Orgasm and Ejaculation In Men
Male ejaculation is a two-stage process, the first part of which is known as emission. That’s the movement of semen from the seminal vesicles into the base of the urethra.
This movement triggers the second phase: the expulsion of semen from the penis by means of strong muscular contractions in the pubococcygeus muscles and the other muscles around the base of the urethra.
Slow or absent ejaculation could therefore be due to a failure of either the emission or expulsion part of the ejaculatory reflex. Sometimes the reasons for this are obvious. Some men with diabetes, for example, have neural degeneration which inhibits the reflex responses of the nervous system necessary for the completion of the sexual act.
And some men who are taking SSRI drugs designed to treat depression may find that they are no longer able to ejaculate normally. These drugs inhibit the ejaculatory response. There are many other drugs, of all kinds, which can do this as well.
Unfortunately, emotional & psychological factors can also cause delayed ejaculation.
And while many of us find physical issues a lot easier to deal with, in the case of delayed ejaculation it’s the emotional factors which are often more important. So, we can divide the causes of delayed ejaculation into two groups – the physical and the psychological / emotional. We’ll look at the physical ones on this page.
Physical Causes of Men’s Difficulty Ejaculating Or Inability To Ejaculate
Researchers have found that some prescription drugs are a significant cause of delayed ejaculation (or DE for short). Let’s say a man is depressed or anxious, and can’t come during sex. Often his slow ejaculations are not caused by the underlying emotional state – usually depression – for which the drugs have been prescribed. In fact, it’s the drugs themselves that cause a delay in reaching orgasm or ejaculating. In particular, SSRIs, the serotonergic drugs used as antidepressants or to overcome anxiety, are associated with a tenfold increase in risk of mild or moderate ejaculation delays.
Although this may be helpful in cases of premature ejaculation, men who are depressed and who ejaculate normally may find that these drugs really slow things down, or stop them coming altogether. There are more conditions that cause ejaculation problems, too. These include neurological diseases such as multiple sclerosis and diabetic neuropathy. Equally, high cholesterol levels have been linked to slowness in ejaculation (and, for that matter, erectile dysfunction). Sometimes, when delayed ejaculation is not particularly serious, it seems to be associated with a low testosterone level and smaller testicular size. In their conclusions, the scientists suggested that although physical issues are often a cause of ejaculation problems, the most common cause of any delay in ejaculation is probably psychological.
Research On Ejaculation Problems
A quick search in the University library reveals that around 85% of men with ejaculation problems of this kind can reach orgasm and ejaculate through masturbation, while around 50% can achieve orgasm through sex with their partner – as long as it does not involve intercourse. (This means reaching orgasm through mutual masturbation and so on rather than sexual intercourse.)
So let’s not forget that vaginal intercourse is just one form of “normal” sexual behavior!
There are many ways for a couple to enjoy sexual pleasure from activities other than intercourse. And Masters and Johnson observed as long ago as the 1950s that “ejaculatory incompetence” or “retarded ejaculation” (as they named it – they really meant DE) can be a source of great sexual pleasure to the woman because it allows prolonged periods of intercourse.
That’s a good point: if a woman is able to reach orgasm with her man’s prolonged thrusting she may be delighted with her partner’s stamina, and think of him as a man who can satisfy her even though he does not attain orgasm himself.
However, problems almost always arise, sooner or later, when a man cannot ejaculate during intercourse. Sometimes a couple wish to start a family, or the woman may come to think that “if he can’t come with me, then he doesn’t find me attractive”. Now, when we’re looking at the causes, what’s very clear is that they don’t really split neatly into two groups – the physical and the emotional. Because even when there’s a physical cause, there can often be emotional factors at work.
Masturbation Style & Other Factors As Causes Of Slow Ejaculation
When a young man uses an idiosyncratic style of stimulation during masturbation as a teenager or young man, he may train or “condition” himself to only come in response to very hard and fast hand movements – intense stimulation. This is known as traumatic masturbatory syndrome.
Pelvic surgery in adult life such as radical prostatectomy is high on the list of culprits for causing difficulties with ejaculation, as is transurethral resection of the prostate and bladder neck surgery. Both of those can delay ejaculation, as can other forms of pelvic surgery and spinal column trauma.
There are more than 20 prescribed drugs which may be responsible for retardation of your ejaculation.
For example, almost all of the drugs licensed for the treatment of obsessive-compulsive or depressive disorders, with the exception of nefazodone and Bupropion, are known to cause ejaculatory or orgasmic difficulty. Even men who have never had any ejaculatory problems before may find that certain medications, such as antidepressants and antipsychotics, can cause ejaculation problems. Changing the medication may help.
Phimosis and frenulum breve have been suggested as linked to the cause of slowness in ejaculating slowness.
You can see these conditions in the pictures below. It’s conceivable they are indeed a factor in the origin of DE but we need to keep in mind the fact that many men who have these issues do not have delayed ejaculation. these issues do not have ejaculatory delays.
Recreational drugs, including alcohol, can also cause a delay in ejaculation.
