What is delayed ejaculation? Is it a medical problem?

Originally posted on *Medical News Today

Delayed ejaculation can cause psychological distress for the man who has the problem, and create stress between sex partners. The problem – a relatively rare sexual dysfunction of both medical and psychological causes – is often misdiagnosed, and it is relatively poorly addressed by research.

Use this page to find out what constitutes a true diagnosis of delayed ejaculation. Certain criteria need to be met, and these do not include an infrequent or non-troubling case of taking longer to reach orgasm, which many men may experience at some point.

Fast facts on delayed ejaculation

Here are some key points about delayed ejaculation. More detail and supporting information is in the body of this article.

  • Delayed ejaculation is a form of sexual dysfunction affecting a man’s ability to reach an orgasm.
  • The disorder is a form of ejaculatory dysfunction (others include premature ejaculation and anejaculation).
  • Delayed ejaculation is not a diagnosis until certain factors have been met, including how persistent and troublesome the problem is.
  • There is no strict figure on the “normal” time taken for men to ejaculate after penetration, and averages vary.
  • Nor is a strict amount of time for penetrative sex diagnostic of delayed ejaculation – but researchers have identified around 20 mins after penetration to be an average length of time taken by men diagnosed with the problem.
  • Delayed ejaculation can be present from the beginning of a man’s sexual activity, or can be acquired, often in certain situations.
  • Most causes are psychological, but organic reasons are also possible and are ruled out first during diagnosis.
  • Psychological causes are often complex, but can sometimes be obvious – such as to do with a couple’s mixed desire for pregnancy.
  • Styles of masturbation can strongly influence the way a man goes on to experience sexual intercourse – certain behaviors are linked to delayed ejaculation.
  • Medical cases may be more straightforward for doctors to treat than psychological ones – by addressing the underlying condition.
  • Psychological issues are not treated in the same way for every man or couple – psychological therapists instead address individual concerns.
  • Sex therapy, which can be arranged via doctors, may include the offer of practical tips to try at home during sexual activity.
  • No pharmacological therapies are available for psychological causes of delayed ejaculation.

 

What is delayed ejaculation?

Delayed ejaculation is one of the ejaculatory dysfunctions (abbreviated to EjD in research papers) and probably the least understood.1 It is also the least common form of male sexual dysfunction, affecting an estimated 1-4% of men.

gtws-manejaculation
Men with a persistent problem of delayed ejaculation are likely to be distressed by it.

Compare this with how many men get premature ejaculation: based on estimates of how many at least think they have a problem with rapid ejaculation, the range for that condition is between 15-30%.

Delayed ejaculation falls in the middle of the spectrum of ejaculatory dysfunction:

  • Premature ejaculation (ejaculation always, or nearly always happening before sexual penetration has been achieved, or within about a minute of penetration)
  • Delayed ejaculation
  • Anejaculation (inability to ejaculate, including “retrograde ejaculation” and “painful ejaculation”).

The term “delayed ejaculation” recently became the officially preferred name for what had once been labeled “male orgasmic disorder.”7 What was considered a derogatory meaning has also been conferred on the disorder: “retarded ejaculation.”1 And another term that is used for the condition is “ejaculatory insufficiency.”

In summary, delayed ejaculation is the difficulty or inability of a man to reach an orgasm and ejaculate semen.

The problem is diagnosed when a man is concerned about a problem during most sexual intercourse encounters over at least six months, with a marked delay or marked infrequency of achieving ejaculation – when other problems have been ruled out and in spite of a normal erection and sexual stimulation.

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What Women Think About When Making Out (a Guest Blog)

***The following is a guest blog written for the site. I find it provides an interesting perspective I want to share, so I hope you enjoy. XO, jd

After a tumultuous breakup, women often rewind and go back to point A, where it all began – the kiss.  The memories may include a powerful smell of cologne, a faint taste of tobacco and coffee, or the softest lips you ever felt.  Maybe he was sloppy and lacking experience, or perhaps his tongue was too aggressive.  Or maybe all you could think at the time was, “SEX, SEX, SEX!”  The point is when making out, female brains are on high alert.  A kiss is often a foreteller of where things will lead, but we have to know how to read the signs and listen to our own thoughts.

WE ARE KISSING.  Sometimes in the act of kissing this is all I’m thinking.  Like a giddy 14-year-old who has waited 9 weeks for the next step with her first boyfriend, the first kiss feels all the same.  “I never expected him or myself to initiate this, but it’s happening.  It’s happening!”  He likes you, definitely.  Time to parade.

