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Ejaculation Problems. Too Fast, Too Slow, or Not at All?


Premature ejaculation (PE) is a very common sexual problem that men experience, affecting anywhere from 30-75% of men at some point in their lives. In addition to PE, men can experience other ejaculation disorders, including delayed ejaculation, failure to ejaculate, and inability to orgasm. All of these problems can have a variety of psychological or physical causes. Fortunately, there are a variety of effective treatments available for these conditions.

The science of ejaculation

Ejaculation, the ejection of semen from the penis, is an important part of the sexual act for men as it typically occurs during orgasm. The ability to control when you have an orgasm can greatly affect sexual satisfaction for men as well as their partners, especially since men usually lose their erections after climax. Ejaculation disorders can negatively impact sexual relationships, harming self-esteem, female sexual satisfaction, and male fertility.

In a healthy male body, physical and mental sexual stimulation leads to an erection; further physical sexual stimulation results in orgasm and ejaculation. Semen is made up of sperm from the testes and seminal fluid produced by the prostate and other glands. Sexual activity causes the production of semen and when the sexual climax is reached, muscular contractions at the base of the penis expel semen through the urethra. Sexual arousal and orgasm are controlled by the brain and require proper levels of various sex hormones, including testosterone, as well as serotonin.

If you are having any type of sexual dysfunction you should seek help from your healthcare provider. They can help diagnose your problem and identify underlying causes, allowing you to find an effective treatment.

Psychological causes of ejaculation disorders

Sex is both mental and physical, so both physical and psychological problems can contribute to male sexual dysfunction. The psychological component of sex is especially important for controlling when (and if) ejaculation occurs, but some medical conditions and medications can also affect ejaculation, including erectile dysfunction.

Psychological problems are a common cause of most types of ejaculation disorders. Many things can affect sexual performance: performance anxiety, stress, depression, anxiety, poor self-image, relationship problems, guilt, unrealistic sexual expectations, or a history of sexual repression or abuse. Once medical problems are excluded as a cause for your sexual dysfunction, psychological and mental health problems should be addressed. Psychotherapy with a psychologist, couples counseling, sex therapy, or psychiatric care may be needed to help you identify and overcome mental barriers to sexual satisfaction.

Premature ejaculation

It is estimated that one-third of men ages 18-59 experience problems with premature ejaculation during their lifetime, but it may be much more common. According to research, it takes an average of about 5 minutes to achieve male orgasm during penetrative sex, but individual expectations can vary. PE is generally considered mild if ejaculation occurs within 1 minute of penetration and severe if it occurs before penetration. However, PE can be defined more broadly as not being able to control when you ejaculate, causing you to do so before you want to.

There are many potential medical causes for PE, including erectile dysfunction, infection or inflammation of the prostate or urethra, and having an overly sensitive penis. Additionally, PE can be caused by low serotonin levels in the brain or low levels of hormones, including testosterone. However, it is believed that many cases of PE have an underlying psychological or psychiatric cause.

Treating premature ejaculation

Treating any underlying medical conditions, including erectile dysfunction, should be the first step in treating your PE. Some medications can help improve PE. These include erectile dysfunction pills, alpha1-blockers (used for enlarged prostate or high blood pressure), and antidepressants that increase serotonin levels, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and clomipramine (Anafranil).

To decrease penis sensitivity during sex topical numbing creams and sprays are available, but simply wearing a condom can help PE in some men. Doing Kegel exercises can help improve PE by strengthening the pelvic floor muscles. Other strategies include masturbating 1-2 hours before sex and having sex with your partner on top.

Here are some techniques that you can try during sex to help control when you ejaculate:

  • Squeeze technique: When you feel you are close to ejaculating, gently squeeze the head of the penis for several seconds to help delay orgasm.
  • Start and stop technique: When you feel you are close to ejaculating, stop stimulating your penis for about 30 seconds to delay orgasm.

Other ejaculation problems

Premature ejaculation is common, but other problems with ejaculation are relatively uncommon, including delayed ejaculation and dry orgasm.

Delayed Ejaculation

Delayed ejaculation, taking longer than normal to achieve orgasm, affects about 1-4% of men. There is no set time limit for when ejaculation should occur during sex, but if it is causing distress or interfering with sexual activity it should be treated. Some men can also experience male anorgasmia, the inability to orgasm during sex, which can be due to the same causes. Causes of delayed ejaculation include excessive alcohol consumption, surgery or injury to the groin, conditions that cause nerve damage, infections, and certain medications, including opioid painkillers, antidepressants, anti-seizure drugs, antipsychotics, and drugs for blood pressure. Hormonal problems can also cause delayed ejaculation, including low testosterone or thyroid hormones as well as high levels of prolactin. Aside from psychological therapy, treatments can include testosterone therapy or medication, including cyproheptadine (Periactin), buspirone (BuSpar), amantadine (Symmetrel), oxytocin (Pitocin), or cabergoline.

Dry Orgasm

If you have dry orgasms that produce little to no semen, you may have retrograde ejaculation. This happens when semen goes into the bladder during climax due to prostate or groin surgery, certain medications, or nerve damage from diabetes, multiple sclerosis, or spinal cord injury. Other causes for dry orgasms include radiation therapy or surgery to remove the bladder or prostate. Male infertility is the main problem caused by dry orgasms and can be treated with medication or other methods to collect sperm for artificial insemination. Semen can be collected using either penile vibratory stimulation or electroejaculation. Both of these methods can be effective even in men with spinal cord injuries.

Ejaculation problems are common and treatable

Premature ejaculation is a common male sexual problem, but there are less common ejaculation disorders, including delayed ejaculation and dry orgasm. It is important to seek medical care for these and other types of male sexual dysfunction because they may be symptoms of an underlying medical condition. However, psychological problems, including guilt and anxiety, may be responsible for many cases of ejaculation problems. A wide variety of medications can treat premature ejaculation and other disorders, but identifying and dealing with psychological problems may be needed for you and your partner to have a healthy sex life.

Key Takeaways

Premature ejaculation is a very common and treatable disorder

Premature ejaculation and delayed ejaculation can have both physical and psychological causes

Psychological counseling, medication, and sexual techniques can successfully treat premature ejaculation and other ejaculation disorders.

REFERENCES

Urology Care Foundation. Premature Ejaculation.

National Library of Medicine. Premature Ejaculation.

Mayo Clinic. Delayed Ejaculation.

Fertility and Sterility. Normal Male Sexual Function: Emphasis on Orgasm and Ejaculation.

The Journal of Sexual Medicine. The Importance of Male Ejaculation for Female Sexual Satisfaction and Function.

Cleveland Clinic. Sexual Dysfunction in Males.

Cleveland Clinic. Premature Ejaculation.

Mayo Clinic. Kegel Exercises for Men: Understand the Benefits.

Cleveland Clinic. Delayed Ejaculation.

Fertility and Sterility. Delayed Orgasm and Anorgasmia.

The World Journal of Men's Health. Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment.

UCLA Health. Delayed Ejaculation.

Mayo Clinic. Retrograde Ejaculation.

Johns Hopkins Medicine. Penile Vibratory Stimulation and Electroejaculation.

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