Causes Of Delayed Ejaculation

You may well have thought for a long time about the causes of your delayed ejaculation. The inability to ejaculate when you want to have sex seems grossly unfair – after all, the guys you see in pornographic material seem to thrust away in their ever-willing partners for what seems like hours, and yet delayed ejaculation can make it impossible to make love in any way, skillfully or otherwise, your partner is unsatisfied, and you are frustrated and unhappy about your loss of potency. So just what is causing your yet delayed ejaculation?

A physical cause such as occlusion of the penile arteries, diabetic induced neuropathy, or penile injury

Needless to say, these are the more intractable cases of yet delayed ejaculation, and they may need the helping hand of a therapist to produce a lessening of symptoms.

Another cause of delayed ejaculation is emotional – anxiety or anger or fear

When you feel unconscious anger at your partner – or women in general – then you’re not likely to want to have sex with her, unless this is the way that you express your anger.

Some sexual therapists suggest that men canot ejaculate because the withholding of sexual favors is like a punishment for their partner, depriving her of the satisfaction of orgasmic pleasure. 

In fact the mechanism by which a man loses his capacity to orgasm is probably more dependent on anger reducing desire than a passive-aggressive withholding of sexual favors: after all, why would you want sex with someone you didn’t feel intimate with? In the latter case, you may be having sex to express anger; yet delayed ejaculation suggests you are so angry you are turned off your partner.

A fear of having sex, or fear of having sex with a particular woman. Delayed ejaculation, especially when it occurs in young men, can be a clear sign that the man in question knows less about his real feelings of sexual attraction than his penis does!

Such problems usually mean that a man does not in fact want to have sex with his partner, and whatever the reason for this, the recognition that it is not necessary to feel sexually attracted to every woman with whom one could potentially have sex is a powerful insight.

This may well be an emotional challenge for all men who were brought up by a woman who used them either as an emotional support or as a vehicle for the expression of their own rage and frustration against men.

Delayed ejaculation is a great way to avoid the ultimate form of intimacy and to minimize the chance of an unappealing sexual encounter.

Other psychological causes

When a man is with a woman with whom he would rather not have sex, delayed ejaculation is possible. Be honest with yourself about this: simply ask, would you rather be with someone other than your partner? If the answer is “yes”, that’s a pretty good clue to the origins of your yet delayed ejaculation.

If you progress too fast from starting sex to the point of penetration, not allowing enough time for sexual arousal to grow and develop, then you will find that your ejaculation becomes more elusive, more challenging to maintain, and more difficult to keep firm.

You may have delayed ejaculation simply because you are not aroused enough, a problem which becomes especially apparent as you get older and require more stimulation and excitement. 

Moving though the stages of sexual arousal too quickly

Men with sexual self-confidence understand the signals they receive from their bodies about how sexually aroused they are, but a lot of men who don’t get erect simply do not understand how aroused (or not) they actually are.

Men want sex, and they tend to get frustrated and unhappy when they can’t have it. Delayed ejaculation seems like a disaster – and psychologically, for may men, it really is. Effective treatment of how to delaye ejaculation is essential to male sexual and emotional health. And yet delayed ejaculation is very common: about 1 man in 12 .

Can delayed ejaculation be treated with drugs?

Impotence is more commonly known as erectile dysfunction: the inability to develop an erection hard enough to permit sexual intercourse. It can have a connection with low sex drive or lack of desire, and it may be associated with delayed ejaculation or premature ejaculation.

ED or erectile dysfunction is more common among older men. This is perhaps because of increasing levels of circulation problems, nerve problems, drug use (i.e. prescription drug use), age-related decrease in levels of testosterone, or a combination of these factors.

The classification of erectile dysfunction varies as does the degree of erection loss: from an erection that is not hard enough for sexual intercourse to an erection which permits penetration but then gradually loses hardness or is short-lived.

Nowadays, Viagra can produce a fairly quick erection, and a rapid boost to an impotent man’s self-esteem and sexual self-confidence. 

How does drug treatment for Erectile Dysfunction (ED) work?