I AM FALLING IN LOVE.  Already.  And we’re thinking about the future: “Wait ‘til I tell my girlfriends about this!”  “Are you going to call me after I leave your car?”  “We’d be a cute couple, picnicking by the lake.”  “Perhaps, we’ll get married.  No, that’s crazy talk!  …We’d have hot children though, with our super genes.”  When we’re kissing, we always want more.  And sometimes it’s not just sex – it’s a phone call the next morning.

WOW HE IS USING A LOT OF TONGUE.  And other thoughts like these.  “Is his hand on my chest– how did that get there?” “My pants are unzipped?  He’s a magician.”  “SLOW DOWN!”  “Am I being too uptight?  I should play it cool.  Maybe I should graze his crotch.”  Tune into your heart, and I’m not being mushy here.  If he’s too aggressive and you’re feeling nervous, tell him to slow down.

AM I DOING THIS RIGHT?  “Does my breath stink?  Fuck, I never quite figured out how to best kiss.  That eHow article said to kiss his jawline.  Oh, biting his lip is supposed to be sexy.  That was awkward… I’ve been kissing the left side for about 3 minutes.  Now to the right.  Shit, we just bumped heads.”  If we’re still kissing, we’re probably doing it right.  Don’t get hung up in the small details, or you might find yourself obsessing over everything in the relationship.

OOPS, HOW DID WE END UP HERE?  “We just had a few drinks!  I barely found you interesting! … Ah, yes, we did have a few drinks.”  “How did we get from talking about the most effective natural detergent to here?”  One word: hormones.  Take a breather and clear your head before moving forward.

WILL THIS LEAD TO SEX?  Kissing stimulates your ovaries to start producing testosterone, which increases sexual excitement.  “This is definitely leading to sex.  Did I shave my vag?”  This is a special moment.  You’re intoxicated by hormones and you just let everything go, including insecurities about your body.

WAIT, WE SHOULD STOP.  “This will not go any further.”  “I want to take things slow.”  “Okay, five more minutes … Two more minutes … Fuck.”  Hahaha… GET LOOSE. 🙂

WE ARE GOING TO HAVE SEX. THAT IS A FACT.  Apparently adrenaline increases while we’re kissing and our inhibitions lower, meaning it’s unlikely we’ll stop to talk about alternative medicine or something.  “I wonder if sex will be good …  Does he have a nice penis?”  If the kissing is good, most likely sex will be even better.

A WANDERING MIND.  “What time is it?”  “Shoot I have to pay my phone bill tomorrow.”  “Game of Thrones tomorrow night!”  “Definitely getting a rash from your stubble.”  “He’s wearing Carlos Santana cologne.  I feel awesome that I know that.  What am I doing again?  Right, kissing!!!”  We’re multi-taskers too.  You kiss and undress us; we kiss and do our taxes.  This is not necessarily a negative thing, but be aware of the fact you aren’t fully caught up in the moment.

While a good first kiss may not always lead to a magical relationship, it’s quite often a bad first kiss is a sign of a lack of chemistry.  I’m a big believer in second chances, but if the spark isn’t there, it may be time to go in search of a new first kiss.

Slut Shaming: My Story

In June 2011, I took part in the first Slut Walk after hearing of it through certain friends in the sex positive community. Earlier that year in February, female university students in Toronto were warned by a police officer not to ” dress like sluts,” so they wouldn’t be sexually assaulted on campus. In response, I met up with a fairly large group of women – and some men – in West Hollywood, California, and walked proudly among them along Santa Monica Blvd. dressed in high heels, tight black leggings, and a tiny shirt, all in protest of the misuse of the word slut.

You’ll notice I say misuse, not use.

I don’t think the issue is using words like slut or whore. It’s the shame we attach to them. It’s the ever-present double standard – if a male sleeps with a number of women, it’s an accomplishment, but if a woman does it, it’s shameful. She’s easy—a slut. Unfortunately, it’s not limited to the male perspective – women are guilty of it as well.

While in high school, I had my first experience with love. J was my first boyfriend. Tall, athletic, tan, and blonde. In an instant, hormones raged between us, and I lost all sense of control. We wanted to be together everywhere, all the time. Attending separate schools and parental intervention made this tough, so we both snuck out at every opportunity. We kissed, we made out, pet heavily, and dry humped until we were raw. We clumsily fumbled through awkward phone sex. We “borrowed” cars; we skipped school. We were uncontrollable. Eventually, between his begging and pleading, and hormones setting my pants on fire, one night after a dance, we had ferocious sex up against a wall behind my school.

