- Problems treating premature ejaculation
- Sex and relationship resources
- 7 Things To Do If He’s Finishing Too Quickly
- I Ejaculate Too Fast! How Can I Fix This?
- The Private Gym Blog
- The Most Common Male Sexual DIsorder
- Ages 18-30
- Ages 30-40
- Age 40-50
- Age 50-60
- Age 60-70
- Age 70-80
- Age 80-90
- Age 90-100
- How To Maintain Good Erectile Performance Over Time
- What is vasectomy?
- How does vasectomy work?
- Types of vasectomy
- Scalpel vasectomy
- No-scalpel vasectomy
- Does vasectomy affect your erectile function?
- Vasectomy and ejaculation
- Before vasectomy. How to prepare for the procedure
- After vasectomy
- Advantages and disadvantages of the vasectomy
- Is it safe? What are the risks associated with a vasectomy?
- Delayed complications of a vasectomy can include:
- Unfounded concerns related to vasectomy
- Does vasectomy protect you for sexually transmitted diseases?
- What are the contraindications of vasectomy?
- Is contraception mandatory after vasectomy?
- Can a vasectomy be reversed?
- Premature Ejaculation: Why Does It Happen?
- Premature Ejaculation
- What Is It?
- Premature ejaculation treatment
• Topical therapies
The most common topical therapy used to treat premature ejaculation includes:
- Anaesthetic creams may be effective.
- Options with evidence of efficacy are EMLA® cream and lidocaine gel.
- There are also so talks of aerosols but these are not commonly used.
💡 Behavioural and cognitive techniques for premature ejaculation have been shown to have a short term success rate of around 50-60 per cent, but are less effective in the long term.
Problems treating premature ejaculation
There are a number of obstacles which can prevent or impact premature ejaculation treatment:
- Patients are often embarrassed to talk about premature ejaculation or see their doctor.
- Doctors are often not trained on how to manage it successfully, which can lead to an unsatisfactory consultation. Patients will often have spent a long time gearing up to see their doctor to discuss it and if the outcome is poor, they are unlikely to come back.
- By the time many patients attend their doctors, the PE has already had a significant psychological impact on their sexual confidence and relationships. This can spill into other areas of life and leads to depression and breakdowns in relationships etc.
Sex and relationship resources
Don’t suffer in silence. If you are struggling with premature ejaculation, ask your doctor for help. For additional help and support with PE, try one of the following resources:
- NHS.UK: to check for any medical issues or be referred to a therapist, visit you local GP or local sexual health centre.
- College of Sexual and Relationship Therapists: find therapists that are able to work with any relationship or sexual issues on this directory.
- Association for the Treatment of Sexual Addiction and Compulsivity: if you feel you are affected by sexual compulsivity, try the ATSAC.
- Sexual Advice Association: a charity which aims to help improve the sexual health and wellbeing of men and women.
- The Institute of Psychosexual Medicine: the IPM is a registered charity which provides education, training and research in psychosexual medicine.
Last updated: 13-11-19
Dr Jeff Foster (BSc MBCHb MRCGP DRCOG) Men’s health specialist Dr Jeff Foster is a Men’s Health specialist, and one of the founders of TFJ Private GP Services in Warwickshire. Dr Foster completed an honours degree in Physiology at King’s College London.
7 Things To Do If He’s Finishing Too Quickly
Source: Troels Graugaard / Getty
Is your man always crossing the finish line before you do? Are you left feeling frustrated? Is this putting a damper on your sex life? According to sex and relationship therapist Marissa Nelson, you’re not alone.
“If you look at the statistics, men and women orgasm at completely different times. If you look at men, they orgasm anywhere between five to seven minutes on average and perhaps three to seven minutes depending on age. For women, that’s fifteen to twenty minutes, sometimes more. Women naturally take a longer time to warm the body up and experience some sexual pleasure, arousal and then orgasm. So if you’re dealing with a guy who is five minutes and a woman who is fifteen to twenty minutes, of course, there’s often going to be discrepancies.
Fortunately, there are ways to deal with this cruel trick that mother nature has played on us, and Marissa has the answers.”
Rule out any possible medical issues
“It’s so important for people to understand that if you’re in a relationship, it’s the couple’s issue, and the couple has to deal with it together. That means we should work towards ruling out biology. Let’s make appointments at our doctors and gynecologists and neurologists just to make sure that everything is where it needs to be. That should be something the couple is doing together.”
Forget about the orgasm (for now)
“We must shift the focus away from sex being about performance and orgasms to being about pleasure. Sex and sexuality are about intimacy and pleasure. It’s a place that you go. It’s something that you experience. That has to happen with surrender. That has to happen with openness. And it has to veer away from, “Oh my God, it’s been five minutes, and he came, and now I’m upset.” This happens a lot with the clients that I see. Sometimes, the guy ejaculates and the woman is still h-rny and aroused, and she wonders what to do with that sexual energy. There has to be a place where the couple focuses on pleasure.”
“The best way to shift the focus away from chasing an orgasm is to extend foreplay, which will increase pleasure. A lot of couples do not spend a lot of time on foreplay. They just jump into the main event. Women need that stimulation that turns the body on and essentially makes sex more pleasurable, so you don’t experience issues like vaginal dryness or discomfort or pain during sex, which happens often. You have to be able, as a couple, to come up with some sort of new way of exploring one another. Explore with touch, you know, different types of sensations, licking and biting and all of these different ways that we can rediscover our partner and enjoy the sexual experience outside of the orgasm.”
