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Male Orgasmic Disorders

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This research paper addresses problem of premature ejaculation and delayed ejaculation. Research paper includes ejaculation problems their history and causes. It further describes Psychological Perspective, along with biological & genetic perspective and types of disorder. Research paper also includes information regarding treatment on these problems.

Sexuality is a very important aspect of overall human personality. Healthy relationship flourishes because of Love, affection and sexual intimacy. In fact healthy relationships along with these essential components contribute to your sense of well-being. There are loads of disorders which can have ill effect on your ability to enjoy sex. Men who carry premature ejaculation also have to deal with the fear of unplanned pregnancy of their partner and this ruins sexual life of that person. Most of the men experience premature ejaculation at least once in their lifetime.   

Main aim of this assignment is to make readers aware of this problem, so they can look at it objectively without any inhibitions.

Research paper contains adequate information about this problem right from its causes, symptoms and its effect on human body and mind. Paper describes various methods which are useful for users to deal with this issue.

Assignment also looks in psychological perspective of premature ejaculation, i.e. psychological aspects which are responsible for causing this problem along with psychological effects of this problem on the person in concern. Along with premature ejaculation, research paper also highlights problem of Delayed Ejaculation which includes information on prevalence of delayed Ejaculation Epidemiology of sexual Ejaculatory Delays (ED) Psychological Causes Somatic Causes Consequences Treatment.

Premature ejaculation (PE)

Premature ejaculation is a condition in which man ejaculates earlier than his or his partner’s likings. All the essential symptoms of premature ejaculation are described in “Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision(DSM-IV-TR)”. According to this manual, premature ejaculation can be defined as relentless and repeated ejaculation with minimal sexual stimulation before or soon after penetration before the person wishes it. There can be many psychological disorders which can contribute in this issue along with physical disorders. In simple words premature ejaculation is ejaculation by man before his partner achieves orgasm little too often (in more than 50% of the sexual encounters).

Broadly ejaculation is considered premature if man ejaculates before two minutes of the penetration. But there is no fixed time period to define Premature ejaculation as it largely depends on the satisfaction of the partner, for E.g. if man ejaculates 5 minutes after penetration and his partner is satisfied with that it cant be termed as Premature ejaculation but some times if man ejaculates after 10 minutes and even then his partner is has not achieved orgasm or hasn’t reached the climax then it might appear as Premature ejaculation to his partner.

 Man can delay his ejaculation for a maximum of 20 minutes some times partner may need 30 to 35 minutes to reach climax in such case it is impossible to satisfy the partner. Premature ejaculation is also known as early ejaculation, rapid climax, premature climax, or rapid ejaculation. Problem can occur in either side or both. Thus it is more related with female reaching climax with vaginal intercourse instead of ejaculation. As described earlier, most of the men experience premature ejaculation at least once in their lifetime; in fact it is the most common type of sexual dysfunction in men younger than 40 years.

Premature ejaculation can be primary as well as secondary. Primary premature ejaculation can be applicable to those men who have had this problem since they became capable of functioning sexually. This type of ejaculation problem is also known as lifelong premature ejaculation.

Secondary premature ejaculation is applicable to those people who didn’t suffer with this problem earlier; their sex life was reasonably good enough and they had acceptable ejaculation control.  But for some unknown reasons they have begun experiencing premature ejaculation later in life. This type of ejaculation problem is also known as acquired premature ejaculation.This type of premature ejaculation can’t be associated with general medical disorder and is also not associated with substance inducement.  

History

History of patient’s premature ejaculation is extremely essential in order to get appropriate treatment which is suitable for him and his partner. It is extremely important to determine ejaculation problem is life long or acquired (i.e. primary or secondary). Patient’s   general medical history is also taken in account as that information might relate to the problem of ejaculation. For example if patient suffers from Angina most probably it leads to heart related problems and this issue also contributes in premature ejaculation during sexual activity because of  mental insecurity regarding his cardiac disorders. In such cases resolution of cardiac problem solves the issue instead of doing any therapy for premature ejaculation. 

Secondary premature ejaculation (acquired) is easy to treat as compared to lifelong (secondary) premature ejaculation. In case of primary ejaculation it is essential to know about prior psychological difficulties along with general medical history as psychiatric conditions are relatively common with people who are suffering from this problem. This might also be related with patient’s prior sex experiences or any particular traumatic sex episode because it keeps playing on his mind subconsciously. Case history should include patient’s relations with his family.

