Sexual Stamina: 10 Tips to Last Longer

Kristopher Bunting, MD

Updated on October 17, 2022

This article is a repost which originally appeared on healthnews.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Whether you have problems with premature ejaculation or you simply want sex to last longer, there are many ways to last longer in bed. Making sex last longer can involve maintaining an erection for longer, delaying ejaculation, and reducing the time to achieve another erection after ejaculating. There are a variety of ways to improve your sexual stamina and make sex more satisfying for both you and your partner.

Key takeaways:

‧ There are many ways to improve male sexual stamina, including medications and sexual techniques. Increased foreplay and emotional intimacy may also improve sexual performance.

‧ Medications for erectile dysfunction and premature ejaculation can improve stamina and sexual performance.

‧ Controlling sexual stimulation by using numbing sprays or gels, certain sexual positions, and other techniques can help men control when they orgasm.

How long should sex last?

Ideally, sex should last for as long as you want it to. Many people think of sex as penetration, but it can (and should) involve much more. Research shows that the average time until ejaculation during penetrative sex is between 5 and 6 minutes. For most people, achieving orgasm is the goal of sex. While 5 minutes of penetration (or less) will get many men where they want to get to, it takes longer for women to climax from penetration alone. So, how can you make sex last longer?

Foreplay

There is more to sex than just penetration and orgasm. Foreplay is important for mutual arousal; it gives you and your partner time to stimulate yourselves and each other. Take time to use all of your senses to get excited and prepare for the main event.

Kegel exercises

Kegel exercises can help both men and women strengthen pelvic floor muscles, improving continence and sexual function. A strong pelvic floor can help you control when you ejaculate.

Work on your relationship

Sex is both physical and mental. Both the body and the mind need to be stimulated and aroused to enjoy sex. Emotional intimacy plays a role in sexual arousal, especially in long-term relationships. Research has shown that emotional intimacy is linked to sexual desire. Furthermore, good communication in a relationship is linked to improved sexual satisfaction and decreased sexual dysfunction. Communicating sexual needs with your partner can improve sex and may help you last longer.

Medication

Medications used to treat erectile dysfunction (ED) and premature ejaculation (PE) can also improve sexual stamina. Commonly used antidepressants such as Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram), and other drugs that raise serotonin levels in the brain can help delay ejaculation. While this can be an unwanted side effect for some, it can help people with PE have more control over when they orgasm.

ED medications can help some men recover more quickly after ejaculating and may improve sexual performance in men without erectile dysfunction. Viagra (sildenafil), Cialis (tadalafil), and other erectile dysfunction medications improve blood flow to the penis. This allows men with mild to moderate ED to have firmer, longer-lasting erections. Remember, these are prescription medications; you should not take them without first being evaluated by a doctor. They can have extremely dangerous interactions with other medications, including nitrates taken for chest pain or amyl nitrate and amyl nitrite (poppers) taken recreationally.

Reduce stimulation

Topical anesthetics are used to treat PE and can help men delay orgasms. A variety of topical numbing creams, sprays, and personal lubricants are available that reduce stimulation of the penis, including condoms with numbing lubricant. However, these can cause skin irritation and discomfort in some people, so check with your partner before using a topical anesthetic.

Other ways to reduce penile stimulation and delay orgasm include wearing a condom and using more lubrication. Wearing a condom not only helps prevent sexually transmitted diseases and unwanted pregnancy, but it can also decrease stimulation of the penis, especially thicker condoms. Using lubrication during sex can reduce friction and stimulation.

Techniques to delay orgasm

There are a variety of techniques that can be employed to help delay orgasm and ejaculation. Techniques recommended for people with PE include the squeeze technique (gently squeezing the head of the penis for several seconds) and the start and stop technique (stop penile stimulation for 30 seconds). Other techniques include pausing and taking a deep breath or shifting your focus away from sexual sensations during sex. In other words, slow down and take a moment to rest before you reach orgasm.

Masturbating before sex can help delay ejaculation, but timing is important. Practicing edging, bringing yourself to the brink of orgasm while masturbating, can help you learn how to recognize when you are about to orgasm and allow you to practice techniques to delay orgasm.

Try something different

There are many Tantric and Taoist sexual practices that can help control ejaculation and improve sexual pleasure for men and their partners. The “sets of nines” technique is an easy way to control mutual stimulation. It involves performing 9 sets of 9 controlled thrusts, beginning with 9 shallow thrusts, followed by 8 shallow thrusts and 1 deep thrust, then 7 shallow thrusts and 2 deep thrusts, and so on, ending with 9 deep thrusts. It is a simple technique, but it is very effective for controlling ejaculation and building up sexual excitement.

Certain sexual positions can help control ejaculation, especially positions that allow for grinding, as opposed to thrusting. Partner on top positions, the lotus position, and the Coital Alignment Technique can maintain constant stimulation for your partner while limiting stimulation to the penis from thrusting. Explore the Kama Sutra and other books for tips on which positions can help you control when you orgasm.

Get healthy

Overall health affects sexual function; eating a proper diet and getting enough exercise can improve your sexual health. Obesity, type 2 diabetes, high blood pressure, heart disease—all of these conditions can affect sexual function and they can all be improved or prevented through diet and exercise.

You can improve your sexual stamina

There are many ways for men to improve their sexual stamina. Foreplay, communication, and emotional intimacy can improve sex. Medications, condoms, and lubricants can delay orgasm and reduce stimulation. A variety of techniques can help men control when they orgasm, including techniques used for premature ejaculation and certain sexual positions. Give some of these a try and find out what works best for you.

Resources:

1. Urology Care Foundation. Premature Ejaculation.

2. The Journal of Sexual Medicine. Original Research—Ejaculation Disorders: A Multinational Population Survey of Intravaginal Ejaculation Latency Time.

3. International Society for Sexual Medicine. Women’s Orgasm Takes Longer During Partnered Sex.

4. Mayo Clinic. Kegel Exercises for Men: Understand the Benefits.

5. Journal of Social and Personal Relationships. The Associations of Intimacy and Sexuality in Daily Life.

6. The Journal of Sex Research. Couples’ Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis.

7. Cleveland Clinic. Premature Ejaculation.

8. International Journal of Impotence Research. Sildenafil Does Not Improve Sexual Function in Men Without Erectile Dysfunction but Does Reduce the Postorgasmic Refractory Time.