My sex education growing up was really limited. I never recall my father acknowledging sex at all, and my mother explained the words PENIS and VAGINA in a way that was clinical at best. That being said, I was always very curious and cautious, even at 14 and 15. I read about sex in bookstores and encyclopedias. I knew about safe sex, so when I lost the battle of willpower versus raging hormones up against the red brick wall, it was with a condom. I wasn’t so smart about concealing the evidence, however, and not long after, my mother discovered poorly hidden shorts and panties stained with blood, which could only have attested to one thing. I was thrown into the car, and driven immediately to her doctor, where, in between her screaming at me and interrogating me, I was tested for every sexually transmitted disease, pregnancy, and even HIV. I was humiliated. She said I was stupid, called me a slut, and though I didn’t know the meaning it of it or the implications it would have on me, I was shamed.

Please don’t take that to mean I stopped having sex. I didn’t.  I became sneakier about it, and at the same time, I grew a deep resentment for my mother. Though I did view sex as slightly shameful for a short time afterward, I decided its risk was well worth the reward. Becoming an adult, I quickly grew to learn there was no shame in sex or my body or the pleasure derived from it. I was very headstrong and determined as a child (not that this surprises anyone who knows me today), and I made it my business to understand sex more… and now it’s my business to make sure other people are able to understand sex a little better and to know there’s no shame in it. No shame in our bodies, what they do, how they feel, what we like to do or have done to them.

The only way we can alter the course of slut or sex shaming is to STOP doing it.

This means mothers and daughters, strangers, friends, enemies, frenemies, and everyone in between needs to step back and remember a time they have felt it in their lives, and then actively choose not to repeat it.

–jd

The Measure of a Man?

A Straight Talkin’ Guide to Penis Enlargement Techniques

 

In case you haven’t noticed, there are very few – if any – issues within the spectrum of sensual wellness that are off-limits to sex educators. With that in mind, I’d like to explore one of the more sensitive issues some men face – the prospect of penis enlargement. Although penile enhancement can be a difficult subject for some men to discuss openly, it’s a topic that’s acquired almost mythic status in pop culture – often for all the wrong reasons.

Fans of late night television are used to seeing infomercial after infomercial pitching dubious and sometimes ridiculous “extension” techniques and products, designed to seduce size-challenged men with fantasies of attaining John Holmes-like stature “where it counts.”

Marked by outrageous claims and suspect (if not outright fictitious) “statistics,” these ads are more about separating desperate men from their hard-earned cash than making them more formidably endowed.

So, rather than adding to the confusion and business mysticism surrounding the topic of penile enlargement, I’d like to give you a general overview of the more reasonable treatment options available. From creams and pills to cosmetic changes and (exceedingly risky) surgery, there are certain treatment options available today that yield positive results. However, as we’ve discussed in our erectile dysfunction series, these options are often not without serious hazards.

A breakdown of several of the most popular options is below – along with some hard truths about their real effectiveness (or, more often than not, the lack thereof).

I. Surgical Procedures

When you examine the dizzying number of surgical possibilities available, the first thing you’ll likely notice is the uniformly high risk of significant physical complications. From organ deformation to a total loss of sexual function, these issues are so common and so grave that many men “opt out” rather than roll the dice in the name of vanity.

II. Psychological Components

Much like an anorexic that sees an obese person in the mirror no matter how thin he becomes, performance anxiety relating to penis size is not uncommon. Guys, how often has the lady in your life said simply something to the effect of “it’s all in your mind” when addressing your concerns? Well, guess what? She’s probably right on the money, since obsessing over penis size has become so deeply ingrained in the male psyche that the AMA has even coined a term, “Penile Dysmorphic Disorder,” to describe the issue!

III. Penis Pumps & Pills

I initially wanted to call this section “The Good, the Bad, & the Ugly,” but the deeper I plunged into my research the fewer “good” things I found to say. Supplements and pills run the gamut from harmless to dangerous, with virtually no testable and verifiable long-term success reported in either case. A point of genuine concern, however, is that many of these supplements fly under the FDA’s radar, meaning they haven’t been properly vetted for consumer safety. On the other hand, penis pumps have produced minor positive results in some test studies, but, once again, the risks involved can be severe – and potentially permanent. Tissue scarring, abrasions, and burst blood vessels are some of the most common injuries reported.