Take the pressure off of him
“The other thing for women to understand is that when it comes to men, outside of men just naturally finishing quicker than women do, a lot of times we can be tipping into premature ejaculation. If this is the issue, a couple of things need to happen. First, women need to be aware of this: excluding any biological factors like hypertension, diabetes, low testosterone—anything that’s going to affect biological and physical sexual functioning—erectile dysfunction and premature ejaculation are often anxiety based. They’re rooted in anxiety, especially with black men. Black men have been conditioned to think that as a black man, sex has to be about performance. It has to be about satisfying your partner and pleasing your partner, and that’s very entangled in their sense of manhood and their sense of self. But what happens when you’re in a situation with a partner, and you ejaculate before you would like to? Well, then that creates panic, that creates anxiety, which creates self-doubt. You know, ‘Oh my gosh, I came, and I can’t believe that that happened.’ And then, the mind chatter starts, and now he’s wondering if he pleased his partner—not to mention if the partner has a reaction to it. What happens after he ejaculates? Does the person just get up and walk away? Does the person not say anything? Does the person do their own thing? That can be a part of that feedback that then creates anxiety.”
Get out of your head and encourage him to do the same
“What I tell a lot of my clients is that if it’s the guy, we have to examine where this anxiety is coming from. I teach them to shift the sexual experience from thinking about performance and taking some of that pressure off. When there is more engagement and pleasure and play and enjoyment, and you’re doing that with your partner, it will be a process, but you’re having fun. You’re not in your head. With sexuality, you cannot be in your head. You have to be in your heart. You have to be in your loins. You cannot be in your head, and that’s what a lot of people do, and then they wonder why they’re not having the sex that they want to have. Well, honey, you are all in your head. You can’t be thinking, and thinking, and thinking, and thinking. You have to be feeling and experiencing.”
Tackle the issue as a team
“It’s important to note that when one person has a sexual issue, it’s not just their problem. It’s a relationship issue. It’s the couple’s problem. I can’t tell you how many times I have people come into my office like, ‘He doesn’t want to have sex or she doesn’t want to have sex. It’s their fault. I’ll be out in the waiting room.’ I’m like, ‘No, no, no! Please have a seat. Come on in, this is part of the growth!’ I really think it’s important that people move away from thinking, ‘Oh, my partner has erectile dysfunction. Oh, my partner doesn’t want to have sex. It’s their problem. They need to change.’”
Be willing to do the work
If the couples need to relearn ways of engaging each other with pleasure, that is what the couple is tasked to do. If the couple has to work on nonsexual touch—some people only touch each other when they want to have sex—then that’s what they have to do. If every time you touch me, it means that you want to have sex, I’m going to be skeptical every time that you touch me or try to be affectionate. It may be that couples need to learn to explore intimate and nonsexual touch to increase trust and vulnerability to have sex, then that’s what needs to happen. Couples need to be able to have these courageous conversations about sexuality and have a lot of empathy, openness, and compassion. Look at it through the lens of curiosity as opposed to criticism because that will kill the openness and the lines of communication going forward, and you don’t want that.
About Marissa Nelson: After years of serving as one of Washington, D.C.’s premier couples and sex therapists, Marissa Nelson and her husband decided to pack their bags and move to the Bahamas. There, Nelson founded Intimacymoons Couples Retreats, which offers specialized training in emotionally focused couples therapy, relationship therapy, and sexual health. To learn more, visit www.intimacymoons.com, www.instagram.com/intimacymoons, or www.twitter.com/xoxotherapy.
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I Ejaculate Too Fast! How Can I Fix This?
It sounds like you’re really struggling with these expectations you have for yourself. Let’s see if we can’t help you feel a little better about yourself.
First, let me see if I can’t put this in perspective a little by clearing up a misconception. The average time it takes someone with a penis to ejaculate once vaginal intercourse starts is just shy of around six minutes. Now, that’s just an average figure, and the numbers here can vary greatly depending on a lot of factors, including age (and you can read more on that here if you’re interested). And for much younger people, or sexually inexperienced people, ejaculation often happens more quickly than that. feeling really nervous about it and freaking out about how long you’ll last can also be a bit self-fulfilling and result in ejaculating sooner.
So, you may be on the faster end of the spectrum so far in your life, but you’re by no means as far from the average as you seem to fear. If you are still concerned about this from a medical standpoint, there’s no harm in talking this over with a doctor and getting checked out, of course. You might also feel better by having a conversation about it. You and a doctor or educator could also talk about some things to help you feel more comfortable or confident which might also extend this time when it comes to what you really want for yourself, things like masturbating before dates, using condoms, making sure you’re taking time with partners to build trust so you feel more comfortable with whatever happens during sex, or extending other kinds of sex before engaging in intercourse (which you can even extend to the point that your partner already feels satisfied and/or reaches orgasm before orgasm begins, which can take a lot of this pressure off).
But ejaculating quickly, in itself, is not necessarily a sign of a problem. Especially in an otherwise healthy young person.
With that said, what I would like to do here is not to give you tips on how to “last longer,” but rather on how you can frame this differently.
Firstly, you’ll want to try and not let yourself be influenced so much by what you think others expect in the bedroom, or what you assume others do in the bedroom. The truth is that our popular image of sex, the way sex is often portrayed in the media or on TV, is not actually how sex usually works in real life. Heck, often even the way that people talk about sex isn’t often the way that sex works in real life: Plenty of people exaggerate how long they “last,” because there is a very pervasive narrative in our culture of judging people based on that. However, that is not always very realistic. Plenty of people or the media also often present sex as being about intercourse alone or mostly, when in reality, people with satisfying sex lives they enjoy rarely are just having intercourse.