9. Nature Reviews Urology. Sildenafil Improves Sexual Function in Men Without Erectile Dysfunction.

10. Mayo Clinic. Erectile Dysfunction: Viagra and Other Oral Medications.

11. Circulation. Drug Interactions With Phosphodiesterase-5 Inhibitors Used for the Treatment of Erectile Dysfunction or Pulmonary Hypertension.

12. Journal of Sex & Marital Therapy. The Coital Alignment Technique (CAT): An Overview of Studies.

 

Explained: Why men must not ignore sexual health problems

While as individuals, we are hardwired to share our issues with our near and dear ones, certain conversations still take place in hushed tones. Sexual wellness is one such topic. Since such issues are not spoken about and people refrain from seeking treatment due to a lack of awareness and right online platforms in the country.

IANS Updated Jul 24, 2022 | 06:43 AM IST

This article is a repost which originally appeared on TIMESNOW

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Men are usually hesitant to discuss sexual matters with others in a social setting.

· Professional consultations for sexual problems have more than doubled since 2020.

· Discussing sexual concerns can help to relieve stress and to discover potential solutions.

When was the last time you heard a man discussing his sexual wellness in a peer group or a social setting, or even with his loved ones? Chances are, you’ve never heard of such a thing. These conversations, while critical, just do not happen.
While as individuals, we are hardwired to share our issues with our near and dear ones, certain conversations still take place in hushed tones. Sexual wellness is one such topic. Since such issues are not spoken about and people refrain from seeking treatment due to a lack of awareness and right online platforms in the country.

Just like physical and mental well-being, men must take care of sexual wellness to lead a healthy and happy life. Thankfully, we’re on our way to speaking out loud about these issues as a society. Sexual wellness consultations increased by almost 139% in the year 2020 compared with the previous year.

1. Performance Pressure: Sexual health and effectiveness are taboo in society and specifically for men for various reasons. It is often assumed that sexual activity comes more naturally to men than women. While that is untrue, this notion gets even more troublesome when men aren’t able to perform in bed. Men suffer from performance anxiety a lot more than women, which is a leading cause of erectile dysfunction.

2. Erectile Dysfunction: The commonly used term for ED is impotence. The mere association of this word with men arouses discomfort in social circles and, more often than not, leads to a scarred image. But the problem is not as rare, just less talked about. As per the Massachusetts Male Aging Study, nearly half of the men in the age group of 40 to 70 face this issue due to reasons varying from arterial malfunction or other abnormalities that can be checked and treated. ED can be caused by endocrinological diseases such as prostate malfunction, hypogonadism or even diabetes. Trouble maintaining an erection could very well be caused by fibrosis or atrophy, which is a sufficiently organic process but could also be caused due to drugs or smoke. Another myth surrounding men’s sexual health is that ED is a psychological disorder. While the cause could be neurological, the issue definitely needs to be probed for clarity and subsequent treatment.

3. Low Libido: Libido comes naturally to all genders, given they’re in a suitable space in their head. Sexual pleasure is a recreational activity that does not need to be and ideally is not supposed to be imposed upon anyone. So, not being in the right mind space, like experiencing stress or anxiety, could lead to low libido. There could be very many reasons that need to get checked by an expert.

4. Premature Ejaculation: Generally, one out of three men has been known to complain about premature orgasm. This creates a lot of pressure upon men as they feel they’re somehow incapable of pleasing their women. This further causes a loss of self-confidence, adversely impacting their mental health and even leading to severe problems. Those days are gone when there wasn’t any scientific explanation for biological processes. Society has advanced a great deal to know for sure that there are underlying causes for many of the activities affecting sexual health. All the community collectively needs to do now is talk openly about sexual diseases and discomfort like other diseases. The bubble needs to burst now more than ever when we are experiencing a time when multiple genders exist in society.

Sexual pleasure, like any other need in life, is an individual’s responsibility. But acceptance in relationships plays a significant role in bringing that sort of communication out loud. This helps improve relationships and emotional health and leads to enhanced confidence and perspective in all aspects of life. Again, acceptance is the key in the end.

(Nilay Mehrotra, Founder & CEO of Kindly)

 

 

 

 

 

Dealing with Premature Ejaculation & Causes of Premature Ejaculation (from The Ultimate Guide To Male Enhancement)

Dealing with Premature Ejaculation & Causes of Premature Ejaculation

The following are two chapters taken from the book: The Ultimate Guide To Male Enhancement.

Edited for content

Chapter 12: Dealing with Premature Ejaculation

What is Premature Ejaculation?

The definition of what constitutes premature ejaculation may vary depending on the source, but it’s commonly accepted as a scenario where the length of time for sexual performance on the part of the male is unsatisfactory, by either the man or his partner. That being said, what constitutes premature ejaculation can be arbitrary. There is no set time that if you orgasm before it then you have premature ejaculation.

Consider this – the average time between arousal and ejaculation is typically three minutes for a man. Considering the
average time for a woman to orgasm is typically 13 minutes after arousal it can be seen how many men may think they have premature ejaculation, but really they are simply normal. With this in mind, you can see why foreplay is so important to satisfying a woman.


Phases of Ejaculation

There are two phases of ejaculation.

● The Emission Phase and

● The Ejaculatory Phase


Emission Phase:

Here are the physical processes which occur during the emission phase of ejaculation:

● The vas deferens begins to contract to move sperm from the testes toward the urethra and prostate gland.

● The seminal vesicles secrete fluids into the urethra

● Chemical messages activate the sympathetic nervous system and begin what’s known as the ‘point of no return’
(PONR). Ejaculation is inevitable at this point.


Ejaculatory Phase:


During the ejaculatory phase, the posterior portion of the urethra senses the sperm and secretions and sends a signal
to the spinal cord. This then sends messages to the muscles at the base of your penis. This causes said muscles to contract, which results in ejaculation.

