Erection and Ejaculation

Erection and Ejaculation

In this section we discuss the below topics, simply click on the link to go straight to the section.

Erections

A male’s first experience with his erection is in the womb. During infancy and early childhood boys touch their penis frequently and learn that this produces an erection and pleasurable sensations. The arrival of puberty brings fresh focus to the penis for boys; they have spontaneous erections (erection without touch) more frequent erections, increased intensity/pleasure with erection and learn to masturbate to produce ejaculate and orgasm. Erection becomes both a sign of sexual arousal and a feedback loop to facilitate further sexual arousal.

Early erection experiences in adolescents and young adulthood are different to those experienced by older men. In youth, erections are usually spontaneous, frequent and are often present before the commencement of sexual activity. Young men who do not have spontaneous erections may worry that there is something wrong with them because their erections do not come as easily as their peers, however lack of spontaneous erection in youth is completely normal and just a variation of male sexual response. Equally, women who have experience with men’s spontaneous erections may come to see a man’s erection as a sign that e is attracted to her. Lack of an immediate erection can then be interpreted as a sign that he is not really into her.  Lack of spontaneous erection is not an accurate sign of a man’s arousal. Some men take time to become erect they respond to a slower pace, others may be distracted by the environment,  nervous and trying to please or perhaps have consumed too much alcohol or drugs.

Men’s sexuality changes with maturation. As men age their sexual arousal broadens from a focus on erection and intercourse to eroticism specific to a man’s personal tastes. Men increasingly desire a personal, intellectual & erotic connection with their sexual partner(s).

As men age they experience changes to their sexual function. For example, men are less likely to get spontaneous erections or erections by fantasy alone. This does not mean that men are not aroused. They may be quite aroused however to need more direct and firmer physical stimulation of their penis than previously. Whilst other men require erotic engagement or meaning to their sexual experience. As men age the rigidity of their erection is more likely to fluctuate during sexual activity. Some men are shocked at this change and become frustrated that it now takes longer to get an erection and they become fearful of losing their erection when giving oral sex believing that they cannot get it back. Equally, older women who are used to their partners erection always being present may see this age related change as a sign that she no longer arouses her partner or that he no longer finds her attractive.  It is normal for a man’s erection to go up and down during sexual activity at any age, but it is more common in older men.

Sexual arousal, desire and response vary across the decades. Our sexual tastes differ across the decades. Around 50 onwards the natural aging process can impact on physical sexual response. For example, half of men aged over 50 will have inconsistent erections; they may find it difficult to get an erection or take much longer to get an erection and maintain it. Our culture does not accept aging well. However aging is inevitable and requires us to accommodate to our changing bodies and sexuality. Aging provides us with the opportunity to adapt to different sexual styles, positions and renegotiate our sexual relationship(s). Rather than struggling with age related changes, take the time to think about what is sexually meaningful to you now and consider how your tastes, desires or needs have changed over the years. If you have a partner find out how their desires may have changed. You may be surprised at what you discover. See age_related_changes_to_sexual_function_final.pdf for further details into physical changes.
Sex gets better as we age because good sex is more than an erection. Good sex is about feeling desire for your partner, mutual arousal, pleasuring your partner and enjoying their arousal. It is about asking your partner to pleasure you and being lost in the moment of that pleasure. It is about connecting with your fantasies and exploring your desires. It can be about love or lust. It can be about sharing yourself and taking time for each other. It can be fun, frivolous, quick, routine or anything you like it to be. Most importantly it is enjoyable. Sex is about feelings. The more enjoyable the feelings the better the sex.

Being a good lover requires you to learn from your partner and to know what you want and how to ask for it. Fantastic sex requires respect, trust, openness and non-judgemental acceptance of individual wants. During adolescences men have a lot of erections but little of these qualities.

When men worry about losing their erection it changes their focus from pleasure to sexual performance. Ironically thinking about how to maintain one’s erection can make it difficult to get or maintain an erection and reduces sexual satisfaction. This is equally true for partners. Working on a penis to make it erect is not the same as lovingly or seductively stroking it. Worrying about performance interrupts feelings and diminishes enjoyment.

As men mature their sexual arousal is enhanced or inhibited by relationship dynamics and can be diminished by fatigue, manual labour, illness and emotional distress. Men’s sexual arousal and erection response reflect their physical, mental, and relationship health. By contrast, libido during adolescence and early adulthood may drive the continuation of sex and desire despite an unhealthy mind or relationship.

