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.

Depression, Anti-Depressants, and Low Testosterone Levels

Hormone deficiency is common in many middle age and older men.  It is of interest that many men using anti-depressants also are found to have low testosterone levels.

Many people that take antidepressants, specifically SSRI’s (selective-serotonin reuptake inhibitors), find out that they have low testosterone.  We are not certain about the mechanism of action of SSRI’s and low T levels but the effect is certainly prevalent.

Many men with depression tend to have lower than average sex drives. It is the depression that is thought to lead to disinterest in pleasurable activities like sex. Men may be so depressed and have a decreased libido, that they don’t feel like having sex.

If your testosterone level were to be lowered, the natural result would be a reduced sex drive. This reduced sex drive could be linked to depression – therefore testosterone could play a role.

Individuals with lower than average levels of testosterone could be experiencing depressive symptoms as a result of their low T. Studies have found that among men with abnormally low levels of T, testosterone therapy helped reduce symptoms of depression.

It is well documented that antidepressants can affect hormones. Therefore some hypothesize that hormonal changes can influence our sex drive. It is not known whether antidepressants are the culprit behind lowering levels of testosterone. Many men that have taken SSRI’s believe that the drugs they took lowered their testosterone.

On average, men tend to naturally experience lower levels of testosterone by the time they reach age 50. By age 60 it is estimated that 1 in 5 men have problems with their testosterone. In cases where men experienced a reduction in their level of testosterone and simultaneously became depressed, increasing testosterone levels can be therapeutic.

In older men, testosterone therapy may prove to yield antidepressant effects. Most medical research demonstrates that testosterone can have positive effects on mood. It seems as though testosterone treatment tends to be most beneficial for men who are experiencing depression as a result of testosterone decline.

Bottom Line:  Many middle age men have been placed on SSRI’s for depression.  This can result in a decrease in the testosterone level.  If you are experiencing a decrease in your libido, have decreased energy, and loss of muscle mass, you may have low T levels.  The diagnosis is easily made with a blood test and treatment consists of testosterone replacement therapy.

Premature Ejaculation-When Comin’ Instead Eof Goin’!

 

Nothing is more embarrassing to a man than a problem of rapid ejaculation.  Men are interested in satisfying their partners and when they ejaculate\cum too soon, it is a source of embarrassment and anxiety for every man and a source of frustration and lack of fulfillment for every partner. Premature ejaculation (PE) is a problem that plagues 36,000,000 men and is defined as ejaculation within 5 minutes of penetration. It is important to point out that premature ejaculation depends on the satisfaction of the partners.  It is a sexual event for a male actually includes erection orgasm, and ejaculation. The exact etiology of PE isn’t clear, but it is felt to be a lack of control of the receptors to the nerves from the spinal nerve to the prostate gland and the seminal vesicles, the two organs behind the prostate gland that store the sperm prior to ejaculation. A list of treatments that have been shown NOT to be beneficial incldues: 1. Long-term psychoanalysis. 2. Getting drunk. 3. Use of one or more condoms. 4. Concentrating on something other than sex while having intercourse. (i.e. Baseball line-ups, or state capitals) 5. Biting one’s cheek. 6. Frequent masturbation. 7. Testosterone injections. 8. Tranquillizers. 9. PD5 inhibitors. Current treatment options available include selective serotonin reuptake inhibitors (SSRI’s), utilizing the side effect of delayed ejaculation via their impact on the receptors in the brain. In numerous studies, these medications taken on a regular basis have been shown to prolong ejaculation. Drugs in this category include Zoloft, Anafranil and Prozac. Topical creams have been tried in the past and recently, a company, Promescent, (for more information go to Promescent.com) has come out with a spray that is applied to the penile glans to lessen sensitivity. It is available online without a prescription and the feedback from the men who have tried it has been very positive. My current recommendation is for men to start with Promescent if that is not successful, then consider the SSRI’s. Bottom Line:  Premature ejaculation is a very common problem affecting millions of American men.  It certainly impacts the relationship between a man and his partner.  Help is available.  Speak to your doctor.

Testosterone, Depression, and SSRI’s or Anti-Depressants-What’s the Connection?

Many people that take antidepressants, specifically SSRI’s (selective-serotonin reuptake inhibitors), find out that they have abnormally low testosterone. So what does this all mean? Did the initial low testosterone lead the individual to become depressed and go on an antidepressant? Or did the treatment with an antidepressant actually slowly reduce the individual’s natural ability to produce testosterone?

It really is a “chicken vs. egg” type argument in regards to whether low T caused depression or an antidepressant caused low T. Unfortunately there is no clear-cut scientific answer as to whether the antidepressant you took caused your testosterone to be lowered.

With that said, new research comes out all the time finding new things about antidepressants (SSRI’s) – they really aren’t well understood. Many antidepressants medications are now linked to development of diabetes, birth defects, etc. Although there are no formal studies to link antidepressants with low testosterone, many people taking these drugs are convinced that they are the root cause.

It could have been that the lower testosterone was what caused the person to feel depressed in the first place. The low T could have also merely been a coincidence among those who are depressed – after all, having low T is a pretty common issue.

Antidepressants and Testosterone: Many people taking antidepressants experience low testosterone. Similarly, many people with low testosterone are taking antidepressants. These two factors could also occur independently. In other words a person may develop low testosterone while on an antidepressant without the antidepressant being the cause. 



Depression and Testosterone: Many people may be experiencing depression as a result of low testosterone. Similarly many people may be experiencing low testosterone as a result of depression. Additionally, these two factors could be totally unrelated and independent of each other. In other words the depression could have nothing to do with low T and vice versa.
Depression and sex drive – Many people with depression tend to have lower than average sex drives. It is the depression that is thought to lead to disinterest in pleasurable activities like sex. People may be in such a depressed, low level of arousal, that they don’t feel like having sex. Therefore in this case, it could be that the depression and not testosterone is causing reduced sexual interest.
Testosterone and sex drive – It is well known that healthy testosterone levels are linked with a healthy sex drive. Men that have low T tend to have less fuel for sex, erectile dysfunction, and other performance issues. If your testosterone level were to be lowered, the natural result would be a reduced sex drive. This reduced sex drive could be linked to depression – therefore testosterone could play a role.
Low testosterone causing depression? – Individuals with lower than average levels of testosterone could be experiencing depressive symptoms as a result of their low T. Studies have found that among men with abnormally low levels of T, testosterone therapy helped reduce symptoms of depression. For this reason it is important to rule out all causes of depression (including low T) before you get on an antidepressant.
Antidepressants and low testosterone – It is well documented that antidepressants can affect hormones. Therefore some hypothesize that hormonal changes can influence our sex drive. It is not known whether antidepressants are the culprit behind lowering levels of testosterone. Many people that have taken SSRI’s believe that the drugs they took lowered their testosterone.
Bottom Line: There is no question that there is a relationship between testosterone and depression. I cannot say for certain that low testosterone is a result of the use of SSRIs. However, if you are taking SSRIs and you are experience a low sex drive or libido, it is very easy to ask your doctor to obtain a blood testosterone test. If it is low, treatment is easily accomplished with either testosterone injections, topical gels or pellets.