Chapter 13: Causes of Premature Ejaculation

Premature ejaculation can be caused by any number of factors. These can be separated into two categories:


● Physical (which can include chemical side effects) and

● Mental (or psychological) causes.


It’s not uncommon for both some mental component to be present in physical cases of premature ejaculation. Worry
about the experience of premature ejaculation often compounds any physical components.


Physical Premature Ejaculation

The most common form of premature ejaculation is due to physical causes. The most common among these is negative conditioning. This is usually because most men masturbate in a hurried and furtive manner. Doing this repeatedly trains the body into ejaculating quickly, so it shouldn’t be surprising to understand how this can lead to issues.

If added stimuli like porn is used, it can further skew what you can expect from real sexual encounters. This then adds to anxiety, which further increases the possibility of premature ejaculation. The easiest way to correct this is to train in a manner contrary to negative conditioning. This will be discussed in detail further in the section.


Hormonal Issues

If you have low testosterone or abnormal levels of catabolic hormones this can have a drastic effect on your ability to maintain an erection. This can turn into premature ejaculation if you have to strive to get erect. It can be further compounded if your hormone imbalances induce negative emotions like anxiety. Diet and exercise is often recommended as a treatment for issues related to hormone imbalances; however, if do-it-yourself treatments aren’t effective, then a full blood work up is necessary to determine the cause of these imbalances.

Chronic and/or acute stress can lower levels of dopamine in the system. This can create a scenario where you can find it difficult just to get aroused even in the absence of anxiety. Stress management is key to helping treat this issue. The amino acid L-Tyrosine has been shown to be effective at helping to restore natural dopamine levels.


Infections

It’s been shown infections of the prostate and urethra may contribute to premature ejaculation. Infections usually require medical attention and antibiotics for treatment.

Pelvic Floor Issues


Pelvic floor spasms may contribute to premature ejaculation. If these symptoms are minor, rest and targeted stretching of the area should help to alleviate the issue. If the problem is more severe, this might require the services of a physical therapist for relief.


A strain in the pelvic floor may cause pain upon Kegeling and symptoms such as “hard flaccid”. Certain muscles like the ischiocavernosus can become perpetually strained. This leads to a difficult to resolve issue, as these muscles are involved in many different bodily functions. Due to this, it’s not easy to allow them to recover as you would if you immobilized an arm or even a leg. A strain may require targeted massage and heat. Specific yoga poses which specifically target the pelvic floor may help to speed healing as well.


A common cause of pelvic floor issues is due to abusing the Kegel. This includes the Reverse Kegel (contractile) exercise. It’s vital you start Kegeling by using only as much contractile force as is needed during any of the Kegel type movements. A limited number of reps should be performed as well and then slowly increased each session.


Prescription Medications

Some prescription drugs may cause premature ejaculation as one of their side effects. If this is the case, contact your physician or pharmacist to see if there are alternative medications.

Mental Premature Ejaculation

Premature ejaculation may be placed on the spectrum of erectile dysfunction, especially if the case is so severe that penetration becomes difficult or impossible. This is often the case if performance anxiety is involve. A common scenario will involve difficulty in obtaining an erection, with almost immediate ejaculation upon or even before penetration. This stage most commonly precedes impotence.

Anxiety, depression and stress are three of the leading mental causes of premature ejaculation. Sometimes, it’s a matter
of which came first though – the chicken or the egg – the premature ejaculation or the anxiety/depression/stress. It’s
not uncommon for men to suffer from these three common challenges without even realizing. It’s even more common for these challenges to surface, when there’s a concern about premature ejaculation.

The Ultimate Guide to Male Enhancement

Understanding male sexual health: More men now reporting low sex drive, Peyronie’s disease, finds study

Understanding male sexual health: More men now reporting low sex drive, Peyronie’s disease, finds study

Scientists found that earlier, more men were diagnosed with erectile dysfunction and premature ejaculation.

Myupchar July 20, 2020 22:17:59 IST

This article is a repost which originally appeared on Firstpost.

Edited for content

Male infertility is a topic that is rarely discussed. However, doctors have seen an increase in the number of male patients coming to sexual health clinics to seek help in recent years. Doctors have seen that different sexual health problems are being reported by men which were not prevalent before, also indicating more awareness and openness regarding male sexual health.

Different male sexual health problems

A study published in the journal International Journal of Impotence Research on 1 July 2020 stated that there has been a switch in the sexual problems which males complain about now.

The scientists accumulated complete data of 2,013 patients who were continuously evaluated by a sexual medicine expert between the years 2006 to 2019. The scientists found that 824 patients were assessed for erectile dysfunction, 369 patients were diagnosed with curvature of the penis (Peyronie’s disease), 322 patients had premature ejaculation, 204 suffered from low sex drive and the remaining 294 had other sexual dysfunctions.

In this study, the scientists found that earlier, more men were diagnosed with erectile dysfunction and premature ejaculation. However, more recently, men have been diagnosed with low sexual desire and Peyronie’s disease.

With the successful treatment options for erectile dysfunction such as Viagra and Cialis and awareness, men have been reporting more about other sexual dysfunctions as well.

Cap-Score: A test to find out sperm quality

Male infertility is one of the major reasons behind the increasing numbers of in-vitro fertilization (IVF) cases throughout the world. Earlier tests like semen analysis, also called seminogram, were done to find out the quality and ability of sperm to fertilize. However, due to the lack of an appropriate diagnostic test for evaluating the fertilizing ability of men, most of the infertility cases get classified as idiopathic or unexplained.

In a recent research article in the journal Reproductive BioMedicine Online, scientists from various universities in the US used Cap-Score to test the sperm capacitation of males.

Sperm capacitation is a natural process where the spermatozoa (motile male sex cell) changes its shape to be able to penetrate and fertilize the female egg. The Cap-Score is a test which determines the percentage of sperm that undergoes capacitation in a certain amount of time. Usually, 35 percent of sperms of a man with normal fertility would undergo capacitation.

In this study, the scientists took the sperm samples from 292 patients and tested their ability to reproduce with the help of traditional sperm analysis test and Cap-Score. Out of these patients, 128 couples became pregnant after three cycles of Intrauterine Insemination (placing sperm inside a woman’s uterus to facilitate fertilisation).

