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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Stop Tramadol

Stop Tramadol

Men who take long-acting opioids for chronic pain appear to be at greater risk of developing low testosterone than men taking short-acting opioids, American researchers have found.

Opioids are pain relievers. Commonly prescribed opioids include hydrocodone, oxycodone, morphine, and codeine.

Opioids are classified as long-acting or short-acting. Long-acting opioids generally provide relief for at least 8 hours. Short-acting opioids release medicine more quickly and relieve pain for less than six hours.

Impact Of Opioids On Testestosterone Levels

The retrospective study focused on 81 men between the ages of 26 and 79 who had been taking an opioid for at least three months. None of the men had been diagnosed with low testosterone before. All of the men were being treated for chronic pain conditions (such as low back pain, chronic headaches, and rheumatoid arthritis) at Kaiser Permanente’s Santa Rosa Medical Center in California.

The hormone testosterone plays a large role in a man’s sex drive. But it is also involved with muscle mass, bone density, and mood. Low testosterone can lead to problems in all of these areas.

Normal testosterone levels are typically between 300 and 800 nanograms per deciliter (ng/dL). For this study, men were considered to have hypogonadism (low testosterone) if their total testosterone levels were less than or equal to 250 ng/dL. All levels were measured before 10 a.m.

Overall, 56.8% of the men were hypogonadal. Rates varied depending on opioid length of action, however. Of the men taking long-acting opioids, 74% had low testosterone. Thirty-four percent of the men taking short-acting opioids were hypogonadal.

After adjusting for daily dosage and body mass index, the researchers found that the risk of developing low testosterone was 4.78 times greater for men taking long-term opioids compared to those who take the short-acting variety.

No association was found between dose and an increased risk of low testosterone.

“We need to know how we can prescribe these very useful medications in a way that brings the greatest benefits to our patients, without introducing additional risks,” said researcher Dr. Andrea Rubinstein in a press release. Dr. Rubinstein is from the Departments of Chronic Pain and Anesthesiology at Kaiser Permanente Santa Rosa Medical Center.

“These medications work well for short-term, acute pain,” Dr. Rubinstein added. “It has long been extrapolated that they can also be used safely long-term to control chronic pain. We are now finding that the long-term use of opioids may have important unintended health consequences.”

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What is postcoital dysphoria (“post-sex blues”)?

What is postcoital dysphoria (“post-sex blues”)?

Sometimes, people feel deep sadness or agitation after consensual sex. The medical term for these feelings is postcoital dysphoria (PCD), but some call it the “post-sex blues.”

In some cases, people become tearful or depressed after orgasm. In others, they become argumentative with their partner. These feelings occur even if the sexual encounter has been satisfying and enjoyable.

Not much is known about PCD, but research published in the journal Sexual Medicine in 2015 has revealed how common it is among women.

Researchers from the Queensland University of Technology (QUT) in Australia asked 230 female university students to participate in a survey about their experiences with PCD. The women ranged in age from 18 to 55 with an average age of 26 years.

Forty-six percent of the women said they’d experienced PCD in the past. About 5% said they’d had symptoms over the past month. And about 2% reported having PCD “always” or “most of the time.”

However, PCD was not linked to intimacy in close relationships, the researchers reported.

Experts aren’t sure why PCD happens. It may be that the bonding with a partner during sex is so intense that breaking the bond triggers sadness. Childhood sexual abuse may play a role as well.

The QUT researchers noted that their findings may not apply to other groups, as their participants were heterosexual, mostly Caucasian, and university students.

Additional studies with larger, more diverse groups may provide more clues. It is also uncertain to what extent postcoital dysphoria affects men.

People who are concerned about the post-sex blues are encouraged to talk to their doctor or a sex therapist.

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Premature Ejaculation

Premature Ejaculation

What is premature ejaculation (PE)?
Premature ejaculation is repeated ejaculation in response to minimal stimulation before, at the time of, or shortly after penetration, but before the man wishes it, and over which the man feels he has little or no control. It is important to recognize that premature ejaculation is a subjective diagnosis and totally depends on the satisfaction of the partners.
How common is PE?
PE is the most common sexual dysfunction reported by men but is still under-diagnosed and under-treated. Estimating the prevalence of PE is difficult since many men do not want to talk about it, while others may not even perceive that they have PE.
However, recent research indicates that 25-30% of men struggle with PE.
PE can happen at any age and its prevalence is consistent across all ages.
Is there variation in incidence between countries?
Global studies consistently report that 20-30% of men experience PE worldwide. This means that PE is experienced at similar rates across the globe.
What is the difference between life-long and acquired PE?
Primary PE refers to men who have experienced this sexual problem since first having sex.
Secondary PE refers to men who had ejaculatory control at some point but began experiencing PE later in life, sometimes even after years of satisfying sex, without explanation.

