Erectile Dysfunction may develop from a multitude of medical, psychological, neurological, and life-style related causes. Successful penile erections relay on an intelligent body-mind interplay between neurobiological signals of sexual desire, healthy central nervous system arousal responses, and good cardiovascular function allowing sufficient blood circulation into the penile erectile tissue (corpus cavernosum and corpus spongiosum) and blood outflow, after a man’s sexual arousal relaxes. Any interruption to this, rather sophisticated, system may cause erectile dysfunction (ED).
Increasing numbers of sex and porn addicts, including physically healthy young men, report age-disappropriate difficulties with obtaining and maintaining erections, as well as having difficulty to ejaculate when having sex with their partner. This type of ED is believed to be caused by chronic pornography over-consumption and it’s harmful impact on the brain’s complex dopamine pathways. A 2014 scientific study of pornographic behaviour, involving fMRI brain scanning, cautions consumers of developing Pornography Induced Erectile Dysfunction (PIED) when using pornography in excess.
Men, who have addicted to sex or porn, may experience
- Inability to obtain or maintain an erection during intercourse, or other sexual practices, involving a partner
- Delayed ejaculation when having sex with a partner
- Loss of sexual interest for their spouse or sexual partner
- Blaming their spouse or sexual partner
Premature, or rapid ejaculation describes a condition where a man ejaculates (cums) too quickly. In its severe and rare form, the man cums before any direct stimulation to the penis occurs, including when he is just thinking about sexually stimulating situations.
It is more common for the man to ejaculate either during, or very soon after penetration. Studies suggest the average Intra Vaginal Ejaculatory Latency Time (IVELT), or the normal average time for the man to ejaculate, is 3-5 minutes after penetration. Obviously, some men regularly last much longer than this, just as there are men who regularly ejaculate much quicker.
The most important criteria of rapid ejaculation include
- That ejaculation occurs sooner than the man and his partner wishes
- And this is causing distress in their sexual relationship
- Longer sex does not equal better sex
- Premature ejaculation is not a lack of duration, but a lack of control
It is important to take the partner’s wishes into account, because what may seem rapid to the man may be already too long for the partner. Most men experience rapid ejaculation on occasions. There is nothing to be worried about.
It becomes a problem only 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. The effects of rapid ejaculation can be detrimental on relationships. Usually rapid ejaculation has psychological reasons. Physical origins are rare.
A new SSRI medication, specifically developed for clinical treatments of premature ejaculation, called Priligy (Dapoxetine), is recommended. Ask your doctor for advice.
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 penile areas, either delivered as a cream, spray or gel. Other men, who repeatedly experience unsatisfying erections or inability to maintain erections during their sexual act may benefit from obtaining a prescription of PDH5 inhibitor drugs, such as Viagra, Cialis or Levitra.
ERECTILE DYSFUNCTION AND IMPOTENCE
Impotence is an inability to achieve or maintain penile erections sufficient to complete satisfactory 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.
Many men will experience occasional or prolonged episodes of impotence due to severe stress, tiredness, lack of energy, relationship upheaval, anxiety, depression, medication for depression, beta blockers, or excessive drug (including prescription drugs) and alcohol abuse.
Physical causes of impotence may be created by cardiovascular problems, poor blood circulation, angina, untreated high blood pressure, high cholesterol, obesity, diabetes, smoking, injury to the spinal cord, and an array of life saving medications treating specific physical and mental health issues.
Impotence can also result from benign prostate enlargement or prostate cancer, where an enlarged prostate gland may cause pressure on sensitive penile nerves. 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, or DE, is a relatively rare condition and should not be confused with impotence. Delayed ejaculation is a condition of involuntary over-control of the ejaculatory reflex. There are multiple causes for DE and may include psychological and physical factors.
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 inside the 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 both, 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, his fear of not being able to cum when he wants too, his expectations of sexual performance, and his negative beliefs of his ability to turning on and pleasing his partner. Such anxieties are reported to contributing to sexual dysfunction, including DE.
Contributing Physical Factors include
- History of Diabetes
- Nerve damage
- Urethral scarring
- Pelvic cancer surgery
- Spinal cord, injury
- Neurological injury
- Penile hypoesthesia
- Desensitisation – Idiosyncratic Masturbation and habitual desensitisation of the penis (rubbing the penis against rough surfaces while masturbation, also intravenous self-injections) are possible causes in the development of delayed ejaculation.
Contributing Psychological Factors include
- 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 ejaculating inwardly into the bladder. Retrograde ejaculation occurs when the internal sphincter or bladder neck does not close properly and the ejaculate is subsequently not forced out of the urethra but may flow back into the bladder. This condition is harmless and the ejaculate will be evacuated with the next urination.
Most men may 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.
CONFIDENTIAL SEXUAL HEALTH COUNSELLING
Get help from Affirmotive Sex Addiction Australia Sex Therapist Heide in Sydney or online (+61) 2 9380 4486 Book a discreet confidential appointment or get professional information on sex addiction and erectile dysfunction.