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Please also remember that long delays in ejaculation might just be one end of a normal distribution of ejaculation time in any population of men. That means premature ejaculation is normal, too – just at the other end of the spectrum.
Physical Causes Of Delays In Orgasm: Surgery, Illness and Aging
One of the interesting things about aging in men is that the sexual organs begin to work less well, it takes longer to achieve a full erection, and his erection may not last as long. Also, by the age of 50 most men have diminished testosterone levels which can impact on levels of sexual arousal. In addition there is a real reduction in the intensity of his physical feelings at the time of climax.
That’s because the nerves responsible for orgasm and ejaculation deteriorate with age. For example, the fast conducting peripheral sensory axons are progressively lost, a change which begins in the third decade of life. In addition collagen infiltrates the myelin nerve cell sheath, sensory receptors in the skin degenerate, and the skin atrophies. These age-related changes combine to make it harder for a man to reach the point of ejaculatory inevitability.
Other factors which impact on a man’s ejaculatory speed and responses are peripheral vascular disease, some types of psychiatric problem, diabetic neuropathy, lower penile sensitivity, reduced spinal stimulation, and a higher penile sensory threshold.
And a fundamental part of the ejaculation reflex, the bulbo cavernosus or glandipudendal reflex, seems to be missing in two out of every nine men who can’t ejaculate easily. This would make a lot of sense, of course – their ejaculations are never even triggered.
Neurobiology and Neuropharmacology May Cause Delayed And Absent Ejaculation
A paper published electronically by Marcel D. Waldinger, emphasizes that orgasm and ejaculation are caused by different nerve circuits and different neurotransmitters. And research into neurotransmitters might one day lead to drugs for treatment. But more is known about the neurobiology of ejaculation than is known about the neurobiology of orgasm. Since one takes place in the body and one in the brain, that’s not too surprising!
Work on rats has shown that rats raised in isolation do not know how to copulate and achieve orgasm by mating when they reach adulthood. If subsequently exposed to other rats, some of these rats will learn how to achieve orgasm and ejaculate; others will not. So perhaps what we learn about sexual behavior as we grow up is an important part of all this.
And other work on rats has shown that a couple of brain chemicals, the neurotransmitter oxytocin, and the neuropeptide opioids, may be linked to copulatory behavior. Brain opioids, for example, seem to inhibit sexual behavior. Clearly, doing similar research in human males is rather problematic! But Waldinger suggests that neuro-receptor agonists should be researched because they may form a class of drugs which acts to alleviate delays in ejaculation in men.
Brain Imaging
Doctors have asked men to ejaculate while they are located inside a PET scanner (yes, really), and have got some interesting information about changes in the activity of the brain.
Perhaps not surprisingly, only half of the volunteers who tried this managed to ejaculate under these conditions, but what emerged quite clearly was that non-ejaculation involved much more activity in the brain cortex than did ejaculation.
This activity was centered on the amygdala and left temporal areas of the brain, and it is known that these areas are responsible for controlling fear and vigilance.
No surprise, perhaps? After all, we know that fear and vigilance inhibit sexual arousal and ejaculation in almost all men.
What it means is that higher than normal activity in these areas of the brain may be the cause of these delayed ejaculation problems. What is less clear from this research is what can be done about it – which is where this website comes in….
* This research was reported in the Journal of Anthology, volume 27, number 3.
Physical Causes and Neurobiological Factors In The Etiology Of Delayed Ejaculation
Ejaculation and orgasm are two separate events in the male body: the first is an event that occurs in the genitals, mediated by nervous pathways through the spinal column. The second, orgasm, is a much more widespread event, with sensations of pleasure originating in the brain, and possibly spreading throughout the body. An illustration of how these two events may occur independently is provided by the so-called “numb come”, more scientifically termed “anesthetic ejaculation”.
The idea of anesthetic ejaculation is rather strange. If you’ve never experienced it, you may find it hard to believe that a man can ejaculate without any sensation of orgasm, but it’s not uncommon. It’s usually due to a lack of physical arousal, while the reflex of emission and release of seminal fluid continues normally.
That’s certainly a different way of seeing male sexuality: normally we see orgasm and ejaculation as more or less the same thing. This lack of clarity is reflected in the Diagnostic and Statistcal Manual DSM IV, which categorizes retarded or delayed ejaculation as “male orgasmic disorder”. Having said that, DSM-IV does offer a reasonable definition of delayed ejaculation:
A persistent or recurrent delay in, or absence of, orgasm in a man who has experienced sexual excitement and arousal during sexual activity at a level which would normally produce an orgasm in a man of that age and circumstances.
Unfortunately the DSM-IV definition also includes the statement that the clinician is the judge of what would be “enough” sexual activity to normally produce an orgasm! Taking this rather subjective element out of the definition allows us to define it in a different way.
Delayed ejaculation is a condition where a man finds it difficult or impossible to ejaculate despite receiving adequate sexual stimulation, becoming erect, and desiring to achieve orgasm and ejaculation. And it can occur in sexual intercourse, masturbation or oral sex. There have been many terms used to refer to this particular problem: for example, lifelong or primary delayed ejaculation, and acquired or secondary delayed ejaculation.