 It’s a known fact that children do get abused sexually and most of the times perpetrator in such cases are family members or family friends. If patient goes through such horrible experiences in his childhood that affects is sex life more often than not.  It is also important know what kind of relation patient had with his earlier partners and how did he rate himself as compared to them i.e. more intelligent, less intelligent, superior , inferior, etc. it is important to know how is patients professional and personal life is faring and whether he is under stress. Overall approach of patient looking towards sex is also important. Some of them think it is dirty and it might be due to their strictly religious upbringing. Non sexual relationship of patient with his partner also matters as smooth non sexual relationship leads to healthy sex relationship.

In case of secondary (acquired) premature ejaculation problem, case history should be approached in little bit different manner. In such cases it is extremely important to keep records of sexual relationship of patient with his partners, i.e. partners with whom he didn’t suffer from this problem and partners with whom he suffered from this problem and since when premature ejaculation became consistent in his sex life. Is premature ejaculation existed from beginning of current relationship? Or ejaculation delay was satisfactory for both the partners to start with. It is important know quality of relationship of the patient with his partner and who is the dominating partner. Case history should include information like; does patient have an impotence problem? If he has erectile dysfunction, did it begin after the premature ejaculation or before? Is he able to achieve coitus or it is prevented by premature ejaculation? How much time his female partner takes to reach climax? Is he suffering from premature ejaculation only during penetration or even during masturbation?

History requires clarification of all these question to get proper treatment regarding this issue.

Causes of premature ejaculation

Experts mostly associate psychological issues with premature ejaculation which has not been confirmed yet. Some of the issues which are responsible for causing this problem are mentioned below, though most of them are discussed in history.

In case of Primary premature ejaculation, a deep-seated emotional disturbance causes this problem every often than not. There can be various reasons for it as mentioned in case history. Sometimes premature ejaculation can be a conditioned response resulting from teen masturbation practices, or even deep urge of sex which might have resulted in unpleasant episode.

In case of secondary premature ejaculation, performance anxiety is the main reason most of the times. There can be many reasons for performance anxiety or performance pressure. Erectile dysfunction is the common factor with this issue. If male is afraid of his erection wont last long because of his experiences from previous sex encounters he may suffer from premature ejaculation.

Sometimes cause is not just limited to male erection it also includes female inability to reach climax. In fact overly dominating female partner may also cause premature ejaculation as it makes further more difficult to talk to her on this issue.

Getting treated from untrained trained sex therapists also aggravates the problem. Conflict between the partners during relationships may also lead to this problem. Some studies show that stasis of sexual energy in the pelvic musculature, which prevents the diffusion of such energy to other parts of the body and this result in premature ejaculation. Some of the studies show that young men with older female partner are prone to premature ejaculation. According some experts female menstruation cycle also plays important role in this issue and overall sex life of both the partners. 

Professional stresses are also contributing in premature ejaculation.PE affects 25%-40% of men in the United States.

Biochemical view of premature ejaculation     

Premature ejaculation is believed as more of a psychological problem. But biochemical views are also important. Generally male reproductive tract which includes penis, prostate, seminal vesicles, testicles, and their appendages gets affected by premature ejaculation along with certain sections of central and peripheral nervous system which play important role in controlling male reproductive tract.

Reproductive organs of the female partner of that person also get affected, as these organs can not experience enough simulation due to lack of orgasm. If premature ejaculation occurs even before commencement of sexual intercourse then it becomes impossible for couples to plan for pregnancy naturally, couple need to go for artificial measures and nobody prefers that.

These kinds of issues are common for the men who were used to quick masturbation process during there teen aged days. Factors such as hormonal differences along with differences in nerve conduction/latency times also contribute in premature ejaculation. Men with over sensitivity of their genitalia also suffer from this problem. Men with higher testosterone levels suffer more from this problem as compared to men with normal testosterone levels. Low serum levels also contribute in premature ejaculation. Biochemical markers just like prolactin also play really important role in premature ejaculation, erectile dysfunction, and metabolic syndrome.   

Physical factors such as problem in phases such as emission and expulsion also lead to premature ejaculation. Emission is the first phase where deposition of seminal fluid from seminal vesicles takes place.

In second phase which is known as expulsion closure of bladder neck, followed by the rhythmic contractions of the urethra takes place. Disorder in any of these functions can lead to premature ejaculation. Few experts indicate at the low level of serotonin in the synaptic cleft in these specific areas in the brain as a reason for premature ejaculation. Scientists say that areas like nucleus paragigantocellularis in the human brain play very important role in ejaculatory control any problem there can lead to premature ejaculation.