The scientists found that those with high Cap-Score were able to fertilize more efficiently and resulted in a higher number of pregnancies. The scientists also found that men who constantly questioned their fertility showed impaired or reduced capacitation ability.

Benefits of Cap-Score over traditional sperm analysis

Scientists found that traditional semen analysis is unable to identify impairments in fertilising ability, which typically leads to a diagnosis of idiopathic infertility. The scientists found that unlike the traditional semen analysis, capacitation is a better test which helps in determining whether or not there would be a successful generation of pregnancy.

Both these studies indicate that with better awareness of male sexual health issues, men choosing to report as well as get treatment for these diseases, and with the widespread adoption of better sperm analysis tests like the Cap-Score by the medical community, male sexual dysfunction and infertility can be better addressed globally.

For more information, read our article on Low Sperm Count.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

To light a fire you need all elements of heat, oxygen and fuel

To light a fire you need all elements of heat, oxygen and fuel

Article courtesy of Anthony_gerio

Edited for content

Many have overcome the PreE by applying some of the techniques advised on various forums. However, there are many cases which say despite putting an effort for a long time, they have not been successful in developing stamina. Often when I look at the posts (the ones which give some information) I see missing links.

To light a fire you need to provide all the necessary elements and without one of them (triangle of heat, O2 and fuel) you cannot generate fire.

The same is for improving ejaculation time. As frustrating as it could be, during the years you have developed your body mechanism in a way that you are not able to prevent ejaculation and thus you have to address all those situations in parallel and if you fail at one, there is a chance that your efforts will not result in satisfactory output. The very main elements that need to be worked on all together are:

– PF elongation and expansion: you need to be able to release and keep your PF released during intercourse. The best way experienced by successful people is to trying RKs (Reverse Kegels) and keeping a very very light RK for as long as a period you can (hours). Now you have find what is a RK, maybe you have been doing it all along during these years. It is worth to mention as much as you progress into your routine, your requirement for RK hold decreases.

– Flexibility and openness of the core: you need to have an open core as they are all connected to your PF and in particular if you are in a dynamic position during sex, any tightness can trigger you PF to react badly and more PF needs space to expand and tight hip is a barrier for it. The core includes all the muscles and ligaments connected to your PF.

– Glutes (Maximus, medium and piriformis)
– hip flexors
– hip abductors
– hip adductors
– hamstring
– lower and upper abs
– Obliques
– lower back (lumbar spine)

– Power and activation of the core: a power core helps you to keep a neutral position and gives you stamina for your the movements in intercourse. Power full abs help to keep the PF down, power full glutes automatically increase the power of the PF and activated Multifidus helps glutes to do their jobs (preventing back PF to lock in) during the sex. Glute max power and activation is a must for PF development.

– Remember that PF is at the centre of your hip and imbalances between hip flexion, hip extension and hip adduction and hip abduction significantly disturb and gets it out of balance. Any weakness in these areas should be addressed by training the muscles responsible for them.

– Memory: you need to remember what you need to do during the sex. Some as soon as the first kiss (I was like this once) loose every thing and their anatomy gets back to the mixed up situation. You need to know:

– keep your PF relaxed and down at all times (keeping a light RK could help initially)
– you need to feel your Transverse abdominal layer within the sex and not letting your abs to be fully deactivated. It is your tool to play with your PF.
– you need to play with glutes as well and keep your back PF expanded.
– you need to remember to breath, not necessary belly breathing which needs a lot of concentration itself (as much as you hear, hey you need to make it your own default) and just breath relatively calm and do not keep your breath.
– you need to keep out all the bad sex memories from the past, it doesn’t matter, you have changed, you have trained and you have overcome the physical aspects which was not your fault. Be in the moment.

I hope this would be of help to some and guide them that in order to see improvement as fast as possible, you do not have the luxury of overlooking any of the above aspects. And remember it may take time to make all the transformations, maybe half a year or more. It is important to be consistent in training and development.

 

Original thread: To light a fire you need all elements of heat, oxygen and fuel

Premature Ejaculation

Premature Ejaculation

What Is It?

Published: February, 2020

This article is a repost which originally appeared on Harvard Health

Edited for content

Premature ejaculation occurs when a man reaches orgasm and ejaculates too quickly and without control. In other words, ejaculation occurs before a man wants it to happen. It may occur before or after beginning foreplay or intercourse. Some men experience a lot of personal distress because of this condition.

As many as one in five men experience difficulty with uncontrolled or early ejaculation at some point in life. When premature ejaculation happens so frequently that it interferes with the sexual pleasure of a man or his partner, it becomes a medical problem.

Several factors may contribute to premature ejaculation. Psychological problems such as stress, depression and other factors that affect mental and emotional health can aggravate this condition. However, there is growing evidence that biological factors can make some men more prone to experience premature ejaculation.

Rarely, premature ejaculation can be caused by a specific physical problem, such as inflammation of the prostate gland or a spinal cord problem.

Symptoms

The key symptoms of premature ejaculation include:

  • Ejaculation that routinely occurs with little sexual stimulation and with little control
  • Decreased sexual pleasure because of poor control over ejaculation
  • Feelings of guilt, embarrassment or frustration

Diagnosis

Premature ejaculation is diagnosed based on typical symptoms. To understand your problem, your doctor will need to discuss your sexual history with you. Be frank and open. The more your doctor knows, the better he or she can help you.

If your sexual history fails to reveal significant mental or emotional factors that may contribute to premature ejaculation, your doctor may want to examine you. Your doctor may examine your prostate or do neurological tests (tests of your nervous system) to determine if there is a physical problem that could be causing premature ejaculation.

Expected Duration

Sometimes, premature ejaculation goes away on its own over weeks or months. Working to relieve stress or other psychological issues may help the situation to improve.

Other men have lasting difficulties with premature ejaculation, and require professional help. Some men respond to treatment promptly, while others struggle with this problem over a prolonged period. Effective treatment is available.