The two corpora cavernosa which run along the length of the penis to the coronal ridge are made up of spongy tissue and smooth (unstriated) muscle. These muscle fibers are normally slightly tense and so regulate the blood flow into the expandable tissues.

When these muscles relax, blood is allowed to enter, whereupon the tissues swell, thereby squeezing the veins between the tunica albuginea and the corpora cavernosa. As the blood flowing in is now not able to drain away, the tissues swell and become harder and more rigid. It’s a complicated process and disruption to any aspect of the erectile mechanism causes the whole process to fail.

The various factors involved in impotence or erectile dysfunction

As we said before, a common cause of erectile dysfunction is a problem with either the veins or the arteries which feed the penis with blood and then drain it away. Arterial insufficiency or veno-occlusive disease both cause erectile dysfunction; but the ultimate cause of such problems is smoking, hyperlipidemia, hypertension and diabetes.

And neurological damage is a frequent cause of impotence; the release of essential components of the erectile mechanism, namely nitric oxide and prostaglandins from the tissues of the penis, can be inhibited by damage to the neural network – damage that can be caused by injury, surgery, multiple sclerosis and diabetic neuropathy .

Testosterone levels fall as the years go by, and a man will have fewer night-time erections and a lower sex drive. SSRIs, sedatives, anxiolytics, antihistamines, antidepressants and, antihypertensives are common medications which have been all been associated with erectile dysfunction.

Stress can induce erectile dysfunction by increasing blood catecholamine levels and causing smooth muscles to remain tense. And on an emotional level, fear of sex, or women, or pregnancy, or fear of sexual failure can all cause erectile dysfunction.

Pharmacologic agents and the treatment of ED

Of course the best answers are Viagra and other vasoactive agents which promote the accumulation of blood in the corpora cavernosa. The drugs which preceded Viagra were injected into the corpora cavernosa and tended to work within ten minutes. Viagra takes rather longer to work but is safer and more effective for the majority of men.

Psychological or physiological erectile dysfunction?

Emotional issues surround all cases of erectile dysfunction. How could they not? But when a case of erectile dysfunction has a purely emotional origin it can happen suddenly and without any previous experience or warning. In the case of erectile dysfunction with a physiological cause, the onset is more gradual. Tests for high levels of cholesterol and high blood pressure can indicate the cause of erectile dysfunction in some cases.

What Treatment Is Available For Erectile Dysfunction?

What Treatment Is Available For Erectile Dysfunction?

During the time he had erectile dysfunction, a friend told me he and his girl decided they could get round the problem by spending a lot of time giving her oral sex so that she had plenty of orgasms.

In return she was happy to stimulate his penis with her mouth, which was very pleasurable even though he wasn’t erect – though it’s not the same as fellatio on an erect penis to orgasm, obviously, as my mate pointed out!

It is actually possible to reach orgasm with enough stimulation to the flaccid penis – and the sensations are pretty good! But….and it’s a big but….this is nothing like intercourse. And after a while, he said, it became all too clear that what she really wanted was intercourse with him inside her.  And he had erectile dysfunction. Oh dear.

Now I know that women regard sex as a very obvious statement of love. I’m not saying that sex can’t just be fun – it obviously can – buy I think as men we often forget how much sex can mean to a woman. In terms of love, that is. You see, from the days when little girls start playing at princesses, the underlying drive is to learn how to make a man fall in love with you. And of course the physical expression of that is making love, sexual intercourse. So where does that leave a woman if a man is impotent? Feeling unloved, I suspect. After all, the keystone of loving relationships between men and women is that sense of love, expressed physically.

Which is is no doubt why my friend’s erectile dysfunction caused him to feel both anxious and depressed, like a failure…. feelings that will be familiar to most men with erectile dysfunction. It’s just possible that if you don’t treat your erectile dysfunction your partner may seek sexual satisfaction with someone else. But if you and your partner don’t mind your erectile dysfunction, and you don’t think it’s affecting your relationship, then please don’t feel that you need to do anything about it!

In the much more likely event that you want to cure your erectile dysfunction, it, so you can enjoy a normal sex life again, the starting point for treatment should be a visit to your doctor who can assess you for any organic, physical causes such as hyperlipidemia, diabetes, or high blood pressure. The next step will be to engage in a course of self-help treatment (assuming you don’t want to see a professional sex therapist). For example, self help for erectile dysfunction.

