Delayed Ejaculation

Delayed ejaculation can be tough to deal with.
It happens when it takes a man longer than he’d like to ejaculate. Most men ejaculate within a few minutes of starting intercourse. Men with delayed ejaculation may take between 30 and 45 minutes. Some men are completely unable to ejaculate. Or, they may be able to ejaculate through masturbation but not with a partner.
It’s easy to understand why a man with delayed ejaculation would feel confused and frustrated.
Many men don’t want to admit they have trouble in the bedroom, especially when they’re unable to climax. Some have trouble talking with their partners about it, leaving partners to wonder what’s wrong. Is the man no longer attracted to his partner? Is the partner doing something wrong? Is he seeing someone else?
Today we’ll talk about some of the causes of delayed ejaculation and some treatment options.
  • Physical Causes

If you are experiencing delayed ejaculation, your first step should be seeing your doctor. Sometimes, delayed ejaculation is caused something physical. For example, nerve damage from stroke, spinal cord injury, or multiple sclerosis can cause ejaculation problems.
Some medications for anxiety and blood pressure have sexual side effects. Excessive use of drugs and alcohol can also contribute.
It might even be a matter of technique. If the pressure and movement you use during masturbation is different from the way your partner stimulates you, or from the rhythm of intercourse, it might take you longer to ejaculate.
  • Psychological Roots

What if your delayed ejaculation has psychological roots?
This is pretty common, actually. In fact, some experts believe that most cases of delayed ejaculation stem from psychological issues, since most men are still able to ejaculate through masturbation.
Still, it can be hard to pinpoint what those psychological issues might be.
Try thinking back on your childhood or the time when you were becoming sexually aware. Were you brought up to think that sex was sinful? Did you ever feel ashamed about having sexual thoughts or feelings? Did you think you didn’t deserve to feel sexual pleasure? Were you ever caught in a sexual act that authority figures didn’t approve of, such as masturbating in the bathroom or touching someone they thought you shouldn’t?
Also think about your relationship with your current partner. Are you happy? Do you trust your partner? How do you get along? Are you fighting a lot these days? Do you give each other the silent treatment? Do you communicate your wants and needs to each other?
It may be that your delayed ejaculation is caused by a combination of these issues.
One way to work on them is through counseling. A trained therapist can help you process any thoughts and feelings that have been bottled up.
You might also consider couples counseling with your partner. A therapist can teach you both how to better communicate with each other and help you resolve any conflicts you’re having.
With any type of therapy you choose, be open and honest with yourself and your therapist. It’s not always easy. But honesty will help you get to the heart of the matter and move progress along.
  • Performance Anxiety

Finally, let’s talk about performance anxiety. You might feel nervous about performing in the bedroom. After all, you want to satisfy your partner. You don’t want anyone to think you’re inadequate or that you can’t deliver. You might feel you have a reputation to live up to. It can be hard to relax with all this pressure.
Performance anxiety often becomes a predictable pattern. If you start a sexual encounter worried about how it will go, that worry will take over and it will be more difficult to ejaculate. That can make you worry more about the next time you have sex. And so on.
Sex therapy can help men with performance anxiety. A sex therapist can help you get your mind off performance and back to enjoying the intimacy you share with your partner.
One strategy is called sensate focus. This is a practice couples can do at home. There are variations, but it usually starts with touching, kissing, and exploring each other’s bodies without intercourse. The goal is to relax and enjoy the experience, not necessarily to ejaculate. With intercourse off the agenda, you won’t feel as much pressure to perform well.
Eventually, couples trying sensate focus do try intercourse again. Often by this time, the man’s anxiety levels have decreased and ejaculation becomes less of an issue.
Don’t suffer in silence.
No matter what you think may be causing your delayed ejaculation, you don’t need to suffer in silence. Talk to your partner and your doctor. Work together on a treatment plan designed for you.

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Low Testosterone

Low Testosterone

What is testosterone deficiency?

You have probably heard about testosterone in light of men’s sexual health. Produced by the testes, this hormone drives libido, gives men their physical characteristics (like facial hair), and helps maintain muscle mass.

Some men’s bodies don’t make enough testosterone. This situation, called hypogonadism, can happen when there are problems with the testes or the part of the brain that triggers testosterone production. Hypogonadism can also be a result of chemotherapy, radiation therapy, inflammation, infection, and obesity.

