SEXUAL HEALTH COUNSELLING FOR MEN AND THEIR PARTNERS IN SYDNEY AND AUSTRALIA-WIDE ONLINE
Erectile Dysfunction may develop from a multitude of medical, psychological, neurological, and life-style related causes. Successful penile erections rely on intelligent body-mind interplay between neurobiological signals transmitting sexual desire, healthy central nervous system responses, and good cardiovascular function allowing sufficient blood flow into the erectile tissue of the penis (corpus cavernosum and corpus spongiosum causing erection) and blood outflow after a man’s sexual arousal relaxes. Any interruptions to this rather sophisticated system may cause erectile dysfunction (ED).
PORNOGRAPHY INDUCED ERECTILE DYSFUNCTION, PIED
Increasing numbers of sex and porn addicts, including physically healthy young men, report difficulties with obtaining and maintaining good erections and having difficulty to ejaculate when having sex with a partner. This type of ED is believed to be influenced by chronic pornography over-stimulation and it’s harmful impact on the brain’s complex dopamine pathways. A 2014 scientific study involving fMRI brain scanning cautions against acquired Pornography Induced Erectile Dysfunction (PIED) due to using pornography in excess over extended periods of time.
MEN, WHO HAVE ADDICTED TO SEX OR PORN, MAY EXPERIENCE
- Inability to obtain or maintain good erections during intercourse or other sexual acts with a partner
- Delayed ejaculation when having sex with a partner
- Loss of sexual interest for a partner
- Blaming a partner for one’s sexual dysfunction
PREMATURE EJACULATION (PE)
Premature, or rapid ejaculation describes a condition where a man ejaculates (cums) too quickly. In its severe and rare form, a man cums before any direct stimulation to his penis has occurred.
Studies suggest the average Intra Vaginal Ejaculatory Latency Time (IVELT), or the normal average time for a man to ejaculate, is 3-5 minutes after penetration. Obviously, some men regularly last much longer, just as there are men who regularly ejaculate much quicker.
THE FOUR MOST IMPORTANT REASONS WHY PE REQUIRES CLINICAL SEX THERAPY
- Ejaculation repeatedly occurs much sooner than a man and/or his partner expect
- Causing distress in a men’s life, lowering his confidence, his self esteem, threatening his wellbeing, and may increase anxiety and depression
- Causation of relationship distress, upheaval, or break up
- Premature ejaculation is not a lack of duration, but a lack of control during intercourse, and may not be present during masturbation
Consensual sex must take the wishes of both partners into account. What may seem rapid to a man may be too long for their partner. Most men experience rapid ejaculation on occasions. There is nothing to be worried about.
PE becomes a problem when it occurs during most sexual interactions. Studies show that about 40% of men are troubled by this problem on more than an occasional basis. Rapid ejaculation has mostly psychological causes. Physical origins are rare.
SEX THERAPY, COUNSELLING, MEDICATION
Most ejaculation issues can be resolved in professional clinical sex therapy sessions when consulting with ASAA’s trained sex therapist.
In extreme cases of premature ejaculation medication may be considered.
A new SSRI medication, specifically developed for the clinical management of premature ejaculation, called Priligy (Dapoxetine), has been reported to be helpful.
*Get your doctor’s advise on this medicine, or on other proven anxiety reducing medication.
Some men with premature ejaculation report hypersensitivity to some parts of their penis. Those men may find relief with applying a topical anaesthetic to these sensitive areas during sex.
Other men with premature ejaculation who repeatedly experience unsatisfying erections, or inability to maintain erections during their sexual acts, may benefit from obtaining a prescription of PDH5 inhibitor drugs.
*Please consult with your clinical sex therapist if you may benefit from medication, or obtain a prescription from your doctor. Medication advertised on the Black Market/Internet are not recommended, and may not be safe to your health.
ERECTILE DYSFUNCTION AND IMPOTENCE
Impotence is the inability to achieve or maintain erections sufficient to complete penetration or intercourse. In an estimated 10% of complete impotence, erections may not be achieved at all. Ejaculation and pleasure feelings are typically not affected.
IMPOTENCE CAN BE CLASSIFIED AS PRIMARY OR SECONDARY
- Primary Impotence: a man has never had successful intercourse with a partner but may achieve normal erections in other situations.
- Secondary Impotence: despite current impotence symptoms, there is some history of success with completing intercourse in the past.
