Delayed Ejaculation-The Other Sexual Dysfunction

Unlike premature ejaculation—usually defined as ejaculating 3 minutes or less after penetration—there isn’t a set amount of time that constitutes delayed ejaculation.

Still, you may have it if you can’t orgasm within 20 minutes after penetration.

Statistically, that time frame is far enough away from the average guy’s norm of about 5 minutes.

Sound like you? Here’s everything you need to know about why it may be taking so long to finish in bed, and how to treat the condition.

What Causes Delayed Ejaculation?

Ejaculation is a complicated process that involves your brain, nerves, and muscles in your pelvic region. Your nerves send a signal from your brain to your pelvis muscles telling them to contract and release semen.

But when your nerves aren’t communicating properly—whether from a disease like diabetes or multiple sclerosis, or from aging—that “ejaculate now” message from your brain can get lost in translation.

Some drugs can also delay your ejaculation, especially those that affect your central nervous system.

Selective serotonin reuptake inhibitors (SSRIs) for depression, certain muscle relaxers, and anti-smoking meds may manipulate the neurotransmitters in your brain, which can postpone your ejaculatory response.

Then there are your hormone levels: Guys with low testosterone or low thyroid hormones may be more at risk for delayed ejaculation.

Psychological issues like anxiety, depression, performance anxiety, relationship conflict, or sexual shame, or even the fear of becoming a father can also hinder or delay an ejaculation.

Finally, if these problems pop up only when you’re with your partner, consider the way you masturbate. If you use an atypical technique—like rubbing your penis against a certain object, or sticking it into a vise-like device—your partner’s may not be able to replicate it.

Although endless sex sounds awesome, but many men with delayed ejaculation complain that the sustained effort makes them feel physically exhausted during the act. As a result a lot of men will actually have to stop sex before they orgasm.

Also, delayed ejaculation can be mentally draining. Men can start to feel depressed or anxious that they’re taking too long to finish.

The explanation is that if you stress about how long it’s taking orgasm, your body produces more of the hormone adrenaline and more adrenaline restricts the blood supply to penis resulting in difficulty holding or maintaining an erection thus contributing to a delay in ejaculation.

Treating delayed ejaculation begins with an appointment to see a urologist—preferably one who specializes in sexual medicine. The urologist will most likely order a full workup, including tests for testosterone, thyroid, and blood sugar levels.

At the present time there is no medication to treat delayed ejaculation. However, there are drugs that have been shown in small studies but without FDA approval to treat delayed ejaculation. These include cabergoline or oxytocin, which act on certain chemicals in your brain whose levels have been disrupted.  However, the most successful treatment includes both medical intervention and sexual counseling with a certified sex therapist.

Bottom Line: Delayed ejaculation is a common problem especially in middle aged and older men. Although no medical treatment is available, you can be helped and can solve the problem with a discussion with your doctor and perhaps a referral to a counselor or sex therapist.

Just Wait A Minute-Delayed Ejaculation

A very common problem among young men is premature ejaculation or reaching orgasm too soon. In older men, delayed ejaculation becomes an issue of major concern where men find it difficult or impossible to ejaculate and experience orgasm during sexual encounters.

This causes relationship distress and anxiety for the man but also impacts the partner as well. While some partners may enjoy the extended intercourse, especially if they experience premature ejaculation when the man was younger, it is common for the partner to blame themselves that they are no longer attractive or may even be suspicious that that the man is having another partner or an affair.

The causes of delayed ejaculation includes anything that disrupts the nervous system path to the genitals such as might occur with multiple sclerosis, spinal cord injury, diabetes mellitus, alcoholism. One of the most common causes is older men is a surgical procedure in the pelvis such as prostate gland surgery for prostate cancer, bladder cancer, or colon cancer. In these surgical procedures there can be injury to the nerves that supply the penis and result in decreased sensation of penis. There are numerous medications that can contribute to delayed ejaculation. Some of the culprits are medications for treating high blood pressure, antidepressants, antipsychotic drugs, some drugs used to treat enlarged prostate gland. Finally, aging results in decreased sensation to the penis and as a result more genital stimulation is required to achieve an orgasm.