Prevention

There is no known way to prevent premature ejaculation. However, you should consider the following advice:

  • Maintain a healthy attitude toward sex. If you experience feelings of anxiety, guilt or frustration about your sex life, consider seeking psychotherapy or sexual therapy.
  • Keep in mind that anyone can experience sexual problems. If you experience premature ejaculation, try not to blame yourself or feel inadequate. Try speaking openly with your partner to avoid miscommunication.

Treatment

Behavioral therapy is one possible approach for treating premature ejaculation. Most commonly, the “squeeze technique” is used. If a man senses that he is about to experience premature orgasm, he interrupts sexual relations. Then the man or his partner squeezes the shaft of his penis between a thumb and two fingers. The man or his partner applies light pressure just below the head of the penis for about 20 seconds, lets go, and then sexual relations can be resumed. The technique can be repeated as often as necessary. When this technique is successful, it enables the man to learn to delay ejaculation with the squeeze, and eventually, to gain control over ejaculation without the squeeze. Behavioral therapy helps 60% to 90% of men with premature ejaculation. However, it requires the cooperation of both partners. Also, premature ejaculation often returns, and additional behavioral therapy may be needed.

Another possible treatment is prescription medication that helps to delay ejaculation. Delayed orgasm is a common side effect of certain drugs, particularly those used to treat depression. This is true even for men who are not depressed. When this type of medication is given to men who experience premature ejaculation, it can help to postpone orgasm for up to several minutes. Drugs used for this type of treatment include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft); and tricyclic antidepressants, such as clomipramine (Anafranil).

Some men with premature ejaculation may benefit from drugs called phosphodiesterase inhibitors, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). A phosphodiesterase inhibitor can be used alone or in combination with an SSRI. One drug should be started at a time, preferably at a low dose.

Some men with premature ejaculation also benefit from reducing the stimulation they experience during sex. A number of creams are available that can partially anesthetize (numb) the penis and reduce the stimulation that leads to orgasm. Another option is to use one or more condoms. However, these techniques may interfere with the pleasure experienced during sex.

When To Call a Professional

Speak with your doctor if you consistently ejaculate before you want to. Remember, one instance of premature ejaculation does not mean that you have a condition that requires treatment. Your doctor may refer you to a sex therapist if premature ejaculation is causing major problems in your sex life or personal relationships or if you would like to consider behavioral therapy.

Prognosis

Many men experience a brief period of premature ejaculation, then improve on their own. Even for men who require medical treatment, the outlook is usually good.

Male Sexual Worries: Trends in the Post-Viagra Age

Male Sexual Worries: Trends in the Post-Viagra Age

This article is a repost which originally appeared on SciTechDaily

Edited for content

Trends in reasons for visiting a the San Raffaele sexual health clinic. Credit: This diagram appears with the permission of the authors and the International Journal of Impotence Research. The EAU thanks the authors, and the journal for their cooperation.

Scientists report a change in why men seek help for sexual problems, with fewer men complaining about impotence (erectile dysfunction) and premature ejaculation, and more men, especially younger men, complaining about low sexual desire and curvature of the penis (Peyronie’s disease).

Presenting the work at the European Association of Urology (virtual) Congress, after recent acceptance for publication, research leader Dr. Paolo Capogrosso (San Raffaele Hospital, Milan, Italy) said:

“Over a 10 year period we have seen a real change in what concerns men when they attend sexual health clinics. This is probably driven by greater openness, and men now accepting that many sexual problems can be treated, rather than being something they don’t want to talk about.”

The success of erectile dysfunction treatments such as Viagra and Cialis, and the availability of new treatments, means that men facing sexual problems have now have treatments for sexual problems which weren’t available a generation ago. Now researchers at San Raffaele Hospital in Milan have studied why men come to sexual health clinics, and how this has changed over a 10-year period.

In what is believed to be the first research of its kind, the scientists questioned 3244 male visitors to the San Raffaele Hospital Sexual Health Clinic in Milan over a 10 year period (2009 to 2019), and classified the main reason for the visit. They found that the number of patients visiting with erectile dysfunction problems increased from 2009 to 2013, then started to decrease.

There were comparatively few patients complaining of low sex drive or Peyronie’s disease in 2009, but complaints about both of these conditions grow from 2009 to the end of the study. In 2019 men were around 30% more likely to report Peyronie’s disease than in 2009, and around 32% more likely to report low sexual desire.

The amount of men complaining of premature ejaculation dropped by around 6% over the 10-year period. The average age of first attendance at the clinical also dropped, from a mean of 61 to 53 years.

“Erectile dysfunction is still the main reason for attending the clinic, but this number is dropping, whereas around 35% of men attending the clinic now complain of Peyronie’s disease, and that number has shown steady growth,” said Paolo Capogrosso. “Our patients are also getting younger, which may reflect a generational change in attitude to sexual problems.”

Dr. Capogrosso continued “We need to be clear about what these figures mean. They do not indicate any change in the prevalence of these conditions, what they show is why men came to the clinic. In other words, it shows what they are concerned about. The changes probably also reflect the availability of treatments; as treatments for sexual conditions have become available over the last few years, men are less likely to suffer in silence.”

These are results from a single centre, so they need to be confirmed by more inclusive studies. “Nevertheless there seems to be a growing awareness of conditions such as Peyronie’s disease, with articles appearing in the popular press*. In addition, we know that the awareness of this condition is increasing in the USA and elsewhere, so this may be a general trend,**” said Dr. Capogrosso.

Commenting, Dr Mikkel Fode (Associate Professor of Urology at University of Copenhagen), said:

“Although these data are somewhat preliminary as they stem from single institution they are interesting because they allow us to formulate several hypotheses. For example the drop in men presenting with erectile dysfunction may mean that family physicians are becoming more comfortable addressing this issue and that the patients are never referred to specialized centers. Likewise, the simultaneous drop in age at presentation and increase in Peyronie’s disease and low sex drive could indicate that both men and their partners are becoming more mindful to optimizing their sex lives. I will be very interesting to see if these trends are also present in other centers around the world.”

Dr. Fode was not involved in this work, this is an independent comment.

