But Premature Ejaculation (PE) is real. So how do you know if you have it? PE is characterized by ejaculation that always or nearly always occurs prior to or within one minute of penetration or is characterized by the inability to delay ejaculation on all, or nearly all, penetrations. In addition to this definition, the inability to delay ejaculation must cause uncomfortable or negative personal consequences, including frustration, distress and/or the avoidance of sexual intimacy to qualify as PE (Althof).
As I’ve previously written, many of the definitions we use in sexual medicine are based on a heterosexual model. This is the way that sex has been studied historically, but non-heterosexuals can experience PE as well, and I like to broaden this definition a bit. When talking about ejaculatory health, I find it useful to characterize PE as ejaculation that occurs within one minute of sexual activity, including anal sex, oral sex and even masturbation. PE is common in these situations, and it happens to a lot of men.
In fact, PE is the most common sexual dysfunction for males. The prevalence of PE has been reported as high as 30% depending on the population (Carson 2006). While many people consider PE to be a young man’s problem, PE can occur at any age (Rosen 2004).
When it comes to PE, there are two primary types – acquired and congenital. Simply put, that means that you may acquire the dysfunction at some point in your life (acquired) or you may be born with it (congenital). Individuals with the congenital version have always had a problem with controlling their ejaculations even from their first time masturbating. People who have the acquired type have experienced normal ejaculations at some point in their lives, but then they suddenly develop the inability to control or delay their ejaculations. Both types can be equally problematic and affect a person’s self-esteem and relationships.
There are currently no FDA-approved treatments for PE despite the prevalence of the problem, which means that the medical treatments that doctors prescribe are considered off-label.
Often, we first try to physically decrease the sensitivity of the penis. We can do this by using a topical anesthetic spray or a condom. Although these treatments can be effective, patients sometimes find them to be onerous and they report that these interventions can interfere with intimacy.
You may have heard of selective serotonin reuptake inhibitors (SSRIs) in relation to depression. However, this family of drugs known as antidepressants are also commonly prescribed to treat PE since a side effect of SSRIs is delayed ejaculation. For those who suffer from PE, these side effects are not negative at all! These medications can be taken daily, or they can be used right before sexual activity. It’s common for patients to experience PE as well as erectile dysfunction. In these cases, phosphodiesterase-5 inhibitors (drugs like Viagra and Cialis) can be helpful, too.
A pain medication called tramadol can also be used to help PE. This on-demand treatment basically dampens your brain’s processing of the genital stimulation that can lead to PE.
Non-medical interventions may be helpful for PE as well. Pelvic floor therapy, cognitive-behavioral therapy, psychotherapy and sex therapy can all be helpful in reducing the instances of PE and reducing the negative effects for those who suffer from it.
Delayed Ejaculation (DE), retrograde ejaculation (RE) and anejaculation are all conditions that are known as diminished ejaculatory disorders. Unfortunately, these types of disorders have not been studied as much as PE, but it’s useful to understand how they are defined.
DE is understood to be the inhibition of the ejaculatory reflex that results in reduced seminal fluid, the absence of seminal fluid and/or impaired ejaculatory contractions. With a prevalence of less than 5%, DE is not as common as PE (Perelman 2006, Jannini 2005). And while DE can happen at any age, the instances of DE become more common with increased age.
There’s no concrete definition as to what constitutes DE, but it has been suggested that the threshold should be set at the inability to ejaculate after 25- to 30-minutes of sexual stimulation (Di Sante 2016, McMahon 2014). Some factors that can contribute to DE may include depression, anxiety, past sexual trauma and relationship issues.
Biological issues can also be at play with DE, including alcohol or illicit drug use, the use of some medications, prior pelvic surgery, trauma, radiation exposure, neurological diseases and diabetes. Although there are many medical interventions available to treat DE, like PE, none are FDA-approved. Available treatments include certain drugs for Parkinson’s disease, some anti-depressants, certain stimulants and the administration of testosterone. There have only been small studies done on the efficacy of these interventions so there is no broad consensus on which ones work best.