Let’s look at your idea that you roommate is having intercourse for an hour at a time. Aside from the fact that the vast majority of people with pensises will ejaculate before that, as you can see from the average numbers I mentioned above, intercourse that goes on for that long is also not likely to be very comfortable or awesome for the person with the vagina. Rather, people tend to switch things up and engage in various different forms of sex – such as manual sex or oral sex, for example. So, when it sounds like your roommate is going at it for an hour? They are probably not having intercourse that entire time. If they are, chances are that everyone in the room isn’t having the best time ever.
In this context, it is important to remember that intercourse is not the be-all-end-all of sex for most people. It is a sexual activity many people do engage in and enjoy, but it is not inherently better or more important or more meaningful than any other, nor the activity that equals satisfaction for everyone, no matter how long it goes on for. And since it is not necessarily and automatically the “climax” of sex, there is no need for sexual activity to be over just because you’ve ejaculated.
There are plenty of sexual activities that don’t require an erect penis — just like there are plenty that don’t require an erect clitoris — so you can switch back to something else after intercourse; or chose not to engage in intercourse at all and go for other activities instead. It’s all about what works best for you and your partner, after all.
It’s great that you are looking out for your partner and her enjoyment, as well. However, I see you making assumptions about what it is that will please your partners: that they are all interested in intercourse, and will feel pleasure only from that or that that alone will satisfy them. And, well, that’s just not sound. For one thing, women are individuals with individual likes and dislikes. Sure, plenty of women do enjoy intercourse, but there are also plenty of women who don’t like it very much — especially when that’s all or most of what’s happening — and plenty who can take it or leave it. So, it’s no good assuming that women, as a whole, require a specific activity in a specific way to feel pleasure. Rather, to know what the specific partner you are with wants and likes, you will have to ask her. She is the only one who can tell you, and if she is not sure yet herself, you can go exploring together.
Another thing to keep in mind is that, both due to anatomy and other factors, intercourse alone is actually not likely to bring someone with a vagina to orgasm. While the vagina has lots of sensory nerve endings right around the entrance, it doesn’t have very many at all further in, and the external clitoris has may more than either of those places — which often isn’t well-stimulated by intercourse alone — so it’s not surprising that about 80% of women won’t reach orgasm from intercourse alone or do so more than really. And again, that’s whether it goes on for a few minutes or 20 minutes. So, while, yes, some women enjoy intercourse very much, it is not likely the only thing that ever gets them off, and certainly not the only thing that creates pleasure. And for most women, your concerns about not pleasing them just because of this are displaced. Pleasing a partner is much more likely to be about other things — like how creative, responsive and communicative you are, and how much you don’t just focus on intercourse, really.
It’s also sound to remember that when it comes to big concerns about length of time to ejaculation or penis size, those are largely male concerns men have about themselves they project unto women (when they do), rather than concerns most women have. As well, any sexual partner you have is much more likely to feel disappointed by you being stressed out or bummed out than they are by when you ejaculate. And the great news about that is that changing our attitudes and ideas is something we have way more ability to do than changing how our bodies work.
Hopefully, what I’ve told you here will allow you to relax some and not place so much pressure on yourself (or your partners!). Sex is not an exam, and you are not failing at it if you ejaculate “too early.” Sex is about what brings pleasure to you and your partner throughout the whole experience, whatever that is at a given time – so, necessarily, it is completely individual and unique to your and your partner. And it’s about a lot more than your penis or when you ejaculate.
And because sex is so highly individual, and different every time and with every new partner, there is really no use worrying about it in advance. What someone wants or doesn’t want, what the unique chemistry is like between the two of you – those are things that you’ll discover in time. So my advice to you is to take a deep breath, and to relax. Go into encounters with an open mind, and communicate with your partners. Don’t make any assumptions about what they want and need, and try not to psych yourself out so much with “performing” in a specific way. Sex is supposed to be fun, after all.
Here are some more links that might be helpful for you:
- Be a Blabbermouth: The Whys, Whats and Hows of Talking about Sex with a Partner
- What’s Sex?
- An Immodest Proposal
- The Great No-Orgasm-from-Intercourse Conundrum
- What Makes Someone Good in Bed?
- Why Cory Loves Premature Ejaculation
The Private Gym Blog
Aging is often very unkind to male sexual function. Nobody informs us exactly what to expect with the process. Rather than proactively addressing them, we so often sit back and observe the changes as they unfold. Although erectile dysfunction is not inevitable, with each passing decade the statistics begin to work against you. By age 40 nearly 50% of men begin to experience erectile dysfunction. This number increases by 10% with each passing decade.
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The Most Common Male Sexual DIsorder
The numbers are similar for premature ejaculation – the most common male sexual disorder. With aging often comes less sexual activity, and with less sexual activity often comes disuse atrophy. The pelvic muscles, which support and control the penis, become weaker. The penis itself actually decreases in size over time. Weight gain and increased body fat with age further exacerbates the problem.
So, what can you expect of your sexual function as you age? Here’s a breakdown by decade of what may happen without pharmaceutical support or without the use of a pelvic muscle exercise program.
Your sexual appetite is prodigious and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection. You get erections even when you don’t want them. You wake up in the middle of the night and morning sporting a rigid erection. When you climax, the orgasm is intense and you are capable of ejaculating an impressive volume of semen forcefully with an arc-like trajectory. Even with such sexual power, there is often an Achilles heel. The number one male sexual disorder – premature ejaculation – plagues a very large percentage of young men.
