Dear Patti,

Ever since high school, I was rarely asked out so I realize how lucky I am to have met Michael. He treats me like I’m the most beautiful woman in the world. We were married six months ago and everything is wonderful except for a sexual problem. My husband’s a great lover but he never reaches a climax when we’re together. He’s admitted that he can only have sexual completion when he’s alone in our apartment. Michael insists that it’s no big deal and that he enjoys sex with me very much, but I still feel insecure because I can’t please him — and sometimes he wants to continue sex for so long it becomes painful. Also, how will I be able to get pregnant? He’s been to his doctor and medical issues have been ruled out. My husband deserves to be happy and satisfied. Is there anything we can do?
— Elizabeth

Dear Elizabeth,

I know this problem is disconcerting, but don’t lose sight of the fact that there’s something very important and positive in this marriage; specifically, not only do you both love and appreciate each other but you also feel comfortable talking to one another. Unfortunately, many couples ignore such issues — especially when sexual in nature — and try to pretend there’s no “elephant in the room.”

What you’re describing is called male orgasm disorder, a problem of involuntary inhibition that affects men, similar to female orgasm disorder in women. While they can get excited and perform sexually, they have trouble reaching an orgasm — even with plenty of stimulation by their partner. Many men downplay this problem as long as there’s no difficulty achieving erections. What happens is that when a man unconsciously holds back so tightly in order to avoid a state of anxiety, he also holds back his climax. (This is the opposite of impotency, in which strong feelings of anxiety can ruin an erectile response altogether.)

Because individuals can be inhibited psychologically and/or physiologically, I highly recommend that you and Michael see a professional sexologist who is experienced in treating sexual disorders with a talk-therapy orientation and with behavioral techniques. Traditional psychotherapy might uncover psychological reasons, such as past trauma involving specific memories that need to be emotionally worked through, the fear of pregnancy, or superficial performance anxiety. Two major conflicts that frequently come up in the treatment of delayed ejaculation are the fear of intimacy/becoming too closely attached and unconscious aggressive tendencies which are defended against by “holding back” all impulses, both hostile and pleasurable.

A goal of behavioral sexual therapy is to distract the man from his extreme need for control so that his orgasmic reflex can respond normally and naturally. The sex therapist will probably start with the condition(s) under which Michael can comfortably climax and then up the ante. Since Michael can bring himself to completion when he’s alone, he’ll probably be given directions to practice masturbating in the locked bedroom, knowing you’re still in the house. He’ll be encouraged to use the mental distraction of erotic fantasy. When he’s accomplished this successfully several times in a row, he’ll then want to create the same scenario with an unlocked door and, finally, an open door. After this exercise has been successful, he’ll repeat the procedure with you being in the same room.

The next step is for the two of you to make love. After you’ve reached orgasm, Michael should then masturbate to climax. This is a very important element since it not only knocks down defenses regarding intimacy but also establishes a mental association between sex with you and the act of completing an orgasm. You and Michael can then gradually build to the point that you can stimulate him to climax after intercourse and, in doing so, demonstrate your happiness in being able to please him. The last phase of treatment — during which time he should discontinue pleasuring himself — will consist of a grouping of sexual experiences until he reaches the goal of climaxing during sexual intercourse. Studies have shown that once this level of intimacy is achieved, the problem usually disappears.