References:

* “Trends in reported male sexual dysfunction over the past decade: an evolving landscape” by Edoardo Pozzi, Paolo Capogrosso, Luca Boeri, Walter Cazzaniga, Rayan Matloob, Eugenio Ventimiglia, Davide Oreggia, Nicolò Schifano, Luigi Candela, Costantino Abbate, Francesco Montorsi and Andrea Salonia, 1 July 2020, International Journal of Impotence Research.

** “The Prevalence of Peyronie’s Disease in the United States: A Population-Based Study” by Mark Stuntz, Anna Perlaky, Franka des Vignes, Tassos Kyriakides and Dan Glass, 23 February 2016, PLOS ONE.
DOI: 10.1371/journal.pone.0150157
PMCID: PMC4764365

A Doctor with Hard Flaccid – Updates and Advice

A Doctor with Hard Flaccid – Updates and Advice

by Romero MD

Original post: A Doctor with Hard Flaccid – Updates and Advice

Hi everyone I am 26 years old and I recently developed this mythical problem called Hard Flaccid.
I am a medical doctor. I finished medical school a few months ago, and I am currently applying for Obstetrics-Gynecology.

First, my story. I have been practicing PE, intermittently, for the past 4-5 years. Basically, only manual stretches (I am satisfied with my girth), but, like many others, I think my injury was caused by Edging and excessive Kegeling, which I have been practicing for over 10 years, for stamina training and erection quality.

And without knowing the extreme importance of Reverse Kegeling. Every time I have sex, I also do intense kegels, in order to last 60-90 minutes of penetration. I know, I know… maybe it’s a little too much… But my girlfriend and I have always liked long love sessions Almost 2 months ago, while I was having sex with my girlfriend, I started to lose my erection suddenly, after performing an intense Kegel, during a sex position that placed my penis at a downward angle (so, I did a “very weighted Kegel”).

I thought I might have torn a muscle or ligament, and we stopped at that moment. The next day, I woke up with a hyper contracted and cold penis. As it didn’t seem to be a penile fracture, nor did I have any skin lesions, hemorrhages or bruises, I decided to simply rest. Because I thought that any fellow urologist would tell me to simply do the same – to rest.

After two weeks of online research, I discovered my diagnosis – Hard Flaccid/CPPS. However, I only have/had symptoms related to the anterior/superficial pelvic floor (Ischiocavernosus and Bulbocavernosus Muscles). I don’t have pelvic pain, difficulty passing stools or other posterior/deep pelvic floor symptoms. But I have/had:

– Sudden erectile dysfunction (9-10/10 to 4/10)
– Sudden premature ejaculation (90min to 3-5min)
– Hyper contracted penis (Hard Flaccid). Which improves sitting, lying down, with Reverse Kegels and with heat; and worsens standing, with physical activity, with Kegels and with Involuntary Kegels
– Cold and soft glans (sometimes scrotum and penis too)
– Mild urinary retention
– Loss of morning and spontaneous erections
– Slight bend of the penis to the left, from the base of the shaft. (IC injury?)
– Slight downward curvature of the penis, from the middle of the penis (BC injury?)
– And a slight twist of the entire shaft, clockwise (IC injury?)

The next day, I visited the Urology Department at my hospital. I was observed by 4 urologists. As expected, none of them had ever heard of Hard Flaccid… After explaining the whole story, situation and symptoms, I was medicated with:

– Ibuprofen (anti-inflammatory), for 7 days
– Cyclobenzaprine (muscle relaxant), for 30 days
– Tamsulosin (alpha blocker, to decrease all sympathetic nervous activity, stressful or non-stressful, to the pelvic floor), for 30 days
– Total sexual abstinence (masturbation and sex), for 30 days, which I was already doing for 2 weeks.
After these 30 days, I will have an appointment with one of the best Andrologist in my country, which will be on August 27

So, after 3 weeks, I have been doing a lot of research (books, websites, forums) … And, according to my symptoms, I am almost sure that I had/have a strain of the Left IC Muscle (and maybe the Left and/or Right BC), which is, consequently, contracting the anterior/superficial pelvic floor and the penile smooth muscle (giving rise to the Hard Flaccid and the shortening of the penis, while it is erect) and, consequently, compressing the pudendal nerve, dorsal nerve and pudendal arteries, giving rise to all the other symptoms.

And that’s why REVERSE KEGELS are so important for the progressive relief of all the symptoms.

Treatments. What I have done to recover:
– Ibuprofen, Cyclobenzaprine, Tamsulosin
– Extraordinary healthy eating (Proteins, vegetables and fruits. Very important in the recovery of any injury) and supplementation (Ginkgo Biloba, Ginseng, L-Arginine, Fish Oils, Vitamins E, D, C, B complex and Zinc)
No masturbation, no sex, NO PORN. And no pictures, no Instagram girls, nothing. Just hugs and kisses from the girlfriend. (Alright… We make love, but only with my hands and mouth. I don’t let her touch my penis… I was in this hardmode for 4 weeks. In the last week, I have been trying very light Edging (5 minutes of very light massage, very soft touches, always with REVERSE KEGEL), every other day, to give a little physiotherapeutic stimulation to the tissues. But without ejaculation (to avoid the Involuntary Kegels associated with orgasm, to keep my libido high and to increase the likelihood of spontaneous erections)

– Lots of REVERSE KEGELS/Front Reverse Kegels, throughout the day.
Very light and Soft Squeezes (“massages”) of the flaccid penis, while Reverse Kegeling, to help relax tissues, throughout the day.
Belly Breath Combos, Hindi Squats and Happy Baby, along with Reverse Kegeling.
– Light external massages, on the anterior/superficial pelvic floor
– 1 hour of STRETCHING (flexibility training) every other day – Pelvic Floor, Hamstrings, Psoas, Piriformis, Quadriceps, Adductors and Abs. (All along with Reverse Kegeling and Belly Breaths). Again, hardmode – Static, Dynamic and Weighted Stretches. I’m literally training to do the front and side splits.

HEAT. Heat relaxes muscles and dilates arteries, increasing blood flow and, consequently, relieving symptoms. I wear shorts, under my pants, during the day. When I get home, I wrap my lower body in a blanket and I use a hot rice sock sometimes. And I place a big and soft pillow under my buttocks, when I am sitting in my chair.

