In the struggle for the opportunity to reproduce, an individual has to out-compete rivals and attract partners.
Sexual selection ultimately dictates who gets to pass their genes into the next generation. Reproduction is the end goal of evolutionary fitness, which is why orgasm evolved to be so pleasurable.
Why would you fight other males to the death if sex didn’t feel so great! Reinforcement and reward are the ultimate motivators of behavior. You can see why orgasm and ejaculation evolved to be amazing!
However, orgasm and ejaculation are two separate but linked physiological processes. Orgasm is a temporary sensation of intense pleasure that creates an altered state of consciousness. Ejaculation is a complex process of semen emission and expulsion that is ultimately responsible for procreation.
In nature, while animals are engaged in sex, they are in a vulnerable position. Rapid ejaculation allows them to get back to protecting themselves quickly. Humans are different because, in many societies, intercourse occurs for purposes other than reproduction.
Orgasm
There is no standard definition of orgasm. However, most of us know one when we feel one. We breathe quicker, our heart races, and our blood pressure rises. We feel the powerful and highly pleasurable, rhythmic pelvic muscle contractions and pulsation of the muscles located at the base of the penis (the ischiocavernosus and bulbocavernosus muscles).
The volume of ejaculate for a healthy man averages about ¾ teaspoon (3.7 ccs). When men are young, they can shoot semen 12 to 24 inches. The ejaculation force gives the sperm a headstart in their journey up the vaginal canal to the cervix and the awaiting egg. As men age, the expulsive force propelling the semen diminishes unless they exercise pelvic floor muscles. After the age of 50, this distance declines to 6 to 12 inches.
Intense and consistent Kegel exercises or the Emsella Chair can enhance the pleasure associated with orgasm.
The Quality and Intensity of Orgasm
Several factors influence the experience of orgasm.
The rhythm of intercourse—a rapid build-up usually results in less intense orgasms.
Testosterone levels drive libido—lower levels of testosterone are associated with less frequent and less intense orgasms.
Source of stimulation—orgasms from penile stimulation cause the contractions of four to eight different pelvic muscles. Orgasms from direct prostate stimulation cause the contraction of twelve different muscle groups, resulting in more intense orgasms that you feel throughout the entire pelvic floor. However, prostate orgasms require anal stimulation, which some men do not prefer.
Ejaculation occurs through the effects of adrenaline triggered by the stress response of the sympathetic nervous system. In contrast, the parasympathetic nervous system facilitates the relaxation response resulting in erections.
Hormones and neurotransmitters that play an essential role in ejaculation:
Interestingly, the exact trigger for ejaculation is unknown, but an entire symphony of biochemistry is occurring behind the scenes that coordinate the process and the experience:
Testosterone supports male sexual function, muscle tone, and especially libido.
Oxytocin (our bonding chemical) in the blood increases with male ejaculation as much as three times normal before returning to baseline 10 minutes after ejaculation.
Dopamine—(responsible for both pleasure and addiction) is vital for normal male sexual response.
Serotonin— low levels of serotonin likely (our feel-good, happiness chemical) inhibits ejaculation.
Nitric oxide— inhibits ejaculation, and researchers have investigated Nitric Oxide boosters as a treatment for premature ejaculation.
Significant steps in orgasm:
- Before the emission phase of ejaculation, the bladder neck closes to prevent semen from spilling into the bladder. If the bladder neck does not close, there is retrograde ejaculation.
- Next, white color prostatic secretions mix with sperm delivered through the vas deferens that starts at the testicle. Sperm and the prostate secretions combine to contribute 20% of semen volume.
- The seminal vesicle fluid, which is mostly fructose and pale yellow, makes up 80% of the total semen volume.
- Rhythmic contractions of the muscles of the pelvic floor and base of the penis propel semen through the urethral tube.
- Ejaculation requires nerve supply from the sympathetic nervous system.
Premature Ejaculation
Most of us watch James Bond movies, but we don’t assume we can do wild stunts like James Bond. However, many people, especially young men, base their expectations for their sexual performance on what they see in pornographic movies. They eventually learn that professional pornographic actors make these movies, and scenes often require multiple different takes. Besides, many of the stars use performance-enhancing medications to prolong erections.
Our survival instinct rewards early ejaculation, so it takes practice to prolong ejaculation. During intercourse, the typical time from vaginal penetration to ejaculation ranges from three to seven minutes for the average man, but fifty percent of men ejaculate within 2 minutes. Ejaculation within one minute of penetration is considered premature. Complicating matters is the finding that it takes men 5 minutes to climax on average, but it takes women 17 minutes, so there is an incentive for men to delay ejaculation.
4% of men ejaculate before penetration.
