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.

What’s Causing Your Erectile Dysfunction? (ED)

Erectile dysfunction or impotence affects nearly 14 million American men.  The condition is often associated with diabetes, heart disease, high blood pressure and literally hundreds of medications that side effects of ED.  There are a number of conditions that can be treated that can significantly improve your erection that doesn’t require medication or surgery.

1. Vitamin D deficiency: vitamin D is a necessary vitamin and when the vitamin D level is decreased, which can be identified by a simple blood test, a man’s erection can be affected. A study has shown that men with severe erectile dysfunction had lower Vitamin D. The solution is as simple as getting outside in the fresh air and getting some sunshine as the sun helps convert inactive vitamin do to the active vitamin that is vital to good health. Many factors affect the skin’s ability to produce vitamin D, including season, time of day, latitude or how far you live from the equator, air pollution, cloud cover, sunscreen, body parts exposed, color, and age. Dermatologists recommend using sunscreen and getting vitamin D from food and supplements rather than risk the harmful rays of the sun.
2. Diabetes: Erectile dysfunction could be caused by undiagnosed or diagnosed diabetes. If your ED is sudden, consider getting screened and if you know you already have diabetes, expect this to be a risk factor. By getting the glucose level under control and lowering the HbgA1C to normal levels, you can improve your erections.
3. Your drinking: Alcohol has a reputation of increasing the desire for sexual intimacy but decreasing the performance or make getting and holding an erection difficult. If you have issues getting it up and you have also started increasing the amount of drinks you have, including the frequency, then consider cutting back. Heavy drinking increases your risk of ED.  One to two drinks per day is acceptable will not impact your erections.  More alcohol will certainly impact your performance in the bedroom.
4. Stress: If you are stressed at work, home or in your relationship, it will affect your sex life. You need to be a relaxed to get in the mood for sex. This problem can also be a catch-22, because if you cannot get it up, you start to stress about that too, making it even more unlikely you will have an erection. So, basically, just relax and take a deep breath and practice mindfulness.
5. Coffee to the rescue: Studied have found that 42 percent of men who drink between two to three cups of coffee a day are less likely to have erectile dysfunction. Caffeine helps relax the arteries and the smooth muscle within the penis which, in turn, helps increase blood flow.
6. Not enough sex: The more sex you have, the less likely you are to suffer from ED. What is considered regular? Experts say you can shoot for two – three sexual engagements including orgasms per week.
7. Smoking: The more you smoke, the more you risk have a flat, flaccid penis. 23 percent of erectile dysfunction occur among men who smoked.
8. Lack of exercise: Exercises, especially weight resistance ones, do a lot to increase a man’s testosterone which helps reduce the likely of ED. Your levels or testosterone normally drop about 1%a year after age 25.
9. Bicycle riding: Studies have shown that the longer you ride your bicycle, the higher your chance of developing ED. You do not have to stop riding though, just make some modifications. You can ride shorter distances, get off of the seat every 10-15 minutes for 30 seconds, find comfortable seat and get a bike that is sized appropriately.
10. Your medications: Some medications like antihypertensive drugs and antidepressants (SSRIs) can cause erectile dysfunction.

 

Bottom Line:  ED is a common problem affecting millions of American men.  Often times the problem can be related to diet, lack of exercise, and poor lifestyle choices. Take a look at these 10 factors that can significantly affect a man’ erection.  Make some adjustments and you will soon be “back in the saddle”!

 

 

Got Premature Ejaculation? Give Kegels a Try

Premature ejaculation is a common condition that impacts so many American men. It leads to a source of frustration not only to the man but to his partner as well. There are dozens of folklore treatments but since none universally effective, that leaves many men continuing to suffer the embarrassment of premature ejaculation or PE. There are medical options, which include oral medication with SSRI or selective serotonin reuptake inhibitors and sex therapy that teach the squeeze technique.

However, a non-medical solution consists of pelvic floor exercise, more commonly called a Kegel exercise (named after Dr. Arnold Kegel), consists of contracting and relaxing the muscles that form part of the pelvic floor, which are referred to as the “Kegel muscles”. Several tools exist to help with these exercises, though many are ineffective. These exercises are usually done to reduce urinary incontinence and aid with childbirth in women, and reduce premature ejaculatory occurrences in men, as well as increase the size and intensity of erections.
Kegel exercises are employed to strengthen the pubococcygeal muscle and other muscles of the pelvic diaphragm. Kegels can help men achieve stronger erections and gain greater control over ejaculation. The objective of this may be similar to that of the exercise in women with weakened pelvic floor: to increase bladder and bowel control and sexual function.
Sexual function
Kegel workouts can provide men with stronger erections. Research published in 2005 issue of BJU International, have shown that pelvic floor exercises could help restore erectile function in men with erectile dysfunction. There are said to be significant benefits for the problem of premature ejaculation from having more muscular control of the pelvis. In men, this exercise lifts up the testicles, also strengthening the cremaster muscle, as well as the anal sphincter muscles, as the anus is the main area contracted when a Kegel is done. This is because the pubococcygeus muscle begins around the anus and runs up to the urinary sphincter.

