Delayed, premature and retrograde ejaculation

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Are ejaculation problems a matter of mind over matter?

Well, if men and their partner don’t care how long it takes them to ejaculate, then it really doesn’t matter. For example, Ian Kerner, PhD, a sex therapist and author of She comes firstShe advises men to bring their partners to the brink of orgasm before intercourse. Then, if he’s prone to premature ejaculation, it doesn’t matter as they both walk away happy.

Conversely, if a man takes longer than average to ejaculate but both partners enjoy marathon sex sessions, then delayed ejaculation can be a real plus.

However, some men are bothered by how long it takes them to ejaculate – and so are their partners. But while the mind often plays a big part in causing ejaculation problems, it’s also the key to overcoming them. Here are some tips on what to do.

Common ejaculation problems

There are three main things that can go wrong with ejaculation:

  • Premature ejaculation is by far the biggest complaint men have about their sexual performance. After studying data from the National Health and Social Life Survey, sociologist Edward Laumann, PhD, estimated that a third of American men complain that they ejaculate too quickly. They want to last longer during intercourse to prolong the pleasure for both themselves and their partners.
  • Delayed ejaculation affects a much smaller number of men – as little as 3% by some estimates. It is one of the least understood ejaculation problems. Some men can’t orgasm at all, at least not with a partner.
  • retrograde ejaculation is the least common ejaculation problem. It causes semen to flow back into the bladder during orgasm instead of exiting through the penis. The semen is then later flushed out during urination.

    Retrograde ejaculation can be caused by diabetes, nerve damage, various medications, and surgeries that disrupt the sphincter. It is harmless and does not affect the feeling of orgasm. (It can also make for easy cleanup after sex.) However, because it affects fertility, some men may need treatment if their partner is trying to conceive.

What Causes Delayed Ejaculation?

There are many different reasons for delayed ejaculation. Some medications — like antidepressants — can cause it. In many men it happens because of age. As we age, the nerve endings in the penis become less sensitive, says Barbara Keesling, PhD, author of All Night: How to Make Love to a Man Over 50and Professor of Human Sexuality at California State University, Fullerton.

“When the reflexes drop, it takes longer,” says Keesling. “Another thing that happens with age is that your ability to have an erection also decreases, making it more difficult to ejaculate without a full erection.”

They can also be involved in your delayed ejaculation problem. By employing a masturbation technique that involves intense pressure, friction, and speed, some men train themselves to respond to levels of stimulation that no partner could replicate — at least not without coaching, which the man is usually reluctant to offer.

Michael A. Perelman, PhD, a sex and marriage therapist in New York, says he sometimes recommends a moratorium on masturbation for men with delayed orgasms. This means more than stopping the practices that may be contributing to the problem. It also allows for the build-up of sexual desire, which “provides a mechanism for lowering the arousal threshold necessary for orgasm,” says Perelman.

But while masturbation can cause delayed ejaculation, it can also help with healing. If a guy doesn’t agree with staying away, Perelman will urge him to at least change his masturbation style — like switching hands — to break old habits. Trouble is, your tried-and-true, fast-and-dirty style of masturbation is probably terrible practice for sex with another person.

So instead of just masturbating efficiently to achieve orgasm, Perelman encourages men to fantasize about having a sexual experience with their partner while they masturbate. He urges her to try “to approximate, in terms of speed, pressure, and technique, the stimulation he’s likely to experience from manual, oral, or vaginal stimulation with his partner.” This takes a little longer, but makes masturbation more like a “dress rehearsal” for sex. You can also talk about your fantasy with your partner afterwards, suggests Perelman.

Premature Ejaculation Cure: Self Love

So what about the much more common problem of premature ejaculation? In this case, masturbation can be just the ticket. Repeated orgasms cause delayed ejaculation in almost every man. Some believe the best tip for premature ejaculation is to double the number of orgasms a man has per week. And if that doesn’t work, double again.

There is some evidence to support this folk remedy.

“Young men with a short refractory period often experience a second and more controlled ejaculation during an episode of lovemaking,” says Chris G. McMahon, MD, in a 2004 study published in the Journal of Sexual Medicine.

Masturbation can also help men control their arousal levels, which is essential for delaying orgasm.

Other ways to treat premature ejaculation

A time-honored technique for premature ejaculation is to distract yourself — thinking about something boring or even gross to delay your orgasm. While this may work for some, it has the unfortunate side effect of distancing men from their partners and the sexual experience.

There is also an obvious alternative: withdraw and stop having sex for a few minutes to delay orgasm. Sex researchers William Masters and Virginia Johnson elaborated on this when they developed the “squeeze pause” technique, also known as “penis grip,” to suppress cravings for climax. As the name suggests, this involves squeezing the glans as orgasm approaches.

Perelman teaches men a variation of the Masters and Johnson technique. It’s all about slowing herself down and altering her movements in a way that maximizes her partner’s pleasure. They do this while maintaining their erection, but without overexerting themselves.

antidepressants for premature ejaculation?

For men who find none of these techniques helpful, there is a pharmaceutical option. Because some antidepressants — selective serotonin reuptake inhibitors, or SSRIs — are known to cause delayed ejaculation, researchers tried them as a way to treat premature ejaculation. It usually takes 2-3 weeks for SSRIs to take full effect. If you stop treatment, the symptoms will return.

A short-acting SSRI called dapoxetine was specifically designed for premature ejaculation. According to a 2006 study published in The lancetWhen the drug was taken one to three hours before sex, it increased the time from penetration to ejaculation from 1.75 minutes to 2.78 minutes in men treated with 30 milligrams of the drug. Men who got 60 milligrams lasted 3.32 minutes.

“A few minutes might not sound like much, but for these guys it was tremendous,” said study lead author Jon L. Pryor, MD, when the results were published in September 2006. However, dapoxetine was not FDA approved and is not available in the United States.

Instead of medication, some men use a desensitizing cream to delay orgasm. There’s an even simpler solution: double up on your condoms to reduce your stimulation. Behavioral therapy and psychotherapy can also help some men. The combination of therapy and medication seems to be more effective than just taking medication.

Treatment of ejaculation problems

Whatever your ejaculation problem, there are solutions. The key is to get help. And we don’t just mean from a doctor, although that’s important – ejaculation problems can, after all, be a sign of more serious medical problems.

But you also need to be open with your partner — something many men are reluctant to do.

“Almost everywhere, men [with ejaculation problems] do not share their preferences for stimulation with their doctor or their partners out of shame, embarrassment, or ignorance,” Perelman told WebMD.

So don’t stay a mom and let shame or male pride ruin your (and your partner’s) sex life. Allowing that tension to build up will only make things worse. With a little openness, some discussion, and maybe some fun new techniques in the bedroom, you can overcome your ejaculation problem. That means less worry and more sex.


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Delayed, premature and retrograde ejaculation
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