Treatment on premature ejaculation

Some treatments are mentioned to get rid from premature ejaculation. Sensitive Focus Treatment isone such treatment. This process requires consistent concentration on the process of sexual arousal and climax during sexual encounter. Person suffering from premature ejaculation has to understand every step during sexual activity. Especially stage just before point of no return is extremely important and that should be recognized.

There is another technique which is called pause and squeeze technique, success of this technique also depends upon active participation by the partner. In this technique partner should be expert in squeezing head of the penis at intervals to prevent orgasm. There are modified techniques to do it. In this technique owner is on man to tell his partner to stop stimulating him to provide him with chance to take a step back. With increasing practice couple starts getting control over the procedure and male arousal. This entire technique is known as outercource. After period of few weeks couples get satisfactory control over the entire process. It has been reported that stop and squeeze technique has 95% success overall. To add to it couples can use this technique as an opportunity to learn about each others unique sexuality.

Stop and start technique is also useful to stop to stop premature ejaculation, patient has to practice this exercise on daily basis if possible, to start with he has to experience tickling feeling just before ejaculation and slowly he has to gain control over this feeling. Patient should avoid use of sex toys or lubricant during this exercise. It is very important that patient should not try to stop ejaculation once he reaches point of no return.  Patient should start and sop masturbating to gain control over ejaculation process. To move further patient can begin stimulations along with paying close attention on body sensations and carry this process forward until he gets tickling sensation. While practicing this exercise patient shouldn’t worry even if he looses erection; he can try to excite himself again. During this entire exercise patient should play close attention to his body, and keeping repeating this process until he gains satisfactory control over ejaculation.

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Kegel Exercise Routines for Men also can play important role in preventing premature ejaculation. There are many variations of this exercise; few of them are mentioned below. a) PC flutter: This Kegel Exercise offers great control. Patient has to rapidly contract   and relax your PC muscle as the name suggests. Main aim of this process is to gain control over PC muscles.

b) Flex Hold: This exercise is ideally designed to increase strength of flex muscles. This process requires more will power that PC flutter exercise. By flexing and holding PC muscles patient increases strength of these muscles.  

c) Flex hold release and repeat exercise: this is an ultimate power exercise, this is a combination of both PC flutter and Flex hold exercise. In Flex hold release and repeat exercise user needs to do both this exercises in rhythm.

d) Chaotic PC flexing: This is an advance technique. Patient has to find something that has rhythm. Music is the best way to move forward.  For one segment of patient’s determined rhythm, he should do the PC Flutter Kegel then do the Flex and Hold for next segment. Patient can use any rhythm only thing is he has to mix it up.

There some medication techniques which can help patients to combat against premature ejaculation. One such technique is,

Oral medication SSRI (Selective Serotonin Reuptake Inhibitor): Loads of clinics and physiotherapists are recommending this technique. These drugs do help to prevent premature ejaculation and significant thing is they can be used as and when needed. They can be consumed few hours before planned sexual activity. These drugs can be used on daily basis also. Most men prefer the daily regimen instead of the as-needed basis because sex affairs are spontaneous most of the time and daily use of these drugs can help in such cases. Dapoxetine is recommended SSRI for premature ejaculation, but still hasn’t been approved by FDA.

Some creams, sprays and aerosols are also available in the market to prevent premature ejaculation. Some experts are recommending topical anesthetic spray and cream therapy to deal with this problem. One such technique is eutectic mixture for premature ejaculation (TEMPE) users who used this technique say that spray and the cream easy to usewhile some complained about moderate numbness. But the overall feedback is positive on this technique, according to most of the users TEMPE provides better ejaculatory control and it has improved quality of their life. But creams like Lidocaine had limited success when it comes to this issue.

Delayed ejaculation symptoms and treatment

As mentioned above ejaculation is a process in which semen is released from the penis. Delayed ejaculation can be defined as male inability to ejaculate during sexual activity.  

In simple words it is a consistent difficulty in achieving orgasm despite having normal sexual desire and stimulation required for it. Delayed ejaculation can occur during intercourse or even with manual stimulation in the presence of a partner. Normally man can achieve climax within 2 to 5 minutes but in case of delayed ejaculation man either doesn’t achieve climax or even if he does, it take 35 to 40 minutes for him to achieve climax. In some cases man can achieve climax during masturbation and he can’t achieve it during real intercourse.

