Sometimes, psychological fears interefere with sexual enjoyment, and these can include the pressure to please the partner, pressure to please the self, pressure to inititate sex or relationships, pressure to be a considerate and experienced lover, pressure to bring partner to orgasm, pressure to orgasm simultaneously with partner, pressure to always be in the mood and ready for sex, and pressure to achieve and maintain erection.

Some treatments have included massive stimulation for men with spinal cord injuries in relation to fertility, but this approach may also increase pressure and anxiety related to performance.

In men with and without disabilites, delayed or retarded ejaculation can be the result of a secondary ilness, injury, or surgical procedure, for example, prostatectomy, cancer, pelvic injury, or other neurologic conditions. Certain medications can affect ejaculation. Seeing as you have not seen anyone for the problem, you may want to consider a psychiatrist, urologist, endrocrinologist to be part of an overall assessment. The best treatment options can be explored using a multidisciplinary approach in order to cover all the bases.

Is your partner open to exploring the condition? I know it must be difficult for you not to personalize the issues, but chances are, it is somehow originating with him either physically or psychologically, and even though you are frustrated and disappointed, keep in mind that it may be affecting him very deeply as well. Often pressure from sexual frustrations are exacerbated by anxiety and expected performance pressures.

Past issues from former relationships can be affecting the situtation as well. Fear of pregnancy, fear of rejection by partner, self-induced performance anxiety, anger and relationship power struggles can also result in retarded ejaculation. The more common presentation is a delay or absence during intercourse, while ejaculation during masturbation is maintained. The factors may extend to all partners, or be confined to a particular partner.

Again, without a full physical and psychological work-up it will be difficult to identify the cause of the issue. I would suggest you explore these options, and seek a therapist that has experience in sexual dysfunction. This type of therapist will be able to help you find appropriate clinicians to accurately assess a physical and emotional history. Hopefully, you both wish to work on the issues together, it may also help you to talk to a therapist seperately to process your feelings and move positively with your husband on a recovery process. Please be patient with the process. Pressure and negative reactions will impede progress with this particular disorder. Good luck and write back if you have other questions regarding the process.

Reviewed by: Kathleen VanKirk DHS