Normal Ejaculation

Mechanism of Ejaculation:

The glans carries the nerve endings that feel physical stimulation. The impulses are transmitted to the spinal cord to the ejaculation center which relays the impulse to the outgoing nerves that set ejaculation to start after a certain amount of stimulatory impulses.

This normally occurs after a variable period that is a minimum of 3-5 minutes. This period usually becomes longer with advancing age.

The volume of the ejaculate varies from 2-5 cc. This too decreases with age, and so does the force of ejaculation that may finally be lost in the elderly and semen is more or less spilled rather than ejaculated. This is natural.

Semen is white. Prosemen is transparent. Prosemen is the scanty fluid that comes out of the penis at sexual stimulation and is different from semen that is ejaculated at the end of intercourse.

What is Premature  Ejaculation / Rapid Ejaculation?

Premature ejaculation / Rapid ejaculation is inability to delay ejaculation until satisfaction of the female partner. This has no time limit and it depends on the interaction of the male and female, but a duration of intercourse of 3-5 minutes is within normal.

What causes Premature ejaculation / Rapid ejaculation?

The main causes of Premature ejaculation / Rapid ejaculation are infections of the prostate or seminal tract, hypersensitivity of the glans or the dorsal nerve that conveys sensation from the glans, or lack of experience with faulty method of sexual intercourse such as too rough intercourse without adequate foreplay and in the absence of lubrication of the vagina.

What is the treatment of Premature ejaculation / Rapid ejaculation

 

Medications:

1-Treatment of Infection:

Infections, especially those of the prostate, can cause premature ejaculation. They may or may not be associated with painful urination or ejaculation. They may also be associated with genital infections of the female partner.

When infection occurs, antibiotics are necessary to cure it. However, in many instances, bacteria can escape the effect of some antibiotics but remain sensitive to others. Culture and sensitivity is when an infected sample (semen, prostate, urine..etc) are examined in the laboratory for the effect of various antibiotics  on the bacteria within, to determine which antibiotic is more effective in treating the infection.

Frequently, infection is detected in both partners; the male and female. This is because the prostate contributes to part of the semen volume and is transferred at sexual intercourse to the lady. Antibiotics may this be necessary for both partners.

2-Desensitization towards ejaculation:

The glans carries the nerve endings that feel physical stimulation. The impulses are transmitted to the spinal cord to the ejaculation center which relays the impulse to the outgoing nerves that set ejaculation to start after a certain amount of stimulatory impulses. The spinal ejaculation center is under control of the brain. The brain in turn is under control of stimulatory and inhibitory chemicals (neurotransmitter). "Serotonin" is a neurotransmitter that inhibits the sexual wave in the brain, and if in excess will cause the brain to inhibit the ejaculatory center in the spinal cord with a resultant delay in ejaculation.

Serotonin-Reuptake Inhibitors (SSRI's) is a category of medications that increase serotonin in the brain. The are originally used as anti-depressants, but are also used under medical supervision for delaying ejaculation. Medical supervision is important to determine the dose and combination of medications so that the inhibitory effect of SSRI's will not abolish sexual behavior all together.

3-Local Anesthetics:

Local anesthetics are used to decrease the sensitivity of the glans and thus delay ejaculation. They are available as sprays, gels and ointments. They have to be applied to the penis after erection occurs and not before that, since if they are applied too early, erection may not occur at all. They should also be left on the glans before intercourse for a few seconds for their effect to start, otherwise they will be washed away by the friction that occurs upon intercourse. A downside of local anesthetics is that they may cause temporary anesthetization of the female genital track if applied in excess.

 

4-Condoms:

Condoms protect the glans from feeling part of the physical stimulation, thus they can delay ejaculation to variable degrees depending on their thickness and whether or not they contain anesthetic medication.

 

Surgery:

Two surgical procedures are feasible for delaying ejaculation. Both procedures can be performed stand-alone or in combination:

1-Dorsal Neurectomy:

The dorsal nerve of the penis conveys sensation from the glans to the ejaculatory center of the spinal cord. It courses on the upper surface of the penis as two trunks that branch into a number of branches as they approach the glans. If one or more of those branches is cut, sensitivity of the glans will be decreased but still preserved. This is performed through a 5-10mm incision on the upper surface of the penis, and requires 15-30 minutes operative time, and requires no hospital stay at all.

2-Glans Augmentation:

A  number of "Fillers" can be injected into the glans to increase its volume and improve its cosmetic look. These fillers have been found to decrease sensitivity of the glans. Thus, glans augmentation can be performed to increase the size of the glans and decrease its sensitivity. The procedure takes 15-30 minutes operative time and requires no hospital stay. Fillers are self-absorbed and disappear within 1-5 years following injection, but they can be re-injected whenever they are absorbed, every 2-3 years for example.

Correct Sexual Technique:

1-The speed and force of intercourse are detrimental for the speed of ejaculation. Slow down!

Keep intromission at a low rhythm until the moment you see your partner close to orgasm: Speed up. Until then, maintain a slow rate, and make it even slower upto stopping temporarily if you feel that you are close to ejaculation before you desire to.

2-Squeeze technique:

Some men can have ejaculation delayed if they or their partners squeeze the glans firmly between thumb and index.

3-Ejaculation Delaying Exercises:

The muscle responsible for delaying and preventing ejaculation is the same one used to stop urination while urine is already flowing. This muscle can be contracted and relaxed voluntarily (at one's wish). Every muscle can be strengthened by contracting and relaxing it repetitively. Thus, if one contracts and relaxes this muscle repetitively (50 times for instance) on daily basis for a couple of months, this muscle will be stronger and one gains control over ejaculation.

4-The female has the same set of muscles that are capable of stopping urination. In the sexual context, these muscles are used to tighten the vagina around the penis. The lady can control those muscles and relax them to widen the vagina and decrease stimulation of the penis in order to prevent ejaculation from occurring prematurely. The male partner may require the vagina to tighten up when he desires to ejaculate or if he feels erection is fading. This can also be dome. Special signs and words can be agreed upon by both partners for the coordinating the balance between contraction and relaxation according to the desires of both partners.