– Sleep. A lot. (Very important in the recovery of any injury)
– I am a very active person (running and weighted calisthenics), but I stopped this type of physical activity since the day of the injury (to avoid Involuntary Kegels). However, I am doing some bodyweight Squats and Hip Thrusts (along with Reverse Kegels) before stretching. I read somewhere that gluteal and posterior chain strength is also important.

ABSOLUTELY NO STRESS (!!!). I have always been a very calm and peaceful person, in all situations of my life. But, after reading that Hard Flaccid was highly influenced by stress and anxiety, I am now completely in a “ZEN state with the Universe” Buddhist monk style.

Not only to avoid any nerve discharge from the Sympathetic Nervous System to the pelvic floor (and, consequently, Involuntary Kegeling, which prolongs the contraction of the pelvic floor muscles, which worsens the compression of nerves and arteries), but also to prevent the rise of Cortisol and Adrenaline and, consequently, the drop in testosterone levels. And (as many of you claim) this is absolutely essential.

I was a little stressed during the first week (before I knew the real diagnosis) and my penis was terrible… Hard Flaccid like a rock, with a loss of 1.5inches in BPFL. After knowing that I really have to relax completely, I immediately felt the first improvements in 3-4 days.

However, on the other hand, I am very convinced that I did a muscle strain, at least, of the Left IC. Those left curvature and left twist… Hmmm… On August 27, I will ask for an MRI. If the radiologist tells me it is normal, I will try to take the images to more doctors.

So… after almost 2 months, I have improved a lot – Now, I only have hard flaccid if I’m standing. A few times, I don’t even have it standing. It happens when I get up after doing Reverse Kegels for a few minutes (or sitting for a while in a more comfortable position) and continue to do Reverse Kegeling while I’m standing. This was impossible 1 month ago.
– The morning erections are progressively coming back
– 3 days ago, I’ve managed to have a 8-9/10 erection during the mini Edging sessions.
– However, I still have a slight bend to the left and the clockwise twist, during erection (I no longer have the downward curve), and I lost about 0.5 inches in BPEL…

1- Now, I would like to ask Pegym’s brightest minds and everyone in this group who is still recovering from Hard Flaccid, what are the most recent updates on this disease/symptom? Regarding physical treatment, exercises, medications and supplements. What am I missing? Where can I improve to speed up recovery?

2- I have been thinking about starting to do a small daily session of Kegels/Front Kegels/IC kegels… In order to give a physiotherapeutic stimulus, just like any other muscle injury. But I’m afraid it could get worse… What’s your opinion? (See post 26)

3- What do you think about adding very light and soft manual penile stretches? (along with Reverse Kegeling) I feel a lot of relief with the soft squeezes. But, in these, the applied force is perpendicular to the penis. I’m not sure if extra parallel force will be beneficial for the tissues. (See post 26)

4- Okay, the last question might be a little funny, but I think it might be relevant. I think I have an injury mostly on the left side. So, is it more advisable to rest the penis in the left groin or in the right groin? It tends to get softer on the right, but naturally falls to the left. (See post 26)

Thanks a lot for reading my story Best regards to the entire PEGym community
And thank you so much, for saving me during the past 2 months UPDATES: post 21, post 23 (stress management), post 26, post 29, post 63, post 66 (HF & Stretching)

Male Sexual Worries: Trends in the Post-Viagra Age

Male Sexual Worries: Trends in the Post-Viagra Age

This article is a repost which originally appeared on SciTechDaily

Edited for content

Trends in reasons for visiting a the San Raffaele sexual health clinic. Credit: This diagram appears with the permission of the authors and the International Journal of Impotence Research. The EAU thanks the authors, and the journal for their cooperation.

Scientists report a change in why men seek help for sexual problems, with fewer men complaining about impotence (erectile dysfunction) and premature ejaculation, and more men, especially younger men, complaining about low sexual desire and curvature of the penis (Peyronie’s disease).

Presenting the work at the European Association of Urology (virtual) Congress, after recent acceptance for publication, research leader Dr. Paolo Capogrosso (San Raffaele Hospital, Milan, Italy) said:

“Over a 10 year period we have seen a real change in what concerns men when they attend sexual health clinics. This is probably driven by greater openness, and men now accepting that many sexual problems can be treated, rather than being something they don’t want to talk about.”

The success of erectile dysfunction treatments such as Viagra and Cialis, and the availability of new treatments, means that men facing sexual problems have now have treatments for sexual problems which weren’t available a generation ago. Now researchers at San Raffaele Hospital in Milan have studied why men come to sexual health clinics, and how this has changed over a 10-year period.

In what is believed to be the first research of its kind, the scientists questioned 3244 male visitors to the San Raffaele Hospital Sexual Health Clinic in Milan over a 10 year period (2009 to 2019), and classified the main reason for the visit. They found that the number of patients visiting with erectile dysfunction problems increased from 2009 to 2013, then started to decrease.

There were comparatively few patients complaining of low sex drive or Peyronie’s disease in 2009, but complaints about both of these conditions grow from 2009 to the end of the study. In 2019 men were around 30% more likely to report Peyronie’s disease than in 2009, and around 32% more likely to report low sexual desire.

The amount of men complaining of premature ejaculation dropped by around 6% over the 10-year period. The average age of first attendance at the clinical also dropped, from a mean of 61 to 53 years.

“Erectile dysfunction is still the main reason for attending the clinic, but this number is dropping, whereas around 35% of men attending the clinic now complain of Peyronie’s disease, and that number has shown steady growth,” said Paolo Capogrosso. “Our patients are also getting younger, which may reflect a generational change in attitude to sexual problems.”

Dr. Capogrosso continued “We need to be clear about what these figures mean. They do not indicate any change in the prevalence of these conditions, what they show is why men came to the clinic. In other words, it shows what they are concerned about. The changes probably also reflect the availability of treatments; as treatments for sexual conditions have become available over the last few years, men are less likely to suffer in silence.”

