Bernard Apfelbaum has one of the most radical explanations for delayed ejaculation (DE).
Apfelbaum observed that the most common form of DE was the lack of ability to reach orgasm with partner — “partner anorgasmia”. And he noted than many of the men who have that problem can reach orgasm much more easily when they are on their own, self-pleasuring.
This led him to suggest that the most common cause of slow or late ejaculation is a lack of sexual desire.
Going a step further, Apfelbaum proposed that the root cause of inability to reach orgasm during intercourse (coital anorgasmia, also known as delayed ejaculation) was what he described as an “autosexual” orientation.
In other words, to put it in simple terms, a man simply prefers his own masturbatory stimulation to anything that he can achieve during sex with partner.
It’s important to note at this point that there is nothing judgmental about the word “autosexual” – it is simply a descriptive term for a particular way of looking at the world, a certain psychological orientation.
But, here’s the puzzle – men with delayed ejaculation (or DE for short) often have a persistent, long-lasting, and a very rigid erection, which is usually taken to be a sign of high sexual arousal.
Apfelbaum explained this by suggesting that such erections were actually “disconnected” or, as he puts it, “desynchronized” from the man’s level of arousal, and were actually generated automatically.
Although Apfelbaum’s theory did not explain how such a high and strong level of genital responsiveness could be obtained when the man was not aroused, it’s certainly an interesting idea. All men know they can have an erection without feeling turned on.
A Moment’s Fun
A Video Showing How Erection Can Go With No Arousal (well, maybe!)
Apfelbaum disagrees with other theories which suggest that the man with delayed ejaculation is likely to be experiencing feelings of either anger, rage, hostility or rejection towards women. It’s more likely the man has another set of issues….
Men with delayed ejaculation often seem to have an excessively overdeveloped sense of obligation, responsibility, and duty towards the sexual partner.
They lack a sense of their own needs. It almost seems like they can’t put themselves first.
Why? Well, a man who has been brought up in an environment where the feminine influence was overbearing or invasive may well find that he is unable to take care of his own needs and wishes, or to make demands that will satisfy his own needs, or to set adequate boundaries.
Depending on the nature of the psychological environment a man experienced during childhood, he may well find that he lives as an adult man with a sense of conscientiousness, a sense of obligation to fulfill the requirements of the woman that he is with.
And that may apply even when she’s not actually explicitly stated what those requirements are! Besides which, he probably also has a high level of motivation to please his partner.
In such circumstances, a man will see his sexual obligations towards his partner as paramount.
In some way, he isn’t aware of his own needs, pleasure and satisfaction.
So he may attempt to have intercourse even when his own motivation to have sex is low, and at the same time he may feel that he is not able to “give” enough to please his sexual partner. That lack of arousal is one of the key factors behind delayed ejaculation.
The woman, by contrast, will pick up the impression he is giving that she is neither a welcome nor appreciated partner in the sexual relationship. She may then respond by withdrawing from him, or by seeking further intimacy; in the latter case the man is likely to withdraw even further.
The outcome of this situation is usually that both partners will repeatedly withdraw from each other, the man retreating into the position called “autosexuality”.
So what we’re calling autosexuality is really an “arousal deficit” model of delayed ejaculation.
And indeed, a recent study conducted by Roland, Keeney and Slob seemed to show that men with ejaculation problems did indeed have significantly lower levels of sexual arousal than men who reported no sexual problems, and men with erectile dysfunction, and men with premature ejaculation.
Indeed, it was the lack of sexual arousal as reported by the men themselves, that occurred again and again in men with slow ejaculation.
Once again, however, the cause of the men’s low levels of sexual arousal was not explained.
Video – causes of low sex drive in men
Video from a counselor
We can only speculate that delayed ejaculation is caused by either physical factors such as a low level of penile sensitivity, or a lack of responsivity in the nerve cells responsible for triggering ejaculation, or an elevated threshold in the ejaculatory reflex itself so that it fails to be triggered even with sexual stimulation approaching “normal” levels.
In addition, any or all of the psychological factors which have been described on another page of this website may take a part in combining with physical factors to produce the syndrome of delayed ejaculation which we are describing.
