Posts Tagged ‘Delayed ejaculation’

“Size” Should Never Outrank “Service”

November 11, 2017

Andrew Siegel MD  11/11/2017

As I stood in the gateway line during the painful process of boarding an airplane, I caught sight of a poster ad stating the following: “Size should never outrank service.” This referred to the smaller size regional jets that offer amenities including first-class, Wi-Fi, etc. Later, I saw another poster ad for the same airline stating: “How fast the flight goes isn’t always up to pilot.” As a physician interested in sexual/pelvic health and language, I found these sentences with double meanings amusing and entertaining.  The ultimate phallic structure is an aircraft and aeronautics provides a rich metaphor for male sexual function, the topic of today’s entry.  

Large and clunky


By Oleg V. Belyakov – AirTeamImages [CC BY-SA 3.0 (, CC BY-SA 3.0 ( or GFDL 1.2 (, via Wikimedia Commons

Small and nimble


Above image, public domain


Terms that apply to aeronautics and sexual function

Aircraft: a machine capable of flight—the penis

Pilot: the person who occupies the cockpit and controls the aircraft—the possessor of the penis

Cockpit (I really like this word!): the front of the fuselage where the pilots sit—the head of the penis

Fuselage: the body of the aircraft—the shaft of the penis

Horizontal and vertical stabilizers of the tail:  aircraft parts that provide stability to keep it flying straight—the pelvic floor muscles that stabilize and support the penis

Flight: the process of flying that includes a launch, a flight pattern and a landing—a sexual encounter

Launch: the takeoff—obtaining an erection

Flight pattern: the aircraft’s movement after takeoff—the sexual act

Landing: the conclusion and most difficult part of the flight, which requires skill, precision and timing to perform competently — ejaculation/orgasm

 Cruising Altitude: the altitude at which most of a flight is flown in route to a destination—a fully rigid erection

Jet fuel: fuel designed for use in an aircraft—in erectile terms, penile blood flow

Fuel line: the means by which fuel is pumped from the storage tanks to the engine—the penile arteries

Thrust: the propulsive force of an aircraft—the surging power of the erect penis

Throttle: a device for controlling the flow of fuel to an aircraft’s engine—the nerves that control the smooth muscle within the penile arteries and within the erectile tissue

Failure to Launch: a condition in which the aircraft is unable to get airborne—erectile dysfunction

Emergency landing: unanticipated landing before the scheduled arrival time—premature ejaculation

Aborted Landing: when an aircraft is about to land, but the pilot halts the landing and regains altitude deferring the landing—delayed ejaculation

Ground Time: the amount of down time between landing and the next flight—refractory period

Mayday: distress signal indicative of a significant problem with the aircraft or flight—a major sexual failure

Bottom Line:  Aeronautics provides an excellent metaphor for male sexual function.  The pilot can be accorded better control, longer flight times, higher altitudes, as well as launching a second flight with less ground time by attending to a few key measures. Although it is impossible to convert a F-15 Eagle (pictured above) into an Airbus A380 (pictured above), it is a fact that size should never outrank service!  Bigger is not always better as function often trumps form. 

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.





When Ejac-“elation” Becomes Ejac-“frustration”

February 13, 2016

Andrew Siegel MD  2/13/2016


(Fireworks, 8/2007, author AngMoKio)

In the arena of male sexual dysfunction (MSD), ejaculation problems play second fiddle to erectile dysfunction (ED). Today’s entry explores common issues with ejaculation other than premature ejaculation, which I have previously addressed:

What my patients tell me: 

“It takes me too long.”

 “I can’t ejaculate.”

 “It happens, but not much fluid comes out.”

 “It just dribbles out with no force.”

 “I barely know that it happened; I just don’t get the same feeling that I used to.”

One would think that MSD is the same as ED, which seems to get all the press. However, MSD is more complex and all-encompassing than having soft or short-lived erections, which is just one aspect of MSD. Sex drive (libido) is an important part of the picture. Ejaculation is another vital component. With regard to ejaculatory issues, premature ejaculation (rapidly achieving climax) gets all the attention. However, there are other ejaculatory issues that contribute in a major way to MSD.