In addition, men’s bodies make less testosterone as they get older. In fact, testosterone levels drop from 1% to 3% each year after a man’s 40th birthday. As a result, some – but not all – men start to have symptoms like low sex drive, fatigue, moodiness, erectile dysfunction (ED), and diminished muscle mass.

How is testosterone deficiency diagnosed?

Two criteria must be present for a man to be diagnosed with testosterone deficiency:

His testosterone levels must be lower than 300 ng/dL. Two total testosterone measurements taken on two different occasions are recommended. Because men’s testosterone levels fluctuate throughout the day, early morning measurements are the rule of thumb.

The man must exhibit symptoms of low testosterone, like the ones mentioned above – low libido, low energy, depression, ED, etc.

If a man meets only one of these criteria, then he does not have testosterone deficiency.

What is testosterone replacement therapy (TRT)?

Testosterone replacement therapy (TRT) is prescribed to some men with testosterone deficiency. This synthetic form of testosterone is typically administered through gels, patches, or injections.

What are the Recommendatios for TRT?

Clinicians should inform testosterone deficient patients that low testosterone is a risk factor for cardiovascular disease. Note: In 2015, the U.S. Food and Drug Administration (FDA) issued an advisory, expressing concerns that men who take testosterone might be at higher risk for heart attack and stroke. (Read more here.) However, the link to such events was considered controversial.

Clinicians should inform patients of the absence of evidence linking testosterone therapy to the development of prostate cancer. Note: There have been concerns that testosterone therapy might lead to prostate cancer, but this link has not been proven. However, testosterone can fuel the growth of existing prostate cancer cells, so TRT is not usually recommended for men with prostate cancer.

The long-term impact of exogenous testosterone on spermatogenesis should be discussed with patients who are interested in future fertility. Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive. Note: Testosterone is important for sperm production, but the synthetic form used in TRT might interfere with this process. Sometimes, sperm counts increase after men stop TRT, but this cannot be guaranteed. Men may decide to bank their sperm before starting therapy.

Clinicians should discuss the risk of transference with patients using testosterone gels/creams. Men are advised to wash their hands thoroughly after applying testosterone to the skin to avoid transfer to another person. They should also cover the application area before sex. (For example, if testosterone is applied to the shoulder, wearing a T-shirt can reduce the risk of transferring the gel or cream to a partner.)

Testosterone levels should be measured every 6-12 months while on testosterone therapy. Note: While on TRT, it’s important for men to see their doctor regularly for follow-up appointments so that testosterone levels can be assessed, and treatment can be adjusted, if necessary.

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What is the difference between sexual performance anxiety and erectile dysfunction (ED)?

Sexual performance anxiety and erectile dysfunction (ED) are both troublesome issues, and it’s possible for a man to have both. But they do have some clear differences.

A man with sexual performance anxiety has worries about his sexual function or his ability to please his partner sexually. He might have questions like these:

  • Will I be able to get a firm erection?
  • Will I ejaculate too quickly?
  • Will I have an orgasm?
  • Does my partner find me attractive?
  • Is my penis big enough?
  • Am I sexually skilled enough?
  • Will my partner reach orgasm?
  • What will happen if my partner is not sexually satisfied?
Men who use pornography can develop sexual performance anxiety if they compare their real-life experiences to what they see in adult films and videos. Usually, such depictions are not realistic, but men may feel nervous or inadequate if they don’t perform the same way.
Sometimes, a man may become so concerned about his performance that he develops erectile dysfunction (ED). The anxiety triggers the production of stress hormones (such as epinephrine and norepinephrine) which can narrow blood vessels in the penis and make it difficult for blood to flow in and form an erection.
Erectile dysfunction (ED) occurs when a man cannot get and maintain an erection firm enough for sex. As noted earlier, ED can be a result of performance anxiety.

