Behind the doors of a sex therapist, clients seek understanding, acceptance, and answers.  But how can mental health professionals help their clients achieve these goals?  Dr. Stephanie Buehler, a licensed psychologist, sex therapist and a recognized author, invites you to “Step Into My Office” with monthly sidebars taken from her own experience.

Male orgasmic disorder, also known as delayed ejaculation (DE), is one of the least understood male sexual problems. DE is defined as a delay in, or absence of, orgasm in a male following normal sexual excitement and arousal during sexual activity. The DSM-IV-TR (2000) has been criticized for not including criterion that the man needs to feel distressed in order for DE to be diagnosed; the DSM-5 now includes this criteria. In addition, there is no criterion for how long is too long in terms of delay; one man’s frustration may be another man’s triumph and vice versa.

The presentation of DE is varied, as is its treatment. Below is one vignette with a younger client named Travis.


Travis is a 24-year-old newly married man who hasn’t been able to ejaculate while having sexual activity with his wife. Travis and his wife were sexually active before marriage, except for intercourse, and Travis always assumed that once he was married and “everything was legal” he would have no problem ejaculating. Travis also had a history of panic attacks, so it was easy to assume that anxiety was the major contributing factor. However, upon thorough assessment, Travis admitted that from about the age of 15 he had been able to ejaculate while watching pornography with an interesting twist: he used a terry cloth hand towel to masturbate so that he could quickly hide any evidence of activity.

I gave Travis the suggestion of masturbating first with a dry hand, and next with lubrication, which Travis did without any problem. However, the DE showed no improvement. Now I recommended that Travis only ejaculate when he was with his wife. After 2 weeks, Travis reported that he had “almost” climaxed. I then met with the couple and we discussed that Travis might need more foreplay than his wife was used to if he was going to have orgasm with her. Two weeks later, Travis came into my office smiling, clearly pleased that he had resolved a problem he found most embarrassing.

For a full list of activities to help overcome a situation like this, as well as tips for improving erectile function and sexual confidence, check out Stephanie Buehler’s book What Every Mental Health Professional Needs to Know About Sex.