There are two types of Delayed ejaculations; one is lifelong delayed ejaculation which is also called primary delayed ejaculation. Lifelong delayed ejaculation is applicable to those men who have had this problem since they became capable of functioning sexually.

Other type of delayed ejaculation is acquired delayed ejaculation. This ejaculation problem is also called as secondary delayed ejaculation. Acquired delayed ejaculation is applicable to those people who didn’t suffer with this problem earlier; their sex life was reasonably good enough, but for some unknown reasons they have begun experiencing premature ejaculation later in life. This type of premature ejaculation can’t be associated with general medical disorder and is also not associated with substance inducement.

Causes of delayed ejaculation

Psychological causes

Various factors can be included in physiological causes of delayed ejaculation, which prevent man from achieving orgasm. Distraction from worry, insufficient sleep, anxiety about pleasing his partner, anxiety about relationship problems, and distraction from the environment are considered as prime reasons for causing delayed ejaculation.

Physical causes

Physical causes may lead to some diseases or disorders and that affects man ability to achieve orgasm.

Certain masturbation techniques are responsible for causing delayed ejaculation. There are not many similarities between real intercourse and masturbation. Factors like pressure, angle and grip make it totally different experience as compared to intercourse with partner and due to this ability to ejaculate might get reduced or eliminated. Causes for delayed ejaculation also include some neurological (stroke or damage to the spinal cord) prostate problems, some allergies, high blood pressure and endocrine diseases (diabetes).  Pelvic surgery that involved trauma to pelvic nerves which are responsible for orgasm can also cause difficulty in achieving orgasm. Some men can’t feel any sensation in the nerves of the glans penis it may or may not include external factors. Delayed ejaculation can also occur as a result of side effect of some medications. These medications are mainly some antidepressants, antipsychotic, antihypertensives.

Psychological causes

Psychological causes can involve many things such as lack of attraction for the partner, religious background where sex is seen as dirty thing. It can also be caused because of some traumatic experiences related to sex in past life, which stays at the back of the mind of that patient.

Treatment

To start with if man has never ejaculated in his life and suffers from lifelong ejaculation problem, then such patient should consult urologist and urologist should be experienced in dealing with such issues.

If man is able to ejaculate in at least some form then he should opt for psychodynamic psychotherapy from sex therapist. Usually these kinds of therapies involve both the partners. A therapist provides much needed guidance to couples to help them in ideal simulation. This generally involves series of homework assignments related to behavioral approach, which teaches them to focus on pleasure instead of concentrating on pressure of performance.This therapy typically helps couples to enhance the relationship and emotional intimacy and that’s what is important in combating such problems. 

Prognosis is also commonly used technique to prevent delayed ejaculation. It requires 12 to 18 sessions and success rate of this technique is around 80%. More positive outcome can be associated with satisfying experiences. This technique makes patient to realize that, the more hard he tries to get rid of this problem more complicated it becomes for him. If couple is planning for immediate pregnancy they need to collect sperms in some other way as ejaculation is difficult. Some masturbation exercises are also useful in preventing delayed ejaculation. In first stage man masturbates in presence of his partner, it looks slightly difficult though as most of the men masturbate alone. Man should learn to ejaculate in front of their partner. During the next stage hand of the man is replaced by hand of his partner. Step by step ejaculation of man moves closer to his partner, finally in desired destination, as ejaculation becomes eminent that can be done in vagina, anus or mouth of his partner. Some therapists recommend sex toys useful for Vibratory and electrical stimulation, to deal with delayed ejaculation. In such cases electrical sex gadgets and vibrators are used they help user to feel the sensation and tickling during each step of sexual activity. Some therapists recommend sex toys such as the fleshlight in order to make him feel vaginal or anal stimulation. In some cases where a couple is going through problematic relationship therapists recommend rational emotive therapy where it is advised to enhance emotional intimacy and it  might be required as a first step.

Conclusion 

Healthy relationship flourishes because of Love, affection and sexual intimacy. There are loads of disorders which can have ill effect on your ability to enjoy sex. Premature and delayed ejaculations are increasingly spreading issues. These issues are responsible for hampering healthy and passionate sex life of many couples. People need to look at these issues objectively without any inhibitions. Loads of new techniques and medications are available to deal with these issues. People should feel free to use them in order to enhance their relationship with their partner.

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