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Everything You Need To Know About Ejaculation Dysfunction

The word ejaculation (derived from ex, meaning “out” and jaculari, meaning “to throw, shoot, hurl, cast”) is defined as the discharge of semen from the urethra (urinary channel), usually accompanied by orgasm.

Although not life-threatening, ejaculation issues are bothersome. It can even lead to quality of life problems that can be relationship-threatening. Most men do not appreciate meager, lackadaisical ejaculation and orgasm, or if the process occurs too rapidly, too slowly or not at all. Sex retains its importance no matter how old we are and achieving a rigid erection and the ability to ejaculate and experience orgasm are all vital components.

The Science Of Ejaculation

Ejaculation occurs after sufficient intensity and duration of sexual stimulation passes a threshold. The ejaculatory center is located within the spine and functions to integrate nerve input from the brain and the penis and coordinates emission and expulsion.

Emission releases the pooled secretions from the reproductive glands into the urethra. Expulsion propels the secretions through the urethra via rhythmic contractions of the pelvic floor muscles. The spinal ejaculatory center is controlled mainly by the neurotransmitters serotonin and dopamine. Serotonin inhibits ejaculation whereas dopamine facilitates it. One’s balance of neurotransmitters is determined by genetics and other factors including age, stress, illness, medications, etc.

Obtaining an erection and ejaculating are separate processes, even though they typically occur at the same time. When the two processes harmonize, ejaculation is more satisfying. Why is ejaculation “better” with a rigid erection?  The urethra is the “barrel” of the penile “rifle.” It is surrounded by spongy erectile tissue that constricts and pressurizes the “barrel” to optimize ejaculation and promote the forceful expulsion of semen.

Fact: It is possible to have a rock-hard erection and be unable to ejaculate, and conversely, to be able to ejaculate with a flaccid penis.

The pelvic floor muscles play a key role in ejaculation. The bulbocavernosus muscle engages when you have an erection and becomes maximally active at time of ejaculation. It is a compressor muscle that surrounds the spongy erectile tissue and contracts rhythmically at the time of ejaculation, sending wave-like pulsations rippling down the urethra to forcibly propel the semen, providing the power for forceful ejaculation.

Ejaculatory Dysfunction Involves

Although premature ejaculation is often a problem of younger men, many other ejaculation issues correlate with aging, weight gain, the presence of prostate symptoms and erection issues. As we age, there is a decline of sensory nerve function, weakening of pelvic floor muscles, and diminished fluid production by the reproductive glands. Furthermore, medications and surgery that are used to treat prostate enlargement can profoundly affect ejaculation. This is what it comprises of.

  • Premature ejaculation
  • Delayed ejaculation
  • Absent ejaculation
  • Skimpy ejaculation volume
  • Weak ejaculation force and arc
  • Diminished ejaculatory sensation

“Doc, It Happens Too Fast”

Premature ejaculation (PE) is a condition in which sexual climax occurs before, upon, or shortly after vaginal penetration, prior to one’s desire to do so, with minimal voluntary control. It is the most common form of ejaculatory dysfunction. It often occurs in less than one minute and leads to dissatisfaction, distress and frustration of the sufferer and his partner.

Fact: In a study of over 1500 men, The Journal of Sexual Medicine reported that the average time between penetration and ejaculation for a premature ejaculator was 1.8 minutes, compared to 7.3 minutes for non-premature ejaculators.

PE can be psychological and/or biological and can occur because of over-sensitive genital skin, hyperactive reflexes, extreme arousal or infrequent sexual activity. Other factors are genetics, guilt, fear, performance anxiety, inflammation and/or infection of the prostate or urethra and also can be related to the use of alcohol or other substances. It is very typical among men during their earliest sexual experiences.

PE can be lifelong or acquired and sometimes occurs on a situational basis.

Lifelong PE is thought to have a strong biological component. Acquired PE can be biological, based on inflammation/infection of the reproductive tract or psychological, based upon situational stressors. PE can sometimes be related to erectile dysfunction, with the rapid ejaculation brought on by the desire to climax before losing the erection.

There are a variety of measures used to overcome PE. Slowing down the tempo requires one to develop awareness of the sensation immediately before ejaculation. By slowing the pace of pelvic thrusting and varying angle and depth of penetration before the “point of no return” is reached, the feeling of imminent ejaculation can dissipate. If slowing the tempo is not sufficient to prevent the PE, one may need to pause and stop thrusting in order for the ejaculatory “urgency” to go away. Once the sensation subsides, thrusting is resumed. The squeeze technique, originated by Masters and Johnson, consists of withdrawal before ejaculation, squeezing the penile head until the feeling of ejaculation passes, after which intercourse is resumed. Although effective, it requires interruption and a cooperative partner. Pelvic floor muscle contractions are a less cumbersome alternative to the squeeze technique. Thrusting is paused temporarily and a sustained pelvic muscle contraction is performed, essentially an internal “squeeze” (without the external hand squeeze) that short-circuits the PE.

