Retarded Ejaculation |
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How the medical profession see retarded ejaculationDr D Richardson and Dr D Goldmeier, produced a report for the The British Association of Sexual Health and HIV (BASHH) special interest group on the recommendations of how retarded ejaculation should be managed. International Journal of STD and AIDS, 2006, 17, 7-13. To go straight to the treatment method for delayed ejaculation, follow this link.
It may not be too cynical
to suggest that the attitude summed up even in the name they give to the
condition might hint at a slightly old-fashioned approach. I prefer to
use the expression "delayed ejaculation" or "male orgasmic disorder". Male orgasm usually has two components - an extremely pleasurable sets of sensations, due in part to muscle contractions, as orgasm takes place, together with the ejaculation of semen. Ejaculation takes place when the various components of semen enter the end of the urethra and create a build up of pressure, which triggers the neck of the bladder to close; this is followed by a series of coordinated contractions of the pelvic muscles, which force the semen out of the body. This process is under the control of the autonomic nervous system, with the hypogastric (sympathetic) and the pudendal (parasympathetic) nerves playing the major role in co-ordinating ejaculation. Some men have trouble ejaculating, a condition
which is sometimes associated with subjective orgasmic difficulties.
Delayed ejaculation, the term I prefer to use, is defined by the American Psychiatric Association (APA) as "persistent or recurrent difficulty or delay attaining orgasm or the absence of orgasm following sufficient sexual stimulation". How common is delayed ejaculation?Estimates vary widely. Masters and Johnson found
17 cases out of 448 they assessed over 11 years - 3.7% What causes delayed ejaculation (retarded ejaculation)?Men with
delayed ejaculation may have slower bulbo-cavernous reflexes, lower penile sensitivity, reduced spinal
stimulation and a higher penile sensory threshold compared to men who
ejaculate normally. Indeed, the bulbo-cavernosus reflex has been found
to be absent in some men with complete primary ejaculatory failure.
And some evidence suggests that sexual organs atrophy, testosterone levels decrease, and erections are harder to get, and intensity of orgasm declines with age, pointing to an age related decline in intensity of orgasm. This may be associated with progressive loss of peripheral sensory axons, producing difficulty in reaching the ejaculatory threshold. There may be congenital abnormalities which could lead to the inability to ejaculate, such as cyst formation between the ejaculatory ducts due to congenital anomalies of the Mullerian or Wolffian ducts. Pelvic surgery may affect a man's ability to
ejaculate. In particular, radical prostatectomy often resulted in loss
of erectile function and ejaculation. And trans-urethral resection of
the prostate can cause delayed ejaculation. Two researchers have observed that almost every psychological problem has been associated with delayed ejaculation. For example, a man who is ambivalent about his sexual relationship may 'hold back' not only his presence in the relationship but also his semen. This can be seen as a type of overcontrol, a way of assuming power in a difficult relationship during intercourse. This is, of course, a hostile act, a position which assumes that men with this problem are overcontrolled and resist "letting themselves go". But there again, as one author has observed, the creaking bed, thin walls, and children wandering about may inhibit orgasm and ejaculation very effectively. So can penile pain: a phimotic foreskin, painfully stretched over an erection, or a recurrent painful torn frenulum. In getting to the bottom of what's going on, a clinician needs to consider whether the problem is orgasmic or ejaculatory. An assessment of the penis and nervous system can exclude peripheral neuropathy, autonomic dysfunction, and spinal cord pathology. Treatment of delayed ejaculationRetarded ejaculation may be due to drug therapy: a variety of drugs are available which are reputed not to interfere with the ejaculatory mechanism. For example, amantadine may be used to treat fluoxetine-induced retarded ejaculation. And Bupropion has been suggested as allowing a reversal of SSRI-induced delayed ejaculation. Again, Yohimbine has been observed to reverse the delayed ejaculation caused by clomipramine, fluoxetine, fluvoxamine, sertraline and paroxetine. But here of course, we are mainly concerned with psychological therapies for delayed ejaculationThe classic method of treatment involves extra vigorous stimulation by hand to the penis using a lube to overcome the "block", and ejaculation by this method nearer and nearer to the vagina, in an attempt to "decondition" the non-ejaculatory response. Other suggestions have included the use of masturbatory exercises, missionary position sex, and the use of vibrators to increase sexual arousal. In reality, these are crude and old-fashioned approaches which do not take account of fears or anxieties which may be inhibiting ejaculation: fear of pregnancy and STI are high on this list. and sexually transmitted diseases should be discussed at the outset. Hypnosis may be helpful for relaxing a man an encouraging him to "let go" during sex.
In summary, retarded ejaculation is not particularly
common, and few case-controlled studies have been done. Many
psychoactive drugs cause retarded ejaculation, and this needs to be
considered. A lot of anecdotal and expert opinion from psychologists and
psychosexual therapists suggest treatment focusing on the emotional and
behavioral. Treatment must address both organic and psychosocial
factors, and therapy must be tailored to the individual's needs.
In men who also have erectile dysfunction, the erectile dysfunction
should be treated first. [ Delayed ejaculation - retarded ejaculation - how to ejaculate during sex ]
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