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.
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.
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.
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.
Please click the below button to watch an extremely informative video on this topic by Body Wisdom Videos.
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 ejaculation latency time 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 most 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 with different 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 sex, partner disinterest in sex, or difficultly/impossible 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 cannot 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 what they find disappointing and they feel awkward and at a loss as to what to say to make their men feel better. If the man is OK about their PE and can satisfy their partner in other ways, women say they are generally not disappointed. PE can also cause sexual problems in females such as difficulty with arousal or orgasm and can also lower their quality of life, if men stop sex due to feeling embarrassed. There are no studies on the effects of PE in homosexual relationships at the time of writing this. 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.
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 your partner 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.
Image: David LaChapell
Delayed Ejaculation & Anejaculation (no ejaculation)
Acquired DE, describes a previously satisfactory 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, lymphadenectomy 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 inhibition of sexual arousal due to psychological or relationship issues. 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, typically involve masturbation without the use of the hand, perhaps lying on the belly, and can result in partial erections and difficulty ejaculating during intercourse. For example, men get used to coming in their own particular way, however then find that stimulation with a partner is insufficient to climax unless they masturbate their specific way. Some 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. Alternatively 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 the impact on the relationship. Inhibited ejaculation, which is due to psychological, relational or masturbation style, respond well to sex therapy, cognitive behavioural therapy, and couples therapy.
Faking orgasm
There is a sexual stereotype that sex should end when the man comes. It is better if you want to end sex to say so, or if you think that your partner has had enough of intercourse then swap out to 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 focus sex on results and performance. Faking orgasms teaches your partner how to be good at NOT making you come. What’s more you are letting your partner go on without any idea of what you like: they 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 them. 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 to climax. Or if you know what will work and you want to orgasm then show your partner how. Otherwise take an experimental approach to find what might be pleasurable. If you have developed an idiosyncratic style of masturbation which involves stimulation without your hand- e.g, face down using a bed, 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
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 body’s 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, stop holding back, and remove 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 [...]