The International Society for Sexual Medicine defines premature ejaculation as a form of male sexual dysfunction characterized by ejaculation within one minute of penetration. The inability to delay ejaculation with nearly all vaginal penetrations can result in distress, frustration, and the avoidance of sexual intimacy. Premature ejaculation affects sexual confidence, relationships, and the satisfaction of both partners
Possible Causes of Premature Ejaculation
No one knows what causes premature ejaculation, but the levels of these substances contribute.
- Low Serotonin: Depressed levels of the neurotransmitter serotonin contribute to premature ejaculation.
- High Testosterone: High levels of testosterone are associated with premature ejaculation.
- Elevated Thyroid levels: Studies show that 50% to 70% of men with a hyperactive thyroid have premature ejaculation. After men take medication to normalize their thyroid hormones, their rate of PE declines to 15%.
What You Can Do About Premature Ejaculation
Try Over-the-Counter Remedies
- Lubricants: For many men, the intense friction of intercourse creates a rapid climax. A straightforward solution is to use a lubricant to reduce friction. I recommend a silicone-based lubricant, which can significantly cut down on friction. Less stimulation will give you more control.
- Condoms: A latex barrier between a man’s penis will also blunt sensations and help men stay in control. Several companies also make condoms with numbing medications like Lidocaine or Benzocaine in the inner lining of the condom, which further decreases sensation.
- Masturbation: Self-stimulating to climax 1 to 2 hours before sex is a common suggestion to take the edge off the drive for ejaculation.
- Numbing Creams: The principal ingredient in these creams or sprays is Lidocaine (or similar medication), a skin numbing agent. Decreasing the sensation of the penis makes it more difficult for a man to achieve orgasm. 5 to 10 minutes before penetration, a man sprays or rubs numbing cream on the underside of the head (frenulum) of the penis. It is important to wipe off the numbing cream before intercourse so that the numbing cream does reduce sensation for your partner. It is not uncommon for a man to last 1-4 minutes longer or more when using a delay spray like Promescent, Stud 100, or KY Duration.
- Herbal therapy: John’s Wort is a natural antidepressant that is recognized worldwide as a mood booster. The natural herb increases the amount of serotonin used by the brain. In addition to mood elevation, St John’s Wort improves premature ejaculation without the side effects of pharmaceutical antidepressants. There are potential interactions between St John’s Wort and medications metabolized by the liver, so check a site like drugs.com for possible conflicts.
- Nitric oxide has an inhibitory role in the ejaculation process. Nitric oxide booster supplements like AFFIRM and PDE-5 inhibitors such as Viagra have been investigated as a treatment for premature ejaculation.
- Caffeine: One study from the University of Texas at Houston found that men who drank two cups of coffee a day were less likely to suffer from premature ejaculation
Combine with Sensory Therapy
- The start-stop technique is somewhat like sexual teasing that involves stimulating the penis until there is the urge to ejaculate, then stopping until the urge to ejaculate subsides, and then restarting.
- Masters and Johnson’s squeeze technique involves squeezing the head (glans) of the penis until the urge to ejaculate subsides.
- Tantric sex: The essence of tantric practice involves slowing down intimacy, coordinating your breathing with that of your partner, becoming exquisitely attuned to them, and then experiencing your sexuality together at that slower pace. This approach heightens pleasure and intimacy, adding a spiritual dimension to the experience.
…If That Doesn’t Work
Self-Guided Sensory Therapy
- Pelvic floor training: This approach involves learning to identify and control the pelvic muscles’ contraction in response to sexual arousal, sexual stimulus, increased penile pressure, and ejaculation.
Mind-Body
- Psychotherapy alone or with medication can help identify relationship and personal issues, leading to anxiety that may contribute to PE. Men can combine psychotherapy with medical treatment. A study conducted in Spain involving 157 patients compared treatment for PE using medication (dapoxetine) or psychotherapy or the two in combination. Initially, participants had a time to ejaculation of less than one minute. Medication extended the time to ejaculation to about 3 ½ minutes. In contrast, psychotherapy extended the time to about 7 ½ minutes.
Medications
- SSRI Antidepressants treat depression as well as premature ejaculation. SSRIs (selective serotonin reuptake inhibitors) include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). An eight-month study involving 480 men experiencing PE evaluated the effects of these four SSRI medications. The resultant delay in the climax was similar among the drugs, averaging 70 to 75 seconds. Side effects generally reported include possible decreased libido, fatigue, yawning, nausea, and diarrhea. Men have to take SSRIs every day to work.
- Fast Acting SSRIs: Priligy, also known as Dapoxetine, is an SSRI ideal for PE due to its short half-life. If taken 1-2 hours before intercourse, Priligy results in a 2-3 fold increase in control and satisfaction. The FDA did not approve Priligy for undisclosed reasons, and it is only available outside the US.