Women can be guilty of expecting a man to always have an erection for sexual activity. In some cases women can judge a man harshly for not responding in a manner to which they expect. I think there is a bit of double standard going on with some women expecting a man to have an erection on cue. There is no such equivalent expectation where a woman is expected to lubricate immediately. It is unfortunate that our culture permits greater flexibility in sexual response for women than men.

Women may benefit from broadening their conception of male sexuality and adjust to the physiological changes that occur with age_related_changes_to_sexual_function.

Many women jump to the following conclusions when their man starts having erection problems:

  • I’ve put on weight and he is no longer attracted to me
  • He doesn’t love me any more
  • He’s having an affair
  • He’s sexually bored with me
  • He’s gay.

If you are thinking any of the above, your reaction during sex is likely to be anger, disappointment, defensiveness, distress or rejection. It is important at this point to ask yourself “Do your reactions to his loss of erection make things worse?” or “How might my reactions contribute to the problem”?

Also instead of personalising the problem ask yourself if it is possible that your man may be fatigued, stressed, worried about his performance, worried about your reaction, depressed, over worked or suffering from the fight you had last night?

The reality is that men are not machines and their sexual response is variable, just like women’s. Our society’s view of male sexuality is mostly focused on the experience of adolescence and young adulthood. The lack of open discussion about age related changes to male sexual function can create unrealistic expectations for both men and women.

Please click the below to access our document on sexual dysfunction in HIV positive gay men.

Sexual Dysfunction in HIV Positive Gay Men

To have an erection you need blood flowing into the arteries of the penis and storage of blood in the erectile compartments inside the penis. If the body is functioning properly during an erection the blood enters the penis faster than it drains out. Thus there is a build up of pressure, as in a hydraulic system, and the penis becomes erect.

Normally the process of erection begins when the brain receives stimulation, either physical (direct touching of the genitals) or mental (sight, smell, taste, fantasy). The brain receives signals to relax smooth muscle in the penis to allow the erectile compartments to fill with blood. As the penis swells with blood, veins that would normally drain blood from the penis are compressed. Hence the erectile compartments continue to fill and the penis becomes erect.

Erectile dysfunction (ED) is generally described as persistent trouble achieving or maintaining an erection sufficient for intercourse, causing marked personal or relationship distress. There are physical, psychological and relationship factors that can cause ED. All men with ED should consult their G.P. for a general health check as physical causes are the most common cause of ED. That said, ED due to physical cause often produces psychological and relationship distress, which can maintain or exacerbate ED.

Physical causes of erectile dysfunction include anything that interferes with: blood flow (into or out of the penis), penile cell health or nerves & chemical transmitters that signal to the brain to commence erection. Smoking does all of these.

For more information, see my presentation on erectile dysfunction at the Australian Centre for Sexual Health

Please click the below to access our document on the common causes of erectile dysfunction.

Common Causes of Erectile Dysfunction
Please click the below to access our document on the psychological causes of erectile dysfunction

Psychological Causes of Erectile Dysfunction

Please click the below button to watch an extremely informative video on this topic by Body Wisdom Videos.

View Video

Image: Paul Nauman

Premature Ejaculation

We have gained a better understanding of premature ejaculation (PE) over the last 10 years. Historically PE was perceived as having a psychological cause related to men’s anxiety, selfishness or lack of control. However, we now know that time taken to ejaculate occurs on a spectrum and that a certain percentage of men are biologically programmed to ejaculate quickly, whilst others are programmed to take much longer to ejaculate. Taking longer to ejaculate than the majority of men is called delayed ejaculation (DE). Men who take longer to ejaculate often report more dissatisfaction than those who have PE.

Definition of premature ejaculation (PE)

The definition of premature ejaculation is ejaculating during intercourse in less than or around 1 minute, with little control of ejaculation and resulted distress about ejaculation time. Worldwide epidemiological studies have found that 80% of men will ejaculate between 3-7 minutes, and 90% of men between 2-15 minutes, with a median of 5.4 minutes (Waldinger, et al, 20005).

Causes of PE

If a man has always ejaculated quickly, from around first intercourse, in different situations and partners, then he is likely to have a genetic setting for short ejaculation time which is lifelong. For these men, it is likely that their dad also has short ejaculation time.