But health situations can affect erections, too. Here are some examples:

  • Diabetes
  • Heart disease
  • High cholesterol
  • High blood pressure
  • Smoking
  • Nerve damage
  • Cancer treatment (such as prostatectomy – removal of the prostate gland)
  • Thyroid disorders
  • Low testosterone
  • Medication side effects
  • Attention deficit (especially in young men)
Sometimes, ED leads to performance anxiety. A man who has had trouble with erections in the past may become anxious about his ability to perform sexually in the future.
While it’s possible to have both sexual performance anxiety and ED, it doesn’t always happen this way. Men who feel confident in the bedroom and in their relationships can still develop ED.
Fortunately, both ED and sexual performance anxiety can be treated.
Men with performance anxiety may consider sex therapy. A therapist can help men work through their concerns, adjust their expectations, and become more focused on the pleasure of sex. For example, a man who is concerned about a small penis might be relieved to learn that his length is in the average range. Or a man who worries about his partner’s orgasm may learn ways to ask his partner what he or she likes.
If the man is in a relationship, it’s often a good idea for his partner to come to therapy with him. Sometimes, partners are the source of pressure and anxiety due to their own worries, sexual problems, or lack of knowledge. Attending therapy together can help a couple with relationship tension, too.
Men with ED have a variety of treatment options, including medications, self-injections, vacuum devices, and penile implants.

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How might cancer patients preserve their sexuality?

How might cancer patients preserve their sexuality?

Many cancer patients face sexual problems from cancer treatment. Diminished libido, arousal difficulties, pain, vaginal dryness, erectile dysfunction (ED), and ejaculation trouble are some of the more common effects.
In some cases, patients can make decisions about sexual function when they plan their treatment with their oncology team. The following slides offer some examples.


 Testosterone is an important sex hormone for men, as it drives much of their libido and sexual function. Some men feel that their quality of life would suffer if they were not able to experience intimacy the same way as they did before cancer. They might opt for less aggressive cancer treatments that preserve testosterone levels, even if that means their prognosis is poorer.

Nerve-sparing Treatments

Nerves play an essential role in sexuality. When a person is sexually stimulated, nerves carry messages between the brain and the genitals. This starts the arousal process – such as an erection for men or vaginal lubrication for women.
Some cancer treatments, such as radical prostatectomy (surgical removal of the prostate gland) can potentially damage nerves related to sexual function. For example, the prostate gland is surrounded by nerves necessary for erections. In nerve-sparing procedures, surgeons preserve as many nerves as possible to lower the risk of ED.
Hysterectomies and colorectal surgeries may also be done in a nerve-sparing manner.

Nipple-sparing Treatments

 Women with breast cancer may choose nipple-sparing mastectomy, which preserves the nipple area. Breasts can then be reconstructed around the nipple. Women may not feel the same nipple sensations as they did before surgery, but keeping the nipples can foster a more positive body image, which contributes to better sexual function.
Keep in mind that there is no one-size-fits-all approach for preserving sexuality after cancer treatment. Patients should ask their doctors what will work best for their personal situation.
While some physical aspects can be addressed, it is still important to maintain healthy intimate relationships with partners and take advantage of products and services that can help maintain sexual function.

For example,

water-based lubricants may make intercourse more comfortable for women with vaginal dryness. Treatments for erectile dysfunction is available, and men should not hesitate to ask about them. (Note: There many approaches to treating sexual problems after cancer, and one’s doctor can provide the best advice.)
Counseling and sex therapy – alone or as a couple – may also be beneficial.

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How does thyroid disease impact a person’s sexual health?

How does thyroid disease impact a person’s sexual health?

Located in the neck, the thyroid is a butterfly-shaped gland that produces a number of hormones important for a person’s metabolism. These hormones have other functions, too, such as controlling body temperature, heart rate, and blood pressure.

Hypothyroidism – an underactive thyroid – occurs when the thyroid gland does not produce enough thyroid hormone. This condition is more common in women, but men can be affected as well.

Hyperthyroidism refers to an overactive thyroid, when the gland produces too much thyroid hormone.

Both types of thyroid disease have been associated with sexual dysfunction.

The prevalence of sexual dysfunction among people with thyroid disease is unclear, but estimates have been made.

In a 2018 review of 12 pertinent medical studies, researchers estimated that between 59% and 63% of men and 22% to 46% of women with hypothyroidism also have sexual problems.

The estimated sexual dysfunction rates for people with hyperthyroidism ranged from 48% to 77% for men and 44% to 60% for women.

The 2018 review also pointed out types of sexual dysfunction linked to hypothyroidism and hyperthyroidism.


Men with both types of thyroid disease were likely to have erectile dysfunction (ED) or problems with ejaculation.

The study authors noted that delayed ejaculation was “strongly associated” with hypothyroidism and that premature ejaculation was similarly associated with hyperthyroidism.