Things start to change ever so slowly, perhaps even so gradually that you barely even notice them. Your sex drive remains vigorous, but it is not quite as obsessive and all consuming as it once was. You still get quality erections, but they may not occur as spontaneously. You may require some touch stimulation to develop full rigidity. While you still wake up in the middle of the night with an erection and experience “morning wood,” it doesn’t occur as frequently as it did when you were in your 20s. The time it takes to achieve another erection after ejaculating increases.
After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion you had two decades earlier. You can usually get a pretty good quality erection, but it now often requires touch stimulation. The gravity-defying erections don’t have quite the angle they used to. At times you may lose the erection before the sexual act is completed. You notice that orgasms have lost some of their kick and ejaculation has become a bit feebler than previous. Getting a second erection after climax is often difficult.
Sexual function is noticeably diminished. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. Your orgasms are definitely different with less intensity of your climax, and at times, it feels like nothing much happened—more “firecracker” than “fireworks.” Ejaculation has become noticeably different – the volume of semen is diminished and you question why you are “drying up.” At ejaculation, the semen seems to dribble with less force and trajectory. Sex is no longer a sport, but a recreational activity, sometimes just reserved for the weekends.
This is not a good decade for male sexual function. Your testosterone level has plummeted over the decades, probably accounting for your diminished desire. Erections are still obtainable but often require a good amount of coaxing and coercion. They are less reliable, and at times your penis suffers with attention deficit disorder, unable to focus and losing its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime, and early morning erections become rare occurrences. Climax is, well, not so climactic and explosive ejaculations are a matter of history.
You may still have some remaining sexual desire left in you, but it’s a far cry from the fire in your groin you had when you were a younger man. The quality of your erections has noticeably dropped. At times, the best that you can do is to obtain a partially inflated erection that cannot penetrate, despite pushing, shoving and manipulating every which way. Spontaneous erections are all but gone.
Although you as an octogenarian may still be able to have sex, most of your brethren cannot; however, they remain appreciative that at least they still have their penises to use as spigots, allowing them to stand to urinate! If you are able to have sex on your birthday and anniversary, you are doing much better than most. To quote one of my octogenarian patients in reference to his penis: “It’s like walking around with a dead fish.”
To quote the comedian George Burns: “Sex at age 90 is like trying to shoot pool with a rope.” You are grateful to be alive and in the grand scheme of things, sex is low on the list of priorities. You can live vicariously through pleasant memories of your days of glory that are lodged deep in the recesses of your mind, as long as your memory holds out! So, when and if you get an erection, you never want to waste it!
How To Maintain Good Erectile Performance Over Time
What can you do to help maintain your erections as you age? The good news is there are natural alternatives and exercise plays a critical role.
Why do we exercise our bodies? The answer is simple, to help maintain our muscles and reverse conditions that arise with aging. The same is true for the pelvic muscle system that helps controls erectile function. Keep the pelvic muscles in shape and you can maintain healthier and longer lasting erections over time. If you are young and healthy, you can make your erections even harder. If you are older, a pelvic muscle exercise program may help you regain your youthful sexual health. The Private Gym Pelvic Muscle Exercise Program can help improve your sexual performance at any age.
Andrew Siegel, M.D., Urologist, Cofounder of The Private Gym, and author of the highly acclaimed book, Male Pelvic Fitness, Optimizing Your Sexual and Urinary Health.
What is vasectomy?
Vasectomy, called also male sterilisation represents a simple surgical procedure performed by a doctor in order to cut or seal the tubes that carry a man’s sperm.
The procedure takes about 15 minutes and it is usually carried out under local anaesthetic, where the patient is awake, but he does not feel pain.
Vasectomy is a permanent form of contraception and is now one of the most popular forms of family planning in the world.
Getting a vasectomy should be a very important decision in your life. You should only get a vasectomy if you’re 100% positive you do not want to be able to get someone pregnant for the rest of your life.
In the United Kingdom, at the beginning of the 21st century, the National Health Service carried out nearly 40,000 vasectomies a year. But now this has dropped to about 15,000.
How does vasectomy work?
The term “vasectomy” comes from the name of the tubes in your scrotum that are blocked during the procedure: vas deferens.
Vasectomy works by stopping sperm from getting into a man’s semen, the fluid that he ejaculates. Sperm, the microscopic cells that join up with an egg to cause pregnancy, are made in your testicles. Sperm leaves the testicles through two tubes called the vas deferens and mixes with other fluids to make semen. The sperm in your semen can cause pregnancy if it gets into a vagina.
Vasectomy has the role to block or cut each vas deferens tube, keeping sperm out of your semen. Sperm cells stay in your testicles and are absorbed by your body.
Three months after the procedure, your semen will not contain any sperm, so it cannot cause pregnancy. This means that when a man ejaculates, the semen has no sperm in it and a woman’s egg can’t be fertilised.
After a vasectomy, the way of having an orgasm or ejaculating will not change.
Types of vasectomy
The types of vasectomy are important to know when men are deciding whether to undergo a vasectomy. There are two types of vasectomy:
- Scalpel vasectomy (conventional vasectomy);
- No-scalpel vasectomy.
In both cases, men are given a local anaesthetic before the procedure. Usually, the anaesthetic is delivered to the scrotum using a needle injection. However, a newer non-needle approach also can be used, if the patient is needle phobic. The anaesthetic is delivered via a pressurized jet injection spray applied to the scrotum, and the technique is painless or nearly painless.
Scalpel vasectomy, also known as traditional vasectomy or conventional vasectomy is an outpatient procedure that is usually performed by a doctor’s office or in a clinic under local anaesthesia. Also, you may be offered a mild sedative about 30 to 60 minutes before the procedure.
