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Please be advised there are two sections on this topic, one by Dr. Stanley Ducharme, a sex therapist, and one by Dr. Ricardo Munarriz, a sexual medicine physician. Stanley Ducharme, Ph. D. For men, erectile dysfunction and ejaculatory problems are the most common sexual difficulties. With the introduction of Viagra however, problems of erectile dysfunction are much less frequent and more easily treated.

BACKGROUND When does an ejaculation problem become a disorder? This is a subjective question and is based on the level of distress that is experienced by the man or his partner. The time from initiating sexual activity to ejaculation varies from one individual to another. This time period is called the ejaculatory latency.

Typically, ejaculatory disorders fall into two categories. These are: delayed ejaculation and early ejaculation. This column will explore some of the psychological factors and treatment options related to these two distinct male dysfunctions. In the vast majority of cases, the most effective therapeutic approach for ejaculatory dysfunction is a combination of biologic and psychologic therapy.

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In addition, they are not well understood by most medical doctors and urologists. It is not unusual for doctors to minimize the dysfunction and to dismiss it. For many men, finding the right professional, who has experience and realizes the seriousness of the problem may be one of the most difficult aspects in the treatment process.

Resolving the problem is most successful when both partners can work together as a team toward a successful solution. If the man is in a relationship, he needs the support and understanding of his partner. This helps to insure a successful treatment. Otherwise, the partner’s frustration and distress may contribute to the continuation of the problem.

In couples where ejaculation is an issue, the partner often internalizes this dysfunction as their mistake; the partner feels responsible ultimately intensifying the man’s stress and performance anxiety. Ejaculation problems may also contribute to a low libido and lack of interest in sexual activity. Without ejaculation, sex can become a source of frustration and devoid of satisfaction.

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In some cases, the woman may not be interested in sexual intimacy because of her frustration and anger at the situation. Ultimately in such cases, couples agree to avoid sexual contact rather than face the emotional pain of another sexual failure. For some men, there may be additional psychological issues that underlie an ejaculatory dysfunction.

The literature suggests that early ejaculation is the most common of any male sexual difficulties. It is certainly one of the most stressful. By definition, early ejaculation is an ejaculation that occurs before it is desired. Typically, the ejaculation has become inevitable either during foreplay or in the first moments following penetration.

As the young man becomes sexually active with a partner, these skills can then be transferred to his new sexual encounters. As the man becomes more sexually experienced, latency of ejaculation increases although not always to the satisfaction of the man and his partner. In addition to early sexual experiences, family attitudes toward sexuality as well as cultural and religious beliefs all play a role in sexual development and ejaculatory control.

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At other times, there may be no clear precipitating events to the onset of a early ejaculation pattern. Essentially, treatment for these cases is similar to younger men but psychological issues are probably even more critical to address. TREATMENT APPROACHES / CONCLUSIONS As mentioned, the most effective approach is a combination of psychological assistance and medical intervention.

Urologists and other medical doctors typically treat early ejaculation with a combination of medications and creams. Anti-depressant medications such as Paxil and Zoloft are often prescribed and are taken by the patient 2 hours prior to sexual activity. If this is not effective, the patient is further instructed to take the medication on a daily basis rather than before sexual activity.

In a therapeutic program, the first step is usually education. It is important that the couple have an understanding of the problem, it’s origins, the prognosis and the need to work together toward a satisfying solution. The partner must also understand that the man is not being selfish and that ejaculatory control is unsatisfying for him as well.

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The most important lesson to be learned by men and their partners is that there is hope and there are therapies that can help resolve the distress of ejaculatory difficulties. Often the first step, deciding to seek treatment and finding the proper professional is the most difficult. Ricardo Munarriz, M.D.

It is theorized that the central regulation is by dopamine and penile hypersensitivity, so treatment may be with Sildenafil and local anesthetic. If you have premature ejaculation there is a 91 % chance that a first degree relative (father, brother, son) will also have it. SSRI’s which are used for depression are a first line treatment as well.

This treatment works better for people whose rapid ejaculation is acquired. Since Sildenafil is more effective than SSRI’s, a combination of an anti-depressant, local anesthetic and Sildenafil is effective in 97% of the time. The anti-depressant with sildenafil is signficantly better than the SSRI alone. Although this is currently the preferred therapy, medical insurance typically covers 30 pills for SSRI’s and only 4 sildenafil tablets per month.