Women with hypothyroidism and hyperthyroidism often have less desire for sex, trouble with vaginal lubrication, and problems reaching orgasm. They are also less likely to be satisfied with their sex lives and more likely to experience sexual pain.

It is not clear why people with thyroid disease have sexual problems, but the authors of the 2018 study suggested some theories.

One possibility involves hormones. In men, thyroid problems might contribute to lower levels of testosterone, an important hormone for sex drive and erections. Low levels of thyroid hormone could contribute to women’s sexual dysfunction, too.

People with hypothyroidism might produce high levels of another hormone called prolactin, which has been linked to hypoactive sexual desire disorder (HSDD) – low libido that causes distress.

Thyroid disease can affect sexuality in subtle ways, too. Sometimes, conditions associated with thyroid disease, like fatigue, depression, anxiety, and metabolic syndrome, result in sexual problems, too.

Fortunately, treating thyroid disease often improves sexual difficulties. Treatments might include thyroid hormone replacement, medications, radioactive iodine, or surgery


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What should heart patients know about medications and sex?

What should heart patients know about medications and sex?

Some heart and blood pressure drugs do have sexual side effects, such as a decrease in sex drive. If this happens, patients should not stop taking their medication.
Instead, patients are encouraged to talk to their doctor. It might be possible to switch to another medication with fewer side effects. It may take time to find the right medicine, but it’s important to make heart health the priority.
Also, men who are taking nitrates for heart disease should not take erectile dysfunction (ED) drugs like Viagra, Cialis, and Levitra. Taking these drugs together could make a man’s blood pressure drop to a dangerous level.
Men with ED and heart disease may need to try a different ED treatment. Vacuum erection devices and penile implants are two options. Lifestyle changes can be effective, too. An Andrologist can help a man decide what steps are best for him.

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What does the term “intersex” mean?

The term “intersex” is used to describe disorders of sex development (DSDs) – situations in which a fetus develops differently from a typical male or female.
For example, a baby may be born with female chromosomes, ovaries, and a uterus, but have enlarged clitoris that resembles a penis. Or, a child may be born with male chromosomes but no testes and ambiguous external genitalia. It’s also possible for a baby to be born with one ovary and one testis.
Intersex conditions start when a baby is developing in the womb. They are sometimes caused by genetic problems. In some cases, hormones that help a baby’s development don’t function properly.

Some examples of intersex conditions are:

  • Complete androgen deficiency syndrome. A child is genetically male but has female reproductive organs.
  • Vaginal agenesis. A girl is born without a fully-developed vagina.
  • Micropenis. A boy’s penis is much smaller than average.
  • True gonadal intersex. A child is born with both an ovary and a testis or an ovotestis (a single organ that has characteristics of an ovary and a testis).
Treatment for intersex conditions is complex and can involve physicians, surgeons, therapists, and support groups for both children and families.
In the past, it was common to conduct surgery and assign a gender to the child as soon as possible.
Nowadays, medical teams are more likely to wait on surgery, as long as the child is healthy. It takes time to see exactly how the child develops physically and emotionally. In some cases, the child may help decide which gender is most appropriate.

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Kegel exercises

Kegel exercises

Why might men benefit from Kegel exercises?

Incontinence is sometimes a problem for men who have undergone treatment for prostate cancer. This is because the treatment can weaken the muscles around the prostate gland. Kegel exercises can help strengthen these muscles so that incontinence is less of a problem.

Diabetes and overactive bladder conditions can also weaken the pelvic floor muscles.

It’s possible that Kegel exercises can also help with erectile dysfunction, but more study is needed. Some men experience more intense orgasms after doing Kegel exercises for some time.

Men who are consistent with their Kegel exercises may see results in three to six weeks.

What are Kegel exercises?

Kegel exercises strengthen the pelvic floor muscles, which support the bladder and control urine flow. They can help both men and women with incontinence (leaking urine or fecal matter). They can also help with sexual function

How do men do Kegel exercises?

The first step is finding the pelvic floor muscles, which can be done while urinating. Men are advised to try stopping the flow of urine. This process can help them target the muscles and understand what Kegel exercises feel like.

From there, the steps are fairly straightforward:

  • Empty the bladder.

  • Lie on the back with knees bent and apart. (Note that some men have no trouble doing Kegel exercises standing up, especially after they’ve had some practice.)

  • Contract or “squeeze” the muscles for three to five seconds.