The diagnosis is made with a careful sexual history. The doctor will ask about the man’s attractiveness of his partner, whether the man uses fantasy during intimacy, and also the masturbation patterns such as the frequency and technique of masturbation.

At the present time there is no FDA approved drug used to treat delayed ejaculation. Effective techniques include behavioral therapy such as temporarily suspend masturbation and by limit orgasm to sexual encounters. In men who have had previous pelvic surgery, increased sexual stimulation such as using vibrators, or erotic videos have often proved helpful. For most men with delayed ejaculation, treatment is usually successful.

Bottom Line: Delayed ejaculation is a common problem affecting millions of older men. The diagnosis is easily made and most men can be helped with behavioral therapy or with added genital stimulation.

Impotence: 14 Secrets for Success

Sure it’s a night you’ll remember. For all the wrong reasons.

It had been a hectic week. You’d been working hard on that proposal, and never once made it home before midnight. Tonight, you were going to make it up to your wife.

You brought roses. She uncorked your favorite wine. After dinner, when you took the phone off the hook, she slipped behind you, kissing your neck in that way of hers that always drives you crazy. Everything seemed to unfold according to plan.

Everything, that is, except a certain part of your anatomy. A certain crucial part.

And that left you to wonder: What in tarnation is going on? Is this going to happen the next time? What the heck can I do about it?

Plenty. Realize, first, that you’re not the only man in the world who’s had this happen. “If men are honest, every one of them will tell you they’ve sustained an impotence episode at one time in their lives,” says Neil Baum, M.D., director of the New Orleans chapter of the Male Infertility Clinic and an assistant professor of urology at Tulane University School of Medicine. “Not every incident is a ten.”

“It can be devastating when it occurs,” he says. “A man’s whole concept of his masculinity may be undermined. ”

Experts sayan estimated ten million men suffer from impotence, the term used when a man is unable to achieve and maintain penetration until he ejaculates.

Until the early 1970s, experts thought that most erection problems pointed to underlying problems in the psyche. Today, the medical community recognizes that almost half of all impotent men have a physical or structural problem that’s at least partly responsible.

What can you do to keep erection problems at bay?

Here’s what our experts advise.

Give yourself time. “As a man gets older, it may take a longer period of genital stimulation to get an erection,” says Dr. Baum. “For men aged 18 to 20, an erection may take a few seconds. In your thirties and forties, maybe .a minute or two. But if a 60-year-old doesn’t get an erection after a minute or two, that doesn’t mean he’s impotent. It just takes longer.”

The time period between ejaculation and your next erection also tends to increase with age. In some men aged 60 to 70, it may take a whole day or longer to regain an erection. “It’s a normal consequence of aging,” says Dr. Baum.

Consider your medication. Drugs your doctor has prescribed might be at the root of the problem. Or it might be those over-the-counter antihistamines, diuretics, or sedatives you’re using. Realize, of course, that what affects your neighbor may have no effect on you.

More than 200 drugs have been identified as problematic. Drug-induced impotence is most common in men over 50, says Dr. Baum. In fact, in an American Medical Journal study of 188 men, drugs were the problem 25 percent of the time.

If you suspect your medication, consult your doctor or pharmacist. He may be able to change the dosage or switch you to a different drug. Do not, however, attempt to do this on your own.

Beware of recreational drugs. Troublemakers that Richard E. Berger, M.D., a urologist with Harborview Medical Center in Seattle, Washington, lists in his book BioPotency: A Guide to Sexual Success, include cocaine, marijuana, opiates, heroin, morphine, amphetamines, and barbiturates.