Apfelbaum’s desire deficit model has a significant influence on the treatment method adopted for the condition.
One of the obvious characteristics of men with delayed ejaculation is that they don’t appear to be able to take care of their own needs during sex.
In fact, they often seem to be very conscientious lovers, with a high degree of self-control, who are very eager to please their partners, and to fulfill what they see as their sexual duty.
However, this internal sense of obligation produces a psychological pressure which often manifests as the man not feeling good enough.
Unfortunately this sometimes conveys itself to his partner, who may come to the conclusion that she isn’t good enough either, because, after all, she cannot bring him to climax!
Now, the treatment approach suggested by Bernard Apfelbaum was based on the assumption that the problem of delayed ejaculation was underpinned by a lack of sexual desire. (Which could be caused by all manner of things – anxiety, anger, conflict, sexual orientation…. medical issues, depression, and so on…..)
However, another important point is that any treatment strategy for DE which relies on intense penile stimulation with the sole objective of “forcing” a man to ejaculate inside his partner is both demanding and coercive.
Such an approach may heighten a man’s anxiety and so make him even less able to perform sexually.
Yet that was the classic approach to DE treatment for many years!
Bernard Apfelbaum suggested a better approach was to investigate, uncover and clarify the arousal and sexual desire disorder or deficit, and then encourage the man to take responsibility for achieving orgasm during intercourse.
This would consist of discussing with the man why he was having trouble reaching orgasm during intercourse, with the intention of having him acknowledge the emotional and psychological factors at work in producing his low arousal.
This does fit rather well with the observation that many men with delayed ejaculation are convinced that are withholding correct sexual functioning from their partner, and that they should be more giving.
However it’s arguable that all treatment approaches require some reframing of faulty beliefs about sexuality, so in this respect Apfelbaum’s treatment approach was not unique.
And indeed, Apfelbaum’s approach has been criticized on several grounds.
He was correct that the long-lasting erections which are characteristic of the delayed ejaculator are not actually a sign of subjective arousal, but really rather mask a lack of sexual desire.
But it seems that the conclusions he reached may have been based on the fact that he worked with one particular type of men with DE: and, therefore, his conclusions can’t be applied universally.
Hartmann and Waldinger have observed, writing in the book Principles and Practice Of Sex Therapy, that a significant number of men with delayed ejaculation also show obsessive-compulsive disorder, or other emotional problems such as anxiety disorders or paraphilias.
So while these men do indeed show DE as part of a complex of inhibited arousal and limited desire around sexual intercourse, they also have much more profound interest psychical interpersonal pathologies that need to be appropriately dealt with, regardless of the treatment approach advocated by the therapist they’re seeing.
Apfelbaum’s approach has also been criticized on the grounds that it makes the assumption that a man with these ejaculation problems only finds his own sexual touch exciting.
This is highly questionable, because many of the men report real desire to enjoy intercourse to completion with their partner. The reason they have a primarily autosexual orientation is because masturbation is actually the only way in which they can be successful in reaching orgasm.
This makes the term autosexual less appropriate, because it’s possible to see what they’re doing as a creative form of compensation for the lack of orgasm during sexual intercourse.
Apfelbaum’s main treatment strategy was to encourage the expression of feelings and to focus on the men’s lack of sexual arousal so as to overcome the performance demands that the man imagines are being placed on him during intercourse.
This is very much a psychodynamic approach, which often requires much more deep-rooted psychological work than cognitive behavioral therapy.
Apfelbaum also used trained surrogate sex therapists in his work with men who had delayed ejaculation, an approach which is difficult to replicate because most therapists simply don’t have access to the resources required.
But the truth is that none of these treatment approaches are completely mutually exclusive: the two fundamental models designed to explain the problem (the inhibition model and the desire-deficit disorder model) seem to reflect different aspects of the same problem.
The psychological pressure on a man has delayed ejaculation may include both feelings of aggression and hostility towards women, as well as feelings of guilt, self-control and excessive tendency to wish to “give” to the partner.
The best treatment addresses these emotional issues and heals them so they no longer impact the man’s sexual behavior.