After you are lying on the table and the anaesthetic has been administered, the surgeon uses a scalpel to make one or two tiny incisions in the scrotum to expose the vas deferens tubes from each testicle. Each vas deferens is lifted from the scrotum, cut, and a portion is removed. The vas ends are tied, cauterized, or closed using clips. A few stitches are used to close the incisions, and the vasectomy is complete, taking about 15 to 30 minutes, depending on how the surgeon has closed the vas deferens.
After local anaesthesia, the doctor makes a tiny puncture hole in the skin of your scrotum to reach the tubes. This means that the doctor does not need to cut the skin with a scalpel.
The tubes are then closed in the same way as a conventional vasectomy, either by being tied or sealed.
There is little bleeding and no stitches with this procedure. It is thought to be less painful and less likely to cause complications than a conventional vasectomy.
Does vasectomy affect your erectile function?
Probably, you have already wondered if impotence can occur after performing a vasectomy.
Well, you should know that the risk for impotency from this procedure is extremely rare. Moreover, according to the International Federation of Gynaecology and Obstetrics (FIGO), some men reported better sex lives after vasectomy.
During a vasectomy, the doctor will tie your vas deferens, the duct that carries the sperm that mixes with the ejaculate. This procedure will not affect your erection and your ability to climax. Erections and climax involve:
- stimulating nerves;
- increasing blood flow to the penis;
- creating muscle contractions;
- mental stimulation.
The vans deferens only affects the sperm, which the body will continue to make. Since sperm is common with other cell types, your body will absorb them naturally.
A vasectomy has no effect on the hormones, bodily processes, or penile structures that affect your ability to get an erection. If you did not have any trouble getting an erection before your vasectomy, you shouldn’t have any issues afterwards.
After three months, you will need to revisit the doctor’s office to test for the presence of semen.
Vasectomy and ejaculation
If you could ejaculate before your vasectomy, you will ejaculate after the procedure too.
Ejaculatory fluid, semen, is made in the prostate and the seminal vesicles, which are not cut during a vasectomy. The amount of fluid that comes out of the testicle with sperm is less than 1% of the overall ejaculate volume. The muscle contractions that force fluid out during ejaculation come from the pelvis and, again, are not affected by vasectomy. The only thing that really changes about your semen after a vasectomy is that it no longer contains sperm. Sperm only accounts for 2% to 5% of the volume of a man’s ejaculate, so you are not going notice a difference once it is gone. In fact, it is probably safe to assume your ejaculations naturally varied that much based on fluid intake, diet, etc.
Your ejaculations should not be painful after a vasectomy. However, an ejaculation involves several strong muscle contractions in the genital area, which means having an orgasm could be uncomfortable if the patient is still experiencing swelling, bruising, or tenderness. Therefore, doctors often recommend waiting a week or more before resuming sexual activity.
Before vasectomy. How to prepare for the procedure
Before vasectomy, your doctor will ask about your circumstances and he will provide you with information and counselling before agreeing with the procedure.
The following facts should be taken into consideration before performing the vasectomy:
- Stop taking aspirin or other blood-thinning medications several days before your surgery. These medications can include warfarin, heparin and aspirin, and other over-the-counter pain medications such as ibuprofen.
- Bring a pair of tight-fitting underwear or an athletic supporter to wear after the procedure to support the scrotum and minimize swelling.
- Shower or bathe on the day of the surgery. Be sure to wash your genital area thoroughly.
- Arrange for a ride home after your surgery to avoid movement and pressure on the surgery area caused by driving.
- You should understand that vasectomy is permanent, and it is not a good decision if you might want to father a child in the future.
After a vasectomy, you should wait until you do not feel any pain or swelling around the surgery site before having sex. This may mean waiting a week or more after your procedure. Having sex immediately after the surgery could reopen the incisions and allow bacteria to enter the wound. This could potentially lead to infection. Condoms generally are not an effective means of protecting the incisions. The surgery site is typically too far above the condom opening to receive any coverage.
It is important to wear tight-fitting underwear or athletic support day and night for the first few days to help support your scrotum and ease any discomfort or swelling. Make sure you change your underwear every day.
After a vasectomy, you can usually return to work 1 or 2 days but should avoid sport and heavy lifting for at least a week after the procedure to prevent complications.
You will need to use another method of contraception for at least the first 8 to 12 weeks, as it can take this long to clear the remaining sperm in your tubes.
Advantages and disadvantages of the vasectomy
- Vasectomy has more than 99% effectiveness in preventing pregnancy. A vasectomy is effective because it’s designed to be permanent, and there is no way you can mess it up or use it the wrong way. Vasectomies prevent pregnancy 24/7 for the rest of your life.
- Vasectomy has no long-term effects on your health.
- Vasectomy does not affect your hormone levels, sex drive or interfere with sex.
- Vasectomy may be chosen as a simple and safer alternative to female sterilisation.
- Vasectomy can make your sex life better.
- Vasectomy does not protect against sexually transmitted infections, so you may need to use condoms as well.
- Vasectomy cannot be easily reversed, and reversals are rarely funded by the NHS.
- You need to keep using contraception after the operation until tests show your semen is free of sperm.
- Possible complications may occur.
- The vas deferens tubes can reconnect, but this is very rare.
Is it safe? What are the risks associated with a vasectomy?
Vasectomies are safe, and very few people have complications. But like all medical procedures, there are some possible risks. The most common risks with a vasectomy are minor and treatable.
