Sex Drive Problems

3 Questions to Ask if You Have Sex Drive Problems in Your Relationship

Take the time to find out: What makes your partner feel sexy?

If a disparity in libidos is causing strife in your relationship, you may need to take a closer look at each partner's role. This process is best done with professional help, preferably through counseling with a certified sex therapist. But there's some work the couple can do first. Joy Davidson, PhD, a New York City–based psychologist who's on the board of directors of the American Association of Sexuality Educators, Counselors and Therapists, recommends discussing the following questions.

1. What turns on the partner who has a low libido? 

Are there certain times when this partner is more motivated to be sexual? What's different about those times? Analyze that and try to replicate those conditions.

2. Are you playful? 

"Look at what you're actually doing," Davidson says. "Is your sex life dull and routine? Do you have fantasies that you can share with your partner? Do you read books about sexual alternatives or surf the Web looking at sex toy sites?" A person with a low libido may be uncomfortable with such ideas. "If you freak out at these questions, it is understandable that you seem to have low libido," says Davidson. Perhaps you have been raised to view sex as something dirty or shameful and need to work through those feelings with a professional. "If you have a sex-negative attitude," she says, "your libido will be repressed too." 

3. What's going on outside the bedroom? 

You or your therapist may look at what Michael Krychman, MD, executive director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach, Calif., calls "environmental sexuality"—basically, what's going on outside the bedroom. For instance, he says, "I've had couples in the same house, texting each other from different rooms," wondering why their sex life has taken a dive.

http://www.health.com/health/condition-article/0,,20188405,00.html

New pill to tackle problem of men falling short in bed

Relationship troubles can often be caused by unhappy sex lives.

 Men whose love lives are falling short can try a new prescription pill to combat the problem.

The first drug made available in the UK for premature ejaculation, called Priligy, can reportedly triple the amount of time a man can last in bed.

It works by altering levels of serotonin in the brain, which should give men more control over ejaculation.

The pill is only available on the internet following a confidential online consultation with a doctor.

Priligy has been available and licensed for use in several European countries in recent months and is now coming to the UK following clinical tests on 6,000 men.

The treatment is sold in packs of three and costs £76 for a pack of three 30mg tablets.

It's designed to be taken between one and three hours before sex.

'Too embarrassed'

Premature ejaculation is thought to be the most common sexual disorder in men, affecting one in three men at some point in their lives.

Research has shown that sufferers avoid relationships and have a lower overall quality of life than men without the problem.

A recent European survey found that British, along with German, men are the most unhappy with their sex lives because of the problem.

Many men are also too embarrassed to discuss it with a loved one or even a doctor.

"By providing consultations online we hope to be able to help as many men as possible," said Nitin Makadia, head of male sexual health at Lloydspharmacy, which is running the service.

"Some men are understandably reluctant to discuss the problem with their GP so we are removing this barrier to treatment."

Doctors who are experts in sexual health assess patients' suitability for treatment through an online consultation. If appropriate, they make Priligy available for the patient to purchase.

The treatment is then sent securely through the post.

Priligy is not currently licensed in the UK, but clinicians can legally prescribe any 'unlicensed' medicine to patients if they consider it to be in the patient's best interest.

All doctors prescribing 'unlicensed' medicines are responsible for the patient's care and the consequences of the treatment.

Peter Baker, head of Men's Health Forum, said drugs should not be the first option for someone suffering from premature ejaculation.

"It's fantastic that this drug now exists and particularly if it gives men the confidence to acknowledge they have a problem. But we can't treat every problem with a drug, and there are a number of techniques men can try which can be effective."

http://news.bbc.co.uk/1/hi/health/8646075.stm

Premature ejaculation gene found

Men who suffer from premature ejaculation may be able to blame their genes, work suggests.

A study of nearly 200 Dutch men found those who climaxed too soon during intercourse had a version of a gene that controls the hormone serotonin.

Men with this version ejaculated twice as quickly as other men in the study.

Serotonin levels are what control the rapidity of ejaculation, say the Utrecht University researchers told the Journal of Sexual Medicine.

Not in the mind

The volunteers in Dr Marcel Waldinger's study were 89 men who had so-called primary premature ejaculation, meaning they had always suffered from it from their first sexual contact onwards.

For a month, their female partners were asked to use a stopwatch at home to measure the time until ejaculation each time they had intercourse.

The results were compared with 92 men with no history of such problems.

