The Mechanism Of Ejaculation
Ejaculation consists of two parts – emission and expulsion.
Emission is where the seminal fluid enters the end of the urethra and the bladder closes during ejaculation. Emission is not associated with any particularly strong sensations, but it serves as a warning of the approach of ejaculation.
Expulsion is the second phase of ejaculation, during which semen is propelled outwards under the power of the perineal muscles. The vigorous contraction of these muscles and the explosive expulsion of semen are associated with the pleasant physical sensations of “release”.
One explanation for retarded ejaculation (abbreviated to RE or DE – the latter is shorthand for “delayed” ejaculation) is that it’s a sign of “over-control” of the ejaculatory reflex.
In other words, a man is stopping himself from ejaculating, consciously or unconsciously… So the question is, why won’t he “let himself go?” Ahh….. now that really is a question….
So his brain is interfering with what’s normally a reflex response of the body. And it isn’t “all or nothing”, either – some men can ejaculate with great effort and some can’t ejaculate at all – and there are plenty of men with more or less serious forms of delayed ejaculation.
Some can only come by masturbation in the absence of a partner – a style of sexual responsiveness which has been labeled, or at least become known as, autosexuality or autoeroticism.
It needs hardly be said that delayed ejaculation can interfere with a couple’s desire to have a child. (No ejaculation? No conception?)
So this is an emotional or psychological cause of a man’s delay in ejaculating, and you can read about it here.
There Are Many Other Causes Of Retarded Ejaculation!
So what factors have been investigated as a potential cause of ejaculation problems?
Well, one group of intrepid scientists interviewed over 1600 Italian men. First they asked about physical illnesses, so they could exclude prostate problems that might lead to retrograde ejaculation.
They also asked about other conditions, such as problems in partner relationship, and various psychological issues. These included stress at work, sex drive, climax (or absence thereof) in the partner, medical treatment in the past three months, and general physical health, looking for such conditions as diabetes and hyperlipidemia.
Among these 1600+ men, 80 men had some degree of delay in ejaculating or total absence of ejaculation.
The scientists discovered that serotonergic drugs are a significant cause of delayed ejaculation. These drugs are prescribed for emotional issues like anxiety or depression.
They also found that neurological diseases such as multiple sclerosis and diabetic neuropathy, and hormonal conditions like hyperprolactinaemia and hypogoandism and low testosterone are linked to delayed ejaculation.
Would you be surprised to learn that partners’ difficulties in reaching orgasm or low libido appeared to be a cause of delayed ejaculation?
(However, it’s important to note they could also be a consequence of difficulties in the relationship.)
In the discussion, the authors say a neurobiological approach to ejaculation problems is justified, but the most common cause of ejaculation delay is psychological
(If you don’t know what this means, it’s all about unresolved conflicts, anxiety, stress, anger, shame and guilt.)
This work showed that a delay in reaching ejaculation which is clearly attributable to psychological causes is the result of disconnection between a man’s sexual arousal and his erection. To put it bluntly, he has an erection but he’s not aroused….
This may be due to a partner’s lack of arousal (which means not very exciting sex!) or external factors like lifestyle stress, which distracts a man from the pleasant sensations of sexual activity.
Maybe he’s also inhibiting his sexual fantasies because of guilt or something similar. And maybe he’s not fully present or mindful of te sexual relationship he has with his partner.
Of course, it could even be that a man wrongly thinks he has delayed ejaculation when he actually comes in a normal time scale. That’s why the definition of DE includes a reference to the level of sexual stimulation he is getting – it has to be enough to normally make a man come….!
At the end of their paper, the authors return to the subject of SSRIs, which are serotonergic drugs used as antidepressants or an anxiolytic agents.
They say that these drugs are associated with a tenfold increase in risk of mild or moderate delayed ejaculation. Why? Because they slow down or inhibit the ejaculatory reflex by increased central serotonergic transmission.
And while men who come quickly might think that useful, depressed men who receive SSRIs or other serotonergic drugs, delays in ejaculating can be a major problem.
Serotonergic drugs can induce various degrees of impaired ejaculation and also low sexual desire, a connection which is not often made by the patient, and sometimes not by his doctor.
More Scientific Research On Delayed Ejaculation
Dr D Richardson and Dr D Goldmeier, produced a review on how Retarded Ejaculation should be defined, managed and treated. International Journal of STD and AIDS, 2006, 17, 7-13.
They observed that scientific evidence for the origin, treatment and management of this condition is lacking.
The authors pointed out that the American Psychiatric Association definition – “the persistent or recurrent difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation, which causes personal distress” – is confusing.
Because orgasm and ejaculation are separate and different events, (orgasm occurs in the mind and emission / ejaculation in the body) the European Association of Urology has defined anorgasmia as “a man’s inability to reach orgasm” and delayed ejaculation as “a condition which requires excessive and possibly abnormal levels of stimulation of the erect penis before orgasm and ejaculation can be achieved”.
Yet men with delayed ejaculation know it – regardless of a definition! They cannot come easily during intercourse, and boy, do they suffer because of it!
Sure, most men with delayed ejaculation can reach orgasm and ejaculate through masturbation.
But only half can have an orgasm when stimulated orally or manually by their partner. And of course, intercourse is even harder….