The side effects that can occur immediately after the intervention include:
- Bleeding or a blood clot (hematoma) inside the scrotum;
- Blood in your semen;
- Bruising of your scrotum; it usually goes away on its own. Putting ice packs on the bruise and taking over-the-counter pain medication can help;
- Infection of the surgery site;
- Mild pain or discomfort; you can take over-the-counter pain medicine and wear supportive underwear that does not let your testicles hang. Long-term pain is uncommon but possible. If this happens you should talk with a doctor or nurse for possible treatment.
Delayed complications of a vasectomy can include:
- Chronic pain (rare); it affects approximately 1 per 1000 patients;
- Fluid build-up in the testicle, which can cause a dull ache that gets worse with ejaculation;
- Inflammation caused by leaking sperm (granuloma); this typically occurs during the second or third postoperative week and involves up to 25% of patients. This complication should be considered if, on examination of the patient, a small, palpable, pea-sized nodule is found at the testicular end of the transected vas. To resolve this problem. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used;
- Pregnancy, if your vasectomy fails (rare);
- An abnormal cyst (spermatocele) that develops in the small, coiled tube located on the upper testicle that collects and transports sperm (epididymis);
- A fluid-filled sac (hydrocele) surrounding a testicle that causes swelling in the scrotum.
Many men worry that a vasectomy could cause serious problems — but these fears are unfounded. The most common concerns include:
- Vasectomy affects your sexual performance. A vasectomy will not affect your sex drive or your masculinity in any way other than preventing you from fathering a child.
- Vasectomy permanently damages your sexual organs. The risk of injury of your testicles, penis or other parts of your reproductive system during surgery is very little.
- Vasectomy increases the risk of heart disease.
- Vasectomy causes severe pain. During surgery, you might feel minor pain, but severe pain is rare. Pain can also occur after surgery, but for most of the patients, the pain is minor and goes away after a few days.
- Vasectomy increases the risk of certain cancers. Although there have been some concerns about a possible link between vasectomy and testicular cancer in the past, there’s no proven link.
- Vasectomy increases the risk of prostate cancer. The effects of vasectomy on prostate cancer were assessed in several clinical trials. A meta-analysis of 684660 vasectomised men found that there is no evidence of a link between vasectomy and prostate cancer.
Does vasectomy protect you for sexually transmitted diseases?
A vasectomy cannot protect you from a sexually transmitted disease (STD), including HIV/AIDS and venereal diseases. Vasectomy protects you from fathering a child, only.
Condoms are still the best defence against these diseases. After a vasectomy, you are protected against pregnancy, but any sexual encounter that carries the risk of contracting or transmitting infection makes it important for vasectomised men to use protection.
What are the contraindications of vasectomy?
Contraindications to no-scalpel vasectomy include:
- Anatomic abnormalities, such as the inability to palpate and mobilize both vas deferens or large hydroceles or varicoceles;
- Past trauma and scarring of the scrotum;
- Acute local scrotal skin infections.
Is contraception mandatory after vasectomy?
Vasectomy represents one of the most effective forms of birth control. However, a vasectomy is not effective right away. Men still need to use other birth control until the remaining sperm are cleared out of the semen. This takes 15 to 20 ejaculations or about 3 months. Even then, one of every five men will still have sperm in his semen and will need to wait longer for the sperm to clear.
Can a vasectomy be reversed?
The vasectomy can be reversed but the procedure is not always successful. If the reversal is carried out within 10 years of your vasectomy, the success rate is about 55%. The success rate falls to 25% if the reversal is carried out more than 10 years after.
Vasectomy reversal is performed in an outpatient surgery centre or the outpatient area of a hospital. During the procedure, the surgeon can use general anaesthesia. To reverse a vasectomy, the surgeon makes a small cut in the side of the scrotum and finds the closed ends of the vas deferens. Then a fluid sample is taken from the end closest to the testicle to test for the presence of sperm. If sperm is found in the fluid, the two closed ends of the vas deferens can be reattached.
Recovering after vasectomy reversal takes usually 1 to 3 weeks. Complications that may occur after vasectomy reversal are the same with those after vasectomy.
After the intervention, sperm starts to appear in the semen in about 3 months. It takes 1 year to achieve a pregnancy after a vasectomy reversal. However, a successful reversal does not guarantee pregnancy. The chance of restored fertility and pregnancy is highest when the reversal is performed not long after the vasectomy.
Premature Ejaculation: Why Does It Happen?
Premature ejaculation is, as its name suggests, a tendency for a man to ejaculate with little sexual stimulation, usually prior to the commencement of sexual intercourse or just after it begins.
Premature ejaculation is considered the most common type of male sexual dysfunction. Doctors estimate between 20 percent and 30 percent of men experience premature ejaculation at some point during their lives.
Men living with premature ejaculation face a great deal of emotional turmoil. They feel distress, embarrassment, and a lack of control.
Reasons for Premature Ejaculation
There are both psychological and biological reasons for premature ejaculation. The psychological causes include:
- Early sexual experiences that establish a pattern in which sex is linked to excitement, anxiety, and a demand to perform quickly for fear of being caught. Men find themselves hypersensitive and unable to slow down and enjoy the pleasure of sex.
- Anxiety about sexual performance or about other life issues. This anxiety can create overstimulation that leads to premature ejaculation.
- Worry over erectile dysfunction. Men anxious about achieving or maintaining erection might begin rushing to ejaculate, then have trouble getting their bodies out of that habit.