How does PE affect a man's psychology?

PE can have a broad impact on many aspects of a man's life. Men experiencing PE can suffer anxiety, embarrassment, inadequacy, depression, anger and guilt.

PE can cause both personal stress, and stress to a relationship. In one study, men with PE were less satisfied with sexual intercourse and their sexual relationship, and suffered more problems with sexual anxiety and arousal compared to non-sufferers.

Some men with PE have trouble staying in relationships or may be scared to begin new ones.

Does PE affect the partner of the man with PE?

PE is a problem for the couple as a whole. Partners sometimes experience frustration and anger. Also, many couples do not discuss the problem with each other or with friends and family and there can be a breakdown of intimacy between them.

Causes - Premature Ejaculation

Unfortunately, the cause of PE is generally unknown. Historically PE was seen as a psychological disorder, but researchers now suggest that most cases are multi-factorial with a contribution from both psychological and physical factors.

PE is categorized as either primary or secondary as mentioned above.

Many researchers believe that premature ejaculation, at least in some men, may be due to a chemical imbalance or changes in receptor sensitivity in the brain or spinal cord.

What are the key factors in diagnosing PE?

Although there are no specific diagnosis or treatment guidelines for PE, the diagnosis of PE is based mainly on a detailed sexual history that establishes:

  1. The patients' perception of his control over ejaculation. Is it poor, fair or good?
  2. The time frame within which he ejaculates. Less than a minute? More than 2 minutes?
    1. The majority of men who self-identify themselves as having PE will ejaculate in less than 2 minutes.
    2. The majority of men who self-identify as NOT having PE will ejaculate in longer than 2 minutes.
    3. PE is considered to be the occurrence of ejaculation prior to the wishes of both sexual partners, (which can vary widely from couple to couple); no clear time cut-offs have been set as to the appropriate duration for sexual contact before reaching orgasm, although the FDA in its assessment of drugs for PE uses 2 minutes as the guideline. Patient self-report time to ejaculation (known as ejaculatory latency time) has been shown to be surprisingly accurate.
  3. That the short ejaculatory latency time is a source of distress for him or for his partner.
  4. That the short ejaculatory latency time is interfering with the satisfaction of sexual relations for him or the couple.
  5. If this condition has been life-long or if it has occurred more recently. Life-long PE is known as primary PE and recently acquired PE is known as secondary PE. If the onset of the problem is more recent, are there precipitating factors?
  6. Frequency of PE. An occasional instance of PE might not be cause for concern, but if the problem happens more than 50% of the time, a pattern usually exists for which treatment may be appropriate.

PE or ED ?

How do I know if I have ED or PE?

ED is a man's inability to attain or sustain an erection for the duration of sexual intercourse. Whereas PE is when a man and/or his partner perceives that he reaches orgasm and ejaculates too quickly and with little control.

In other words, PE is ejaculation before a man and his partner wants it to happen. There are men however who develop PE as a result of poor erection sustaining capability. In this situation, they condition themselves to reach orgasm/ejaculation quicker so they can do so before they lose their erection. The treatment of this begins by treating the erection problem first. With treatment many men can resolve the PE problem. Differentiating between the two conditions is a very important step for patients and physicians. An experienced physician should be able to define the real problem relatively easily.

Treating Premature Ejaculation

What types of treatment are available for PE?

  • Medications
  • Physical & Psychological Treatment

What medications are currently available for PE?