In the men with premature ejaculation, serotonin appeared to be less active between the nerves in the section of the brain that controls ejaculation.

Dr Waldinger says this low activity of the hormone means nerve signals do not transfer in the normal way in these men.

"This contradicts the idea, which has been common for years, that the primary form of premature ejaculation is a psychological disorder," he said.

Fast reactors

The findings also mean it might be possible to treat the condition with gene therapy, he said.

Paula Hall, a sexual psychotherapist for Relate, said: "Premature ejaculation is definitely not purely psychological.

"But there can be a psychological element. The acid test is how much control they have on their own. If the problem only occurs with their partner then it is more likely to be psychological."

She said men with primary premature ejaculation tended to be fast reactors generally.

"These men have very quick reflexes. They may be excellent at playing tennis or computer games, for example."

She said there was good evidence that serotonin was linked ejaculation and that researchers were developing drugs for the condition that prolong this hormone's action.

Currently there is no medication for the condition on the market.

Treatments involve counselling and the use of anti-depressants - not for depression but for their unexpected yet wanted side effect of delaying ejaculation.

A third of men are believed to suffer from premature ejaculation.

http://news.bbc.co.uk/1/hi/health/7657092.stm

Premature Ejaculation

Practice Essentials

Premature (early) ejaculation is the most common sexual disorder in men younger than 40 years, with 30-70% of males in the United States affected to some degree at one time or another. It has historically been considered a psychological disease with no identified organic cause.

Signs and symptoms

Premature ejaculation can be lifelong or acquired. With lifelong premature ejaculation, the patient has experienced premature ejaculation since first beginning coitus. With acquired premature ejaculation, the patient previously had successful coital relationships and only now has developed premature ejaculation.

Patient characteristics in lifelong premature ejaculation can include the following:

• Psychological difficulties
• Deep anxiety about sex that relates to 1 or more traumatic experiences encountered during development

In patients with lifelong premature ejaculation, inquire about the following:

• Previous psychological difficulties
• Early sexual experiences
• Family relationships during childhood and adolescence
• Peer relationships
• Work or school
• General attitude toward sex
• Context of the event (eg, marital versus nonmarital)
• Sexual attitude and response of the female partner
• Nonsexual aspects of the current relationship
• level of involvement of the sexual partner in treatment

Clues from these and similar questions usually point toward causative factors that may be addressed specifically with therapy.

Patient characteristics in cases of acquired premature ejaculation can include the following:

• Erectile dysfunction
• Performance anxiety
• Psychotropic drug use

In patients with acquired premature ejaculation, inquire about the following:

• Previous relationships
• Current relationship
• Nonsexual aspects of the current relationship
• level of involvement of the sexual partner in treatment
• Impotence problems
• Capacity for coitus
• Sexual context
• Sexual response of partner

Diagnosis

In males with premature (early) ejaculation and no other medical problems, no specific conventional laboratory tests aid or affect treatment. Checking the patient’s levels of serum testosterone (free and total) and prolactin may be appropriate if premature ejaculation is observed in conjunction with an impotence problem. If depression or other conditions coexist, laboratory studies specific to depression or to another medical or psychological problem are appropriate.

Other conditions that should be considered in making the diagnosis of premature ejaculation include the following:

• Severely delayed orgasm in the female partner
• Adverse effect from a psychotropic drug
• Presence of preejaculate
• Erectile dysfunction

Management

Medical treatment for premature (early) ejaculation includes several options. Any serious primary medical condition (eg, angina) should be treated, as should any accompanying erection problem (eg, erectile dysfunction). To achieve the best outcome, the female partner should be included as fully as possible in the treatment and counseling sessions. Outpatient care can be scheduled as appropriate for the clinical circumstances.

Nonpharmacologic therapy may include the following:

• Efforts to relief of underlying performance pressure on the male
• Sex therapy (eg, instruction in the stop-start or squeeze-pause technique popularized by Masters and Johnson)
• Second attempt at coitus – If another erection can achieve be achieved shortly after an episode of premature ejaculation, ejaculatory control may be much better the second time

Pharmacologic therapy may include the following:

• Topical desensitizing agents (eg, lidocaine and prilocaine) for the male
• Selective serotonin reuptake inhibitor (SSRI) therapy (eg, sertraline, paroxetine, fluoxetine, citalopram, or dapoxetine); alternatively, use of an agent with SSRI-like effect
• Phosphodiesterase type 5 (PDE5) inhibitor therapy (eg, sildenafil, tadalafil, or possibly vardenafil)
• Other agents (eg, pindolol or tramadol)

No recommended surgical therapy exists.

