What is ejaculatory incompetence?
Ejaculatory incompetence means the inability of the male to reach a climax. It is a rather unfortunate term, because the wording suggests that the person is 'incompetent' in some way. For this reason, sex therapists are beginning to use other titles such as 'ejaculatory dysfunction' or 'ejaculatory overcontrol' or 'retarded ejaculation'.

This disorder is quite common, but nowhere near as frequently seen as the other main male sexual problems, impotence (erectile dysfunction) and premature ejaculation. It tends to occur mainly in men who have been rather strictly brought up, and who are very 'controlled' in their lives. They may have difficulty in showing emotions, and in 'letting go'. Because these men can keep going for ages when they have intercourse they are often initially very popular with their partners! But when they are in a regular relationship, especially one in which the couple hopes to have children, it can become a major problem. Both the man and woman can become sore and frustrated and the female partner often feels resentful and almost insulted that her man will not ejaculate when they make love.

There is one major exception to the above pattern. Ejaculatory incompetence quite often occurs for no apparent reason in men who have had no previous difficulties, but who have recently been put on certain medicines, particularly antidepressants, by their doctors. In these cases, a slight change in medication will usually cure the problem. Excessive use of alcohol can also cause difficulty in ejaculation.

What can be done?
Unfortunately, there is no instant cure for the ordinary type of ejaculatory incompetence described above. But there is a very good chance of putting things right through counselling, provided both the man and his partner really want to cure the problem.

The usual method of treatment is based on the pioneering work of American experts who have developed ways of helping the man to relax and 'let go' when he is with his partner. Generally, it is the case that the man can reach orgasm by self-masturbation, but not through intercourse. The therapist may encourage the couple to gradually proceed to a situation where the man can ejaculate just outside his partner's vagina, and eventually proceed from there to a more 'advanced' situation where he is able to cope with ejaculating inside her.

In a slightly different variety of therapy devised by American experts Masters and Johnson, the couple first go through a period of treatment in which actual sex is 'off limits', but kissing and cuddling are encouraged. Then they progress to a stage where the woman, sitting astride the man, masturbates him till he reaches orgasm (even if this takes two hours or more). Finally, they progress to a situation in which she lowers herself onto him shortly before he climaxes.

Generally, the object of therapy is to gradually diffuse the man's anxiety about giving up his 'control' so that he can ejaculate inside his partner without difficulty.

Where can I get help?

There is some NHS help available from psychosexual clinics - your GP can refer you.

Family Planning Clinics.

RELATE psychosexual counsellors.

British Association for Sexual and Relationship Therapy, an organisation whose members are trained in sexual counselling.

Institute of Psychosexual Medicine, an organisation whose members are all doctors trained in psychosexual therapy.

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