Andrew Siegel, MD 2/21/15
Male sexual problems go beyond difficulties with obtaining or maintaining a rigid erection. Ejaculatory timing dysfunctions are commonplace, ranging from premature ejaculation on one extreme to delayed ejaculation on the other extreme. Premature ejaculation is one of the most prevalent male sexual disorders and seems to get all the attention, so today’s focus is on delayed ejaculation (DE). The condition of DE used to be referred to as “retarded” ejaculation, but because of the politically incorrect nature of the “R” word, this label has gone by the wayside, similar to “impotence,” which has been replaced by “ED” and “frigid,” which has been replaced by “anorgasmic.”
How Long Is Too Long?
A classic study of 500 couples across five countries measured time from penetration to ejaculation, with results ranging from 33 seconds to 44 minutes with the median being 5.4 minutes. It has been proposed that any time from penetration to ejaculation that exceeds 20-25 minutes that causes distress to the delayed ejaculator or partner meets the criteria for diagnosis of DE.
Ejaculation 101: A Few Words On The Science Of Ejaculation
Ejaculation occurs after sufficient intensity and duration of sexual stimulation enables passing an ejaculatory threshold. Men with premature ejaculation are thought to have increased sensitivity and excitability of the penis, whereas men with delayed ejaculation are thought to have decreased sensitivity.
The ejaculatory center, located within the spine, integrates nerve input from the brain and the penis and coordinates the phases of emission and expulsion. Emission releases the secretions from the prostate, seminal vesicle and epididymis via the ejaculatory ducts and prostate ducts into the urethra. Expulsion propels the ejaculate through the urethra via rhythmic contractions of the pelvic floor muscles.
The spinal ejaculatory center is controlled mainly by the neurotransmitters serotonin and dopamine, although there others are involved as well. Serotonin inhibits ejaculation whereas dopamine facilitates it. One’s balance of neurotransmitters is determined by genetics and other considerations including age, stress, illness, medications and other factors.
DE is a condition in which ejaculation occurs only after a prolonged period of time following penetration. Some men are unable to ejaculate at all, despite having a rigid and very durable erection. Prolonged erection without ejaculation can result in testicular vaso-congestion, a.k.a. “blue balls.” With arousal and the increase in genital blood flow, the testicles can become swollen and a bluish tint can develop because of engorgement of veins. It can be painful, causing a tense, heavy, pressure-like discomfort in both testicles. The cure: ejaculation.
DE can be problematic for both the delayed ejaculator and his partner, resulting in frustration, exhaustion, soreness, if not pain. The sexual partner often feels distress and responsibility because of the implication that the problem may be their fault and that they are inadequate in terms of attractiveness or having the facility to enable a climax. The combination of not being able to achieve sexual “closure,” the inability to enjoy the mutual intimacy of ejaculation, and denying the partner the gratification of knowing that they are capable of bringing their man to climax is a formula for relationship stress. As tempting as it is to think that DE is an asset in terms of pleasing your partner, in reality a marathon performance has major shortcomings.
Interestingly, some men with this condition can ejaculate in an appropriate amount of time with masturbation. As well, some men can ejaculate in a normal period of time with manual or oral stimulation from their partner although they cannot do so with intercourse. It is plausible that one’s masturbation technique can provide more sensory stimulation than can be duplicated by sex with a partner. The amount of sensory stimulation derived from intercourse is predicated upon partner skill, anatomy, pelvic floor tone, the quality of the “fit” and many other elements, both physical and emotional.
Physical Or Psychological?
There can be underlying medical conditions that factor into problems of ejaculation. For example, hypothyroidism is strongly associated with delayed ejaculation whereas hyperthyroidism is associated with premature ejaculation. Since serotonin and dopamine as well as oxytocin, prolactin, and other chemicals are involved with ejaculatory control, any drug that modifies the levels of these chemicals may affect ejaculation timing. The selective serotonin reuptake inhibitors (SSRIs) – the most widely prescribed medications for depression – are notorious for their effect on delaying ejaculation, and are in fact, used for the treatment of premature ejaculation. Various neurological conditions that disrupt the communication between the spinal ejaculatory center and the brain/penis can cause ejaculatory dysfunction. In general, as men age, they more commonly note DE that may be on the basis of declining function of nerves as well as changes in genital skin.
As with so many sexual dysfunctions, excessive focus on the problem instead of allowing oneself to be “in the moment” can create a self-fulfilling prophecy of doom. In other words, if a man goes into a sexual situation mentally dwelling and consumed with the problem, it is likely that ejaculation will be prolonged.
One solution is to avoid ejaculation for a number of days prior to intercourse, the same line of reasoning used for managing premature ejaculation by masturbating immediately before intercourse. Although numerous medications have been tried to help improve DE, none are FDA approved and none have met with much success. This is as opposed to premature ejaculation, which can be managed with topical anesthetics, selective serotonin reuptake inhibitors, and pelvic floor training. Sexual counseling using sensate focus therapy has proven to be of benefit to some patients with DE. This is a series of specific exercises for couples originally developed by Masters and Johnson.
Wishing you the best of health,
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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com
Private Gym: http://www.PrivateGym.com -available on Amazon as well as Private Gym website
The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.
Tags: Andrew Siegel MD, Delayed ejaculation, dopamine, ejaculatory timing issues, emission, erection, expulsion, male pelvic fitness, penis, premature ejaculation, Private Gym, sensate focus therapy, serotonin