Retrograde Ejaculation (RE) is when all or part of the ejaculate is expelled into the bladder instead of out through the tip of the penis. Most of my patients freak out a little when I explain RE to them, but it really isn’t painful, dangerous, or gross at all. The incidence of RE ranges from 0.3% to 2% among patients that attend fertility clinics which is the population most frequently studied for RE.
RE occurs when the bladder’s internal sphincter does not close all the way, which causes the flow of semen to travel backward during an ejaculation. Those who experience RE often tell me that their urine is a whitish color when they go to the bathroom after sex.
It’s not always obvious what the cause of this ejaculatory disfunction is, but we know that certain medications, including prescriptions for enlarged prostates, often contribute to instances of RE. Surgeries on the prostate can also cause RE which unfortunately is something that’s not always disclosed to patients prior to undergoing prostate surgery. There are no treatments that have been shown to be effective for RE. Stimulants and the injection of bulking agents like collagen have been tried as treatments, but data on these and other RE treatments are limited.
Anejaculation is the inability to ejaculate at all. Patients with this condition can produce sperm normally, but they cannot expel the semen even when they have proper stimulation. Only 0.2% of the population experience anejaculation, making it a relatively uncommon condition (Kinsey 1948). Like DE, anejaculation can be caused by a mix of physical and psychological factors. Luckily, anejaculation often occurs with normal orgasmic sensation, so patients are able to enjoy a full orgasm they just don’t have the ejaculate to show for it. That can be a strange and incongruous concept since we mostly associate an orgasm with cum, but even though the two are related, they don’t have to occur together. While some patients are distressed by anejaculation, others are not. However, it’s particularly problematic for those individuals who are trying to impregnate their partners.
When ejaculation causes pain, it can severely affect a person’s life. Agonizing pain is the absolute opposite of the intense pleasure you’re supposed to feel during ejaculation. Those who experience painful ejaculation often become disinterested in sex or masturbation. It can also lead to a concurrence of other sexual function issues including erectile dysfunction, low libido, anxiety and depression.
Painful ejaculation has been estimated to occur in 1% to 10% of men (Ilie 2007). The good news is that painful ejaculation is often a condition that isn’t permanent. This ejaculatory dysfunction can be brought on by a number of causes, including obstruction of the ejaculatory ducts, tightness in the pelvic floor muscles or connective tissues, infection, trauma or inflammation of the urinary or genital organs and some neurological conditions. Often, one or more of these issues occur at the same time. To treat this ejaculatory disfunction, we often administer antibiotics, pain medications and anti-inflammatory drugs or we suggest physical therapy. In some cases, surgery becomes necessary.
Popstar Labs ReviewThe pain felt from painful ejaculation can occur in different places on your body. Many patients say that they feel pain in their testicles, near their rectum, in the lower abdomen, in the groin area and in their penis. This pain can also be accompanied by changes in bowel movements or urination. Occasionally, but not always, patients will see blood in their semen when painful ejaculation occurs. The important thing to remember is that pain during ejaculation is never normal and it should always be followed up with a visit to your doctor.
It can be difficult to talk about ejaculatory issues, but as a urologist and sexual health professional, I can assure you – we’ve heard it all before. Ejaculatory disfunctions are really quite common and there are many treatments that can help. If you experience any changes in the timing of your ejaculations or volume of your semen, or you experience pain when you orgasm, it’s wise to be open and honest with your healthcare practitioner. We’re here to help!
Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJ, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). J Sex Med. 2014 Jun;11(6):1392-422.
Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho KF, McNulty P, Rothman M, Jamieson C. Premature ejaculation: an observational study of men and their partners. J Sex Med. 2005 May;2(3):358-67.
Much like the Loch Ness Monster or Bigfoot, the female orgasm can seem elusive. Despite all advancements in sexual health, the female orgasm remains for many a complete mystery. What do we have to do, get Scooby and the gang in on the job? Although, now that I think about it, I bet that Fred knows his way around 😏. Why is the female orgasm, or the “Big O '' shrouded in such mystery? Who can we call? Ghostbusters? Not quite. The answer is Popstar. While we may not know anything about ghosts, we sure as hell know a lot about busting. Popstar has the tips to make your woman say “oh” and help you reach the “big O”.
