Feeling frustrated in bed? Does it take you long to ejaculate or you never get there? Watch this video until the end and learn what ...

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How to Overcome Delayed Ejaculation and Enjoy Better Sex

fellas are you having a hard time finishing well today we're going to talk about delayed ejaculation I'm Dr Arena Malek urologist and pelvic surgeon and if you're new here I make content each and every week on sexual and Urologic health so make sure if you like what you see you subscribe and share this Channel with your friends so delayed ejaculation is a condition where it takes a man longer than usual to achieve Climax and ejaculate and usually the number that we see is anywhere between 20 and 30 minutes however the clinical definition is a little bit more stringent and it is a marked delay or Market in frequency of ejaculation that has occurred almost 75 to 100 percent of the time in the last six months and that causes the individual distress or bother and this is pretty uncommon it occurs at about one percent of men where they have lifelong delayed ejaculation and four percent of men where they get acquired delayed ejaculation in this video yeah we're going to cover the physiology of erection that causes the diagnosis and the treatment options for delayed ejaculation so make sure to stick around until the end so ejaculation is the process of releasing semen from the body and occurs in many steps the first step is emission where semen enters the urethra through the ejaculatory duct and the bladder neck closes to make sure that your semen will not go backwards into the bladder and the process of expulsion where the semen is pushed out through the urethra usually with the support of the pelvic floor muscles and the muscles around the urethra called the bubble cavernosus muscles interestingly ejaculation is a reflex once you get to the point where your body sends signals to your spinal cord and then to your brain that you need to ejaculate ejaculation occurs and there's nothing you can do to stop it and typically orgasm occurs at the same time as ejaculation but orgasm is a brain triggered event whereas ejaculation is a spine spinal cord triggered event and so these can occur most often together but not always and specifically some hormones like dopamine are increased during orgasm whereas other hormones like prolactin are suppressed so some of the Medical Treatments all of which are off label kind of try to work with these hormones to help improve the time to ejaculation and orgasm so why would anyone have delayed ejaculation well there's a number of different causes it can be psychological I mean it's due to something in your brain or something that's bothering you in your brain or it can be physiological meaning that's from your body and sometimes it can be a combination of both so psychological issues can be many it can be due to certain fears you have it can be due to having a strong religious convictions or guilt associated with ejaculation it can be a relationship conflicts it can be due to idiosyncratic masturbation techniques which I've talked about before in my video about when the small chances where masturbation can and become harmful it can be due to Performance anxiety or the lack of stimulation or arousal so all of these things can contribute to a psychological delayed ejaculation physiological causes mean from your body that you cannot control can be due to things like having surgery which affects the nerves that carry those signals to the spinal cord to cause the ejaculatory reflex or having medical conditions like multiple sclerosis or spinal cord injury or we see this quite often interestingly there's also data to suggest that low testosterone is commonly seen in men with delayed ejaculation however supplementing testosterone doesn't always correct the problem so we don't think that the low testosterone is causing the delayed ejaculation but certainly something to get checked out other hormones that can be abnormal are those like prolactin and your thyroid levels that can also affect ejaculation certain congenital abnormalities can play a role and lastly aging and the reason isn't aging can cause delayed ejaculation is because the sensitivity of the penis can decrease during Age this is just because as people age not only does their whole body get older but also their nervous system gets older and this can change the receptors that take sensory input and convert that into signals to your body and so it can be useful in those cases to experiment with different types of stimulation like vibration different types of temperature and see if those things can also cause different types of Sensations sent to your spinal cord that can lead to ejaculation and orgasm so how do we diagnose delayed ejaculation well it's really important to get a good ejaculation there's several things we want to get a sense of we want to get a sense of what is going on in your relationship and is this a situational occurrence that only happened with certain people is it recent has it become a more common thing for many many years or have you had it for your entire life we also want to get a sense of all the other issues that may be associated with sexual dysfunction so are you having issues with arousal ejaculation are you having an orgasm at the time but not feeling ejaculation because that could be a sign of something called retrograde ejaculation and a lot of you have been asking me to make a video on retrograde ejaculation so I will do that at some point in the next few months we'll also want to know your masturbation habits and your medical history is is there certain medications or surgeries that you've had that might be affecting your nervous system during the examination we'll want to assess one do you have normal secondary sex characteristics meaning do the testicles seem to be a normal size are the other structures like the vast deferens and the epididymis normal and palpable on both sides unless of course you've had a vasectomy what is the nervous response of that area so how do you respond to light touch or pinprick and are your reflexes intact so there are certain tests we can do in the office to assess your reflexes as I mentioned before ejaculation is a reflex and typically if we do any testing it will be based on your history and your physical examination perhaps if there's a concern for retrograde ejaculation we may check the urine after orgasm to see if there is sperm indeed in the bladder also if there's any abnormalities in the prostate the testicles this vas deferens or epididymis we may proceed with an ultrasound again all of these things are dependent on what we find during the examination and during your history so what do we do for treatment well treatment really depends on what the cause is so if it's psychological in nature there are a whole host of treatment options that can be offered by a psychologist with with expertise in sexual medicine this can include things like cognitive behavioral training if it's associated with masturbation there can be things like masturbation retraining and adjustment of sexual fantasies can also proceed with Psychotherapy to kind of focus on areas of conflict and Sensei focused exercises so focusing on touch and intimacy rather than the sexual encounter and building yourself up to the sexual encounter itself and things like mindfulness training to reduce anxiety associated with sex I've made a whole video about mindfulness so make sure you check that out and also things like couples counseling can be very helpful in men who have a low testosterone and have delayed ejaculation supplementing the testosterone can be helpful in a small subset of patients although not always if it's neurologic in nature and you're not having retrograde ejaculation then you may be having an ejaculation and that is actually useful to seek out an infertility specialist where they can then work with you to obtain the sperm for fertility purposes using things like vibratory stimulation intellectual ejaculation or even surgical procedures to remove the semen from the areas where it's stored in the body and as I mentioned earlier there are a whole host of off-label treatments nothing is FDA approved that can help with delayed ejaculation I'm not going to list them all here because as I mentioned they are off labels so seeking out care from an expert in sexual medicine can be very helpful in managing delayed ejaculation and experimenting with these medications to see if something helps okay I hope you guys found this helpful and as always you want to take care of yourself because you're worth it foreign [Music]

Dr.

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