Overcoming Ejaculation Problems

Too fast? Too slow? Treating Ejaculation Problems

From the WebMD Archives

Are ejaculation problems an issue of mind over matter?

Well, if a man and his partner don't mind how long it takes him to ejaculate, then it really doesn't matter. For example, Ian Kerner, PhD, a sex therapist and author of She Comes First, advises men to bring their partners to the brink of orgasm before having intercourse. Then, if he's prone to premature ejaculation, it doesn't matter since both of them come away satisfied.

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 do mind how long it takes them to ejaculate. They mind a lot -- and so do their partners. But while the mind often plays a big role in creating ejaculation problems, it's also key in overcoming them. Here are some tips on what to do.

Common Ejaculation Problems

When it comes to ejaculation, there are basically three different things that can go wrong.

  • Premature ejaculation is by far the biggest complaint that men have about their sexual performance. After studying data gathered by 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, both for themselves and their partners.
  • Delayed ejaculation (or retarded ejaculation) affects a much smaller number of men - as few as 3%, according to some estimates. It's one of the most poorly understood ejaculation problems. Some men cannot reach orgasm at all, at least not with a partner.
  • Retrograde ejaculation is the least common of the ejaculation problems. It causes semen to back into the bladder during orgasm instead of exiting by way of the penis. The semen is then later flushed out when you urinate.



    Retrograde ejaculation can be caused by diabetes, nerve damage, various medications, and surgery that disturbs the sphincter muscle. It's harmless and won't interfere with the feeling of orgasm. (It can also make for an easy post-sex clean-up.) But since it does affect fertility, some men may need treatment if their partners are trying to get pregnant.

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What Causes Delayed Ejaculation?

There are lots of different reasons for delayed ejaculation. Some medicines -- like antidepressants -- are common culprits. For many men, it's age. As we grow older, the nerve endings in the penis become less sensitive, according to Barbara Keesling, PhD, author of All Night Long: How to Make Love to a Man Over 50, and a professor of human sexuality at the California State University, Fullerton.

"When the reflexes slow down, it takes longer," Keesling says. "Another thing that happens with age is that your erection ability goes down too, so it becomes more difficult to ejaculate without a full erection."

You may also have a hand in your delayed ejaculation problem. By adopting a masturbation technique that involves intense pressure, friction and speed, some men train themselves to respond to a level of stimulation no partner could duplicate -- at least not without coaching, which the man usually is reluctant to provide.

Michael A. Perelman, PhD, a sex and marital therapist in New York City says he sometimes tries to get men with delayed orgasm to agree to a masturbation moratorium. This does more than stop the practices that may be contributing to the problem. It also allows a build-up of sexual desire, which provides "a mechanism for reducing the threshold of arousal necessary for orgasm," he says.

But while masturbation can cause delayed ejaculation, it can also aid in the cure. If a guy won't agree to keep his hands off, Perelman will urge him at least to alter his masturbation style -- to switch hands, for example -- in order to break old habits. The problem is that your tried-and-true, quick-and-dirty masturbation style is probably terrible practice for sex with another person.

So instead of just masturbating efficiently to achieve orgasm, Perelman encourages men to fantasize about a sexual experience with their partners while they masturbate. He tells them to try "to approximate, in terms of speed, pressure and technique, the stimulation he likely will experience through manual, oral, or vaginal stimulation with his partner." It might take a little longer, but it makes masturbation more of a "dress rehearsal" for sex. You can also talk to your partner about your fantasy afterwards, Perelman suggests.

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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. Having repeated orgasms will bring on delayed ejaculation in almost any guy. Some believe that the best premature ejaculation tip is to double the number of orgasms a man has per week. And if that doesn't work, to double it again.

There's some evidence to support this folk remedy.

"Young men with a short refractory period may 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 may also help men learn to control their level of arousal, which is essential for delaying orgasm.

Other Ways to Treat Premature Ejaculation

One time-honored technique for premature ejaculation is to distract yourself -- to think about something boring or even disgusting 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's also an obvious alternative: pull out and stop having sex for a few minutes to postpone orgasm. Sex researchers William Masters and Virginia Johnson elaborated on this when they developed the "squeeze-pause" technique, also known as the "penis grip," to quell the desire to climax. As the name implies, this involves squeezing the head of the penis as orgasm approaches.

Perelman helps men last longer by teaching them a variation of the Masters and Johnson technique. It involves slowing themselves down and altering their movements in a way that maximizes their partner's pleasure. They do this while maintaining their erection but without overexciting themselves.

Antidepressants for Premature Ejaculation?

For men who aren't helped by any of these techniques, there's a pharmaceutical option. Since some antidepressants -- selective serotonin reuptake inhibitors, or SSRIs -- are known to cause delayed ejaculation, researchers tried them as a way to treat premature ejaculation. Your doctor may prescribe an antidepressant for you to take four to six hours before intercourse, men prone to premature ejaculation can last longer.

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Not surprisingly, drug companies were quick to take notice. A short-acting SSRI called dapoxetine has already been developed specifically for premature ejaculation. According to a 2006 study published in The Lancet, when taken one to three hours before sex, the drug increased the time from penetration to ejaculation from 1.75 minutes to 2.78 minutes for men treated with 30 milligrams of the drug. Men who got 60 milligrams lasted 3.32 minutes.

"A couple of minutes may not sound like much, but for these guys it was huge," said the lead author of the study, Jon L. Pryor, MD, when the results were published in September 2006. However, dapoxetine has not yet been approved by the FDA and is not available in the United States.

Although they also have not been FDA approved for use to treat premature ejaculation , the antihistamine cyproheptadine and the anti-flu drug amantadine have been used with moderate success to treat delayed ejaculation, McMahon says.

Instead of drugs, some men use a desensitizing cream to delay orgasm. There's an even simpler solution: double up your condoms to reduce your stimulation.

Treating 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 be signs of more serious medical issues, after all.

But you also need to talk openly with your partner -- something that many men are loath to do.

"Almost universally, men [with ejaculation problems] fail to communicate their preferences for stimulation to either their doctor or their partners, because of shame, embarrassment, or ignorance," Perelman tells WebMD.

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

WebMD Feature Reviewed by Brunilda Nazario, MD on December 09, 2010

Sources

SOURCES: Ian Kerner, PhD, author, She Comes First. Lauman, E. JAMA, 1999; vol 281: pp 537-544. Michael A. Perelman, PhD, sex and marital therapist. Perelman, M. Journal of Sex Education & Therapy, 2001; vol 26: pp 13-21. Perelman, M. Journal of Sexual Medicine, 2006; vol 3: pp 1004-1012. McMahon, C. Journal of Sexual Medicine, 2004; vol 1: pp 58-65. Masters, W and Johnson, V. Human Sexual Inadequacy, 1970. Masters, W and Johnson, V. Human Sexual Response, 1980. Simon, H. The Harvard Medical School Guide to Men's Health, Free Press, 2002. Pryor, J. The Lancet, 2006; vol 368: pp 929-937. Barbara Keesling, PhD, author, All Night Long: How to Make Love to a Man Over 50.

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