If a man’s ejaculation time was previously longer than 2 minutes and is now persistently shorter than about 1 minute, he has acquired PE. There are both physical and psychological causes for acquired PE and men should seek a medical review. For example, PE can be caused by thyroid & urological conditions, diabetes, spinal cord injury, lumbar surgery, neurodegenerative disorders or drug or alcohol withdrawal. Additionally, men can develop PE because of relationship, psychological distress or sexual performance concerns. Sexual problems in the partner can also cause PE, specifically painful intercourse, partner disinterest in sex or difficultly with penetration.

Some men may experience intermittent PE. That is, they sometimes come quickly and other times not. Intermittent PE is most likely to be either psychological, interpersonal, related to recency of last ejaculation or lack of sexual experience. Intermittent PE is best treated with sex therapy.

Some men think that they have PE, when they in fact have normal ejaculation times. They may be influenced by unrealistic images portrayed in pornography. Sometimes a females partner’s difficulty achieving orgasm can also result in dissatisfaction with ejaculate times. A diagnosis of PE can not be made with reference to the time takes for a woman to orgasm.

Impact of PE on Men and their Partners

A lot of men worry about ejaculating too quickly, believing that lasting longer equates to being a good lover and that short ejaculation disappoints their partner. Many men feel frustrated, disappointed, embarrassed, ashamed or guilty. Some have lowered sexual and self confidence due to PE. PE can lower quality of life and cause other sexual problems such erectile dysfunction. PE can interfere with sexual intimacy and general intimacy in relationships.

Increased time to ejaculate does not make a good lover. In fact women may complain that lengthy intercourse is painful. When asked, women partners (of men with PE) say that they are not disappointed by ejaculation time, rather that they are disappointed that ejaculation indicates the end of sex. Women report a man’s reaction to PE is more important than when they ejaculate. If a man becomes embarrassed, apologises and stop sex, that is disappointing as they feel they are at a loss as to what to say to make their men feel better. PE can also cause sexual problems in females such as difficulty with arousal or orgasm and can also lower their quality of life. There are no studies on the effects of PE in homosexual relationships. Clinically, I see many gay men who worry about lasting longer.

Treatment

Major medical advances have occurred with the treatment of PE. The first stop is a visit to your G.P. who if unfamiliar with treatment can refer you to a sexual health physician. Dr Chris McMahon at the Australian Centre for Sexual Health is a world specialist in this area.

Sex is a couple behaviour and PE is a couple problem. The best treatment results occur when a couple approach’s the treatment of PE together. If you are unhappy with how you have sex, ask yourself “what can I do to make it better?” Rather than relying on them to make it better. Tell your partner your ideas and each share responsibility for improving your sex life.

You may also find my webcast document on PE: treatment from a Sex Therapist Perspective of interest.

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Image: David LaChapell

Delayed Ejaculation & Anejacultion (no ejaculation)

Delayed ejaculation (DE) is less common than PE. DE describes men who take longer than 20-30 minutes to ejaculate during intercourse and who are distressed by this. Often men with DE will stop intercourse due to exhaustion, irritation or futility. Men who have long ejaculation times from around first intercourse, in different situations and with different partners have lifelong DE. This includes men who have a genetic predisposition to take longer to come as well as those with congenital conditions which stop ejaculation. Some men with lifelong DE may have enjoyed longer ejaculation times in their youth, however as they age they find that time to ejaculate increases and can prohibit ejaculation or orgasm.

Acquired DE, describes a previously satifactory ejaculation time which is now persistently longer than 20 minutes, or too long to complete intercourse to ejaculation/orgasm. Acquired DE has multiple causes such as diabetes, spinal cord injury, urethritis, hypogonadism, thyroid condition, medication side effects, multiple sclerosis, alcohol or drug abuse, lymphadectomy for testicular cancer, prostate, colorectal or anal surgery, as well as psychological and relationship distress.

Some men may experience intermittent DE. That is, sometimes they take a long time to come and other times not, perhaps they can ejaculate by themselves but not with a partner or with other stimulation but not during intercourse. Men with intermittent DE, usually experience and inhibition of sexual arousal due to psychological or relationship issues, such as performance anxiety or relationship conflict. Intermittent DE can also be affected by time since last ejaculation (time between ejaculations increases with age) and idiosyncratic masturbation style.