I know what you’re thinking? How is it 2024 and we still have questions about the female orgasm. Dr. Ruth is 95 years old for crying out loud. By now, every man should know how to satisfy their female partner. Well, culturally, the scientific community tasked with understanding sex is largely male-dominated and focused. The patriarchy strikes again.
Before we understand the how, we must understand the why. The reason for the male orgasm is pretty obvious. The male orgasm is directly tied to ejaculation for procreation. The male orgasm is like blowing on a dandelion, just spreading seeds. The only difference being you don’t get to make a wish. The male orgasm has a blatant evolutionary purpose.
The elusive female orgasm isn’t quite as obvious. One theory is that the female orgasm was primarily to induce ovulation. Somewhere along the line, evolution introduced spontaneous ovulation, where a woman’s ova are released without copulation. Translation: her eggs are released without knocking boots. With spontaneous ovulation, the female orgasm is free to make its secondary role its primary: pleasure.
With the female orgasm no longer having any evolutionary benefit, pleasure becomes the main focus, and can help bond women with their partners (assuming it is a duet and not a solo performance). Orgasmic pleasure, is well, for lack of a better word, orgasmic. The pursuit of pleasure can encourage women to have more sex, which one could argue circles back to its original evolutionary purpose. That being said, we are fully onboard for the pleasure over procreation impulse.
If you have been following our blog you know that we love to debunk a myth. We are practically the mythbusters of busting a nut. So what are some commonplace fables of the female orgasm. Probably the most common misconception is that orgasm through penetrative sex is common. *Game show buzzer incorrect sound*. Women are lucky in the sense that they have more than one way they can achieve orgasm: vaginally, through clitoral stimulation, or even through the cervix. If you or your partner are very talented, it can be a blend of all three. Sort of like a yummy sex smoothie!
In the past it was believed that women who could not achieve vaginal orgasm were “sexually dysfunctional” or “damaged”. Now we know that plenty of women do not orgasm from penetration and that orgasm can occur without penetration at all.
Another common myth is that orgasms don’t change. A lot of people think that a female orgasm is a sure fire thing. Well, honey, even Samanth Jones “lost” her orgasm. There are numerous factors that can affect a woman’s orgasm. A woman’s ability to achieve orgasm can change during their menstrual cycle. They can be more intense or less pleasurable, depending on the partner. Stress and certain medications can make it a bit more difficult for orgasms to occur. Naturally changes in the body such as menopause can also significantly impact pleasure and orgasmic potential.
Our next myth is that the inability to orgasm is a psychological problem. I’m almost certain a man made this one up. I think the connotation is the problem here. While there could be a psychological block stopping you from reaching a climax, there is nothing wrong with you psychologically. There’s a difference. There are numerous other factors that affect a woman's ability to achieve an orgasm. It could be a physical or emotional block, or a protective response to prior sexual trauma.
Just like there are health benefits to the big O, there are certain health issues that could hinder you from being able to climax. High blood pressure and diabetes can negatively impact blood flow to the genitals which can make orgasm challenging. There are numerous anti-depressants that are notorious for affecting a woman’s ability to climax. Hormone changes that can occur from certain birth controls, menopause, and even pregnancy can affect a woman’s libido, in turn, affecting the production of lubrication and the ability to climax. Certain surgical procedures can also mess with orgasm. Surgeries like hysterectomy, labiaplasty, and midurethral slings placed for incontinence can interfere with or sometimes render a woman incapable of achieving orgasm.
Anorgasmia, a condition where a person is physically unable to have an orgasm is not uncommon. It is estimated that 10-15% of women experience anorgasmia. Men can suffer from anorgasmia as well. To learn more about anorgasmia, check out our blog post here.
Moving onto our next myth: good sex equals an orgasm. I know I didn’t pay much attention in algebra, but I definitely must’ve zoned out during this lesson. This is false of course. First of all, what someone deems as “good sex” varies from person to person. Clitoral stimulation might be one woman’s must-have, another may need vaginal penetration, while another may prefer an emotional connection. Good sex can’t be defined universally.