In fact the treatment on this website consists of a series of enjoyable exercises which you will do with your partner, a relaxation program to relax you when you have sex and reduce your anxiety, and a series of techniques which will allow you to keep an erection once you have one, so that you need have no fear of losing it during sex. In addition, you may like to try Viagra, provided that your doctor has prescribed it and regards it as a useful adjunct to your treatment.

General notes about erectile dysfunction

Erectile dysfunction is very common. And hardly anything could be more troubling for a man than losing his erection, his ability to penetrate a woman in the act of lovemaking.

The loss of erection means he feels emasculated, much less of man, not able to show his potency – which naturally affects his partner as well, who may wonder if it is her lack of attractiveness which is putting him off sex. (And who will be frustrated by the lack of sex.)  Many cases of erectile dysfunction are due to emotional or psychological stress such as depression, anxiety, or relationship troubles. The penis is a good indicator of what is going on in a man’s mind, and if it flops unexpectedly, there could well be some significance to that fact.

How is erectile dysfunction treated?

Most doctors would like to see a combination of treatment approaches – lifestyle changes such as stopping smoking, losing the excess pounds, and increasing one’s level of physical activity may be enough for a man to get his erection back. Of course, reducing any prescription or non-prescription drugs that may have a role in erectile dysfunction is necessary. 


A good approach to the treatment of erectile dysfunction which lies in psychological effects is to use any psychotherapy technique which reduces anxiety around sex, relationships or intimacy. A man’s partner can help with the treatment techniques of sensate focus, which involve gradually increasing levels of intimacy and sexual stimulation. These approaches are also useful when anxiety that arises from physically based erectile dysfunction is being treated.

Drug Therapy

Viagra (sildenafil), Levitra (vardenafil hydrochloride) and Cialis (tadalafil) have all been approved for the treatment of erectile dysfunction. They belong to a group of drugs called phosphodiesterase (PDE) inhibitors, which work by enhancing the effects of nitric oxide (the chemical that relaxes smooth muscles in the erectile mechanism of the penis), or rather preventing its breakdown, thereby allowing it to continue its effect of increasing blood flow.

The advised amount of Viagra as a starting dose is 50 mg, though 25 mg or 100 mg may be required. Levitra and Cialis start at 10 mg, and the doctor may adjust this dose to 20 mg or 5 mg as required.

None of these phosphodiesterase inhibitors is to be taken more than once a day and nitrate-based drugs such as nitroglycerin for heart problems can be seriously affected by them. Also, combining a phosphodiesterase inhibitor with an alpha-blocker may result in a drop in blood pressure.

Testosterone can effectively reduce erectile dysfunction in a large number of men with lowered levels of their own testosterone, and men have claimed that other oral drugs such as yohimbine hydrochloride, or the more esoteric dopamine and serotonin agonists are effective, but scientific evidence is lacking.

Vacuum Devices

Mechanical vacuum pumps induce an erection by producing a partial vacuum, the effect of which is to help suck blood into the penis, so it engorges and expands. These are not penis enlargement pumps, they are medical devices which include an elastic band, which, when fastened around the base of the penis, will ensure the erection is maintained when cylinder is removed, so that a man and his partner will be able to have sexual intercourse.

Alternatively, a stiff rubber sheath may be placed on the penis before it becomes erect and if left in place can help to enable penetration and intercourse.

Erectile dysfunction must be given full care by both the patient and his doctor, because it may be a sign of high cholesterol or diabetes. When a man has erectile dysfunction caused by high cholesterol, he is at considerable risk of a heart attack within two or three years.

This raises the question of treatment: how is erectile dysfunction best treated? The ideal way of approaching treatment is for a man with a loving partner to start by improving his physical health, eating a more balanced diet, taking more exercise and having all the test for low testosterone; then, for the man and his partner to work together on the exercises which will specifically address his erectile dysfunction.

You may want to consider Viagra if you are under the care and supervision of primary care physician. Viagra has very much short-circuited the treatments for erection problems, and this is especially true in the physical cases, where the cause is organic (i.e. in the body) in origin.