IV. The Cosmetic Cure

An attractive man is a confident man – in or out of bed. If you’re sufficiently terrified after reading the litany of dangers inherent in the business of penis enlargement, try less severe solutions. Trimming or shaving pubic hair can make the penis appear larger, as can diet and toning the stomach region. These are not only safe “cosmetic cures,” but the exercise involved in toning will also increase stamina and physical health – critically important components of everyone’s sex life.

So before you invest in a litany of questionable supplements and risky medical procedures, ask yourself – and your lover – if any of this is truly necessary. Don’t be surprised if she says she loves you just the way you are, and shares her own way of celebrating what Xaviera Hollander calls “the best part of a man.”

 

–Daniel M.

Life in the Shadow of Performance Anxiety, Part I

Communication Is Key in Overcoming Erectile Dysfunction

Whether you choose to call it male sexual dysfunction, sporadic impotence or erectile dysfunction (ED), the inability to achieve and maintain the type of erection required for satisfying sex is a surprisingly common condition in the United States today. According to the Mayo Institute, some eighteen million Americans suffer from ED each year.

What’s most striking about this figure, and the first thing we should commend, is that these people are taking the first step toward achieving greater sexual health. Let’s face facts – it’s not always easy to talk about sexual problems with your partner, and it can be downright daunting to discuss such a stigmatizing issue.

Understandably, the choice for some is to simply avoid bringing the issue out into the open. But like any sexual challenge, avoiding the problem won’t make it go away. However, it will likely lead to performance anxiety and other relationship tension. As in all areas of life, communication is key in achieving a great sex life, and I’d like to share some knowledge to help you down the right path.

First of all – let’s address that 900 pound gorilla in the living room – While ED is most likely to affect a man over the age of forty, it does not mean he’s less virile or that he’s losing interest in his lover. In many cases, the reality is very different. Like other areas in which stamina is required, erectile dysfunction can simply be the sign of a body crying out for help. Many of the common issues that threaten the overall livelihood of middle-aged men – including heart disease, Type 2 Diabetes, and hypertension – can erode a man’s ability to perform at his sexual peak.

The solution to overcoming these issues is often just a need for greater physical fitness. To quote another Mayo Institute statistic, fully 33% of our nation’s population is obese. Not merely overweight, mind you, but clinically obese. While it’s certainly not my place to lecture anyone about their weight (and I urge everyone to feel good about who they are regardless of body type) correcting the medical issues that contribute to ED can lead men (and their lovers!) to making life changes beneficial to both the physical and mental health of their relationships. Eliminating fatty foods and working out regularly, for example, will give couples heightened stamina and endurance in all areas of life, including the bedroom!

Some prescription medications, including several major anti-depressants in the SSRI family, are known to trigger side effects that can contribute to ED. If you have any reason to believe this is happening to you, bring your concerns to your primary physician at your earliest convenience.   You should also have your doctor run tests for hormonal imbalances, as certain types, if sufficiently advanced, can affect a man’s ability to process and respond to erotic stimuli.

Whether ED is the result of physical, medical or psychological issues, there are a number of easily available prescription medications available that may help one achieve and maintain a satisfactory erection. To some, however, this is seen as “treating the symptom” and not as a true long-term cure. Now that we’ve covered the physical and medical basics, I’ll be addressing how to enlist your lover’s help in taking back control of your body in Part II!

Dear jessica: My Husband Lacks Confidence, Down There!

Dear jessica,

 

My husband, to be blunt, seems to lack confidence in his “size.” At first I started noticing some self-effacing comments. But now it seems to affect his mood when we’re in bed. How can I convince him that I’m not a “Size Queen,” and what tips can you give me to spice things up sexually with him?

 

–       Brooke

 

Dear Brooke,

 

This is an excellent question more people should address! You need to remind yourself – and your husband – at the end of the day, what really matters here is you and your husband experience sexual pleasure on your own terms. Yes, some women are “size queens,” and perhaps your man had some experiences before meeting you that affected his confidence. Just let him know you love him for who he is – and just the way he is. There are plenty of ways to make sex more enjoyable – be sure to pick positions, which organically create the kind of friction you both enjoy: try cowgirl, putting your legs between his, until your clitoris is firmly against his pubic bone. Or have him take you “doggy style.” This position works wonders for helping less-than-massive men reach the G-Spot, especially as you are pushing your hips up against him. And speaking of the G-Spot, my educational DVD ‘jessica drake’s Guide to Wicked Sex: The G-Spot and Female Ejaculation,’ contains additional tips to help you and your husband have a more rewarding sex life, while another entry in the series, “Positions,” can help you bring more creativity and variety to the bedroom. Enjoy!

 

xo,

jd