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There is research still needed in this area.

Not able to last as long as you’d like during sex? That can have several causes. You might be super-excited about a new partner or routine; you might just be off your game; you may just need to relax; or it may be that many forms of media depict unrealistic expectations of how long the average man actually lasts.

Another study got right down to it: Researchers asked 500 couples to press a stopwatch at penetration, then again at ejaculation for one month. Reported durations ranged from 33 seconds to 44 minutes. But the average for vaginal sex was three to seven minutes, with 5. 4 minutes the precise median (Waldinger, 2005).

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If you’re ejaculating too quickly for your or your partner’s satisfaction, there are several strategies you can try to last longer. In this technique, you begin sexual activity and continue until you feel almost ready to ejaculate. Then your partner squeezes the end of your penis at the point where the head (glans) joins the shaft.

Also known as “edging,” the stop-start method is something you can practice with a partner or as you masturbate. When you’re masturbating and feel like you’re about to come, pause until the urge to ejaculate passes. Then resume stimulating yourself. Over time, you’ll learn to recognize when you’re approaching “the point of no return” and be able to extend intercourse.

This can reduce sensation, which might make you last longer. Anesthetic creams are sold that have the same effect. Some companies sell over-the-counter, disposable, moist towelettes you apply to your penis before sexual activity; they can reduce sensation and help you last longer. Read everything you ever wanted to know about premature ejaculation here.

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It is described as an inability to delay ejaculation to a point that is mutually desirable for both partners. To understand premature ejaculation, one should first understand the process of erection. An erection develops when blood flows into the erectile chambers of the penis. These chambers, known as the corpora cavernosa, are elastic sleeves filled with blood vessels within the penis and are adjacent to the urethra, which is the urinary channel.

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Ejaculation takes place when a signal is sent from a control center in the brain which leads to contraction of muscles adjacent to the urethra which cause the semen to be ejaculated from the tip of the penis. After ejaculation, the erection subsides. The blood which had been trapped in the elastic sleeves is now released and the penis gradually returns to its non-erect state.

A variety of causes have been suggested for premature ejaculation. Some suggest it may be caused by stress or anxiety. Others suggest it is a learned response. An easy way to picture the process is to think of the control center in the brain as a thermostat. In some men, this thermostat is set too low.

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With that in mind, the different treatments are designed to lengthen the time to ejaculation by resetting the thermostat. There are a variety of treatment options available for premature ejaculation, which are listed below. Masters and Johnson first described a method to prolong the time to ejaculation which relies on behavior modification.

Each time, he brings himself closer to orgasm until he learns the point where it can no longer be controlled. By repeating this procedure a number of times on different occasions, a man can learn the “point of no return”. A man can practice this with his partner by engaging in sexual stimulation until he reaches the point just before ejaculation.

This step is repeated several times until a man feels comfortable postponing his ejaculation. Although this method is effective, it can take weeks or months to cause a change in the threshold for ejaculation. Although this works for some men, it can be difficult for others to achieve favorable improvement with this technique.

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As a man approaches climax, either he or his partner squeezes the tip of the penis just below the head of the penis as he approaches the point of climax. Pressure is held there until the sensation of impending orgasm diminishes. Thispressure can even be held until there is some reduction in erection.

Oversensitivity can be a cause for premature ejaculation. Some men find that the sensation of sex with a condom is less intense. By wearing a condom, they may reduce the amount of sensory input so that it takes a longer period of stimulation to reach climax. Another approach to decrease sensitivity requires the use of a topical anesthetic cream to desensitize the penis.

In addition, there can be times when the topical aesthetic cream is transmitted to the female partner which can cause her to have decreased sensitivity as well. There are several different medications which can delay ejaculation. They belong to a class of medications known as selective serotonin reuptake inhibitors (SSRIs) which are types of antidepressants.

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When these drugs are used to treat depression, men notice the side effect that it may cause them to take a longer period of time to reach ejaculation. The medications likely affect the “thermostat” in the brain which controls the signal for ejaculation. Although these drugs are not indicated for the treatment of premature ejaculation, they are frequently used with benefit in men who have premature ejaculation.