Back in the 1950s, Masters and Johnson observed that ejaculatory incompetence, as they termed it, can be a source of pleasure because it allows prolonged periods of intercourse.
This is a point we should keep in mind: that if a woman is able to reach a vaginal orgasm through prolonged thrusting she may be delighted with her partner’s stamina and ability to satisfy her without reaching orgasm himself. (Or she may be extremely frustrated and sore, lacking lubrication, and feeling alone and isolated. Not a great choice, eh?)
The Importance Of Relationship Issues
Relationship problems always arise with delayed ejaculation.
If a couple wish to start a family, that’s a problem – or a woman may think her man doesn’t find her attractive or arousing.
So why do men take so long to come? (How long is long, though? Well, as it happens, the normal range of intercourse is from two minutes to 9 minutes. That is a broad guide obtained by asking the man’s partner to use a stopwatch… yes, indeed. How romantic. This is the intra-vaginal ejaculatory latency time or IELT, as measured with a stopwatch.)
But, really, I know you want to know what is the normal delay before a man reaches the point of ejaculation?
The answer this question depends on your definition of normal, but there is a kind of consensus that between four and nine minutes is somehow “average” for IELT.
And of course, the average ejaculation time varies. For example, it’s just over two minutes in groups of younger men - no surprise there!
I wonder how other factors like infections can affect delayed ejaculation. For example, yeast infections can make a man’s sexual responses slower or faster. And sexually transmitted infections may also disrupt the natural length of sexual activity.
Of course, how long intercourse lasts depends on many other factors: how aroused the man and woman are before intercourse, how easily she reaches orgasm (or not) through vaginal intercourse, whether the man comes first, and if that means the end of sexual activity (as it usually does for heterosexual couples), how intimate the couple feel during sex, and so on.
Studying the causes of retarded ejaculation is not easy, that’s a certainty. But somewhere between 10 and 12% of men seem to experience it – an astoundingly high proportion, of whom very few seek treatment.
In a research project entitled Sexual Dysfunction In The US: Prevalence and Predictors, almost 8% of men had some degree of difficulty with ejaculation.
In the United Kingdom, a study on around 5000 men suggested just over 5% had some difficulty coming, though only 3% of men said the delays in ejaculating lasted six months or more.
Why Physical Causes Of Ejaculatory Dysfunction Matter
As a man ages, the sexual organs shrink, attaining full erection and sustaining a good quality erection become more problematic, and his testosterone levels drop, producing lower desire and arousal.
Men also say they feel less at the time of ejaculation (because of the less powerful muscle contractions in the PC muscle).
There is also an attenuation of responsivity because of some degree of degeneration of the neurological reflex arc responsible for the ejaculation reflex.
Why? well, because the fast conducting peripheral sensory axons are lost progressively from 30 years of age onwards. Also, collagen infiltrates the myelin sheath of the nerves, and skin (cutaneous) sensory units degenerate, and there is some degree of dermal atrophy.
There may be lower penile sensitivity, reduced spinal stimulation, and an increased sensory threshold. And there is even evidence that the bulbo cavernosus or glandipudendal reflex doesn’t work in around twenty percent of men who have complete primary ejaculatory failure.
As you can see, these age-related degenerative changes will all make it harder to reach the ejaculatory threshold as a man gets older.
And other things don’t help: peripheral vascular disease, psychiatric problems, diabetic neuropathy, and social or emotional problems….
Masturbation Styles, Physical Problems, And More!
If a man uses an “idiosyncratic” (for which read hard and fast) style of stimulation during masturbation as a teenager or young man he may develop traumatic masturbatory syndrome, which you can read about here.
Some congenital abnormalities of the male reproductive system – in particular the Mullerian and Wolfferian ducts – may block the seminal ducts. And there are plenty of other possible issues around the development of the male genitals, or surgery used to correct them, which may cause ejaculatory failure. These are, of course, not quite the same as delayed ejaculation problems due to emotional issues.
But we must keep in mind the practical and pragmatic as well: two researchers, Munjack and Kanno, identified over 20 medical drugs which may be responsible for retarded ejaculation. These include psychoactive, anticholinergic, anti-adrenergic, and antihypertensive drugs, tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants, and antipsychotics.
And drugs for the treatment of obsessive-compulsive or depressive disorders, excluding nefazodone and Bupropion, are linked to many cases of ejaculation delay or absence of orgasm or both.
If you’re in this situation, changing medication may help.
What about drugs to speed up ejaculation, you may ask? Problem is, there aren’t any. Although limited evidence exists that amantadine, Yohimbine and cyproheptadine have a limited impact. Amantadine promotes dopamine release centrally, while Yohimbine is an alpha-2 adrenergic antagonist. Cyproheptadine is a serotonin and histamine agonist. It has been shown that when men have delayed ejaculation as a result of taking SSRIs, Amantadine can reverse this effect; there is also evidence that Yohimbine and cyproheptadine can do the same.
Cyproheptadine has been successful in reversing retarded ejaculation caused by clomipramine, nortryptiline, fluoxetine, imipramine, nortryptiline and fluvoxamine.
Poor research confuses the issue, but Cyproheptadine, Yohimbine and amantadine are the drugs which hae been recommended for reversing delayed ejaculation in a few, very limited cases..
This research was reported in the Journal of Anthology volume 27 number 3.