Other methods include using thick condoms to decrease sensitivity, or alternatively, topical local anesthetics can be applied to the penis before intercourse. Another desensitization technique is more frequent ejaculation, since PE tends to be more pronounced after longer periods of sexual abstinence. Pre-emptive masturbation prior to engaging in sexual intercourse, may help achieve this. Erectile dysfunction medications can be helpful for acquired PE that is due to erectile dysfunction and certainly can help achieve a second erection after climax. Selective serotonin reuptake inhibitors, commonly used for depression, anxiety, etc., can substantially delay ejaculation.

“Doc, It Takes Too Long”

Delayed ejaculation (DE) is a condition in which ejaculation occurs only after a prolonged time following penetration. Some men are unable to ejaculate at all, despite having a rigid and durable erection.

DE can be problematic for both the delayed ejaculator and his partner, resulting in frustration, exhaustion, soreness, if not pain. The sexual partner often feels distress and responsibility because of the implication that the problem may be their fault and that they are inadequate in terms of attractiveness or enabling a climax. The combination of not being able to achieve sexual “closure,” the inability to enjoy the mutual intimacy of ejaculation, and denying the partner the gratification of knowing that they are capable of bringing their man to climax is a formula for relationship stress. As tempting as it is to think that DE is an asset in terms of pleasing your partner, in reality a marathon performance has major shortcomings.

Interestingly, some men with this condition can ejaculate in an appropriate amount of time with masturbation. As well, some men can ejaculate in a normal period of time with manual or oral stimulation from their partner although they cannot do so with intercourse.

Hypothyroidism is strongly associated with delayed ejaculation, whereas hyperthyroidism is associated with premature ejaculation.

Since serotonin and dopamine, as well as other hormones and chemicals, are involved with ejaculatory control, any drug that modifies their levels may affect ejaculation timing. Selective serotonin reuptake inhibitors delay can substantially delay or prevent ejaculation in a man without pre-existing ejaculation issues. Various neurological conditions that disrupt the communication between the spinal ejaculatory center and the brain/penis can also cause ejaculatory dysfunction.

Fact: As with so many sexual dysfunctions, excessive focus on the problem instead of allowing oneself to be “in the moment” can create a self-fulfilling prophecy of failure. In other words, if a man goes into a sexual situation mentally dwelling and consumed with the problem, it is likely that the problem will occur. This goes for both premature and delayed ejaculation.

One solution is to avoid ejaculation for a number of days prior to intercourse, the same line of reasoning used for managing premature ejaculation by masturbating immediately before intercourse. Sexual counseling using sensate focus therapy has proven to be of benefit to some patients with DE.

“Doc, I Can’t Ejaculate”

Absent ejaculation happens with surgical removal of the male reproductive organs, as occurs with radical prostatectomy or radical cystectomy for prostate and bladder cancer, respectively. It can also occur in the presence of neurological disorders. In these circumstances, orgasm can still be experienced, although ejaculation is absent.

“Doc, It Happens, But Not Much Fluid Comes Out”

Skimpy ejaculatory volume is common with aging as the reproductive organs “dry out” to some extent. It also happens with commonly used urological medications that either reduce reproductive gland secretions or cause some of the ejaculate to go backwards into the urinary bladder.

“Doc, It Dribbles Out Without Force Or Feeling”

What was once the ability to forcefully ejaculate a substantial volume of semen in an arc several feet in length associated with an intense orgasm gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis. These issues clearly correlate with aging, weakened pelvic floor muscles and erectile dysfunction.

How To Optimize Ejaculation

  • Healthy Lifestyle: A healthy diet and eating habits, healthy weight, regular exercise, adequate sleep, alcohol in moderation, avoiding tobacco, and minimizing stress.
  • Pelvic Floor Muscle Training:  Strong pelvic floor muscles are capable of generating powerful contractions to forcibly ejaculate semen and help control the timing of ejaculation. Keep your pelvic floor muscles fit through pelvic floor muscle training.
  • Breathe Deeply And Slowly: During sexual activity, there is a tendency for shallow and rapid breathing because of excitement and increasing sexual tension. The depth and rhythm of breathing can affect ejaculation; deep, full breaths are optimal.
  • Stay Sexually Active: All body parts need to be used on a regular basis, as nature intended, including our reproductive organs.

Disclaimer: The content is purely informative and educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Andrew Siegel MD

I am passionate about wellness advocacy and educating the community about healthy lifestyle and preventive measures. I have created a weekly blog and many educational booklets, brochures and videos. I have authored 3 books, FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity, PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food, and MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health. In the works is THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health.

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