Biological and other causes for premature ejaculation include:
- Abnormal hormone levels
- Low levels of the neurotransmitter serotonin
- Abnormal condition affecting the ejaculatory system
- Thyroid problems
- Inflammation or infection of the reproductive organs, specifically the prostate or the urethra
- Damage to the nervous system, which could have been caused by trauma or surgery
- The use of drugs
- Diabetes and/or cardiovascular disease
Premature Ejaculation: Treatment and Coping
Men experiencing premature ejaculation caused by psychological issues should consider behavioral therapy. Such therapy might involve masturbating an hour or two before sex to give yourself a better chance of delaying ejaculation, or arousing your partner prior to sex so that your orgasms can take place at the same time.
A man also might choose to avoid intercourse for a while, focusing instead on other forms of sexual play and giving himself a chance to work through the anxiety and pressure that is affecting his performance.
Other ways to treat or cope with premature ejaculation include:
- The stop-and-start method. The man slows down or reduces stimulation when he feels himself nearing climax. This might involve removing his penis, or simply becoming very still. Once the moment has passed, he then resumes intercourse.
- The squeeze. The man’s partner squeezes the tip of his penis when he feels himself about to climax. The partner maintains the squeeze for several seconds, until the urge to ejaculate passes. After another 30 seconds, the man and his partner can go back to sex. Repeating this can help the man train his body away from premature ejaculation.
- Condom use. Condoms reduce the amount of stimulation the man is receiving and can help him last longer.
- Desensitizing lubricants. These contain a mild anesthetic that temporarily numbs the skin of the penis.
- Medication. Antidepressants can be prescribed to help delay a man’s orgasm.
And, of course, there’s the old joke about “thinking of baseball stats” when the urge to climax approaches. Focusing his thoughts on something non-sexual can help a man last longer.
What Is It?
Published: May, 2017
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.
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Premature ejaculation treatment
Premature ejaculation often goes away without treatment. But if it happens frequently, and it makes you or your partner unhappy, you may want to talk to your family doctor. There are several possible methods for delaying orgasm.
Behavioral methods are helpful for more than 95% of men who have premature ejaculation.
In this type of treatment, you practice controlling your ejaculation, either alone or with a partner.
- In the start-and-stop method, you or your partner will stimulate your penis until you feel like you are about to have an orgasm. Then the stimulation stops for about 30 seconds. Once you regain control of your response, stimulation begins again. This process is repeated 3 or 4 times before you allow yourself to have an orgasm.
- The squeeze method works in a similar way. When you feel like you are about to ejaculate, you or your partner will gently squeeze the head of your penis for about 30 seconds so that you begin to lose your erection. You repeat this process several times before you allow yourself to reach orgasm.
In addition to using a behavioral method, you may want to try thought distractions. For example, while you’re being sexually stimulated, think about the names of players on your favorite sports team.
Anxiety, depression, and other emotional issues can lead to premature ejaculation. For these issues, seeking the help of a psychologist, psychiatrist, or sex therapist may be helpful. Couples therapy may also help if relationship problems are the cause of premature ejaculation.
Several medical treatments may help men who have premature ejaculation. Some antidepressants seem to help delay ejaculation, including antidepressants called selective serotonin reuptake inhibitors (SSRIs). These antidepressants are available with your doctor’s prescription. However, the U.S. Food and Drug Administration (FDA) has not approved the use of these medicines to treat premature ejaculation. Also, antidepressants may cause side effects such as nausea, dry mouth and drowsiness. Antidepressants may also decrease your desire to have sex. Your family doctor can help you decide if an antidepressant is right for you.
Medicines used to treat erectile dysfunction may also help prevent premature ejaculation. Your doctor may prescribe one of these medicines alone or in combination with an antidepressant.
Anesthetic creams can also be used to prevent premature ejaculation. These creams are applied to the head of the penis to make it less sensitive. Usually, the cream is applied about 30 minutes before sex and then washed off once it has decreased the feeling in your penis. The cream must be washed off before sex. If it is left on, it can cause a loss of erection and vaginal numbness.
For some men, simply wearing a condom can help delay ejaculation because it may make the penis slightly less sensitive.
Here’s a sad but true fact: Around 30 percent of men are dissatisfied with how long they last in bed, according to new research in the Journal of Sexual Medicine.
In the study of over 1,200 men, 376 of them reported that they ejaculated sooner than they wanted to during sex. Then the researchers split these men up into two groups—men who met the criteria for premature ejaculation (classified as ejaculating in less than two minutes) and men who lasted longer, but were still finishing sooner than they wished.
Interestingly, most of the men in this study didn’t actually meet the diagnostic criteria for premature ejaculation. This could point to the fact that even healthy men may wish they lasted longer in bed (something that we’re sure most women wouldn’t argue about). Plus, this finding may point to the need for a broader definition of premature ejaculation, note the researchers.
MORE: The Trick That Can Help Men Last Longer in Bed
So what did men blame for their quick release? When the researchers asked guys why they thought this happened, most men from both groups chalked it up to either a lack of control or hypersensitivity, a.k.a. being too aroused. Fewer men cited problems with their partner, anxiety, or health issues.
MORE: What Premature Ejaculation Can Really Do to Your Sex Life
With most guys attributing this issue to a lack of control, it can be helpful to let your partner know that there are things you both can do to remedy the situation. For starters, check out these five ways to help him last longer in bed. Plus, you can always assure him that are other ways he can please you if he finishes well before you do. He’s still got perfectly functioning fingers and a tongue, doesn’t he?
MORE: 7 Things That Can Mess with His Erection
Do you think you suffer from premature ejaculation? Don’t fret — here are some tips and techniques to help you slow it down.