- Viagra and other PDE5 inhibitors reduce performance anxiety, increase nitric oxide release, lower levels of stress hormones (reduced urogenital sympathetic tone), and dilate the smooth muscle located in the vas deferens and the seminal vesicles. By reducing stress hormones, they theoretically can reduce PE.
Delayed Climax [or…Delayed Ejaculation]
A surprisingly broad range of factors can delay ejaculation.
Imbalances in hormones and body chemistry:
- As a man ages, ejaculation tends to take longer.
- Low testosterone or thyroid hormones can delay ejaculation.
- Drinking alcohol before sex can delay orgasm
- Medications can delay ejaculation. These can include 5 alpha-reductase inhibitors, alpha-blockers, anticholinergics, antidepressant drugs (including selective serotonin reuptake inhibitors), antiepileptics, antihistamines, antihypertensives, antipsychotics, anxiolytics, monoamine oxidase inhibitor, muscle relaxants, and opiates. Make sure you check the list of side effects of the medications that you take.
Issues with physical health:
- Infections of the urethra, prostate, or testicles can delay ejaculation.
- Conditions that affect the nervous system, such as diabetes, multiple sclerosis, pelvic radiation, pelvic trauma, prostate surgery, retroperitoneal surgery, or spinal cord injury, can delay or eliminate ejaculation.
- Physical or developmental abnormalities present from birth also can play a role.
Psychological Factors
- Depression and other types of psychiatric disorders
- Unrealistic expectation. There is a disparity between the reality of sex with a partner and their preferred sexual fantasy during masturbation for many men.
- Concern about pregnancy, performance anxiety, fear of intimacy, sexual orientation conflicts, shame, and guilt can delay orgasm.
What You Can Do About It
For men with delayed ejaculation causing personal distress, there are several treatment options to improve the situation.
Try This First:
Strengthening the pelvic floor:
Kegel exercise programs that strengthen the pelvic floor bolter the orgasm muscles. This resource from UCLA will explain how.
Exercises enhancing and coordinating mind-body responses:
Relaxation and breathing exercises allow you to focus better on pleasure. Tantric yoga is an excellent example of something which incorporates all the above techniques.
…If That Didn’t Work
Strengthening core muscles and the pelvic floor:
The Emsella Chair uses powerful magnetic fields to contract muscles. The FDA approved the chair to help women with incontinence, and it also has been shown to improve sexual function. The manufacturer developed a protocol for men that I am studying on men in my office. I hope that it will boost the intensity and duration of orgasm.
Make sure that your body chemistry is balanced:
- Check free and total Testosterone levels and make sure that they are adequate. I prefer my patients have levels at least 400 or higher.
- Test thyroid levels and replace thyroid hormones as needed.
- As we described earlier, antidepressant medications delay ejaculation. If this is an issue for you, consider alternative therapy to SSRIs.
Psychosocial therapies:
Sometimes there are underlying psychological issues that get in the way of orgasm. Visiting a sex therapist can help a man address his psychological issues that are getting in the way of climax. Suppose the problems are related to the couple’s interaction. In that case, couple’s therapy and the use of interactional techniques can improve the sexual experience by enhancing the interpersonal bonding in the relationship and the emotional quality of the sexual encounter.
In some cases, unrealistic sexual fantasies and images can make it difficult for real sex to live up to expectations. It is essential to readjust to ‘normal’ and ‘typical’ rather than the fantasy.
Male Vibrators:
In the same way that women can be stimulated to orgasm by vibrations, male vibrators help men achieve climax. I remember one couple who came to see me because it typically took 3 hours for the gentleman to ejaculate. I referred them to a website to purchase a male vibrator. When they returned to my office one month later, the wife brought me a bouquet of flowers. With the help of a male vibrator, he was able to achieve orgasm in about 20 minutes.
The Final Climax:
We’ve learned that the primary purpose of the male orgasm is a reward for battling other aggressive males for the right to reproduce. However, humans have evolved to achieve this pleasure strictly for the sake of enjoyment. Because of this, and the finding that on average, men climax in 5 minutes whereas women climax in 17 minutes, premature ejaculation has become a liability. I hope that the suggestions in this chapter are useful in prolonging ejaculation. However, it is also essential to incorporate and master other sexual techniques in addition to penetrative intercourse so that you and your partner will be satisfied. On the flip side, as men age, it can become difficult to achieve orgasm. However, there are also technologies and medications to assist in this endeavor as well. Please don’t be intimidated or ashamed of trying something new.
Congratulations on reading this and other articles in this series. It means that you take your sexual health seriously and seek advice from a reputable source. For more information, please visit www.brandeismd.com or www.affirmscience.com.
Stay tuned to Pornhub Wellness for additional articles. Please suggest other topics and send in your questions. In my 25 years, I have seen a lot, and if I don’t know the answer to your question, I will consult my colleagues. Your sexual health is vital.