Problems Associated with Erectile Dysfunction
Many cases of sexual dissatisfaction are related to problems in the control of ejaculation or in the loss of sexual desire unrelated to achieving or maintaining an erection.
Premature ejaculation is ejaculation that occurs too early, usually before, upon, or shortly after penetration. This condition, also called rapid ejaculation, is the most common sexual dysfunction. As many as 30 to 40 percent of men may have this problem. Even when rapid ejaculation is not deﬁned by a man as a problem, it limits the sexual satisfaction of his partner.
Premature ejaculation is common among adolescent boys who fear being caught having intercourse or making their partner pregnant, or who have anxiety about their sexual performance. Some boys may ﬁnd the excitement of seeing a nude body or touching a female to be so overwhelming and so stimulating that they may ejaculate even before they get their pants unzipped. In most men, ejac- ulatory control increases with sexual experience.
When premature ejaculation persists into adulthood, it often signals a problem in the relationship. One consequence of premature ejaculation is that the man begins to feel inadequate in meeting his partner’s sexual needs since he may not maintain an erection long enough for his partner to achieve orgasm. He often
tries to distract himself mentally during the sexual experience or reduce his thrusting in an effort to slow ejaculation. Some men may concentrate so heavily on not ejaculating that they lose all sense of pleasure in sexual intercourse.
There is no agreed-upon amount of time that has to pass before an ejaculation is no longer considered premature. Some experts have used the number of thrusts and the partner’s achievement of orgasm as criteria. But there is no stan- dard for how long the sex act should last. Some men may feel they are accom- plished lovers if they can pull off a “quickie”; others may feel they demonstrate their masculinity by prolonging intercourse to satisfy their partner.
No one is sure what causes premature ejaculation. Some question whether premature ejaculation is abnormal and point out that in the animal kingdom rapid ejaculation is an evolutionary adaptation to ensure procreation of the species. For men, however, most experts think of it as a psychological or learned prob- lem. Although the condition rarely has a physical cause, in some cases inﬂam- mation of the prostate gland or a nervous system disorder may be involved.
Three different approaches are used to treat premature ejaculation. Counsel- ing by a psychologist, psychiatrist, or sex therapist may be recommended based on the assumption that the problem is psychological in origin. Success rates of counseling are difﬁcult to evaluate, since therapists use a variety of methods to measure success.
The second approach to treating premature ejaculation is behavior modiﬁca- tion. A popular technique is the “stop-start” exercise. The male works with his partner to stop sexual stimulation just short of reaching ejaculation. The erec- tion is allowed to subside. Then stimulation is started over and the procedure is repeated. This gives the man conﬁdence when the deliberately subsided erection returns. The aim is to improve the man’s ability to maintain higher levels of sex- ual excitement without ejaculating.
The third and most recently introduced treatment method is medication. One of two drugs, clomipramine or sertraline, can be used to produce a rapid and dra- matic delay in the ejaculation response, which persists only as long as the drug is continued. These drugs have few side effects. While the potential beneﬁts of these medications are signiﬁcant, there are some concerns that treatment may be offered without ﬁrst evaluating the man’s health history, current health status, and actual need for the medication.
Retarded ejaculation is the opposite of premature ejaculation—the inability to have an orgasm even with prolonged erection. This condition is rare. But as men get older, it normally takes longer to reach orgasm. Often, however, this condi- tion is caused by blood pressure medications, tranquilizers, and antidepressants, as well as by diabetes. Psychological causes include fear of vaginal penetration and fear of ejaculating in the partner’s presence. Treatment usually involves undergoing behavioral therapy to reduce anxiety and learning techniques for timing ejaculation.
Retrograde ejaculation is a condition in which semen travels up the urethra toward the bladder instead of through the penis. This condition is seen with some spinal cord injuries, after removal of the prostate gland, or after bladder surgery. It does not have any negative effects on the man’s health.
Loss of libido (sexual desire) is a decrease in sex drive that occurs in both men and women. Nearly half of those seeking sex therapy have low libido. Most often, this common condition develops after years of normal sexual desire and activity. It may be caused by boredom, stress, depression, conﬂict with a partner, or changes in hormone levels. Often it is related to the increased use of medica- tions, particularly in middle age.
A loss of libido may occur as a consequence of erectile dysfunction or it may precede erectile dysfunction. There is no “normal” amount of sexual drive or desire. Having less sexual desire than your partner does not indicate that you have a problem, only that there is a difference in how much sex each of you wants. If loss of libido has become a problem in your relationship, it is important to seek a physician’s help to rule out medical causes. If psychological factors are involved, sex education, counseling, or behavioral therapy may help you and your partner communicate better and achieve a more intimate sexual rela- tionship.
Decreased orgasmic intensity is another symptom of men who have problems with sexual function. It is not quite the same as loss of libido because the man still has the same level of sexual desire, but he experiences the loss of or dimin- ished sensation of pleasure usually associated with ejaculation. Those who lose the sensation may lose interest in sex altogether. Others may become anxious, which often leads to erectile dysfunction.
The intensity of orgasm depends on many factors, including the setting in which sexual activity occurs, feelings toward the partner, the amount of fantasy and foreplay, the partner’s physical response to stimulation, and the amount of time that has passed since the previous orgasm. Men with diabetes or with a neu- rological condition such as multiple sclerosis often experience decreased orgas- mic intensity. With age, some loss of orgasmic intensity is normal.