These medications can “reset the thermostat” so that a man can last longer before reaching ejaculation. These drugs may need to be taken anywhere from 1-12 hours before sexual activity. For a subset of men, one of these pills may need to be taken on a daily basis to provide benefit.

Men often note that if they climax quickly with their first erection they can last a longer time if they are able to get a second erection. With the second erection, it may take a longer period of time until they ejaculate. However, for many men, it may be difficult to obtain the second erection.

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Viagra is taken one hour before sexual activity. Once a man has his first erection and ejaculation, he may find Viagra makes it easier to obtain the second erection. In summary, premature ejaculation is a common problem for which a variety of treatments are available..

Topical anesthetics that help premature ejaculation can be purchased over-the-counter at most drugstores. Oral medication, The FDA has not specifically approved any oral medication as a treatment for premature ejaculation, but many drugs have been shown to help delay ejaculation. A doctor may prescribe oral medication as an “off-label” therapy, meaning the drugs are being prescribed to treat something they have not been approved to treat.

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    Non-invasive treatments are often tried first. Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option:Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S.

    PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients. If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors.

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    An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device. If oral drugs don’t work, the drug Alprostadil is approved for use in men with ED.

    Alprostadil is injected into the side of penis with a very fine needle. It’s of great value to have the first shot in the doctor’s office before doing this on your own. Self-injection lessons should be given in your doctor’s office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment.

    Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office. Men who have penile erections lasting longer than two to four hours should seek Emergency Room care.

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    Penile implants are devices that are placed fully inside your body. They make a stiff penis that lets you have normal sex. This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous. There are two types of penile implants. The simplest kind of implant is made from two easy-to-bend rods that are most often made of silicone.

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    The implant can be bent downward for peeing or upward for sex. With an inflatable implant , fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff.

    Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate. There is generally no change to a man’s feeling or orgasm. Penile implants are most often placed under anesthesia.

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    If a man is on blood thinners, then he may need to talk with a medical expert about stopping the medications for elective surgery and healing. Most often, one small surgical cut is made. The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum.

    For the first month, men should limit their physical activity. The surgeon will explain when and how much exercise to do during the healing period. Men most often start having sex with their penile implants by eight weeks after surgery. If there is persisting swelling or pain, the use of the implant may be delayed.

    There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically.

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    Most men with penile implants and their partners say that they’re satisfied with the results, and they return to more spontaneous intimacy. Several restorative or regenerative treatments are under investigation for the future treatment of ED:Extracorporeal shock wave therapy (ESWT) – low-intensity shock waves that aim to fix the erectile tissues and help restore natural erections.

    Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. Most therapies not approved by the FDA are not covered by government or private insurance benefits. Supplements are popular and often cheaper than prescription drugs for ED.

    Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged’ PDE 5 Inhibitors as their main ingredient. The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill. The FDA has issued consumer warnings and alerts.

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    An erection occurs when the blood flow to the penis increases, causing it to change shape and size. There are three stages to an erection: This is the penis’s “normal” state, and it occurs when there is no sexual arousal or stimulation via sight, touch, or fantasizing. During this phase, blood flow to and from the penis is equal.

    The penis starts to swell during this phase. The penis becomes erect as visual, imaginary, or touch stimulation continues. The brain and nerves continue to send more blood to the penis and restrict blood flow from it. The penis becomes fully erect, allowing manual stimulation or vaginal, anal, or oral sex to occur.

    People can experience erections at any point during the day or night. These can be in response to arousal or may be random. Given the variable nature of erections, it is difficult to quantify a ‘normal’ occurrence rate. People going through puberty may experience more frequent erections, while those of older age or people with erectile dysfunction (ED) may experience significantly less, or none at all.

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    However, this can vary significantly due to the many factors that can affect erection duration. It is also worth noting that a person does not need an erection to achieve orgasm. People may worry that they are on either end of the spectrum and that their erection lasts either too long or not long enough.

    ED occurs when a person is unable to get or keep an erection long enough for sexual activity. Several factors, such as stress or relationship issues, can worsen ED. Some of ED include:Several treatments are available for ED, including medications, physical interventions, and, potentially, surgery. PE is a form of sexual dysfunction that may prevent people from having satisfactory sex.