These are results from a single centre, so they need to be confirmed by more inclusive studies. “Nevertheless there seems to be a growing awareness of conditions such as Peyronie’s disease, with articles appearing in the popular press*. In addition, we know that the awareness of this condition is increasing in the USA and elsewhere, so this may be a general trend,**” said Dr. Capogrosso.

Commenting, Dr Mikkel Fode (Associate Professor of Urology at University of Copenhagen), said:

“Although these data are somewhat preliminary as they stem from single institution they are interesting because they allow us to formulate several hypotheses. For example the drop in men presenting with erectile dysfunction may mean that family physicians are becoming more comfortable addressing this issue and that the patients are never referred to specialized centers. Likewise, the simultaneous drop in age at presentation and increase in Peyronie’s disease and low sex drive could indicate that both men and their partners are becoming more mindful to optimizing their sex lives. I will be very interesting to see if these trends are also present in other centers around the world.”

Dr. Fode was not involved in this work, this is an independent comment.

References:

* “Trends in reported male sexual dysfunction over the past decade: an evolving landscape” by Edoardo Pozzi, Paolo Capogrosso, Luca Boeri, Walter Cazzaniga, Rayan Matloob, Eugenio Ventimiglia, Davide Oreggia, Nicolò Schifano, Luigi Candela, Costantino Abbate, Francesco Montorsi and Andrea Salonia, 1 July 2020, International Journal of Impotence Research.

** “The Prevalence of Peyronie’s Disease in the United States: A Population-Based Study” by Mark Stuntz, Anna Perlaky, Franka des Vignes, Tassos Kyriakides and Dan Glass, 23 February 2016, PLOS ONE.
DOI: 10.1371/journal.pone.0150157
PMCID: PMC4764365

Premature Ejaculation, What Is It?

Premature Ejaculation

What Is It?

Published: February, 2020

This article is a repost which originally appeared on Harvard Health

Premature ejaculation occurs when a man reaches orgasm and ejaculates too quickly and without control. In other words, ejaculation occurs before a man wants it to happen. It may occur before or after beginning foreplay or intercourse. Some men experience a lot of personal distress because of this condition.

As many as one in five men experience difficulty with uncontrolled or early ejaculation at some point in life. When premature ejaculation happens so frequently that it interferes with the sexual pleasure of a man or his partner, it becomes a medical problem.

Several factors may contribute to premature ejaculation. Psychological problems such as stress, depression and other factors that affect mental and emotional health can aggravate this condition. However, there is growing evidence that biological factors can make some men more prone to experience premature ejaculation.

Rarely, premature ejaculation can be caused by a specific physical problem, such as inflammation of the prostate gland or a spinal cord problem.

Symptoms

The key symptoms of premature ejaculation include:

  • Ejaculation that routinely occurs with little sexual stimulation and with little control
  • Decreased sexual pleasure because of poor control over ejaculation
  • Feelings of guilt, embarrassment or frustration

Diagnosis

Premature ejaculation is diagnosed based on typical symptoms. To understand your problem, your doctor will need to discuss your sexual history with you. Be frank and open. The more your doctor knows, the better he or she can help you.

If your sexual history fails to reveal significant mental or emotional factors that may contribute to premature ejaculation, your doctor may want to examine you. Your doctor may examine your prostate or do neurological tests (tests of your nervous system) to determine if there is a physical problem that could be causing premature ejaculation.

Expected Duration

Sometimes, premature ejaculation goes away on its own over weeks or months. Working to relieve stress or other psychological issues may help the situation to improve.

Other men have lasting difficulties with premature ejaculation, and require professional help. Some men respond to treatment promptly, while others struggle with this problem over a prolonged period. Effective treatment is available.

Prevention

There is no known way to prevent premature ejaculation. However, you should consider the following advice:

  • Maintain a healthy attitude toward sex. If you experience feelings of anxiety, guilt or frustration about your sex life, consider seeking psychotherapy or sexual therapy.
  • Keep in mind that anyone can experience sexual problems. If you experience premature ejaculation, try not to blame yourself or feel inadequate. Try speaking openly with your partner to avoid miscommunication.

Treatment

Behavioral therapy is one possible approach for treating premature ejaculation. Most commonly, the “squeeze technique” is used. If a man senses that he is about to experience premature orgasm, he interrupts sexual relations. Then the man or his partner squeezes the shaft of his penis between a thumb and two fingers. The man or his partner applies light pressure just below the head of the penis for about 20 seconds, lets go, and then sexual relations can be resumed. The technique can be repeated as often as necessary. When this technique is successful, it enables the man to learn to delay ejaculation with the squeeze, and eventually, to gain control over ejaculation without the squeeze. Behavioral therapy helps 60% to 90% of men with premature ejaculation. However, it requires the cooperation of both partners. Also, premature ejaculation often returns, and additional behavioral therapy may be needed.

Another possible treatment is prescription medication that helps to delay ejaculation. Delayed orgasm is a common side effect of certain drugs, particularly those used to treat depression. This is true even for men who are not depressed. When this type of medication is given to men who experience premature ejaculation, it can help to postpone orgasm for up to several minutes. Drugs used for this type of treatment include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil) or sertraline (Zoloft); and tricyclic antidepressants, such as clomipramine (Anafranil).

Some men with premature ejaculation may benefit from drugs called phosphodiesterase inhibitors, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). A phosphodiesterase inhibitor can be used alone or in combination with an SSRI. One drug should be started at a time, preferably at a low dose.

Some men with premature ejaculation also benefit from reducing the stimulation they experience during sex. A number of creams are available that can partially anesthetize (numb) the penis and reduce the stimulation that leads to orgasm. Another option is to use one or more condoms. However, these techniques may interfere with the pleasure experienced during sex.

When To Call a Professional

Speak with your doctor if you consistently ejaculate before you want to. Remember, one instance of premature ejaculation does not mean that you have a condition that requires treatment. Your doctor may refer you to a sex therapist if premature ejaculation is causing major problems in your sex life or personal relationships or if you would like to consider behavioral therapy.

Prognosis

Many men experience a brief period of premature ejaculation, then improve on their own. Even for men who require medical treatment, the outlook is usually good.

Additional Info

American Society for Reproductive Medicine
https://www.reproductivefacts.org/