By Martin Downs
Reviewed By Michael Smith
You don’t have to admit it to your buddies. You don’t have to stand up in a support group and say, “My name is … ” It’s enough to admit to yourself that sometimes you climax too quickly during sex; or at times, you’re not able to ejaculate at all.
Or perhaps your sexual performance satisfies all concerned. If that’s so, you’ve probably heard and heeded the following advice.
Premature Ejaculation: Strategies for Staying
Are you a premature ejaculator? The answer is another question: Do you think you are? It’s subjective.
A man may ejaculate before intercourse even begins. Few would doubt that counts as “premature.” But what if you typically reach orgasm after only a minute or so? You may consider yourself a premature ejaculator then, if your goal is take a woman to extremes of ecstasy. But there are problems with that conclusion.
First, it assumes she’ll have an orgasm if you last longer, because women tend to climax later than men do. “There’s a lot more to it than thrusting,” says sex educator Beverly Whipple, PhD. Many women simply don’t have orgasms with their partners, while they do on their own. Second, some women don’t have orgasms though vaginal intercourse. Only clitoral stimulation does it for them. So don’t think that once you master your orgasm, you’ll master hers, too. What’s more, Whipple says, if you focus solely on your stamina during intercourse, “you miss out on a whole lot of the fun along the way.”
That said, here’s what you can do.
Wrap it. Some men find the sensation of sex without a condom too intense, causing them to lose control quickly. Think about when your troubles began. Perhaps you always used condoms while you were roving; then when you got a monogamous partner you shucked them.
Over-sensitivity doesn’t seem to be the main cause of premature ejaculation, however. The problem is usually pinned on anxiety and inexperience.
Know yourself. It may have been in our evolutionary best interest to ejaculate quickly: Impregnate the female and move on before predators find you in a compromising position. According to this theory, “The ability to prolong intercourse is a learned response,” says Drogo Montague, MD, director of the Center for Sexual Function at The Cleveland Clinic.
To learn control, you must be aware of your sexual response and recognize when you’re approaching “the point of no return.” Before you get there, lessen the stimulation by slowing down or stopping. Once that feeling subsides, you resume until you reach the threshold again, then slow or stop, over and over. It takes practice — time spent experimenting with masturbation or frequent sex with a patient partner.
Anxiety is often part of the problem. You may have an underlying attitude that sex is shameful, and what’s more, your past experiences have made you feel inadequate. So you’re compelled to get the dirty deed done quickly, though at the same time you feel obliged to perform like a machine.
We tend to think of the male orgasm as mechanical, a simple matter of friction. “It’s an oversimplification,” says Richard Balon, MD, a psychiatrist at Wayne State University, in Detroit, Mich. Sex and psychology can’t be separated, even for men. If nothing else helps, therapy may.
Numb it. Until recently, a popular option besides therapy and the start-and-stop technique was to desensitize the penis with a topical anesthetic. “I don’t really encourage them to go the anesthetic route,” Montague says. It’s messy and inconvenient, and it may make you so numb you won’t feel anything.
Take a pill. Doctors now prescribe SSRIs (selective serotonin reuptake inhibitors) such as Prozac to men with premature ejaculation. Delayed ejaculation is a well-documented side effect of SSRIs. The downside is that they can also dampen your libido.
Montague, who is working with a committee to draft guidelines on using SSRIs for premature ejaculation, says some men take the drugs continuously, while others are told to pop a pill when they anticipate sex. Either way, SSRIs help many men.
Let off steam. After a long period of abstinence, you may be so hot and bothered that it’s difficult to control your orgasm. Calm your libido with masturbation, and the thrill of a sexual encounter might not overwhelm you. Montague says it’s a good solution for some, but not all. “Men with severe premature ejaculation seem to have the problem regardless,” he says.
You would have to get the timing right for it to help. Men have what’s called a “refractory period” — a length of time after ejaculation during which they can’t have another orgasm. For some men, it’s very short; for others, it lasts hours.
Going, and Going, and Going …
Less common than premature ejaculation, but just as distressing, is the inability to have an orgasm — known as anorgasmia or delayed ejaculation, and also by the ugly medical terms “ejaculatory incompetence” and “retarded ejaculation.” If it’s a persistent problem, consider these possible causes and solutions.
Fatigue or stress. Men aren’t always up for sex. Consider the time of day. Maybe you’re having sex too late at night, when you can barely stay awake, or too early in the morning. Or perhaps worries invade your thoughts, to the effect of a cold shower. Find a way to relax first, rather than having sex to relax.
Something is missing. There may be a certain turn-on that’s absent from the sex you’re having. Maybe you think it’s kinky, and you’re too embarrassed to tell your partner, so you keep having “normal” sex. Maybe you’re not attracted to your partner, but you continue the sexual relationship for whatever reason. If you’re not getting what you need, couples therapy or therapy for you alone may help.
Prescription drugs. SSRIs, as mentioned before, can delay ejaculation. That’s good for men who ejaculate too soon, but if you’re taking an SSRI for something else, it can be a problem. Some antipsychotic drugs and blood-pressure medications may have this effect, too.
Alcohol. It depresses your central nervous system, which can suppress your orgasm. Heavy drinking can also impair your ability to get an erection.
Originally published Feb. 3, 2003.
Medically updated Feb. 28, 2005
SOURCES: Beverly Whipple, PhD, professor emerita, Rutgers University • Drogo Montague, MD, director, Center for Sexual Function, The Cleveland Clinic • Richard Balon, MD, professor of psychiatry, Wayne State University • Journal of the American Medical Association, Feb. 10, 1999 • European Federation of Neurological Societies Guidelines on Neurosexology • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association • National Institutes of Health • The Kinsey Institute.