Find a quiet and private place to practice your reverse Kegels. You’ll need to take your time when you first begin. You need to be patient if you don’t feel like you’re understanding the technique right away. You’ll need to settle into a place without any interruptions. Then, you will need to:
1. Relax the penile area completely and clear your mind of tension and anxiety. You want to be calm and relaxed so that the blood can flow into your penis.
2. Begin contracting the penile muscles. Focus on contracting the muscles near the front of your penis while keeping the rest of the pelvic area as relaxed as possible. The goal is to make your penis become stronger and more erect without actually having an erection.
3. Breathe deeply and slowly as you push out the muscles in the penile area and maintain focus on strengthening only the top and lower end of the penis. Take note of how relaxed and loose the muscles directly under your penis are.
4. Let go of the contraction and breathe more deeply as you exhale. Let your penis relax, then take another deep breath and contract again. Make sure you are only focusing on the front of your penis; push out, hold for a few seconds, then relax the muscles.
5. Repeat the cycle for at least 10-15 times per session so that you feel comfortable with the movement. The entire process will feel awkward at first, but it’s very important to focus on relaxation and keeping the muscles as loose as possible outside of the contractions. You can work your way up to 40-50 exercises per session as your penis becomes stronger.

Practicing Kegels for PE treatment isn’t the most effective PE cure but good results still possible so you should try it especially in a combination with other remedies such as SSRIs. The best thing about Kegels exercises it their absolute safety and the cost is just right-it’s free!

Bottom Line: Kegel exercises are not just for women but can also be used by men to treat premature ejaculation. Remember, a Kegel a day may keep your ejaculation away….or at least delayed for a few minutes!


Don’t Let Anti-Depressants Put Your Sex Life To Bed

Today depression can be successfully treated with medication.  Unfortunately, sexual dysfunction is a common side effect of nearly all classes of anti-depressant medications. The side effects include decreased libido, inability to orgasm, decreased sensation in the genitals, vaginal dryness (in women), and erectile dysfunction (in men).

There are other causes of loss of libido, which includes hormone deficiency in both men and women and can easily be diagnosed with a blood test for testosterone and if the level is diminished, replacement therapy can easily be accomplished with injections and gels in men and with medication and gels in women.

If anti-depressants are the likely cause, there are several possible options. There are some anti-depressants that are less likely to cause loss of libido.  Wellbutrin is one of those medications that is associated with less sexual side effects than other anti-depressants.

The drugs used to treat erectile dysfunction, Viagra, Levitra, and Cialis have been effective in resolving the side effects of anti-depressant medication in both men and women.

For those who are on anti-depressant medication, consult with your doctor and tell him\her about the sexual side effects and the doctor may be able to decrease the dosage of the anti-depressant medication that causes the sexual side effect yet provide adequate medication to control the depression.

Another option is to ask your doctor about changing the time of day that you take your medication.  For example, if you plan to have sexual intimacy in the evening, then take your anti-depressant medication before you go sleep.  Thus the blood level of the anti-depressant will be lowest the next evening at the time you engage in sexual intimacy.

You can also ask your doctor if you can divide your anti-depressant medication and take it twice a day rather than one large dose which will elevate the blood level of the anti-depressant more than using smaller doses several times a day.

Finally, consider a drug holiday.   This involves taking a short break from your anti-depressant medication. There are reports that a two-day break from antidepressant therapy can lower the rate of sexual side effects during the break without increasing the risk of a recurrence of depressive symptoms. This approach, the weekend holiday, works with quick-clearing drugs, such as Zoloft and Paxil. One potential risk with taking a drug break from antidepressants that have very short half-lives, such as Zoloft and Paxil, is the recurrence of symptoms of depression.

Bottom Line:  Sexual side effects are commonly associated with the use of anti-depressant medications.  However, if you speak to your physician, alternatives may be found that will put your sex life back on track.

Dr. Neil Baum is a physician in New Orleans.  He can be reached at (504) 891-8454 or on his website, http://www.neilbaum.com

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 form their doctor can over come this problem.  This translates to less worry and more sex.  Who could ask for anything more?

Dr. Neil Baum is a urologist in New Orleans, Louisiana and can be reached via his website, www.neilbaum.com or (504) 891-8454