  1. Desensitization treatments:these are aimed at reducing the sensitivity of the penis immediately before sexual relations. It is noteworthy to mention that there is no evidence that men with PE have any difference in penis sensitivity than men without PE. Although these techniques work for some men with mild PE, they can cause a reduction in sensitivity so that sexual satisfaction during intimacy is also reduced. Little research has been done on these techniques and their true benefit. Techniques that are employed by some men include:
  2. Using condoms: the use of a single condom may reduce sensitivity enough to make a difference in ejaculatory control for some men. Using multiple condoms, however, reduces sensitivity, potentially to the point where the sensation during relations is less than satisfactory for men.
  3. Using desensitization ointments: local anesthetics like lidocaine/prilocaine creams can be applied to the undersurface of the head of the penis (the glans) 30 minutes before sex. Desensitization ointments are best applied and then washed off 5-10 minutes before sexual relations, otherwise they will cause a numbing effect for the partner also. Some men use these creams underneath a condom.
  4. Masturbating prior to intercourse: many men with PE, even those with primary (life-long) PE, have much better ejaculatory control if they have sexual relations a second time within a short period of time after the initial encounter. Some men use masturbation in the hours before anticipated intimacy as a means to improve ejaculatory control.
  5. Non-FDA approved treatment options: a number of over-the-counter and prescription 'medications' have been used for PE:
  6. Herbal therapies: there are currently no studies that show the effectiveness of herbal products (also known as nutriceuticals). Many of these products contain androgens (testosterone, DHEA and androstenedione) that may be inappropriate for some men to use. Furthermore, some herbal products used for male sexual health contain Viagra and Cialis, which is of concern to men taking nitroglycerin-containing medications, since taking these together can be deadly
  7. PDE-5 inhibitors: medications such as Viagra®, Levitra® and Cialis® have been used by some men for PE. Studies suggest that they may help some men suffering from PE. Scientists are not sure why these medications would work in men with PE. However, it is generally believed that these medications can help men with PE who also have ED.
  8. Antidepressant medications: Antidepressants have been used for the treatment of PE. Prozac®, Paxil® and Zoloft® have been used with some success for this condition. Although no antidepressants have been specifically used to treat PE, several weeks of treatment with some of these medications has been shown to help many men with PE. Several weeks of treatment is required for these medications to work. The drawbacks of these medications include the need for daily use (when men stop using them they return to having rapid ejaculation), the stigma that they are anti-depressant drugs (for example, airline pilots are not permitted to take these medications and fly) and side effects (drowsiness, nausea, dizziness, dry mouth and a range of sexual problems, such as decreased or increased sexual interest, ejaculation or orgasm problems, and impotence).


What types of psychological treatments are available?

Distraction techniques: distracting mental exercises during sex can be used to help PE (such as thinking of mundane things like baseball, work, etc.). These techniques are probably most useful for men with occasional PE or men who experience PE in the initial stages of a new sexual relationship. For men with long-standing PE, the consistent use of these techniques usually interferes with spontaneity and satisfaction.

Psychological Therapy: these treatments have been utilized for decades and are associated with success in many people. However, it is questionable for how long these treatments work. For example, for a man who has derived benefit from the techniques described, how long-lasting are the beneficial effects? It is estimated that 25% of men helped by such techniques retain the benefit for 2 years after starting the treatments.

PE can be both due to, and the cause of, psychological stress or other mental health and personal issues. Psychological treatments often involve counseling or sexual therapy that can include talking about relationships and experiences with a mental health professional and/or learning practical tools. By investigating relationships and individual issues that may be causing or compounding PE, mental health professionals can help find effective ways of coping with and solving problems that may be causing PE. For many couples affected by PE, working with a therapist together may produce the best results.

Some psychological therapies also focus on helping the individual find ways in which they can control ejaculation. Healthcare practitioners may provide instruction about distraction techniques, and "stop-start" and "squeeze" techniques that allow the patient to develop a sense of ejaculatory control.

The stop-start method works to help the individual identify ways of controlling their sexual stimulation and ejaculatory response. This method requires the man to engage in sexual stimulation, either with or without his partner, until he realizes that he is about to ejaculate. At this point he stops for about thirty seconds, reducing his urge to ejaculate, and then begins the sexual stimulation again. These steps are repeated until ejaculation is desired. In the final step of the sequence, stimulation is continued until a climax is achieved.

The squeeze method also involves sexual stimulation until just prior to the "point of no return". Once the man senses that he is about to ejaculate, his partner stops sexual stimulation and gently squeezes the tip or the base of the penis for several seconds. Further stimulation is withheld for 30 seconds and then resumed. The couple may choose to repeat the sequence as many times as they like, or continue stimulation until ejaculation is desired. These exercises have little benefit if conducted by the man himself and require the participation of partner.

The only treatment approved by FDA for PE

New medications are being developed to treat PE. The first is a quick acting drug taken one to four hours before sex, called Dapoxetine. In trials, Dapoxetine has been shown to effectively treat men with PE. The difference between this drug and SSRI medications is that it does not need to be taken every day and is not prescribed for depression. Dapoxetine is currently approved by the FDA.

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