Our Greatest Wealth Is Health

Andrew Siegel MD   9/1/2018

Ejaculation issues can be bothersome and distressing and sometimes even relationship-threatening. Most men do not particularly care for meager, weak-intensity ejaculation and orgasm, or if the process occurs too rapidly, or too slowly, or not at all. Functioning sexually—the ability to achieve a reasonable erection, ejaculate, climax and satisfy one’s partner—retains its importance no matter what our age.

Artwork above is photo taken of drawing in Icelandic Phallological Museum in Reykjavik

The word ejaculation (from ex, meaning “out” and jaculari, meaning “to throw, shoot, hurl, cast”) is defined as the discharge of semen from the urethral channel, usually accompanied by orgasm.

A Few Words on the Science of Ejaculation

Nerve input from the brain and the penis is integrated in the spinal ejaculatory center. Ejaculation occurs after sufficient intensity and duration of sexual stimulation passes an “ejaculatory” threshold—the “point of no return.”  The phases of ejaculation are emission and expulsion.  Emission releases pooled reproductive gland secretions into the urethra and expulsion propels these secretions via rhythmic contractions of the pelvic floor muscles.

The spinal ejaculatory center is controlled mainly by the neurotransmitters serotonin and dopamine. Serotonin inhibits ejaculation whereas dopamine facilitates it. One’s balance of these neurotransmitters is determined by genetics and other factors including age, stress, illness, medications, etc.

The processes of obtaining a rigid erection and ejaculating are separate, even though they typically occur at the same time. When the two processes harmonize, ejaculation is more satisfying.  This is so because the urethra functions as the “barrel” of the penile “rifle,” surrounded by spongy erectile tissue that constricts and pressurizes the “barrel” to optimize ejaculation and promote the forceful expulsion of semen.

Fact: It is possible to have a rock-hard erection and be unable to ejaculate, and conversely, to be able to ejaculate with a flaccid penis.

The pelvic floor muscles play a key role in ejaculation. The bulbocavernosus muscle engages when one has an erection and becomes maximally active at time of ejaculation. It is a compressor muscle that surrounds the spongy erectile tissue that envelops the urethra and contracts rhythmically at the time of ejaculation, sending wave-like pulsations rippling down the urethra to forcibly propel the semen, providing the power behind ejaculation.

Ejaculation Problems

• Premature ejaculation
• Delayed ejaculation
• Absent ejaculation
• Skimpy ejaculation volume
• Weak ejaculation force and arc
• Diminished ejaculatory sensation

Although premature ejaculation is often a problem of younger men, many of the other ejaculation issues correlate with aging, weight gain, the presence of prostate symptoms and erectile dysfunction. As we age, there is a decline of sensory nerve function, weakening of pelvic floor muscles, and diminished fluid production by the reproductive glands. Furthermore, medications and surgery that are used to treat prostate issues can profoundly affect ejaculation.

“It happens too fast”

Premature ejaculation (PE) is a condition in which sexual climax occurs before, upon, or shortly after vaginal penetration, prior to one’s desire to do so, with minimal voluntary control. It is the most common form of ejaculatory dysfunction. It often happens in less than one minute and leads to dissatisfaction, distress and frustration of the sufferer and his partner.

In a study of over 1500 men, The Journal of Sexual Medicine reported that the average time between penetration and ejaculation for a premature ejaculator was 1.8 minutes, compared to 7.3 minutes for non-premature ejaculators.

PE can be psychological and/or physical and can occur because of over-sensitive genital skin, hyperactive reflexes, extreme arousal or infrequent sexual activity. Other factors are genetics, guilt, fear, performance anxiety, inflammation and/or infection of the prostate or urethra, and can be related to the use of alcohol or other substances. It is very typical among men during their earliest sexual experiences.

PE can be lifelong or acquired and sometimes occurs on a situational basis. Lifelong PE is thought to have a strong biological component. Acquired PE can be biological, based on inflammation/infection of the reproductive tract or psychological, based upon situational stressors. PE can sometimes be related to erectile dysfunction, with the rapid ejaculation brought on by the desire to climax before losing the erection.

A variety of measures can be used to overcome PE. Slowing the tempo requires one to develop awareness of the sensation immediately before ejaculation. By slowing the pace of pelvic thrusting and varying the angle and depth of penetration before the “point of no return” is reached, the feeling of imminent ejaculation can dissipate. If slowing the tempo is not sufficient to prevent the PE, one may need to pause and stop thrusting so that the ejaculatory “urgency” goes away. Once the sensation subsides, thrusting is resumed. The squeeze technique, originated by Masters and Johnson, consists of withdrawal before ejaculation, squeezing the penile head until the feeling of ejaculation passes, after which intercourse is resumed. Although effective, it requires interruption and a cooperative partner. Pelvic floor muscle contractions are a less cumbersome alternative to the squeeze technique. Thrusting is paused temporarily and a sustained pelvic muscle contraction is performed, essentially an internal “squeeze” (without the external hand squeeze) that short-circuits the PE.

