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), can be lifelong, generalized to all types of sexual stimuli and/or partners, or situational. If it is situational, it may occur only during coitus, masturbation, oral sex, or other activity, or only while a man is with a partner but not when masturbating alone, and so forth. It is considered to be relatively rare; the Laumann study (1999) reported that it occurs in about 8% of the population, while another study suggests that lifelong DE is even rarer, about 1.5 cases in 1,000 (Waldinger & Schweitzer, 2005). In clinical sex therapy practice, however, I have found it to be a common complaint, perhaps because there are few places men can turn to when encountering this issue.

The presentation of ED is varied, as is its treatment. In Part I we heard of Travis, a 24-year-old newly married man who wasn't able to ejaculate while having sexual activity. Today, we meet Norman, an older man experiencing lack of erections and DE.


At age 81, Norman was in seemingly good health but was bothered by his lack of erections and DE while his wife of some 40 years was still enjoying their sex life and regular orgasms. Norman visited an urologist, who administered an injection of alprostadil, which didn’t help. Because of Norman’s advanced age, the urologist could not recommend surgery for a pump, and referred Norman to me.

Norman was very open-minded about sex and we developed rapport quickly. I told him, though, that because of his advanced age we could probably assume that the small arteries going to the penis were hardened, causing his erection to be less firm and stimulation more difficult to perceive, which lead to DE.

Norman was surprised to learn that, in men, orgasm and ejaculation are two different events and that men are able to have orgasm without ejaculation. We discussed how different parts of the body—the so-called erogenous zones where skin is more enervated, the perineum, and the anus—might still have enough sensitivity to produce orgasm with adequate stimulation. Then I surprised Norman with two more suggestions: a vibrator and pelvic floor exercises. The vibrator would add more stimulation, and it and the pelvic floor exercises would bring blood flow and hopefully nerve growth to the penis. Norman left my office like a man on a mission to shop for sex toys.

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.