Men can experience occasional or prolonged episodes of acquired impotence due to severe stress, tiredness, lack of energy, relationship upheaval, anxiety, depression, medication for depression/anxiety management, beta blockers, excessive drug use (including prescription drugs) and alcohol abuse.
Physical contributors to impotence include cardiovascular problems, poor blood circulation, angina, high blood pressure, high cholesterol, obesity, diabetes, smoking, injury to the spinal cord, and some prescribed medications.
Impotence can also result from benign prostate enlargement or prostate cancer. Life saving prostate surgery may also contribute to erectile dysfunction.
Impotence in Australian men is prevalent in about 3% in the 40-49 years old age group, 42% in the 60-69 years old age group, and increases to 64% in the 70-79 years old age group.
DELAYED EJACULATION (DE)
Delayed ejaculation, or DE, is a relatively rare condition and should not be confused with impotence. Delayed ejaculation may occur due to insufficient sexual arousal, sexual mistrust, or involuntary over-control of the ejaculatory reflex. DE can be influenced by a multitude of psychological and physical conditions, and some medications managing those conditions.
UNDERSTANDING MALE ORGASM AND EJACULATION
Male orgasm and ejaculation are two different phases and mostly (but not always) occur closely together. A man can orgasm without ejaculation, or ejaculate without orgasm.
- Phase one – seminal fluid gathers at the base of the penis with usually no greater sensation then a ‘warning’ of the approaching orgasm.
- Phase two – (shooting phase) requires the contraction of the striated and bulbar muscles of the perineum, and is responsible for orgasm. The perineal musculature is the area between the anus and the scrotum.
Phase two can be interrupted by a man’s conscious or unconscious thought process. This may include his lack of sexual focus and fantasy, a lack of privacy, a lack of sexual arousal, fear/embarrassment of his sexual performance ability, negative body image, and memories of past sexual failure. Such anxieties are common contributors to sexual dysfunction, including DE.
PHYSICAL HEALTH CONTRIBUTING FACTORS
- History of Diabetes
- Nerve damage
- Urethral scarring
- Pelvic cancer surgery
- Spinal cord, injury
- Neurological injury
- Penile hypoesthesia
- Desensitisation or penile nerve damage caused by idiosyncratic masturbation and habitual desensitisation of the penis (e.g. rubbing the penis against hard surfaces while masturbating, over-masturbating to pain and penile bleeding, also intravenous self-injections) are possible causes in the development of delayed ejaculation.
CONTRIBUTING PSYCHOLOGICAL FACTORS, DE
- Learnt techniques of delaying or withholding ejaculation; e.g.Tantra sex
- Younger men who are starting out in sex and are ‘paralysed’ with sex negative feelings, such as anxiety, sexual inadequacy, sexual fears, sexual shame, or sexual guilt, are prone to be affected by DE.
- Older men who have experienced an emotional stressful childhood or adulthood development, may have grown mistrustful of release and letting go, and may subsequently experience major difficulties with sexual release.
- Men who have developed difficulties with being sensual may find it difficult to develop sexual thoughts and sufficient arousal.
- Men who have developed aversions to their own, or to their partners, genitals may not achieve sufficient levels of arousal.
- Men, who experience difficulties focusing on their own sexual pleasure, may be at risk to lose arousal/erections and developing delayed ejaculation.
- Poor mental health and side-effects of prescription drugs including beta-blockers, some anti-depressants, and antipsychotic medication can interfere with sexual arousal and ejaculation.
Retrograde ejaculation is a condition of involuntarily ejaculating inwardly into the bladder. Retrograde ejaculation occurs when the internal sphincter or bladder neck does not properly close and the ejaculate is subsequently not forced out of the urethra but flows backwards into the bladder. This condition is harmless and the ejaculate will be evacuated by urination.
Most men do not require any treatment.
For those men who opt for medical intervention, the following treatment options are available
- Bladder neck reconstruction
- Cryopreservation of semen, semen harvesting
- Pharmacological treatment
Causation of Retrograde Ejaculation include
- Certain medications
- A history of diabetes Mellitus
- Damage to the bladder neck
- Damage to the bladder neck nerve supply
- Pelvic surgery and pelvic cancer surgery
- Spinal cord lesions
- TURP Transurethral resection of the prostate
Please see your GP or Urologist for appropriate advice. Men who want to start a family may also want to consult with a Fertility Specialist.