Background

Premature (early) ejaculation—also referred to as rapid ejaculation—is the most common type of sexual dysfunction in men younger than 40 years. An occasional instance of premature ejaculation might not be cause for concern, but, if the problem occurs with more than 50% of attempted sexual relations, a dysfunctional pattern usually exists for which treatment may be appropriate.

Most professionals who treat premature ejaculation define this condition as the occurrence of ejaculation earlier than both sexual partners wish. This broad definition thus avoids specifying a precise “normal” duration for sexual relations and reaching a climax. The duration of intimate relations is highly variable and depends on many factors specific to the individuals involved.

For example, a male may reach climax after 8 minutes of sexual intercourse, but if his partner regularly climaxes in 5 minutes and both are satisfied with the timing, this is not premature ejaculation. Alternatively, a male might delay his ejaculation for up to 20 minutes of sexual intercourse, but if his partner, even with foreplay, requires 35 minutes of stimulation before reaching climax, he may still consider his ejaculation and subsequent loss of erection premature because his partner will not have been satisfied (at least, not through intercourse).

Because many females are unable to reach climax at all with vaginal intercourse, no matter how prolonged, the second situation described may actually represent delayed orgasm in the female partner rather than premature ejaculation in the male; the problem can be either or both, depending on the point of view. Such differences in perspective highlight the importance of obtaining a thorough sexual history from the patient (and preferably from the couple).

Premature ejaculation may be lifelong or acquired. Lifelong premature ejaculation applies to individuals who have had the condition since they became capable of functioning sexually (ie, post puberty).

Acquired premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and, for unknown reasons, began experiencing premature ejaculation later in life. Acquired premature ejaculation is not related to a general medical disorder and usually is not related to substance inducement, though in rare cases, hyperexcitability might be associated with a psychotropic drug and resolve when the drug is withdrawn.

Diagnostic criteria (DSM-5)

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies premature (early) ejaculation as belonging to a group of sexual dysfunction disorders that are typically characterized by a clinically significant inability to respond sexually or to experience sexual pleasure.

Sexual functioning involves a complex interaction among biologic, sociocultural, and psychological factors, and the complexity of this interaction makes it difficult to ascertain the clinical etiology of sexual dysfunction. Before any diagnosis of sexual dysfunction is made, problems that are explained by a nonsexual mental disorder or other stressors must first be addressed. Thus, in addition to the criteria for premature (early) ejaculation, the following must be considered:

• Partner factors (eg, partner sexual problems or health issues)
• Relationship factors (eg, communication problems and differing levels of desire for sexual activity)
• Individual vulnerability factors (eg, history of sexual or emotional abuse, existing psychiatric conditions such as depression, or stressors such as job loss)
• Cultural or religious factors (eg, inhibitions or conflicted attitudes regarding sexuality)
• Medical factors (eg, an existing medical condition or the effects of drugs or medications)

The specific DSM-5 criteria for premature (early) ejaculation are as follows:

• In almost all or all (75-100%) sexual activity, the experience of a pattern of ejaculation occurring during partnered sexual activity within 1 minute after vaginal penetration and before the individual wishes it
• The symptoms above have persisted for at least 6 months
• The symptoms above cause significant distress to the individual
• The dysfunction cannot be better explained by nonsexual mental disorder, a medical condition, the effects of a drug or medication, or severe relationship distress or other significant stressors

The severity of premature (early) ejaculation is specified as follows:

• Mild (occurring within approximately 30 seconds to 1 minute of vaginal penetration)
• Moderate (occurring within approximately 15-30 seconds of vaginal penetration)
• Severe (occurring before sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration)

The duration of the dysfunction is specified as follows:

• Lifelong (present since first sexual experience)
• Acquired (developing after a period of relative normal sexual functioning)

In addition, the context in which the dysfunction occurs is specified as follows:

• Generalized (not limited to certain types of stimulation, situations, or partners)
• Situational (limited to specific types of stimulation, situations, or partners)

Pathophysiology

Premature ejaculation is believed to be a psychological problem and does not represent any known organic disease involving the male reproductive tract or any known lesions in the brain or nervous system. The organ systems directly affected by premature ejaculation include the following:

• Male reproductive tract (ie, penis, prostate, seminal vesicles, testicles, and their appendages)
• Portions of the central and peripheral nervous system controlling the male reproductive tract
• Reproductive organ systems of the sexual partner (if female) that may not be stimulated sufficiently to achieve orgasm

Perhaps the most pronounced effect of premature ejaculation, however, is psychological: Both partners are likely to be dissatisfied emotionally and physically by this problem. Attempted pregnancy is a particular concern. If the premature ejaculation is so severe that it happens before commencement of sexual intercourse, conception will not be possible unless artificial insemination is used.