  • Release and relax the muscles for three to five seconds.

  • Repeat

Doing three sets of ten Kegel exercises each day is a common routine. It can take time to reach this level, however, so men should be patient with themselves and do what they can to build gradually.

During Kegel exercises, men should breathe as they normally do. They shouldn’t hold their breath. They should also take care not to contract the muscles in the stomach, abdomen, thighs, or buttocks.

Men with a catheter in the penis should not do Kegel exercises until the catheter is removed and a physician gives approval.

Some men find it helpful to “schedule” their Kegel exercises when they do a routine activity, like getting ready for bed in the evening.

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What is a prolactinoma and how can it affect a person’s sexual function?

What is a prolactinoma and how can it affect a person’s sexual function?

A prolactinoma is a benign (noncancerous) tumor of the pituitary gland, which is located at the base of the brain. The pituitary gland is sometimes called the “master gland” and is responsible for producing a number of important hormones involved with growth, metabolism, blood pressure, and reproduction.
One of these hormones is prolactin. In women, prolactin helps with the production of breast milk. Men’s bodies make prolactin, but the hormone doesn’t have a known purpose for them.
Prolactinomas make excessive amounts of prolactin. High levels of prolactin in the blood can reduce levels of the sex hormones estrogen and testosterone.
While the tumor itself is benign, the high levels of prolactin it produces can cause serious problems for both men and women.
A woman with a prolactinoma may start having changes in her menstrual periods. Her breasts might start to produce milk, even if she is not pregnant or nursing. She might become less interested in sex. Vaginal dryness may also occur, as estrogen is important for vaginal lubrication. Some women with prolactinomas have trouble becoming pregnant.
A man with a prolactinoma might develop erectile dysfunction.
Other symptoms include headaches and vision problems. These may occur if the tumor grows large enough to compress the optic nerves, which are close to the pituitary gland.
Prolactinomas can often be treated with medication. If this doesn’t work, surgery to remove the tumor is another option. In rare cases, radiation might be used. Sexual problems usually get better once the tumor is treated and prolactin levels return to normal.
Prolactinomas are the most common type of pituitary gland tumor, but it’s not common for them to cause symptoms.  Women are more likely to get prolactinomas than men are. Scientists aren’t sure exactly why prolactinomas develop.
Men and women who are concerned about prolactinomas should see their healthcare professional. Diagnosing a prolactinoma usually involves a blood test to measure prolactin levels. Imaging tests, such as magnetic resonance imaging (MRI) or a computerized tomography (CT) scan are usually ordered so that the doctor can get a closer look at the pituitary gland and the surrounding area. Sometimes, a vision test is also done.

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Is it safe for heart patients to have sex?

Is it safe for heart patients to have sex?

For most heart patients, sex is safe. However, patients should still check with their doctor first.

Having a heart attack during sex is a common worry. But the risk is small.

Research suggests that having sex is the equivalent of a brisk walk or climbing two flights of stairs.

In 2015, the Journal of the American College of Cardiology published new research concerning sex and heart attack risk. A group of German scientists worked with 536 people who had had a heart attack. The patients answered questions about sexual activity in the year before their heart attack. Then, the scientists followed their health progress for ten years.

Sexual activity is unlikely to trigger a heart attack, the researchers concluded. Less than 1% of the patients had sex less than an hour before their heart attack. And almost 80% didn’t have sex within the previous 24 hours.

During the ten year follow-up period, there were 100 “cardiovascular events” (such as a heart attack or death from heart disease) among the patients. However, these events were not linked to sex, the researchers wrote.

Still, there are times when heart patients should not have sex. For example, a person with symptoms of heart disease (such as chest pains during light activity or at rest) should wait until the symptoms are stable before having sex.

Patients with uncontrolled high blood pressure, advanced heart failure, recent heart attack, an arrhythmia, or a weak heart muscle should not have sex until a doctor says it’s okay.

Sometimes, doctors recommend restricting sexual activity. This might mean having sex less often, playing a more passive role, or having less vigorous sex to keep one’s heart rate down.

Patients who are concerned about heart health and sexual activity should talk to their doctor. He or she can give the best advice on a patient’s personal situation.

Remember, too, that heart patients who have sexual restrictions can still enjoy intimacy with a partner. Kissing, hugging, touching, and caressing are all ways to be physically close.

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