Inhibited ejaculation is essentially the opposite of premature ejaculation - ejaculation takes a long time or does not happen at all. If a man can ejaculate after prolonged stimulation he suffers from retarded ejaculation, if he can not ejaculate at all he suffers from anejaculation. Often the man can ejaculate normally in some situations (solo masturbation, or manual or oral sex from his wife) but not in others (usually intercourse). Once thought to be very rare, recent studies have suggested that from 5% to 10% of men experience some level of inhibited ejaculation at some time.

• Physical: Neurological diseases such as strokes and nerve damage to the spinal cord or back can impair ejaculation. Diabetic neuropathy, spinal cord lesions, and multiple sclerosis can also cause this problem.
  
  
• Drug Induced: Many drugs can interfere with normal sexual function. Selective serotonin reuptake inhibitors (SSRIs) are infamous for this, with drugs like paroxetine (Paxil®), fluoxetine (Prozac®), sertraline (Zoloft®) and thioridazine (Mellaril®) being among the most common to cause problems.
  
  
• Psychological: This is the most common cause. Guilt or thinking sex is dirty or shameful is a very common cause, with wrong religious teaching and anti-sex parents being the root problem. Traumatic events, such as an unplanned pregnancy, or being caught during sex or masturbation are another cause, and fear of these same things can also cause inhibited ejaculation. A man's anger or frustration with his wife can be an issue, as can withdrawal or a desire to manipulate or control.
  
  
• Idiosyncratic Conditioning: If a man learns to reach climax using a method that produces stimulation very unlike the stimulation of intercourse, he may have difficulty finding intercourse arousing enough to reach ejaculation. Unusual methods of masturbation (such as using a shower head or striking the penis against a solid object) are the most common, but having sex by "dry humping" through clothes or being manually brought to orgasm though clothes can also do it.
  
  

• Treatment - Physical Causes: Obviously a doctor must deal with such issues. In addition to treating the cause, there may be drugs that can help. In difficult cases a specialized vibrator designed for this purpose may help the man who can not ejaculate any other way.
  
  
• Treatment - Drug Induced Causes: First the warning - do not ever change dosage or stop taking a drug without a doctor's authorization. Since drugs affect each man differently, it's often possible to change prescriptions and eliminate the ejaculatory difficulty without losing the needed drug benefit. It may also be possible to use a lower dose, or to take doctor regulated "drug holidays" that allow normal sexual function without lowering drug levels enough to lose the beneficial affects. It may also be possible to add another drug which counteracts the ejaculatory side effect of the original drug.
  
  
• Treatment - Idiosyncratic Conditioning Causes: The solution here is to gradually modify the form of stimulation that does work. If a man become conditioned to ejaculate from clothed sex the couple first removes his pants and proceeds as before. When this is working well, her pants come off. Soon they are naked, and he is climaxing by rubbing against her vulva. Next they could add some lubrication as they do this. Gradually they work up to external rubbing and switching to intercourse at "the last moment", or have intercourse with him switching to external rubbing to climax. A similar gradual change would be use for a man who has been conditioned by an unusual form of masturbation. Initially the wife is just present, then she gradually takes over doing it the way the man does it. Slowly she modifies what she does to move towards a "pumping" with her lubricated hand.
  
  
• Treatment - Psychological Causes: This is often the most difficult one. Success depends on how long the problem has gone on, how serious the man is about fixing it, and the health of the marriage relationship in general. Dealing with the causes can help, particularly if shame, guilt or anger are present, but often this is a dead end. Conditioning through small steps is usually needed, and often it's the primary factor in being cured. What follows is a suggestion for doing it yourself - if you work at this for a couple of months and have no success it's time to find a professional.
  
  

One of the problems with psychological inhibited ejaculation is "over thinking." The man is too concerned about if he will climax, how close he is, how long have we been doing it, and so on. This interferes with the natural process that leads to climax, so distracting the man from such thinking is critical. In fact, some men may be able to overcome the problem simply by distracting their thinking. Focusing on his wife, having a sexual fantasy about his wife, or listening to her describe a sexual fantasy about them can all help distract the man. Even something as mundane and non-sexual as math problems may work, but a sexual distraction is far better.