Some have questioned whether premature ejaculation is purely psychological. A number of investigators have found differences in nerve conduction/latency times and hormonal differences in men who experience premature ejaculation compared with individuals who do not. The theory is that some men have hyperexcitability or over sensitivity of their genitalia, which prevents downregulation of their sympathetic pathways and delay of orgasm.

A group of nerves in the lumbar spinal cord has been identified as the possible generator of ejaculation. This nerve site is thought to be linked to excitatory and inhibitory dopamine pathways in the brain, which play significant roles in sexual behavior. While research continues, this knowledge is providing the foundation for possible development of medications specifically targeting delay of ejaculation.

Other questions have been raised regarding possible biochemical components of premature ejaculation. Testosterone is thought to play a role in the ejaculatory reflex. Higher free and total testosterone levels have been demonstrated in men with premature ejaculation than in men without premature ejaculation.

Research published in a Chinese andrology journal showed that semen from men with premature ejaculation contained significantly less acid phosphatase and alpha-glucosidase than did the semen of control subjects. The researchers concluded that these biochemical parameters may reflect dysfunction of the prostate and epididymis, possibly contributing to premature ejaculation; however, their conclusions have yet to be supported by subsequent studies.

A study by Corona et al found that many men with premature ejaculation have low serum prolactin levels. However, this same study found that men in the lowest quartile of serum prolactin levels who had premature ejaculation also demonstrated associated metabolic syndrome, erectile dysfunction, and anxiety. Thus, whereas biochemical markers (eg, prolactin) may contribute to premature ejaculation, organic and psychological associations (eg, anxiety) suggest that biochemical parameters play only a partial role. Further research is needed.

Psychological factors have been found to contribute greatly to premature ejaculation, beyond merely reducing the time to ejaculation. Whereas patients with premature ejaculation show significantly lower intravaginal ejaculatory latency time (IELT) overall, IELT in those who fit DSM-5 criteria for premature ejaculation overlaps with IELT in patients who do not fit the criteria.

However, whereas a shorter IELT has been the measure of premature ejaculation in many studies, the perception of ejaculation control has been shown to mediate patient or partner satisfaction with sexual intercourse and ejaculation-related distress. Although premature ejaculation probably is not a purely psychological disorder, such associations demonstrate that psychological factors play a significant role in its pathogenesis.

Etiology

As noted (see above), the cause of premature ejaculation is considered psychological, although this has not been definitively confirmed.

One psychological explanation for premature ejaculation is that males are conditioned by societal pressures to reach climax quickly because of fear of discovery when masturbating as teenagers or during early sexual experiences with others. This pattern of rapid attainment of sexual release is difficult to change in marital or long-term relationships. The increasing acknowledgment that female arousal and orgasm require more time than male arousal may lead to increased recognition and definition of premature ejaculation as a problem.

It has been theorized that evolutionary factors are involved. From an evolutionary perspective, it seems logical that males who can ejaculate rapidly might be more likely to fertilize a female than those who require prolonged stimulation to reach climax. The genes of a male who ejaculates rapidly (but not before intromission) would be more likely to be passed on. In some settings, a male who could not complete the fertilization process quickly might be pushed away or killed by a competing male because of his obvious vulnerability during intercourse.

Lifelong premature ejaculation

In patients with lifelong premature ejaculation, in which the male has never experienced sexual relations without also experiencing premature ejaculation, a deep-seated emotional disturbance may be present, and the causes may be multiple.

Sometimes, the behavior is a conditioned response resulting from teen masturbation practices, but it can also result from deep anxiety about sex that relates to traumatic experiences encountered by the patient during development (eg, incest, sexual assault, conflict with one or both parents, or other serious disturbances). In most cases of lifelong premature ejaculation, a primary care physician or a urologist should consult with a psychiatrist, psychologist, or other professional.

Acquired premature ejaculation

With regard to acquired premature ejaculation, some type of performance anxiety is often a major factor.

