There are of course “Mental” or psychosocial-behavioral and cultural factors that explain DE?

Theories of psychosocial causes of DE tended to highlight four categories:  

• psychic conflict
•  insufficient stimulation (compared to masturbation)
• and relational issues.

Early psychodynamic explanations saw DE as an outgrowth of psychic conflicts suggesting malingering, unconscious, and unexpressed anger, whereas other theorists suggested that men with DE were “unwilling” to receive pleasure.

Other early mental health explanations saw DE as an outgrowth of anxiety, lack of confidence, and poor body image, etc. Anxiety can draw the man’s attention away from sexual cues that enhance arousal and can interfere with genital stimulation sensation resulting in insufficient excitement for climax; this is true even if an erection was maintained.

Depression can lead to DE as it is the most important condition affecting sexual desire;

Masturbation related factors have been shown to be a frequent cause of DE.

I identified three masturbatory factors associated with DE:

• masturbatory frequency
• idiosyncratic masturbatory style
• unsettling disparity between masturbatory fantasy and reality.

High frequency (varies from man to man) masturbation is often associated with DE.

However, the primary factor causing DE is usually an “idiosyncratic masturbatory style,” a technique not easily duplicated by the partner during sex. 

What the man rehearsed by himself is so different from what he is experiencing from his partner that he is unable to function and ejaculate.

These men engage in patterns of self-stimulation notable for one or more of the following idiosyncrasies:

• speed
•  pressure,
•  duration, body posture/position,
•  specificity of focus on a particular “spot” in order to produce orgasm/ejaculation.

Sometimes there is a disparity between the reality of sex with their partners and the sexual fantasies (whether or not unconventional) these men prefer using during masturbation are another cause of DE. That disparity takes many forms, such as partner attractiveness, body type, sexual orientation, and the specific sex activity performed. 

There are many partner issues that affect males’ ejaculatory interest and capacity, anger generally is an important factor that can be both a direct cause and a maintainer of sexual dysfunction. Anger acts as a powerful anti-aphrodisiac and must be ameliorated through individual and/or couples’ consultation.  While some men avoid sexual contact entirely when angry, others attempt to perform, only to find themselves insufficiently aroused and unable to function.

A partner who is upset and fears being found unattractive can easily become very angry. That can lead to the kind of mutual recriminations which evoke negative consequences for both partners. Misguided accusations and questions regarding the man’s sexual orientation can be especially provocative and problematic. Such tensions often lead to avoidance of partnered sex entirely as feelings of disconnection increase. 

Sex therapists have reported good success rates using cognitive-behavioral techniques. Often the single most important suggestion that a sex therapist can make is essentially common sense:

• the man must temporarily suspend masturbatory activity and limit orgasmic release to his/their desired goal activity, e.g. such as orgasm during penetrative sexual encounters with their partner.
• Research has definitely shown that temporarily refraining from ejaculating alone usually causes a man’s need/desire for a “release” to increase, as his stimulation requirements to reach orgasm or threshold for ejaculation decreases, thus making it easier to ejaculate during partnered sex. While this is usually not sufficient to solve the problem on its own, the probability for success during partnered sex is increased greatly.
• Ejaculating during intercourse must be the only outlet allowed until it begins to happen more easily. Reducing or discontinuing both self and partnered manual (or partner oral) stimulation to ejaculation is often difficult, especially if it was the only sexual activity that “worked.” Men often need support from both their therapist and partner to adhere to this restriction. In my experience, this can take anywhere from a few attempts to a number of months. It is often necessary to remind repeatedly that the need for such restraint is only temporary and not a permanent injunction against masturbation. 

When a patient refuses to stop solo self-stimulation, I typically negotiate a reduction in masturbation frequency with a minimum commitment of no ejaculation within 72 hours (based on experience) of their next partnered sexual encounter.

For men whose sexual fantasies do not align with their reality, guided modification/change of fantasy may be useful to align sexual preference with experience. These efforts must, of course, take into account that for many men sexual preferences are relatively fixed.  

Sexual Dysfunction in Marriage: Dealing with and Delayed Ejaculation

If you’ve been making love for quite a while, and your husband just can’t seem to reach climax, or you often stop before he’s finished, then he could have delayed ejaculation. The causes of delayed ejaculation are quite similar to those of erectile dysfunction: there’s a problem in that not enough blood goes to the penis to make it hard enough, and then not enough arousal is present to achieve climax.

When Delayed Ejaculation is Caused by an Arousal Addiction–like Porn or Video Games

In other cases, though, it could be a problem not with the circulation system, or with the relationship, but with the arousal process in the brain.

Philip Zimbardo is a Ph.D. psychologist studying men, and in his TED Talk, The Demise of Guys (and I’m paraphrasing because he was talking really fast), he said this:

We’ve become so desensitized because of porn use that what is “normal” is no longer arousing, and people need more and weirder and different to achieve the same level of stimulation.

This is why erectile dysfunction and delayed ejaculation are often two sides of the same coin; with erectile dysfunction the man isn’t able to stay stimulated; with delayed ejaculation the man isn’t able to get stimulated enough. In both cases they need something MORE, and that more was fed to them by porn when the arousal mechanisms in the brain went haywire.

There’s a community of porn addicts on the internet at Your Brain on Porn, who have congregated together to abstain from porn and masturbation and “reset” their brains. There is a wealth of information there and it’s one of the best resources I’ve found on the internet to “see inside” what these guys go through. And what many of them say is that, when they’re using porn, they stop being able to get aroused naturally. Even when they’re having sex, they can’t climax unless they’re watching porn at the same time. Without the porn, they just aren’t aroused enough.

And here’s what’s interesting about what Zimbardo said: this effect is true not only with porn, but also with other arousal addictions. An addiction to video games, for instance, mimics the effects of porn on the brain, where the dopamine receptors are looking for more and more intense stimulation to reach the same high. And so video games become more graphic and more fast-paced. So even if the arousal addiction is not with pornography it can still affect the arousal processes in the brain.