Go easy on the alcohol. Shakespeare hit it on the head when he said in MacBeth that alcohol provokes desire but it takes away the performance. That happens because alcohol is a nervous-system depressant. It inhibits your reflexes, creating a state that’s the opposite of arousal, says Dr. Berger. Even two drinks during cocktail hour can be a cause for concern, he says.

Over time, too much alcohol can cause hormonal imbalances.

“Chronic alcohol abuse can cause nerve and liver damage,” says Dr. Baum. “When you have liver damage, you cause a dynamic where the man has an excess amount of female hormones in his body.” You need to have the right proportion of testosterone for everything to work properly.

Know that what’s goodfor the arteries is goodfor the penis. “In the last five years, it’s become quite evident that the penis is a vascular organ,” says Irwin Goldstein, M.D., co-director of the New England Male Reproductive Center at Boston University Medical Center in Massachusetts. The very things that clog your arteries-dietary cholesterol and saturated fat-also affect blood flow to the penis. In fact, says Dr. Goldstein, all men over age 38 have some narrowing of the arteries to the pems.

So watch what you eat. “High cholesterol is probably one of the leading causes of impotence in this country,” says Dr. Goldstein. “It appears to affect erectile tissue.”

Don’t smoke. Studies show that nicotine can be a blood vessel constrictor, says Dr. Baum. A study of healthy adult mongrel dogs at the University of California at San Francisco showed that the inhalation of smoke from just two cigarettes was enough to prevent five dogs from getting a full erection and a sixth dog from maintaining one. The researchers believe that inhalation of cigarette smoke blocks erection by inhibiting the smooth muscle relaxation of the erectile tissue.

Do what you need to feel good about your body. Are you thinking about taking off a few pounds?

Studying karate? Starting a weight-training program? Do it. “Sex is body contact,” says James Goldberg, Ph.D., research director of San Diego’s Crenshaw Clinic in California. “The more a person feels good about his body, the better he’ll feel going into the event.”

Don’t overdo it on the exercise. If you exercise excessively, you’ll stimulate the body’s natural opiates, the endorphins. “We’re not sure how they work, but they tend to lessen sensation,” says Dr. Goldberg. “Over the short run, exercise is good for you. Beyond a certain point, though, the body gets into the habit of protecting itself.”

Wait out pain. Your body also produces its own opiates when you’re in pain, says Dr. Goldberg. These opiates can tum off any sexual stimuli. “There’s not much you can do,” he says, except wait for a better time.

Relax. Being in a relaxed frame of mind is crucial. Here’s why. Your nervous system operates in two modes. When the sympathetic nerve network is dominant, your body is literally “on alert.” Adrenal hormones prepare you to fight or take flight. Nerves shuttle your blood away from your digestive system and penis and into your muscles.

You can tum on your sympathetic nervous system just by being too anxious, says Dr. Baum. “For some men, the fear of failure is so overwhelming that it floods the body with norepinephrine, an adrenal hormone. That’s the opposite of what you need to have an erection.”

The key here is to relax and let your parasympathetic nervous system take over. Signals that travel along this network will direct the arteries and sinuses of the penis to expand and let more blood flow 111.

Avoid whole-body stimulallts. That means caffeine and certain questionable substances touted as potency enhancers. “The main thing during sex is to be relaxed,” says Dr. Goldberg. “Stimulants tend to have an overall effect. They constrict the smooth muscle that must dilate before an erection can occur.”

Refocus your attemioll. One way to relax is to focus with your partner on the more sensual aspects of intimacy. Play with and enjoy each other without worrying about that erection.

“The skin is the largest sexual organ in the body,” says Dr. Goldberg, “not the penis. So don’t be led by your penis. The whole body has to react.”

Plall ahead. Dr. Berger thinks it is a good idea to decide in advance what you’ll do if you don’t get an erection. “What are your alternatives?” If you’re not so focused on the erection itself, it will make it easier for the erection to come back, he says.