Performance pressure (ie, fear of failure to satisfy the partner) can arise from various precipitating events. Erectile dysfunction is one of the more common events of this type. Fear that an erection will not last may precipitate premature ejaculation. In such cases, the patient may say that the early climax was the result of being extremely excited by his partner, in an effort to avoid admitting that he was unable to maintain his erection throughout intercourse.

Often, however, the situation is more complex. Erectile dysfunction may not be involved, and the key factor may be, for instance, a belittling attitude on the part of the partner. In addition, a female partner actually may have difficulty achieving climax through intercourse and may require direct clitoral stimulation to experience an orgasm. If she does not communicate this to the male partner (and she may conceal it because of feelings about her own inadequacy), coital satisfaction is unlikely.

Because most physicians are not trained sex therapists, it is important to sort out conflicts in the relationship and then refer couples for counseling to professionals with experience and training in that area. Physicians who have some training or experience in treating premature ejaculation and are comfortable managing the problem may choose to begin treatment. If the patient does not respond favorably or if the physician is uncomfortable with treating the condition, the next step is referral to a sex therapist, psychologist, or psychiatrist.

Epidemiology

United States statistics

An estimated 30%-70% of American males experience premature ejaculation. The National Health and Social Life Survey (NHSLS) indicates a prevalence of 30%, which is fairly steady through all adult age categories. (In contrast, erectile dysfunction rises in prevalence with increasing age).

However, various surveys have shown that many men do not report premature ejaculation to their physician, possibly because of embarrassment or a feeling that no treatment is available for the problem. Some men might not even perceive premature ejaculation as a medical problem. Such survey data suggest that the percentage of men who experience premature ejaculation at some point in their lives is almost certainly more than the 30% reported in the NHSLS.

International statistics

Estimates of premature ejaculation in European countries and India mirror the prevalence in the United States. The prevalence in other parts of Asia, Africa, Australia, and elsewhere is unknown.

According to the DSM-5, the estimated prevalence of premature (early) ejaculation is highly variable and depends on the definition being employed. Although more than 20-30% of men aged 8-70 years report being concerned about the rapidity of their ejaculation, only 1-3% would be classified as having premature (early) ejaculation according to the current DSM-5 criteria (ie, ejaculation occurring within 1 minute after intromission and before the individual wishes).

Age- and race-related demographics

Premature ejaculation can occur at virtually any age in an adult man’s life. As a reported condition, it is most common in men aged 18-30 years but may also occur in conjunction with secondary impotence in men aged 45-65 years.

At present, there are no reproducible data indicating major differences between racial groups with respect to the incidence or prevalence of premature ejaculation. However, a few surveys suggest that some degree of racial variation may exist.

A telephone survey of 1320 men without erectile dysfunction by Carson et al found that premature ejaculation was reported by 21% of non-Hispanic African Americans, 29% of Hispanics, and 16% of non-Hispanic whites. An analysis of the NHSLS by Laumann et al found that premature ejaculation was more prevalent among African American men (34%) and white men (29%) than among Hispanic men (27%).

In a small study of a sexual health clinic in Australia, 59% of premature ejaculation diagnoses were in men of Asian or Middle Eastern descent, whereas 41% were in men of Western or European birth. However, in view of the small number of such studies and the lack of suitable control subjects, it is difficult to draw firm conclusions from these data.

Prognosis

Masters and Johnson maintain that the great majority (>85%) of men with premature ejaculation can be treated successfully with the squeeze-pause technique alone, typically within 3 months of the start of therapy. However, clinical experience varies widely, and some authors have reported much poorer success rates.

With a combination of methods, including selective serotonin reuptake inhibitor (SSRI) therapy, improvement or cure should be possible in most cases, provided that the couple (not just the man) is committed to working on the problem together. Numerous published reports also indicate that counseling and medical therapy can help achieve success rates as high as 85%, matching the high rates originally reported by Masters and Johnson.

The problem with all treatments for premature ejaculation is that the relapse rate ranges from 20% to 50%, depending on the study cited; thus, the durability of the response can be questionable. Some males may need to make a long-term commitment to periodically repeating the behavioral techniques; long-standing habits can be difficult to modify.

Some men who achieve success with medical therapy (ie, SSRIs) might need to use the medication for the rest of their lives, just as some people with depression need lifelong antidepressant therapy to prevent repeated bouts of the disorder and many people with hypertension need lifelong anti-hypertensive therapy to control their blood pressure. Precise long-term failure rates are not well established and depend on the duration of follow-up for a particular cohort of patients.