    It is important for someone who has had an erection for 2 hours or more to seek immediate emergency care. Tissue damage can begin 4-6 hours after erection onset. Any damage to the sensitive penile tissue may be permanent and nonreversible. Treatments to help reduce a prolonged erection include:medication to decrease blood flowaspiration to drain blood from the penissurgery to restore normal blood flow to the penis In some cases, a person may not need to see their doctor for erection troubles.

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    However, a person should talk withv their doctor if they frequently have an issue with achieving an erection. Their doctor may be able to help them identify a root cause, such as medication or emotional issues. The doctor can also provide treatment to help the person get an erection. If a person has a prolonged erection that is unrelated to sexual activity and lasts more than a few hours, they should seek immediate medical help.

    Erections typically start during arousal and normally go away when arousal stops or following ejaculation. Factors such as stress, alcohol, and medication can affect a person’s ability to achieve and maintain an erection. If a person has continual trouble with getting an erection, they should talk with their doctor because they may have ED.

    A persistent, prolonged erection of the penis that will not go down is called priapism. This unwanted erection may or may not be caused by sexual arousal, is usually very painful and can last for 2 hours or longer. The sooner you treat it, the less risk that the penis will be damaged.

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    If your erection is prolonged (lasts longer than 2 hours), seek emergency treatment. Hospital treatment of priapism may include medicine to help blood leave the penis. It may also including using a needle and syringe to release some of the blood in the penis. Surgery may also be an option..

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    So nighttime erections aren’t a result of touching your penis inadvertently or having sexy dreams. They’re all about your nervous system, Ramin emphasizes. But that still leaves open the question: What’s the point of this automatic response? Nobody really knows.”There is no true purpose to development of nocturnal erections,” he says.

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    These erections keep your penile tissue soft and stretchy. They also prompt the smooth muscles in your penis to relax, allowing the blood to rush in and get you hard. That keeps it in fighting shape for when you’re awake and need it. Without this regular sleepytime workout, the muscles may become too contracted, and eventually, the length of your erect penis may shorten, Köhler says.

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    If you notice a change in your nighttime erections, best thing to do is get it checked out. And try these lifestyle tips for how to get stronger erections and stay hard. Alright, let’s say you’re having erection issues during sex and you’re having trouble determining if you’re getting nighttime erections for the obvious reason that you’re asleep.

    (That would indicate that you had an erection.) This test isn’t full-proof, especially if you’re a restless sleeper who moves around a bunch. If putting stamps on your peen isn’t appealing-and we don’t blame you-you can purchase a , a portable home device to evaluate the quality of your nocturnal penile erections.

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    The results are stored on the machine, making them simple to then share with your doctor. Additional reporting provided by Michelle Malia. Elizabeth Millard is a freelance writer focusing on health, wellness, fitness, and food. Marty Munson, currently the health director of Men’s Health, has been a health editor at properties including Marie Claire, Prevention, Shape and Real, Age.

    You may think nothing is happening when you sleep. But parts of your brain are quite active during sleep. And enough sleep (or lack of it) affects your physical and mental health. When you sleep, your body has a chance to rest and restore energy. A good night’s sleep can help you cope with stress, solve problems or recover from illness.

    Sleep helps us in many ways. We need it for: In children and young adults, deep sleep (sleep that’s harder to wake from) supports growth. The body releases growth hormone during this type of sleep. The body also increases production of proteins, which we need for cell growth and to repair damage.

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    The last two stage of non-REM sleep is when you sleep deeply. It’s hard to wake up from this stage of sleep. happens about an hour to an hour and a half after falling asleep. REM sleep is when you tend to have vivid dreams. As you sleep, your body cycles through non-REM and REM sleep.

    Healthcare providers call this motion hypnic myoclonic or hypnic jerk. Hypnic jerks are common and not anything to be concerned about as this occurrence is unlikely to cause any complications or side effects. This period of light sleep features periods of muscle tone (muscles partially contracting) mixed with periods of muscle relaxation.

    That’s why REM sleep is the stage where you’ll have intense dreams. At the same time, major muscles that you normally control (such as arms and legs) can’t move. In effect, they become temporarily paralyzed. Usually, REM sleep arrives about an hour and a half after you go to sleep.

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