While Viagra may not be a complete cure, it can be a great asset in overcoming the problem – even for men whose problems are psychosomatic (e.g. in cases of performance anxiety, Viagra can help overcome this anxiety by providing a confidence boost).

Sleep Apnoea and Erectile Dysfunction

Sleep Apnea and Erectile Dysfunction

ED or erectile dysfunction can be associated with sleep apnea. Some new research indicates that erectile dysfunction associated with obstructive sleep apnea syndrome (OSAS) may be caused by chronic intermittent hypoxia-oxygen deprivation (CIH), an effect of sleep apnea that plagues men who have obstructive sleep apnea.

In an experiment designed to test this hypothesis, University of Louisville researchers discovered that after seven days of exposure to CIH which resembled that in a man with obstructive sleep apnea, male mice had a fifty per cent reduction in the number of spontaneous daily erections. And after thirty five days of exposure, the time it took male mice to mount a mate had increased by a factor of sixty times.

David Gozal, MD, professor at the University of Louisville, commented that it appeared even relatively short periods of CIH could have a major impact on sexual activity and the male’s ability to become erect. The research work looked at the effects on behavior and physiology of mice exposed to CIH for periods ranging from thirty five days to more than twenty weeks.

A group of control mice were not exposed to the same stimulation and did not experience CIH. The mice were all examined for changes in sexual behavior, as well as the number of erections they developed and how their mating behavior was affected. A number of physiological parameters such as testosterone and estradiol levels were examined, together with endothelial and neuronal nitric oxide synthase activity.

These compounds play an essential role in the mechanism of erection. These compounds are abbreviated to eNOS and nNOS; eNOS is a molecule whose levels are raised by Viagra, and it plays a major part of the male sexual physiology.

After only thirty five days’ exposure to CIH, the male mice took sixty times longer to mount their partners during sexual activity, but also experienced an increase in the time between becoming aroused and penetration of about forty fold.

The length of time between penetration and ejaculation was also affected, so much so that in five out of seven experimental mice, ejaculation did not take place, while in normal mice it took only a few minutes

Dr Gozal added that the variation in responses between mice mirrors the variation between men, who show very different responses to sleep apnea, and who clearly do not all experience the impact on erectile function to the same degree.

There were no significant changes in testosterone and estradiol levels in the experimental mice, although there was a decrease in eNOS expression in the mice which were subjected to CIH for fifty six days.

Even more interesting, after as little as one week’s exposure to sleep apnea, and a recovery period of forty two, the mice had only regained about three quarters of their original capacity for erections.

 This implies there is some permanent effect or that longer recovery time is required. In any even, the impact f sleep apnea on erectile function is severe, and it looks like a major cause of erectile dysfunction in men.

Given enough time, the effects of sleep apnea were reversible. Using a drug commonly prescribed for erectile dysfunction, tadalafil, which works by increasing the availability of nitric oxide through PDE5, the mice were restored to normal sexual and erectile functioning, so that the impact of CIH was almost completely reversed.

This applied to all aspects of sexual behavior, including time to mount, penetration and time to ejaculation as well as number of erections and spontaneous erections.

 The point here being that tadalafil affected both erectile physiology and mating behavior. This could indicate that PDE5 has a role in the central nervous system control of sexual behavior.

Dr Gozal indicates that more research is needed to elucidate the relationship between sexual behavior, sexual physiology and sleep disruption and episodes of hypoxia during sleep.

This is incredibly important for men with erectile dysfunction, because CIH is a very common occurrence in OSA.

In summary, though, erectile dysfunction appears to be yet another dysfunction associated with – and most likely caused by – obstructive sleep apnea. And even though this work was done on mice, chronic intermittent hypoxia has some very profound impacts on multiple organ systems, which make it extremely likely that the same effects apply to humans.

This means that early identification of the condition and application of some effective therapy for OSA is extremely important for regulating erectile dysfunction in men who suffer form both conditions.

This news was originally published in the Thoracic Society’s peer-reviewed journal, the American Journal of Respiratory and Critical Care Medicine.