No known direct morbidity or mortality results from premature ejaculation. Indirectly, premature ejaculation may alter self-esteem, may cause marital dysfunction, and may be a factor in depression, with its obvious consequences. Severe premature ejaculation can cause stress within a marriage or other relationship, which might contribute to conflicts and separation or divorce in some cases. Conception is also difficult in cases of premature ejaculation before vaginal intromission.

Erectile dysfunction may be associated with premature ejaculation, and it may be difficult or impossible to establish which condition developed first. For lifelong premature ejaculation, associations with certain anxiety disorders have been noted. For acquired premature ejaculation, associations with drug withdrawal, thyroid disease, and prostatitis have been found.

Patient Education

Patients with premature ejaculation may be referred to a licensed sex therapist, psychologist, psychiatrist, or marital counselor for additional help. Numerous books and articles in the lay press are available at any public library. Many can also find information on the Internet regarding this subject.

Future research might indicate whether better sex education during adolescence can decrease the incidence of premature ejaculation in young men. Early successful treatment of erectile dysfunction may help prevent acquired premature ejaculation in older men.

http://emedicine.medscape.com/article/435884-overview#showall

Premature ejaculation: experts arrive at a definition

Premature ejaculation is a distressing condition that men usually suffer in silence

Experts in sexual medicine from around the world have, for the first time, defined lifelong and acquired premature ejaculation, paving the way for clear medical recognition and the development of better treatment.

Acquired premature ejaculation is when men who have had normal sexual function during their lifetime experience sex that lasts less than three minutes, while lifelong premature ejaculation is when sex lasts for a minute or less.

This is the first time the conditions have been given uniform classifications.

The new definition for acquired premature ejaculation specifically refers to intravaginal sex between a man and a woman that results in distress, frustration or avoidance of sexual intimacy.

Patrick Jern, post-doctoral researcher of psychology at Abo Akademi University, said premature ejaculation was a common sexual complaint.

“We don’t have a very good understanding of its causes,” he said.

Dr Jern said current diagnostic criteria for lifelong premature ejaculation were quite stringent, meaning a lot of men experiencing problems with their ejaculatory control did not fulfill them.

Lead author of the new guidelines for the diagnosis and treatment of premature ejaculation, emeritus professor Stanley E. Althof, said previous definitions had been mostly based on expert opinion rather than evidence.

This had, in turn, affected research efforts because in designing their studies, researchers in the field had been using different definitions and groups.

“The experimental group for one author might be the control group for another paper. It all became very confusing,” he said.

Professor Althof said having a conservative, evidenced-based definition would allow recognition of the condition by regulatory agencies and development of new therapies.

“With a conservative-evidenced based definition, regulatory agencies will view premature ejaculation as a genuine condition, rather than a lifestyle disorder,” he said.

Dr Michael Lowy, a sexual health physician specialising in premature ejaculation who wasn’t involved in the recommendations, said the condition was very distressing but men usually suffered in silence.

Treatment guidelines include psychotherapy for men alone as well as couples; behavioural techniques that enable men to build up confidence; and online treatment programs. They also include a number of drugs such as oxytocin, topical anesthetics and a common class of antidepressants known as SSRIs, among others.

Dr Lowy said researchers had a lot of experience treating premature ejaculation with selective serotonin re-uptake inhibitors (SSRI), which raises serotonin levels and, as a side effect, delays ejaculation.

Due to a lack of research into populations of homosexual and bisexual men, acquired premature ejaculation has not been defined for men who have sex with men.

http://theconversation.com/premature-ejaculation-experts-arrive-at-a-definition-27023

Sexual conditions guide

Sexual problems in men

A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm and resolution.

Research suggests that sexual dysfunction is common. According to the Sexual Advice Association, one in 10 men experiences sexual problems, while about 50% of women report some degree of difficulty. Yet it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.

What causes sexual problems?

• Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medicines, including some antidepressant medication, can affect sexual desire and function.
• Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.

Who is affected by sexual problems?

Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the older population, which may be related to a decline in health associated with ageing.

How do sexual problems affect men?

The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.

What are ejaculation disorders?

There are different types of ejaculation disorders, including:

• Premature ejaculation -- This refers to ejaculation that occurs before or soon after penetration.
• Inhibited or retarded ejaculation -- This is when ejaculation is slow to occur.
• Retrograde ejaculation -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.

