Excitement About Patient Education: Sexual Problems In Men (Beyond The Basics)
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.
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.