If the man has never ejaculated through any form of stimulation (such as wet dreams, masturbation, or intercourse), a urologist should be consulted to determine if there is a congenital or physical cause.
If, however, he is able to ejaculate in a reasonable period of time by some form of stimulation, he should seek sex therapy from a therapist specializing in ejaculatory problems. Treatment usually includes both partners. The therapist will usually educate the couple about the fundamentals of sexual response and how to communicate and guide the partner to provide ideal stimulation, rather than trying to make a sexual response occur.
Therapy commonly involves a series of homework assignments wherein the couple, in the privacy of their home, engage in sexual activities that reduce performance pressure and focus on pleasure.
Typically, sexual intercourse will be prohibited for a limited period of time, while the couple gradually enhances their ability to enjoy ejaculation through other types of stimulation.
In cases where there is a problematic relationship or an inhibition of sexual desire between the couple, therapy to enhance the relationship and emotional intimacy may be required as a preliminary step.
Sometimes hypnosis may be a useful adjunct to therapy, particularly if a partner is not willing to participate in therapy. Self-treatment of this problem will probably be unsuccessful in most cases.
If a medication is believed to be the cause of the problem, other medication options may be discussed. (Never stop taking any medicine without first talking to your doctor.) This may be difficult in certain instances, especially when the medication is working appropriately to solve a pre-existing medical or psychological problem.
Outpatient treatment commonly requires about 12 – 18 sessions with an average success rate in the range of 70 – 80%.
A more positive outcome is associated with having a previous history of satisfying sexual experiences, a short duration of the problem, feelings of sexual desire, feelings of love toward one’s sexual partner, motivation for treatment, and absence of serious psychological problems.
If medications are causing the problem, your health care provider may recommond switching or stopping the medicine (if possible). A full recovery is possible if this can be done.
Marital stress, sexual dissatisfaction, inhibited sexual desire, and avoidance of sexual contact may result if the problem is not addressed and remedied. If pregnancy is desired, sperm may have to be collected using other methods because of the lack of ejaculation.
Review Date : 9/22/2009
Reviewed By : Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.