In Male Sexual Issues, part 1, the focus was on ED. This second part will provide some information on the other male sexual issues which are: Premature Ejaculation (PE), Delayed Ejaculation (DE) and Anejaculation, and Low Sexual Desire.
PE - The clinical definition of PE is “a persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximatively 1 minute following penetration and before the person wishes it.”
It is prevalent in about 20 to 30% of males. PE can occur as a fear of experiencing ED.
The median time for Intra-Vaginal Ejaculation Latency Time (IELT) which is the time penetration occurs before ejaculation is 5.4 minutes. The range goes from 1 minute to 45 minutes. PE is definitively present when the IELT is below a minute. Any time between 1 minute and 1.5 minutes, it may be a case of PE.
PE is experienced as a result of “over-excitement” without the ability to control or manage the erection. This results in the sexual response going very rapidly from excitement to orgasm, skipping the phase in between called a plateau phase.
As with any sexual issue (male or female), PE can have biological, psychological or social causes, or more often than not, a combination of some of these three categories.
PE can be lifelong or acquired. PE is described as lifelong when it has always been experienced. This is more common in younger males. PE is described as acquired when it is experienced after a period of time where IELT was above 1 minute. This is more common in older males.
PE treatment tends to be more effective when doing a combination of medical and psychological actions.
- Topical analgesics which will numb the sensation may help with allowing for a longer period of IELT.
- Treating underlying conditions which could affect IELT such as hyperthyroidism or bacterial prostatitis.
- SSRIs which are usually prescribed for anxiety can help delaying climax and orgasm. However, these have side effects, one of which being loss of libido all together. Dapoxetine on demand is specifically recommended to support treatment of PE.
- Therapy will help with all the psychological and social impact causes by helping the brain find responses to possible internal conflicts and remove the anxiety associated with experiencing PE.
DE and anejaculation are when someone experienced either a delay or infrequent or a complete absence of ejaculation. This needs to be experienced almost every time sexual activity takes place.
Organic causes of DE can be linked to drugs such as anti-anxiolytics or blood pressure. All medication has side effects, and any medication linked to brain or cardiovascular issues has the potential to affect sexual function. Any spinal cord injury or nerve damage may be a cause of DE.
Psychological factors are often linked to anxious thoughts of various nature or fear of something.
Anejaculation is the complete absence of ejaculation which can be antegrade (experienced in most cases, ejaculation happens through the penis externally) or retrograde (this is when the semen travels backwards into the bladder rather than progressing through the penis).
True anejaculation has always a biological cause linked to either nerve damage or drug use.
Anejaculation may be experienced as a result of anorgasmia (unable to reach orgasm). In this case, physical factors may be an issue but psychological factors may also be part of the problem.
Finally, low desire… this is when someone experienced little or no desire for sexual activity or is unable to trigger any thoughts or fantasies of sexual nature which lead to little or no sexual activity.
Testosterone levels are one of the first checks to be made, but any other medication may have side effects which could impact desire (for example anti-anxiolytics such as SSRIs).
Exploring through therapy the psychological and social impact of potential causes are usually an important part of the treatment, including exploring sexual identity and reflecting on possible asexuality.
Taking a holistic approach to explore all the aspects which may be interacting with sexual functions is critical to resolving the issues and finding sexual wellbeing.
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