Some men unwillingly sabotage themselves by engaging in solo masturbation. A build up of sexual tension is a good thing in trying to overcome ejaculation problems, so don't drain it away. The man must agree to not masturbate other than during the prescribed times. Once he can climax with his wife in the room solo masturbation is no longer allowed. And once she can bring him to orgasm all masturbation is stopped.

This outline is for a man who can't even masturbate with his wife in the room - find the spot where you have trouble and start there. You may be able to skip some steps, but if your first try after skipping a step fails, go back to the one you skipped.

1. Initially the man tells his wife he is going to go masturbate, then goes to the bedroom to do so while his wife stays in another room.
   
   
2. The man masturbates while his wife is right outside the door.
   
   
3. The wife is in the bedroom, but the room is dark and she is sitting in a chair facing away from the bed. - She joins him on the bed, laying so she is not touching him. Initially the room is dark, but on subsequent tries the room is dimly lighted (candle or bathroom light on with door open a crack). If this is too difficult she can move back to the chair, but watching him.
   
   
4. The wife sits next to him on the bed, clearly watching him masturbate in good light.
   
   
5. She touches him as he masturbates. Her leg against him, her hand on his arm, and so on. Initially the touch is not moving, once he can climax this way she can stroke him.
   
   
6. If the man normally masturbates dry, now is a good time to add a lubricant. If he loses the ability to climax at this point they back up and do some of the proceeding steps with lubricant. From here on lubricant is used.
   
   
7. She begins to touch his genitals as he masturbates. She does this in a way that does not significantly interfere with his normal movements.
   
   
8. He teaches her how to stimulate him by "hand riding." She places her hand over his, finger for finger, and moves with him as he masturbates. Then she stimulates him as she has seen him do, and his hand rides hers. In this second step the man is teaching her how firmly to hold his penis, and how quickly to move.
   
   
9. They now work for her stimulation to be a part of his climax. Initially he starts, and asks her to take over when climax is imminent. They gradually make the change sooner and sooner. She can also start the stimulation, hand it off to him after a while, and then pick it up as he is about to climax. Both of the periods of her stimulation are gradually increased until she can bring him to climax by herself.
   
   
10. Now intercourse begins. Initially she is on top - he is passive, just receiving. Following some manual stimulation, intercourse is done for a short time, and is followed by her bringing him to climax by hand. The wife is in control here, she moves from manual to intercourse and back to manual as she feels is best - she should not extend intercourse because he indicates he is "very close," as this can lead to frustration and relapse if he does not quickly climax.
    
    
11. She increases the amount of manual stimulation before intercourse, working up to his being on the verge of climax before intercourse.
    
    
12. A reduction of light, or total lack of light may help at this point, or it may not. It may also be advisable to cut back to two or three attempts a week, as more frequent ejaculations may take away too much of his drive for orgasm.
    
    
13. It should be understood that a single climax during intercourse does not mean the problem is forever gone: a single "success" could be followed by one or more attempts when the man cannot ejaculate in the vagina. Continue the same technique until orgasm during intercourse occurs every time.
    
    
14. Begin to make changes: reduce the amount of stimulation prior to intercourse starting, or change position. The wife should remain "in control" as this is done - if intercourse goes for too long she needs to stop him and finish him by hand.
    
    

If the couple gets stuck, a vibrator might help. The vibrators sold as sex toys are usually far too weak - a vibrator made for sore muscles is stronger and more likely to work. Be careful, and have the man determine how the vibrator should be used.
If the above does not show any sign of working in 6 to 8 weeks, please find a counselor or physiologist who has experience working with inhibited ejaculation. The longer it's left untreated, the more difficult it is to resolve. Professional treatment usually requires 12 to 18 sessions, and has a success rate of 70 to 80%.