Talk to your partller. Don’t risk increasing the tension in the bedroom by maintaining a sullen silence.

Together. you can play detective and figure out what’s going on. Pressure at work? Strain over a child’s illness. A touchy issue you two haven’t resolved yet?

“If you understand some of the things that can cause impotence, you can find a way to explain it without attributing it to something that’s not there,” says Dr. Berger. “And you should talk about what your alternatives are. Will you continue your lovemaking in a different way? Don’t let the erection, or lack of it, interfere with your intimacy.”

PANEL OF ADVISERS

NEIL BAUM. M.D., is director of the New Orleans Male Infertility Clinic, a clinical assistant professor of urology at Tulane University School of Medicine, and a staff urologist with Touro Infirmary in New Orleans, Louisiana.

RICHARD E. BERGER. M.D., is a urologist with Harborview Medical Center in Seattle, Washington.  He is the author of Biopofency: A Guide fa Sexual Success.

JAMES GOLDBERG. PHD., is research director of the Crenshaw Clinic at San Diego, California, and a clinical research pharmacologist.

IRWIN GOLDSTEIN. M.D., is co-director of the New England Male Reproductive Center at the Boston University Medical Center in Massachusetts and is an assistant professor of urology at Boston University School of Medicine.

EjD, Ejaculatory Dysfunction-The New Sexual Dysfunction

Millions of men suffer from EjD or ejaculatory dysfunction.  The most common variety is premature ejaculation followed by retarded ejaculation or not being able to achieve an orgasm.  Another less common EjD is retrograde ejaculation or seminal fluid going back into the bladder instead of exiting the penis at the time of orgasm.  This article will discuss the three common EjD conditions and what can be done to resolve them.

It is estimated that one-third of American men suffer from premature ejaculation or ejaculation within seconds of vaginal penetration.  This is of great concern and embarrassment to those who experience this malady.

One folk remedy that is available to all men is self-stimulation or masturbation. Having repeated orgasms will bring on delayed ejaculation in nearly every man. The best premature ejaculation tip is to double the number of orgasms a man has per week. And if that doesn’t work, double it again.  Now isn’t that a great assignment?

Another method that requires cooperation with the partner or significant other is the “pull out technique.” This consists of having sex for a few minutes then pulling out and stopping for a few minutes to postpone orgasm.

Another method is to decrease the stimulation of the penis using desensitizing cream such as topical xylocaine.  Also, using one or more condoms can decrease the sensation and can prolong ejaculation.

When these non-pharmacologic techniques are ineffective there are medications that can help prolong the time from penetration to ejaculation. Selective serotonin reuptake inhibitors, or SSRIs — are known to cause delayed ejaculation.  Using an SSRI four to six hours before intercourse, men prone to premature ejaculation can last longer.

Delayed ejaculation (or retarded ejaculation) affects a much smaller number of men.  With this problem, men cannot reach orgasm at all, at least not with a partner.  It is most common associated with aging where more stimulatin is required for a man to reach an orgasm with advancing years because the nerve endings in the penis become less sensitive.  Delayed ejaculation may be caused by medicines – like antidepressants– are common culprits.

Retrograde ejaculation is the least common of the ejaculation problems. Retrograde ejaculation can be caused by diabetes, nerve damage, and various medications such as alpha-blockers like Flomax, which are used to treat enlargement of the prostate gland. Retrograde ejaculation is harmless and won’t interfere with the feeling of orgasm. (It can also make for an easy post-sex clean-up.) But since it does affect fertility, some men may need treatment if their partners are trying to get pregnant.

Bottom Line

EjD is a common medical condition that can be overcome.  Be open and communicate with doctor and share your concern with your partner.  Don’t suffer in silence and let the tension mount up and compounding the problem.  Most men with some advice and perhaps some medication from their doctor can overcome this problem.  This translates to less worry and more sex.  Who could ask for anything more?