of efforts in the bedroom, it takes a lot of couple exploration to see you through each journey of lovemaking.”