What is it?
The inability to ejaculate or a long delay before ejaculation.
What's the risk?
About one man in twenty is affected.
What causes it?
1. Most of the causes are psychological, including performance anxiety, self-consciousness, a belief that sex is somehow dirty or immoral, stress and relationship difficulties. Some men find that they can ejaculate normally by self-masturbation but are totally unable to ejaculate when the penis is in their partner's vagina. This does not mean that the vagina is too loose and not giving adequate stimulation to the penis. The problem is psychological.
2. Age. It is not unusual for men over the age of 70 to experience failure of ejaculation. This may simply be part of the ageing process. However, ageing is associated with decreased penile sensitivity, which means older men need more prolonged and direct penile stimulation to achieve ejaculation than younger men. Sometimes ejaculation fails just because they do not have sufficient penile stimulation.
3. It can be the result of the side-effects of certain antidepressant drugs or of nerve damage.
4. It can also be caused by physical factors such as a hormone imbalance or nerve damage resulting from pelvic injury or surgery or diabetes.
How can I prevent it?
You can't do much, except find better ways of coping with stress, of relaxing, and of resolving difficulties with your partner.
Should I see a doctor?
You should see your GP if the problem is persistent and causing you anxiety or affecting your relationship. The GP may be able to advise you about self-help measures or refer you to a specialist clinic or a qualified sex therapist.
What are the main treatments?
. Relaxation exercises, "superstimulation" (e.g. using a vibrator or body oil combined with vigorous rubbing), sex therapy or a large dose of a drug called yohimbine (but check this with your doctor first because there are side effects and not everyone can take yohimbine, e.g. men with high blood pressure).
. Avoid penetration until you're very near the point of ejaculation.
. It may be necessary to change any drugs that might be causing the problem.
How can I help myself?
. Talk to your partner about your problem. This may help relieve some of the pressure you feel under to perform well during sex. Try to find ways together to make sex more exciting.
. Try relaxation exercises to tackle stress. One simple but effective exercise involves tensing and relaxing each of your muscle groups in turn, starting with your feet and then moving up your body. Clench each set of muscles for a few seconds, focus on the feeling and then gradually relax. Finish with your forehead. This exercise helps counteract the muscle tension that accompanies stress.
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Who else can help?
Sexual Dysfunction Association
Web site: www.sda.uk.net
Windmill Place Business Centre,
2-4 Windmill Lane,
Southall,
Middlesex UB2 4NJ
Tel: 0870 774 3571 (open Monday to Friday, 9 am–5 pm)
For information and advice on all sexual dysfunctions.
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