In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation is often is due to nervousness over how well a man will perform during sex. Certain medications, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord.

Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backwards and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medicines, particularly those used to treat mood disorders, may cause problems with ejaculation. This does not generally require treatment unless it impairs fertility.

What is erectile dysfunction?

Also known as impotence, erectile dysfunction is defined as the inability to attain and/or maintain an erection suitable for intercourse. Causes of erectile dysfunction include diseases affecting blood flow, such as atherosclerosis (narrowing of the arteries); nerve disorders; psychological factors, such as stress, depression, and performance anxiety (nervousness over his ability to sexually perform); and injury to the penis. Chronic illness, certain medications, and a condition called Peyronie's disease (scar tissue in the penis) can also cause erectile dysfunction.

What is inhibited sexual desire?

Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in sexual activity. Reduced libido can result from physical or psychological factors. It has been associated with low levels of the hormone testosterone. It also may be caused by psychological problems, such as anxiety and depression; medical illnesses, such as diabetes and high blood pressure; certain medications, including some anti-depressants; and relationship difficulties.

How are male sexual problems diagnosed?

The doctor will most likely begin with a thorough history of symptoms. The doctor may arrange other tests to rule out any medical problems that may be contributing to the dysfunction. The doctor may refer you to other doctors, including a urologist (a doctor specialising in the urinary tract and male reproductive system), an endocrinologist (a doctor specialising in glandular disorders), a neurologist (a doctor specialising in disorders of the nervous system), sex therapists and other counsellors.

What tests are used to evaluate sexual problems?

Several tests can be used to evaluate the causes and extent of sexual problems. They include:

• Blood tests -- These tests are done to evaluate hormone levels and identify other possible underlying medical problems.
• Vascular assessment -- This involves an evaluation of the blood flow to the penis. A blockage in a blood vessel supplying blood to the penis may be contributing to erectile dysfunction.
• Sensory testing -- Particularly useful in evaluating the effects of diabetic neuropathy (nerve damage), sensory testing measures the strength of nerve impulses in a particular area of the body.
• Nocturnal penile tumescence and rigidity testing -- This test is used to monitor erections that occur naturally during sleep. This test can help determine if a man's erectile problems are due to physical or psychological causes.

How is male sexual dysfunction treated?

Many cases of sexual dysfunction can be corrected by treating the underlying physical or psychological problems. Treatment strategies may include the following:

• Medical treatment -- This involves treatment of any physical problem that may be contributing to a man's sexual dysfunction.
• Medication -- Medicines may help improve sexual function in men by increasing blood flow to the penis. Intra-penile injections and urethral pellets may also be used.
• Hormones -- Men with low levels of testosterone may benefit from hormone supplementation (testosterone replacement therapy).
• Psychological therapy -- Therapy with a trained counsellor can help a person address feelings of anxiety, fear or guilt that may have an impact on sexual function.
• Mechanical aids -- Aids such as vacuum devices and penile implants may help men with erectile dysfunction.
• Education and communication -- Education about sex and sexual behaviours and responses may help a man overcome his anxieties about sexual performance. Open dialogue with your partner about your needs and concerns also helps to overcome many barriers to a healthy sex life.

Can sexual problems be cured?

The success of treatment for sexual dysfunction depends on the underlying cause of the problem. The outlook is good for dysfunction that is related to a treatable or reversible physical condition. Mild dysfunction that is related to stress, fear, or anxiety often can be successfully treated with counselling, education, and improved communication between partners.

Can sexual problems be prevented?

While sexual problems cannot always be prevented, dealing with the underlying causes of the dysfunction can help you better understand and cope with the problem when it occurs. There are some things you can do to help maintain good sexual function:

• Follow your doctor's treatment plan for any medical/health conditions.
• Limit your alcohol intake.
• Stop smoking.
• Deal with any problems with drug abuse - drugs such as cocaine can be responsible.
• Deal with any emotional or psychological issues such as stress, depression, and anxiety. Get treatment as needed.
• Increase communication with your partner. 

When should I seek medical advice?

Many men experience a problem with sexual function from time to time. However, when the problems are persistent, they can cause distress for the man and his partner, and have a negative impact on their relationship. If you consistently experience sexual function problems, seek medical advice for evaluation and treatment.

http://www.webmd.boots.com/sexual-conditions/guide/mens-sexual-problems