When men think about sexual problems, erectile dysfunction usually comes first. This is understandable, since millions of American men are unable to obtain and maintain an erection hard enough for sexual intercourse. But good sex is about more than just having an erection. In fact, success begins with sexual desire or sexual desire and ends with ejaculation and orgasm.
Doctors have made huge strides in treating erectile dysfunction. New developments are improving the lives of some men who suffer from abnormal ejaculation.
normal ejaculation
The male sexual response process usually involves several stages. It begins with desire and interest, followed by excitement triggered by erotic thoughts and sensory stimulation, causing the blood vessels in the penis to dilate and lead to an erection.
Ejaculation is the next stage and involves complex physiological functions. Firing occurs first, initiated by the autonomic nervous system, causing muscles to contract and release secretions. This is followed by the action of additional muscles that expel semen from the vas deferens and seminal vesicles into the urethra.
Orgasm is the ejaculation event itself. The muscles close to prevent entry into the bladder and other muscles begin rhythmic contractions to expel semen out of the urethra. Ejaculation is usually accompanied by the pleasure of orgasm.
After ejaculation, as the blood vessels adjust, the penis will reduce swelling and return to a relaxed state. Sexual response depends on the interaction of the psychological, neurological, vascular and reproductive systems. Given its complexity, problems may arise that affect ejaculation.
Premature ejaculation
Biologically speaking, the purpose of sex is reproduction. In most animals, intercourse is brief and ejaculation occurs shortly after penetration. However, for humans, sex involves a wide range of psychological and interpersonal factors. Therefore, premature ejaculation is defined by the desire and satisfaction of both parties, not by time.
Premature ejaculation occurs before need or shortly after penetration before mutual satisfaction. Some men experience this occasionally, while others experience it repeatedly. Large surveys show that it is the most common male sexual dysfunction, affecting up to 30% of men, and is most common in young, inexperienced men but can occur at any stage of life. Most affected men are healthy; others have psychological, health problems, such as diabetes or urinary problems. Premature ejaculation can be treated with or without associated problems. Treatment uses behavioral techniques, medications, or a combination.
Behavioral therapy involves three techniques - pause and squeeze, start-stop and Kegel exercises. When orgasm occurs, pause and squeeze to interrupt activity, apply gentle pressure to the penis for 20 seconds, then resume. Start and stop bringing about orgasm through self or partner stimulation, then stop delaying orgasm. Kegels identify and strengthen the pelvic muscles through controlled movements.
Behavioral therapy is safe, simple, and helps 60-90% of men, but it takes a lot of time and works best with therapist supervision and partnership, as relapse is common. Therefore, drugs now play an important role.
Medication was started inadvertently due to the antidepressant side effects of delayed ejaculation. The use of antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), as a routine or single precoital dose to treat premature ejaculation has yielded good results. Non-responders often see good results when adding an erectile dysfunction drug such as sildenafil to an SSRI.
While treatment progresses, antidepressant medications can have side effects and are expensive. For this reason, some men prefer to use desensitizing condoms with mild anesthetic benzocaine.
delayed ejaculation
Premature ejaculation is rarely caused by disease. However, delayed ejaculation or lack of ejaculation may be caused by psychological or physical problems. Common causes of delayed or inhibited ejaculation include alcohol, medications such as SSRIs, tricyclic antidepressants and some antihypertensive medications, and diabetes. When a medication is the cause, changing the prescription often solves the problem. Some men who must continue taking SSRIs to treat depression or anxiety may benefit from Viagra, Levitra, or Cialis. Psychological problems often respond well to behavioral techniques or sex therapy.
retrograde ejaculation
During normal ejaculation, the muscles in the bladder neck prevent semen from entering the bladder. During retrograde ejaculation, the bladder muscles are unable to perform this function normally. As a result, semen flows into the bladder and nocturnal emissions do not occur. Retrograde ejaculation is a common complication after transurethral resection of the prostate (TURP), with approximately 50% to 75% of men experiencing retrograde ejaculation after surgery. It is also common in people with diabetes. When caused by diabetes or surgery, the problem is permanent. However, if a medication is the cause (such as certain medications used to treat benign prostatic hyperplasia and high blood pressure), switching to an alternative may improve the problem. Although retrograde ejaculation can impair fertility, it does not eliminate the pleasure of orgasm.
Decreased or no ejaculation
As men age, sexual function naturally changes over time. Healthy men can usually maintain erectile function and even fertility throughout their lives. However, there may be a gradual decrease in their sexual desire, penis hardness, ejaculate volume, sperm count and motility, and orgasm intensity. According to one study, ejaculate volume decreases by approximately 0.03 ml with each additional year of age. Although the amounts are small, this reduction adds up over time.
Spinal cord injury or disease may also cause an inability to ejaculate. Many men who undergo radical prostatectomy to treat prostate cancer are still able to orgasm. However, ejaculation is not possible because the surgery removes the structures required for this function.
Pain or blood during ejaculation
Ejaculation is usually pleasurable, but sometimes it can be uncomfortable or even painful. When this happens, men should see a urologist to be evaluated for conditions such as prostatitis, urinary tract infections, and other urinary tract conditions.
Semen is usually colorless. However, if blood enters semen (hemospermia), it will appear brown (old blood) or red (fresh blood). Although worrisome, hematospermia is usually not serious. Prostate disorders (such as prostatitis, benign prostatic hyperplasia, and rarely cancer), stones, cysts, and blood vessel abnormalities may be causes. However, the specific cause is often not determined. Nonetheless, men with hematospermia should seek medical evaluation.