An idiosyncratic masturbation style, is a style of masturbation that is hard to replicate during partnered sex. Idiosyncratic masturbation, most typically involve masturbation without the use of the hand and can result in inhibited arousal and difficulty ejaculating. For example, men get used to coming in their own particular way, however they then find that stimulation with a partner is insufficient to climax with their partner or during intercourse.  Some of my clients have benefited from the consumer website, traumatic masturbation syndrome. Despite the name, it gives a lot of encouragement from millions of men who have difficultly transferring solo masturbation style to partnered sex. It also provides advice on masturbation retraining using the hand. Another site is i.came , which has a lot of different suggestions for masturbation.

Impact of DE on Men and their Partners

Of course orgasm is not required on every sexual occasion, however if you almost never have one this can led to lack of interest in sex, reduction of sexual arousal, a sense of futility about sex and sexual avoidance. DE may not pose a problem for a couple until they want to conceive.

Treatment

DE is less researched than PE. We know little about the timing mechanism of ejaculation. However treatment involves identifying the cause and reducing the distress of DE and impact of the relationship. There are some medications that have had success at resolving medication induced DE. Inhibited ejaculation, which is due to psychological, relational or masturbation style, respond well to sex therapy, cognitive behavioural therapy and couples therapy.

Faking orgasm

Some men fake orgasms if they have delayed ejaculation or have difficulty ejaculating intravaginal. Men usually fake orgasm as they don’t want to disappoint their partner or are concerned about their partner has had enough. Although this show consideration for your partner it is destructive for your sexual relationship.

There is a sexual stereotype that sex should end when the man come. It is better for you want to end sex to say so or if you think that your partner has had enough of intercourse then do something different. It is O.K to start sexual touch and not finish with orgasm. There are a lot of wonderful aspects to sex such as intimacy, body warmth, and comfort. Don’t diminish these by faking an orgasm.

If you are faking orgasm stop it. It is a lie and makes sex about results and performance. Faking orgasms teaches your partner how to be really good at NOT making you come. What more you are letting your partner go on without any idea of what you like: she or he can’t read your mind. Faking orgasms hinders intimacy, inhibits sexual arousal, and builds resentment. Faking orgasm is about giving up on your sexuality and shutting down. It is not only bad for this relationship but sets you and your partner up for bad sex in the future.

O.K. so you got my message. What to do if you have been faking it for ages? Tell your partner that you are having trouble reaching orgasm. If you think you know why tell her/him. If you don’t know why then say so. If you think that you could come by masturbating then don’t be afraid to stop intercourse and masturbate yourself. Or if you know what will work and you want to orgasm then show your partner. Otherwise take an experimental approach to find what might be pleasurable. I you have developed an idiosyncratic style of masturbation which involves stimulation without your hand–face down using a bed for example– then show them this and ask them to touch you whilst you bring yourself to orgasm. Some men find the website traumatic masturbation syndrome helpful. If you have been faking it your partner will love to see you authentically aroused. It is your responsibility to teach your partner what you like. It is not your partners responsibility to magically work it out without any help from you.

Female Ejaculation

Men usually ejaculate and orgasm together. Women are different. Women can ejaculate without orgasming and usually orgasm without ejaculating. Ejaculation comes from spongy tissue surrounding the urethra, in response to prolonged stimulation and/or intense arousal. .

Some women hold back their ejaculate fearing they might urinate. Don’t worry; it is not urine, go with it. If you are worried about urinating, empty your bladder before sex. Sometimes there is large amount of fluid other times small. The consistency and colour of ejaculate fluid changes depending on the length of stimulation. If you are worried about drenching the mattress place a towel or waterproof lining underneath. Good sex is when you are lost in the moment and not concerned about your bodies responses. Good sex is often messy!

Ejaculating feels quite different to orgasm. One is not better than the other and ejaculation does not make for better orgasms. Embracing ejaculation is about understanding your own sexual response, stopping holding back, and removing shame about how your body responds.

Further Articles of Interest

Impotency Clinic AMI owes $50 million

By Paul Smith, Australian Doctor Newsletter January 7, 2011 The impotency company behind the “Bonk Longer” advertisements owed more than $50 million when it was put into voluntary administration last month. The Advanced Medical Institute [...]