The processes of having an erection and ejaculating are separate, even though they usually occur at the same time. However, it is possible to have a rock-hard erection and be unable to ejaculate, and conversely, to ejaculate with a limp penis. Regardless, it sure is nice when the two processes harmonize. All things being equal, with a good quality erection, ejaculation will be more satisfying.

Why is ejaculation better with a rigid erection than without?

The urethra (tube within the penis that conducts semen) is the “barrel” of the penile “rifle.” It is surrounded by spongy erectile tissue called the corpora spongiosum (“spongy body”) which constricts and pressurizes the “barrel” to optimize ejaculation and promote the forceful expulsion of semen, the “ammo.” The word ejaculation derives from ex, meaning out + jaculari, meaning to throw, shoot, hurl, cast for a good reason!

Additionally, the pelvic floor muscles play a key role in the process of ejaculation. The bulbocavernosus (BC) is a compressor muscle that surrounds the spongy body and at the time of ejaculation it contracts rhythmically, sending wave-like pulsations rippling down the urethra to forcibly propel the semen in an explosive eruption, providing the horsepower for forceful ejaculation. This BC muscle engages when you have an erection and becomes maximally active at the time of ejaculation.

Issues with ejaculation are extremely common complaints among middle-aged and older men. These are often bothersome and distressing, and include the following:

  • Delayed ejaculation
  • Absent ejaculation
  • Skimpy ejaculation volume
  • Weak ejaculation force and arc
  • Diminished ejaculatory sensation

Ejaculatory problems often correlate with aging, weight gain, the presence of lower urinary tract symptoms and ED. The older you are, the heavier you are, the more that you are having problems with urination and obtaining/maintaining an erection, the greater the likelihood that you will also have ejaculatory problems. This is often on the basis of an age-related decline of sensory nerve function as well as weakened pelvic floor muscles. Additionally, aging reproductive glands produce less fluid and the ducts that drain genital fluids can obstruct. Furthermore, medications that are used to treat prostate enlargement can profoundly affect ejaculatory volume.

So What’s The Big Deal Anyway?

Most men do not appreciate meager, lackadaisical-quality ejaculations and orgasms. Sex is important and getting a rigid erection is vital, but the culmination—ejaculation and orgasm—is equally important. We may be 40, 50, 60 years old or older, but we still want to point and shoot like we did when we were 20 and desire to retain that intensely pleasurable feeling of yesteryear.

Delayed Ejaculation

I have previously addressed this topic:

Absent Ejaculation

This is part of the spectrum of delayed ejaculation, except in this instance, climax is never achieved. Alternatively, it happens with surgical removal of the reproductive organs, as occurs with radical prostatectomy or radical cystectomy for prostate and bladder cancer, respectively.  It can also occur in the presence of  neuropathy, e.g., with diabetes and other neurological disorders. In these circumstances, orgasm can still be experienced, although ejaculation is absent.

Skimpy Ejaculation Volume

This is very common with aging as the reproductive organs “dry out” to some extent. It also happens with certain medications that either reduce reproductive gland secretions (Proscar, Avodart) or cause some of the ejaculate to go backwards into the urinary bladder (Flomax, Rapaflo, Uroxatral).

Weak Ejaculation Force, Arc and Sensation

What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated in a arc several feet in length gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis.  These issues clearly correlate with aging, weakened pelvic floor muscles and ED.

Bottom Line: In addition to sex drive issues, erectile dysfunction and premature ejaculation, there are a spectrum of other male sexual problems that are bothersome and distressing.  With aging, weight gain and weakening of the pelvic floor muscles, ejaculation and orgasm often become less spirited, with diminished volume, force and trajectory. However, there are solutions!

 To Optimize Ejaculation:

  1. Maintain a healthy lifestyle: good eating habits, healthy weight, engage in exercise, obtain adequate sleep, consume alcohol in moderation, avoid tobacco and minimize stress.
  1. Pelvic floor muscle training: Whereas a weakened BC muscle may result in semen dribbling with diminished force or trajectory, a strong BC can generate powerful contractions to forcibly ejaculate semen. Keep the BC and the other pelvic floor muscles fit through pelvic floor muscle exercises.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.

“I’m Almost There”: What You Need To Know About Delayed Ejaculation

February 21, 2015

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.

Delayed Ejaculation

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,

2014-04-23 20:16:29


A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback:

Private Gym: -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.