Other methods include using thick condoms to decrease sensitivity, or alternatively, topical local anesthetics can be applied to the penis before intercourse. Another desensitization technique is more frequent ejaculation, since PE tends to be more pronounced after longer periods of sexual abstinence. Pre-emptive masturbation prior to engaging in sexual intercourse may help achieve this. Erectile dysfunction medications can be helpful for acquired PE that is due to erectile dysfunction and certainly can help achieve a second erection after climax. Selective serotonin re-uptake inhibitors, commonly used for depression, anxiety, etc., have a side effect of substantially delaying ejaculation and are often used effectively for PE.

“It takes too long”

Delayed ejaculation (DE) is a condition in which ejaculation occurs only after a prolonged time following penetration. Some men are unable to ejaculate at all, despite having a rigid and durable erection.

DE can be problematic for both the delayed ejaculator and his partner, resulting in frustration, exhaustion, and soreness and pain for both partners. The sexual partner often feels distress and responsibility because of the implication that the problem may be their fault and that they are inadequate in terms of attractiveness or enabling a climax. The combination of not being able to achieve sexual “closure,” the inability to enjoy the mutual intimacy of ejaculation, and denying the partner the gratification of knowing that they can bring their man to climax is a perfect storm for a stressful relationship. As tempting as it is to think that DE is an asset in terms of pleasing your partner, a “marathon” performance has major shortcomings.

Interestingly, some men with this condition can ejaculate in an appropriate amount of time with masturbation. As well, some men can ejaculate in a normal time frame with manual or oral stimulation from their partner although they cannot do so with vaginal sexual intercourse.

Underlying medical conditions can factor in: hypothyroidism is strongly associated with delayed ejaculation, whereas hyperthyroidism is associated with premature ejaculation. Since serotonin and dopamine as well as other hormones and chemicals are involved with ejaculatory control, any drug that modifies their levels may affect ejaculation timing. As stated previously, selective serotonin re-uptake inhibitors delay can substantially delay or prevent ejaculation in a man without pre-existing ejaculation issues. Various neurological conditions that disrupt the communication between the spinal ejaculatory center and the brain/penis can also cause this type of ejaculatory dysfunction.

Fact: As with so many sexual dysfunctions, excessive focus on the problem instead of allowing oneself to be “in the moment” can create a self-fulfilling prophecy of failure.  In other words, if one goes into a sexual situation mentally dwelling and consumed with the problem, it is likely that this may spur on the problem. This goes for both premature and delayed ejaculation.

One solution is to avoid ejaculation for several days prior to intercourse, the same line of reasoning used for managing premature ejaculation by masturbating immediately before intercourse. Sexual counseling using sensate focus therapy has proven to be of benefit to some patients with DE.

“Ejaculation doesn’t happen”

Absent ejaculation happens with surgical removal of the male reproductive organs, as occurs with radical prostatectomy and radical cystectomy for prostate and bladder cancer, respectively. It can also occur in the presence of neurological disorders. In these circumstances, orgasm can still be experienced, although the ejaculation is “dry.”

 “Not much fluid comes out”

Skimpy ejaculatory volume is common with aging, as the reproductive organs “dry out” to some extent. It also occurs with commonly used prostate medications that either reduce reproductive gland secretions or cause the semen to be ejaculated backwards into the urinary bladder, a.k.a.,retrograde ejaculation. Even though ejaculation is backwards, the sensation tends to be unchanged.

“It dribbles out without force or much of a pleasant sensation”

What was once the ability to forcefully ejaculate a substantial volume of semen in an arc several feet in length associated with an intense orgasm gives way to a lackluster experience with a small volume of semen weakly dribbled out of the penis. These issues clearly correlate with aging, weakened pelvic floor muscles and erectile dysfunction.

Ways to Optimize Ejaculation

• Healthy lifestyle: Wholesome and nutritious eating habits and maintaining a healthy weight, regular exercise, adequate sleep, alcohol in moderation, avoidance of tobacco, and stress management will help keep all organs and tissues functioning well, including the ejaculatory “apparatus.”
• Pelvic floor muscle training: Strong pelvic floor muscles under good voluntary control can help control the timing of ejaculation as well as enable powerful contractions to forcibly ejaculate semen. Readers are directed to the Male Pelvic Fitness book that I wrote and the PelvicRx DVD (interactive DVD and digital access) that I co-created as excellent resources for learning how to properly pursue pelvic floor muscle training.  For more detailed and scientific information on the topic of pelvic floor training, please see a review article I wrote for the Gold Journal of Urology: Pelvic floor training in males: Practical applications.

Fact: The “ejaculator” muscle is the bulbocavernosus muscle,  also responsible for expelling the last few drops of urine after emptying your bladder.  Many men have both erection/ejaculation issues as well as an after-dribble of urination, called post-void dribbling.  Whip the bulbocavernosus into shape and you can improve all functions of the muscle. Note in image below (from 1909 Gray’s Anatomy, public domain) how this muscle surrounds the deep, inner part of the channel that conducts urine and semen.  When strengthened, this muscle will be you BFF in the bedroom!

Ejaculator muscle (in red)

• Breathe deeply and slowly: During sexual activity there is a tendency for shallow and rapid breathing or breath holding because of excitement and increasing sexual tension. Depth and rhythm of breathing can affect ejaculation with deep, full breaths optimal.
• Stay sexually active: All body parts need to be used on a regular basis, including our reproductive organs. Keep the erectile and ejaculatory muscles fit by using them as nature intended.

Wishing you the best of health,

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor