CategoriesPremature Ejaculation

Male Superior Position

Yet another reason for emphasizing the female-superior and the more effective lateral coital positioning is that the most popular position in our culture, the male-superior positioning, presents the greatest difficulties with ejaculatory control.

If the coital connection is to be brief with both partners obviously wishing rapid pelvic thrusting to release of their high levels of sexual tension, coital positioning does not matter. But if there is desire to prolong the connection either for mutual pleasure or because the female partner needs more opportunity to feel and think sexually, the male superior position, which places the greatest strain on ejaculatory control, should be avoided when possible.

On every occasion, before female-superior coital position is established and then possibly converted to a lateral mounting arrangement, a comfortable period of precoital sex play is encouraged. The wife should employ the squeeze technique at least two or three times before penetration is attempted.

It takes a significant period of time to alter an early imprinting of the pattern of rapid ejaculation.

However, in the two-week treatment program, sufficient competence in ejaculatory control can be developed to alleviate mutual fears of performance, obviate the spectator role, and provide all the opportunity necessary for continued improvement in control subsequent to release from the acute stage of therapy.

Before the couple leaves the clinic, the cotherapists emphasize the fact that problems of ejaculatory control continue to a minor degree for at least the subsequent year. Several techniques to encourage continuing success in ejaculatory control are described for marital-partner benefit. The unit is reminded that after returning to the demands of their everyday world, regularity of sexual exposure is of primary concern.

For the first six months the squeeze technique should be employed on at least a once-a-week basis prior to coital opportunity; the remainder of the unit’s sexual opportunities during the week are encouraged to develop in a natural, unconstrained fashion. This approach provides the man with the necessary means for transition from a controlled sexual experience to a completely extemporaneous opportunity.

It is also suggested that the couple take advantage of the wife’s menstrual period each month to provide at least one session of 15 to 20 minutes devoted specifically to male sexual stimulation with manual manipulation and repetitive application of the squeeze technique for control of the ejaculatory process.

Ejaculatory Control Techniques

Usually are indicated for a minimum of six to twelve months after termination of the acute phase of therapy. During the routine follow up discussions after termination of the unit’s acute phase of treatment decision to terminate use of the squeeze technique is made by professional evaluation of the degree of control during the unit’s spontaneous matings.

It also is important to emphasize that if circumstances lead to separation of marital members for a matter of several weeks, coital exposure after the couple is physically reunited may find the male returning to his role as a premature ejaculator. Obviously, the procedure in this situation is to reemploy the squeeze technique for several consecutive coital exposures.

If constituted with warmth and understanding ejaculatory control will return rapidly.

With adequate warning of the possibility of these complications, a more relaxed concept of freedom of sexual approach is possible for couples contending with severe premature ejaculation.

numerable approaches to the treatment of premature ejaculation have been described, discarded, or conducted with varying levels of professional acceptance. Hypnotic suggestion, both in natural and drug-induced states of receptivity, has been a popular approach to the problem.

Penis Cream

There has been widespread acceptance of anesthetic creams and jellies prescribed for application to the erect penis theoretically to reduce neurogenic end-organ sensitivity to the stimuli of manipulation or vaginal containment. Specific drug preparations, tranquilizers, barbituates, etc., have been prescribed in an effort to dull male sensitivity to stimuli in general and to stimuli of sexual content in particular.

Many men have tried with varying degrees of success to lower their natural sexual tension levels by ingestion of sizable quantities of alcohol before anticipated sexual encounter.

Frantic men consume a never ending list of potions, nostrums, and poisons, all designed to reduce rapidity of ejaculatory response, all curiously directed to a male’s sexual functioning alone without regard for his partner’s involvement. Any form of sexual inadequacy is a problem of mutual involvement for partners in a marriage.

With a wife’s full cooperation, her willingness to learn and to apply the basic principles of ejaculatory control, and the warmth of her personal involvement expressed openly to her mate, reversal of this crippling marital distress is essentially assured. As further support of this argument for the necessity of involvement of the wife in the resolution of a well established premature ejaculatory pattern, it should be pointed out that the squeeze technique is not effective if done by the male attempting to teach himself control.

If a man manipulates his penis to erection and then applies the squeeze technique to control an imminent ejaculatory response, he usually can halt the natural progression of sex tension increment and successfully depress his ejaculatory urge.

However, once this man returns to the stimulation of a heterosexual relationship, it is as if he had made no prior solitary attempts at control. What is obviated by solitary attempts to learn ejaculatory control is the fact that with a female partner the individual male cannot entirely set the pace of sexual functioning, nor can he entirely, deny the sexual stimuli absorbed from the obvious psycho sexual involvement of his marital partner.

In The 11 Years:

186 men have been treated for premature ejaculation. There have been 4 failures to learn adequate control during the acute phase of therapy. Adequate control is defined as sufficient to provide orgasmic opportunity for the sexual partner during approximately 50 percent of the coital opportunities. The failure rate is 2.2 percent.

Three of the failures were with couples; and one was with a man previously divorced because of his premature ejaculatory pattern, who brought a replacement partner to the treatment program.

In two of the four instances there was no real motivation on the part of the male partner to learn ejaculation control. These men had accompanied their non orgasmic wives as a cooperative venture, but when they learned that they were in fact contributing to their wives’ sexual dysfunction they refused further cooperation. They simply could not accept a reversal of their deeply ingrained double standard of sexual function.

There is no specific explanation for the two remaining failures to control the premature ejaculatory tendencies of the men involved. Both units were fully cooperative but the techniques simply did not work. One of these men, 64 years old, was the only failure among 19 men 50 years or older treated for premature ejaculation.

A brief note of clinical warning is in order. After learning to control a premature ejaculatory tendency, 23 of the couples treated by clinic personnel were confronted by a brief period of secondary impotence just before or shortly after termination of the acute phase of therapy.

Sexual Function Improvement

Most couples, delighted with the significant improvement in sexual functioning, enter a period of marked frequency of coital connection as compared with their sexual exposure rate just before visiting the clinic.

Sometimes the male partner simply cannot meet the suddenly elevated frequency demand and encounters an episode of erective failure. He only has to have one such experience before all his fears of performance flood his consciousness. What new form of dysfunction is this? Has the treatment caused it? His initial anxiety reaction is of serious proportion.

The thought that he was sexually satiated for the moment never occurs either to the concerned husband or his sexually enthusiastic wife. Care must be taken by authority to warn couples of the possibility of a transitory experience with impotence, as they are adjusting their overwhelming pleasure with their newfound sexual function to the practicality of the male’s level of sexual responsivity.

With prior warning the couples take an episode of impotence in stride, even laughing at the concrete evidence of their sexual greediness. Without adequate warning, a persistence of symptoms of secondary impotence is possible, for the fears of performance and spectator roles return to their dominant position before adequate explanation of the distressful event is available,

In brief, the problem of premature ejaculation is uniquely one that can be resolved effectively and permanently. For successful resolution of the problem, a man needs some understanding of the origin of distress, a knowledge of techniques to establish control, and, above all else, a cooperative, involved sexual partner.

CategoriesMale Sex & Vaginismus

Male sex and Vaginismus

Male sex and vaginismus is a psycho physiological syndrome affecting women freedom of sexual response by severely, if not totally, impeding coital function. Anatomically this clinical entity involves all components of the pelvic musculature investing the perineum and outer third of the vagina.

Physiologically, these muscle groups contract spastically as opposed to their rhythmic contractual response to orgasmic experience. This spastic contraction of the vaginal outlet is a completely involuntary reflex stimulated by imagined, anticipated, or real attempts at vaginal penetration.

Vaginismus is a classic example of a psychosomatic illness.

Vaginismus is one of the few elements in the wide pattern of female sexual dysfunctions that cannot be unreservedly diagnosed by any established interrogative technique.

Regardless of the psychotherapist’s high level of clinical suspicion, a secure diagnosis of vaginismus cannot be established without the specific clinical support that only direct pelvic examination can provide. Without confirmatory pelvic examination, women have been treated for vaginismus when the syndrome has not been present.

Conversely, there have been cases of vaginismus diagnosed by pelvic examination when the clinical existence of the syndrome had not been anticipated by therapists. The clinical existence of vaginismus is delineated when vaginal examination constitutes a routine part of the required complete physical examination.

CategoriesMale Sex & Vaginismus

Male Painful Sex

Vaginismus occasionally develops in women with clinical symptoms of severe dyspareunia (painful intercourse). When dyspareunia has firm basis in pelvic pathology, the existence of which escapes examining physicians, and over the months or years coition becomes increasing painful, vaginismus may result.

The patient is not reassured by console that “it’s all in your head” or equally unsupportive pronouncements, when she knows that it is always severely painful for her when her husband thrusts deeply into the vagina during coital connection.

As examples of this situation, vaginismus has been demonstrated as a secondary complication in two cases, of severe laceration of the broad ligaments. Also recorded are two classic examples of onset of vaginismus, the first in a young woman with pelvic endometriosis, the second in a 62 year old postmenopausal widow (without sex-steroid replacement therapy) who through remarriage sought return to sexual functioning after seven years of abstinence.

The two women developing a syndrome of vaginismus subsequent to childbirth laceration of the broad ligaments supporting the uterus (universal-joint syndrome) have similar histories. A composite history will suffice to demonstrate the pathology involved.

Mr. And Mrs. D
was seen with the complaint of increasing difficulty in accomplishing vaginal penetration developing after 6 years of marriage. There were two children in the marriage, with onset of severe dyspareunia oriented specifically to the delivery of the second child. The second child, a post mature baby of 8 pounds 14 ounces, had a precipitous delivery.

There is a positive history of nurses holding, the patient’s legs together to postpone delivery while waiting for the obstetrician. As soon as sexual activity was reconstituted after the delivery the patient experienced severe pain with deep penile thrusting. During the next year the pain became so acute that the wife sought subterfuge to avoid sexual exposure.

The intercourse frequency decreased from two to three times a week to the same level per month. On numerous occasions the patient was assured, during medical consultation, that there was nothing anatomically disoriented in the pelvis and that pain with intercourse was “purely her imagination.”

Supported by these authoritative statements, the husband demanded increased frequency of sexual function. When the wife refused, the unit separated for serveral months. During these month period, the woman assayed intercourse on two separate occasions with two different men, but with each experience the pelvic pain with deep penile thrusting was so severe that her obvious physical distress terminated sexual experimentation.

The couple was reunited with the help of their religious adviser, but with attempted intercourse vaginal penetration was impossible. After 8 months of repeatedly unsuccessful attempts to reestablish coital function, the unit was referred for therapy.

Couple E
married 8 years when seen in the Clinic. They mutually agreed that coital connection had not been possible more than once or twice a month in the first two years of marriage. Each time, the wife had moaned or screamed in pain as her husband was thrusting deeply into her pelvis. After the first two years of marriage, every attempt at vaginal penetration had been unsuccessful.

Both had been under intensive psychotherapy, the husband for three and the wife for four years, when referred to the Foundation. During the routine physical examinations, advanced endometriosis was discovered, and severe vaginismus was demonstrated.

In due course the wife underwent surgery for correction of the pelvic pathology. After recovery from the surgery she returned with her husband for therapeutic relief of the vaginismus which, as would be expected, still existed despite successful surgical correction of the endometriosis.

Couple F
a 66 year old husband and his 62 year old wife, were seen in consultation. When the wife was 54 years old, her first husband died after a three-year illness during which sexual activity was discontinued. She remarried at 61 years of age, having had no overt sexual activity in the interim period.

She had never been given hormone-replacement therapy to counteract the natural involution of pelvic structures. First attempts at coital connection in the present marriage produced a great deal of pain and only partial vaginal penetration.

With reluctance the wife sought medical consultation. Her physician instituted hormone-replacement techniques. After a 6-week respite, further episodes of coital activity also resulted in pain and distress.

Despite the fact that by this time the vaginal walls were well stimulated by effective steroid replacement, the new husband found it impossible to attain vaginal intromission. The wife had developed obvious psychosocial resistance to the concept of sexual activity in the 60 plus age group based on the pain that had been experienced attempting to consummate her new marriage.

And a real sense of embarrassment created by the need for medical consultation and the necessity of admitting that she had been indulging in coital activity at her age.

As a result of the trauma that developed with attempts to renew sexual function subsequent to almost ten years of continence, she developed involuntary spastic contraction of the vaginal outlet. Judicious use of Hegar dilators and a detailed, thorough, and authoritative refutation of the taboo of aging sexual function (based on the belief that sexual activity in the 60, 70, or even 80 year age groups represents some form of perversion) were quite sufficient to relax and relieve the vaginal spasm.

premature ejaculationCategoriesFertility Problems

Male/Female Tubal Obstruction

Adhesions are scars which form on the outside of the oviducts. They tie down the tube; it cannot move at ovulation to scoop up the free-floating egg. Adhesions can be due to previous pelvic infections, or surgery. If the scarring is widespread, the open ends of the fimbria may be completely blocked. When liquid is passed through the tubes, it cannot flow out. This is known as hydrosalpinx.

Corrective surgery to free the tubes from external adhesions has a success rate of 60 to 70 percent. However, this high rate only applies if the mucus linings inside the tubes have not been damaged by the scarring. Yet, when the fimbria are blocked, this internal lining is almost always severely damaged. The pregnancy rate then drops to between 5 and 20 percent. Keep in mind that there is always the risk that an operation to unblock the tubes can produce even more scar tissue. In these cases, one choice is in vitro fertilization.

Male Tubal Obstruction

The epididymes can be felt by gently rolling the testicles between the fingers and thumb. They are small comma-shaped lumps on top of the testicles; “epididymes” is Greek for “upon the twins.” They are, in fact, tightly coiled tubes which, if stretched out, would measure 20 feet. After baby sperm leave the testicles, they mature in the epididymes, and develop swimming skills. If the epididymes tubes are blocked, the result is tubal obstruction. In rare cases, blocked tubes are the result of a birth defect. The vas tubes which carry the mature sperm to the penis can also be blocked.

Blocked tubes are a common problem in male infertility. They occur for the same reasons as in women; scars from previous infections or surgery. Surgery to repair defective tubes can be successful if the blockage is mild. However, if the degree of scarring is great, the outcome for unblocked tubes is low. One option in these cases is in vitro fertilization.

premature ejaculationCategoriesFertility Problems

Male Factor Infertility

The first and simplest fertility test involves a specimen of the male ejaculate. An average ejaculate contains one-half to one full teaspoon of semen. The average ejaculate volume after 3 days of abstinence is 3 to 5 cc. Sperm make up only about 3 percent of the average ejaculate. The other 97 percent consists of fluids made in the prostate gland and the seminal vesicles.

Sperm Count (millions per cc)Pregnancy Rate (percent)
5 – 1027.8
10 – 2052.9
20 – 4057.1
40 – 6060.0
60 – 10062.5
Over 10070.0

100 million sperm per cc is very high; 15 million is very low. The lower the counts, the higher the risk of infertility. There is no general agreement on the lower limit; some specialists believe that even a very low sperm count does not rule out the chance of fertilization, providing the sperm are well-formed and have good swimming skills.

In an average ejaculate, there will always be defective sperm. About 20 percent will lack proper structure or motility. They can have three tails but no head, a head but no tail, and so on. They can lack all sense of direction, clump together, swim feebly, or not swim at all. To reach the oviducts, sperm must move forward, and at fairly high speed.

Sperm Washing: When sperm are deposited at the top of the vagina, they have great distances to travel before they reach the oviducts. This allows time for “capacitation”, the enzymes in the head become activated to help sperm enter the tube and penetrate the wall of the egg. Sperm washing is a high-tech procedure which allows capacitation for poor quality sperm. It can be used in combination with in vitro fertilization.

Hormone drugs can stimulate under-active testicles, and raise the sperm count. If the problem is found to be that the man produces antibodies to his own sperm, steroids can suppress this immune reaction. When planning for intercourse at specific ovulation dates, keep in mind that it takes 72 days altogether for sperm to mature in the testicles and epididymes, before they are ready to be ejaculated.

A recent study found that men who were not under stress to “perform” produced higher sperm counts than those who were. Many women can sympathize with this. It is much the same “performance pressure” as feeling “obliged” to always have an orgasm. Keep a partner from feeling such pressure at specific ovulation dates. One way could be by more frequent intercourse. Studies on college athletes showed that abstinence appears to have little effect on sperm quality.

premature ejaculationCategoriesFertility Problems

Looking Inside

A laparoscopy is a surgical procedure to examine the internal structures. A coloured solution is introduced into the uterus via the vagina and cervix. The laparoscope is inserted though a small cut in the abdomen wall. When the tubes are open, the coloured fluid can be seen to flow through them, and out into the pelvic cavity. If some fluid pools in little pockets, there may be scarring. The egg can get trapped in the pocket, and die. The pelvic cavity, ovaries, and uterus are also examined to see if endometriosis, inflammation, or some birth defect could be causing the problem. Where appropriate, surgical procedures to relieve a minor problem will be done at the same time.

A laparoscopy is a surgical procedure to examine the internal structures. A coloured solution is introduced into the uterus via the vagina and cervix. The laparoscope is inserted though a small cut in the abdomen wall. When the tubes are open, the coloured fluid can be seen to flow through them, and out into the pelvic cavity. If some fluid pools in little pockets, there may be scarring. The egg can get trapped in the pocket, and die. The pelvic cavity, ovaries, and uterus are also examined to see if endometriosis, inflammation, or some birth defect could be causing the problem. Where appropriate, surgical procedures to relieve a minor problem will be done at the same time.

A hysteroscopy is a procedure performed through the vagina. A fluid or carbon dioxide gas is introduced into the uterus via the vagina and cervix to expand the area and allow a better view. The mucus-secreting glands of the cervix are examined to see if they are working properly. The cervical canal and uterus lining are checked for structures which might add to the problem: polyps, fibroids, or bands of scar tissue. Some minor surgical procedures can be done at the same time, if appropriate.

A hysterosalpingogram (HSG) is an internal X-ray of the uterus and tubes. A radio-opaque dye is injected into the uterus through the vagina and cervix, and the X-ray is taken. HSG is a painful procedure. Cramps and spasm can give a false-positive result; there appears to be a blockage where, in fact, none exists. The iodine solution in the dye can cause an allergic reaction. HSG has become less popular in recent years.

premature ejaculationCategoriesFertility Problems

Other Fertility Tests

There are many different tests to find the cause of fertility problems. They include:

  • Evaluation of cervical mucus. This involves an examination of mucus production, which may be scanty and blocking the sperm.
  • Postcoital tests. These occur after intercourse to evaluate the progress of sperm inside the vagina.
  • Basal body temperature charting. This test checks the timing of ovulation dates.
  • Hamster test. Sperm are evaluated to find out whether or not they can penetrate hamster eggs.
  • Hormone assay tests. These check the sex hormone levels of the partners.

One major problem with these tests is that they all take time. If the woman is no longer young, it may be suggested that she bypass all tests and goes straight for in vitro fertilization. However, most tests are covered by much medical insurance, and in vitro fertilization often is not.

It is only natural to want to know the cause of infertility. If either partner has tubal obstruction, or corrective surgery works, the problem is cured. If the problem is with the egg or sperm, hormone therapy is highly effective. The couple can then have as many children as they wish. With in vitro fertilization, an entire new program must be undertaken each time for each new baby. No single program can guarantee success.

Research from in vitro programs shows that time is a critical factor in choice. In’ one program, 35 women over age 40 had their eggs fertilized outside the uterus. When the fertilized eggs were returned to the uterus, only 5 women achieved pregnancy and none carried the fetus to term. Yet when these same women received eggs donated by women under age 35, 20 got pregnant and 15 delivered babies.

CategoriesAging Male Sex

Male Sex Steriod

Little is known of the male climacteric.

When does it occur, if it develops? Is it a constant occurrence? What is the specific symptomatology? Should sex-steroid-replacement techniques be employed? What, if any, are the patterns of sexual responsivity engendered by these replacement techniques? So little is known of the male climacteric.

Now that these definitive laboratory studies can be done with some confidence, relative rapidity, and at not too staggering a cost, much more will be known of the male climacteric within the next few years.

There will be more basic information on the effects of steroid replacement not only upon the aging male’s sexual response cycle per se but also, and infinitely more important, upon the total metabolic function of the climacteric male.

Without the gross advantage of fully supportive laboratory data, tentative clinical conclusions have been drawn regarding the influence of steroid-replacement techniques upon the aging male’s sexual functioning.

These conclusions may have to be restarted or even possibly abandoned in the not-too-distant future as more definitive information is accrued from the healthy combination of clinical and laboratory evaluations.

When the male notices alteration of his orgasmic response pattern from the usual two-stage to a one-stage process, when he consistently responds during the orgasmic experience with the loss of seminal fluid volume without significant ejaculatory pressure, when the average ejaculatory volume is cut at least in half, and when none of these reactions develop under the extenuating circumstances of a long-continued plateau phase of voluntary ejaculatory control, he may be experiencing the physiological expression of reduced production of male sex-steroid to metabolically dysfunctional levels.

Occasionally prostatic pain develops from spastic contractions of the organ during the ejaculatory process.

These spastic contractions create a continuing sense of ejaculatory urgency that may last through the entire orgasmic experience until full expulsion of the seminal-fluid bolus has occurred.

With the subjectively painful evidence of physiological prostatic spasm recurring with most ejaculatory experiences and no obvious pathology of the prostate gland demonstrable to adequate urological examination, sex-steroid replacement also may be indicated.

Until there is a more reliable laboratory definition of a general metabolic need for testosterone replacement and until the clinical existence of the male climacteric can be defined with security during treatment of older men for sexual dysfunction, individual eases must be treated empirically.

If the sexually dysfunctional male describes physiological or psychological symptomatology that appears to indicate the clinical need for the sex-steroid replacement and if the general physical and laboratory evaluations are negative, there is no professional hesitancy to institute such replacement techniques.

However, sex-steroid-replacement techniques are not employed routinely for the 50 to 70 year age group man referred for therapy.

Steroid replacement concepts and specific techniques, together with indications and contraindications for the aging male will be presented in more complete form by the Foundation in monograph format in the future.

Erection Response In Aging Male

The sexual myth most rampant in our culture today is the concept that the aging process per se will in time discourage or deny erective security to the older-age-group male. As has been described previously, the aging male may be slower to erect and may even reach the plateau phase without full erective return, but the facility and the ability to attain erection, presuming general good health and no psychogenic blocking, continues unopposed as a natural sequence well into the 80 year age group.

The aging male may note delayed erective time, a one-stage rather than a two-stage orgasmic experience, reduction in seminal-fluid volume, and decreased ejaculatory pressure, but he does not lose his facility for erection at any time.

Sexual Advantages

If this concept can be presented to and accepted by the general population, one of the great deterrents to the sexual functioning of the aging male will have been eliminated. When the conceptive ability is no longer important and reduction in seminal fluid volume and total sperm production no longer is of consequence, the aging male is potentially a most effective sexual partner.

He needs only to ejaculate at his own frequency and not based on uninformed socio-cultural demand.

There are even some sexual advantages that accrue as the male ages.

He has increased ejaculatory control and can; if he wishes, serve his female partner deftly and with full erective security. His sexual effectiveness is based not only upon his prior sexual experience but also upon the specific element of increased physiological control of the ejaculatory process.

If the aging male does not succeed in talking himself out of effective sexual functioning by worrying about the physiological factors in his sexual response patterns altered by the aging process, if his peers do not destroy his sexual confidence, if he and his partner maintain a reasonably good state of health, he certainly can and should continue unencumbered sexual functioning indefinitely.

CategoriesAging Male Sex

ED in Aging Male

Composite case studies have been selected to identify and illustrate the dysfunctional characteristics of the male aging process.

Both Mr. and Mrs. A were 66 and 62 years of age when referred to the Foundation for sexual inadequacy. They had been married 39 years and had three children, the youngest of which was 23 years of age. All children were married and living outside the home.

They had maintained reasonably effective sexual interchange during their marriage.

Mr. A had no difficulty with erection, reasonable ejaculatory control, and, aside from two occasions of prostitute exposure, had been fully committed to the marriage. Mrs. A occasionally orgasmic during intercourse and regularly orgasmic during her occasional masturbatory experiences had continued regularity of coital exposure with her husband until five years before referral for therapy.

Mr. A had recently retired from a major manufacturing concern. He had been relatively successful in his work and there were no specific financial problems facing man and wife during their declining years.

Both members of the marital unit had enjoyed good health throughout the marriage. At age 61, he had taken his wife abroad on a vacation trip which entailed many sightseeing trips with a different city on the agenda almost every day.

They were chronically tired during the exhausting trip, but because they were on vacation and away from home there was a definite increase over the established frequency of coital connections. Mr. A noted for the first time slowed erective attainment.

Regardless of his level of sexual interest or the depth of his wife’s commitment to the specific sexual experience, it took him progressively longer to attain a full erection. With each sexual exposure his concern for the delay in erective security increased until finally, just before termination of the vacation trip, he failed for the first time to achieve an erection quality sufficient for vaginal penetration.

When the coital opportunity first developed after return home, erection was attained, but again it was quite slow in development. The next two opportunities were only partially successful from an erective point of view, and thereafter he was secondarily impotent.

After several months they consulted their physician and were assured that this loss of erective power comes to all men as they age and that there was nothing to be done. Loath to accept the verdict, they tried on several occasions to force an erection with no success. Mr. A was seriously depressed for several months but recovered without apparent incident.

Approximately 18 months after the vacation trip, the couple had accepted their “fate.” The impotence was acknowledged to be a natural result of the aging process. This resigned attitude lasted approximately four years.

Although initially the marital unit and their physician had fallen into the socio-cultural trap of accepting the concept of sexual inadequacy as an aging phenomenon, the more Mr. and Mrs. A considered their dysfunction the less willing they were to accept the blanket concept that lack of erective security was purely the result of the aging process.

They reasoned that they were in good health, had no basic concerns as a marital unit, and took good care of themselves physically. Therefore, why was this dysfunction to be expected simply because some of their friends reportedly had accepted the loss of male erective prowess as a natural occurrence?

Each partner underwent a thorough medical checkup and sought several authoritative opinions, refusing to accept the concept of the irreversibility of their sexual distress. Finally, approximately five years after the onset of a full degree of secondary impotence, they were referred for treatment.

Sexual functioning was reconstituted for this marital unit within the first week after they arrived at the Foundation and as soon as they could absorb and accept the basic material directed toward the variation in the physiological functioning of the aging male.

No longer were they concerned with the delay in erective attainment; there were no more attempts to will, force, or strain to accomplish erection under assumed pressures of performance.

In short:

They needed only the security of the knowledge that the response pattern which initially had raised the basic fear of dysfunction was a perfectly natural result of the involutional process.

When they could accept the fact that it naturally took longer for an older man to achieve an erection, particularly if he were tired or distracted, the basis for their own sexual inadequacy disappeared.

Some six years after termination of the acute phase of therapy, this couple, now in the early seventies and late sixties, continue coital connection once or twice a week.

The husband has learned to ejaculate on his own demand schedule, and neither partner attempts a rapid return to sexual function after a mutually satisfactory sexual episode.

Husband and wife B

The husband, age 62, and his wife, age 63, were referred to the Foundation. They had two children, both of whom were married and lived out of the home.

Their sexual dysfunction had begun when the husband was 57 years old. He had noted some delay in attaining erection and marked reduction in ejaculatory volume and was particularly concerned with the fact that the ejaculatory experience was one of mere dribbling of seminal fluid from the external urethral meatus, under obviously reduced pressure.

All these involutional signs and symptoms developed within approximately a year after he had noticed some delay in onset of erection attainment.

The more he worried about his symptoms the more frequent the occasions of impotence.

Mrs. B was completely convinced that this pattern of sexual involution was true to be expected as part of the aging process.

Rather than distress her husband, she suggested that they use separate bedrooms.

She changed from a pattern of free and easy exchange of sexual demand to one of availability for coital connection only at her husband’s expression of interest. To resolve her own sexual tensions, she masturbated about once every ten days to two weeks without her husband’s knowledge.

Finally, Mr. B developed severe prostatic spasm with ejaculation during approximately half the increasingly rare occasions when there was sufficient erective security to establish a coital connection. It was the persistence of this symptom of pain that first brought medical consultation and ultimately referral for treatment.

In the evaluation of this man during the physical examination, there was marked muscular weakness noted, a history of easy fatigability, and increasing lassitude in physical expression.

Mr. B also had been distressed in the last two to three years before referral to therapy with distinct memory loss for recent events. He described the loss of work effectiveness for approximately the same length of time.

With these overt symptoms suggestive of steroid starvation, testosterone replacement was initiated empirically. Within those days there was the partial return of ejaculatory pressure and a moderate shortening of the time span for the delayed erective reaction. The prostatic pain did not recur.

Husband and wife B Steroid Replacement

Once Mrs. B could accept the explanation for the onset of her husband’s sexual dysfunction, she was pleased to return to the role of an active sexual partner. The coital connection has continued regularly for the past three years with both members of the marital unit supported by steroid-replacement techniques.

In brief, for the sexually dysfunctional aging male, the primary concern is one of education so that both the man and his wife can understand the natural involutional changes that can develop within their established pattern of sexual performance.

Sex steroid replacement should be employed only if definite physical evidence of the male climacteric exists. As the newer techniques for establishing testosterone levels in blood serum become more widely disseminated, it will be infinitely easier to define and describe the male climacteric and therefore to offer testosterone replacement to those who need it, on a more definitive basis than the empirical diagnosis.

With effective dissemination of information by proper authority, the aging man can be expected to continue in a sexually effective manner into his ninth decade. Fears of performance are engendered by a lack of knowledge of the natural involutional changes in male sexual responsivity that accompany the aging process.

Really, the only factor that the aging male must understand is that loss of erective prowess is not a natural component of aging.

Statistical evaluation of the aging population and a consideration of treatment failure rates will constitute the following section. This material arbitrarily has been placed in the male rather than the female.

First, it was felt important to keep the statistical consideration of the aging marital units together, and second, because there were 56 males So years old or over in marital units accepted for treatment and only 37 wives 50 or older, it seemed appropriate to include the brief statistical discussion in the chapter reflecting the larger segment of the aging population.

CategoriesAging Male Sex

Aging Male Sex

The natural aging process creates a number of specific physiological changes in the male cycle of sexual response. Knowledge of these cycle variations has not been widely disseminated.

There has been the little concept of a physiological basis for differentiating between natural sexual involution and pathological dysfunction when considering the problems of male sexual dysfunction in the post-so age group.

If all too few professionals are conversant with anticipated alterations in male sexual functioning created by the aging process, how can the general public be expected to adjust to the internal alarms raised by these naturally occurring phenomena?

Tragically, yet understandably, tens of thousands of men have moved from effective sexual functioning to varying levels of secondary impotence as they age, because they did not understand the natural variants that physiological aging imposes on previously established patterns of sexual functioning.

Sexually Impaired at 50

From a psychosexual point of view, the male over age 50 has to contend with one of the great fallacies of our culture. Every man in this age group is arbitrarily identified by both public and professional alike as sexually impaired.

When the aging male is faced by unexplained yet natural involutional sexual changes, and deflated by widespread psychosocial acceptance of the fallacy of sexual incompetence as a natural component of the aging process, is it any wonder that he carries a constantly increasing burden of fear of performance?

Before discussing specifics of sexual dysfunction in the aging population, the natural variants that the aging process imposes on the established male cycle of sexual response should be considered.

For sake of discussion, the four phases of the sexual response cycle excitement, plateau, orgasm, and resolution will be employed to establish a descriptive framework. Also for descriptive purposes, the term older man will be used in reference to the male population from 50 to 70 years of age and the term younger man used to describe the 20 to 40 year age group.

In recent years the younger man’s sexual response cycle has been established with physiological validity and will serve as a baseline for comparison with the physiological variations of aging.

If an older man can be objective about his reactions to sexual stimuli during the excitement phase, he may note a significant delay in erective attainment compared to his facility of response as a younger man.

Most older men do not establish erective response to effective sexual stimulation for a matter of minutes, as opposed to a matter 9f seconds as younger men, and the erection may not be as full or as demanding as that to which previously he has been accustomed.

It simply takes the older man longer to be fully involved subjectively in acceptance and expression of any form of sensate stimulation.

If natural delays in reaction time are appreciated, there will be no panic on the part of either husband or wife. If, however, the aging male is uninformed and not anticipating delayed physiological reactions to sexual stimuli, he may indeed panic and responding in the worst possible way to try to will or force an erection.

The unfortunate results of this approach to erective security have been discussed at length in treatment of impotence.

Aging Male Erections

As the aging male approaches the plateau phase, his erection usually has been established with fair security. There may be little if any testicular elevation, a negligible amount of scrotal-sac vasocongestion, and minimal deep vascular engorgement of the testes.

Most older men who have had a pre-ejaculatory fluid emission (Cowper’s gland secretory activity) will notice either total absence of, or marked reduction in, the amount of this pre-ejaculatory emission as they age.

From the aspect of time-span, the plateau phase usually lasts longer for an older man than for his younger counterpart. When an aging male reaches that level of elevated sexual tension identified as thoroughly enjoyable, he usually can and frequently does wish to maintain this plateau-phase level of sensual pleasure for an indefinite period of time without becoming enmeshed by ejaculatory demand.

This response pattern is age-related; the younger man tends to drive for early ejaculatory release when plateau-phase levels of sexual tension have accrued. One of the advantages of the aging process with specific reference to sexual functioning is that.

Generally speaking, control of ejaculatory demand in the 50 to 70 year age group is far better than in the 20 to 40 year age group.

In the cycle of sexual response, the largest number of physiological changes to come within objective focus for older men occurs during the orgasmic phase (ejaculatory process). The orgasmic phase is relatively standardized for younger men, varying minimally in duration and intensity of experience unless influenced by the psychosexual opposites of long-continued continence or high level of sexual satiation.

For younger men, the entire ejaculatory process is divided into two well-recognized stages. The first stage, ejaculatory inevitability, is the brief period of time (2 to 4 seconds) during which the male feels the ejaculation coming and no longer can control it before ejaculation actually occurs.

These subjective symptoms of ejaculatory inevitability are created physiologically by regularly recurring contractions of the prostate gland and, questionably, the seminal vesicles. Contractions of the prostate begin at o.8-second intervals and continue through both stages of the male orgasmic experience.

The second stage of the orgasmic phenomenon consists of the expulsion of the seminal-fluid bolus accrued under pressure in the membranous and prostatic portions of the urethra, through the full length of the penile urethra.

Again, there are regularly recurring 0.8-second inter-contractile intervals. This specific interval lengthens after the first three or four contractions of the penile urethra in younger men.

Subjectively, the sensation is one of flow of a volume of warm fluid under pressure and emission of the seminal fluid bolus in ejaculatory spurts with pressure sufficient to expel fluid content distances of 12 to 24 inches beyond the urethral meatus.

As the male ages he develops many individual variants on the basic theme of the two-stage orgasmic experience described for the younger man. Usually his orgasmic experience encompasses a shorter time span.

There may not be even a recognizable first stage to the ejaculatory experience, so that an orgasmic experience without the stage of ejaculatory inevitability is quite a common occurrence.

Even with a recognizable first stage, there still may be marked variation in reaction pattern. Occasionally, the older man’s phase of ejaculatory inevitability lasts but a second or two as opposed to the younger man’s pattern ranging from 2 to 4 seconds.

In an older man’s first-stage experience, there may be only one or two contractions of the prostate before involuntary initiation of the second stage, seminal-fluid expulsion.

Alternatively, the first stage of orgasmic experience may be held for as long as 5 to 7 seconds. Occasionally the prostate, instead of contracting within the regularly described pattern of 0.8-second intervals, develops a spastic contraction, creating subjectively the sense of ejaculatory inevitability.

Inadequate Testosterone

The prostate may not relax from spasm into rhythmically expulsive contractions for several seconds, hence the 5-7-second duration of the first-stage experience. In addition to objective variants in a first-stage orgasmic episode, there may be no possible objective or subjective definition of the first stage of orgasmic experience at all.

The stage of ejaculatory inevitability may be totally missing from the aging male’s sexual response cycle. A single-stage orgasmic episode develops clinically in two circumstances.

The first circumstance is that of clinical dysfunction developing as the result of inadequate testosterone production.

Actually the lack of a recognizable first stage in orgasmic experience can result from low sex-steroid level for the male just as steroid starvation in the female may produce an orgasmic experience of markedly brief duration.

The second occasion of an absent first stage in the orgasmic experience develops after there has been prior denial of ejaculatory opportunity over a long period of intravaginal containment in order to satisfy the aging male’s coital partner sexually.

There also are obvious physiological changes in the second stage of the orgasmic experience that develop with the aging process.

The expulsive contractions of the penile urethra have onset at 0.8second intervals but are maintained for only one or two contractions at this rate:

The expulsive force delivering the seminal fluid bolus externally, so characteristic of second-stage penile contractions in the younger man, also is diminished, with the distance of unencumbered seminal-fluid expulsion ranging from 3 to 12 inches from the urethral meatus.

CategoriesAging Male Sex

Aging Male & Female

Arbitrarily, statistics reflecting the failure rates of treatment procedures for sexual dysfunction in the aging population will be considered in this section rather than dividing the material between the discussions of sexual inadequacy in the aging male and female.

A brief single presentation seems in order since only marital units are available for consideration in this age group. The male and female statistics are essentially inseparable from a therapeutic point of view, and the overall sample is entirely too small for definitive individual interpretation.

Statistics

In 51 of the total of 56 aging marital units treated for sexual dysfunction, the husband was the instigating agent in bringing the marital unit to therapy. Among the remaining 5 couples, the referral apparently was by the mutual accord in 3 and only at the demand of the wife in 2 couples.

There also was a higher incidence of referred male sexual dysfunction than of female sexual inadequacy in the aging population. Therefore the discussion will focus on the male partner’s age as a point of departure.

Since the husband was the partner most often involved in dysfunctional pathology and was the member of the unit that usually took the necessary steps to accomplish referral to the Foundation, the aging male will be statistically highlighted.

The 56 marital couples referred for treatment divide into 33 units with bilateral complaints of sexual dysfunction and 23 units with unilateral complaints of sexual inadequacy. Thus, there were 89 individual cases of sexual dysfunction treated from the 56 units with husbands’ age 5o years or over as a common baseline.

This 33:23 ratio is a reversal of the overall statistics for dual-partner involvement of marital units as opposed to singly involved units. The fact that there was a dominance of bilateral sexual deficiency among the older marital units is in accord with previously expressed concepts of cultural influences.

Certainly, the older the marital unit the better chance for the Victorian double standard of sexual functioning. With these pressures of performance, one could almost expect more male than female sexual pathology to be in identified unit partners over 50 years of age referred to the Foundation.

The clinical complaints registered by the aging population (male and female) in the 56 marital units referred for treatment. There was a 30.3 percent failure rate to reverse sexual dysfunction, regardless of whether both partners or a single partner is involved, in any marriage with the husband over 50years of age. With gender separation, for the aging male (50 to 79) there was a 25 percent failure rate to reverse his basic complaint of sexual inadequacy as compared to a 40.7 percent failure rate for the aging female (50 to 79).

These statistics simply support the well-established clinical concept that the longer the specific sexual inadequacy exists, the higher the failure rate for any form of therapeutic endeavor.

On the other hand, there was a significantly less than 50 percent failure rate in treatment for any form of sexual dysfunction, regardless of the age of the individuals involved. In short, even if the sexual distress has existed for 25 years or more, there is every reason to attempt a clinical reversal of the symptomatology.

There is so little to lose and so much to gain. Presuming generally good health for the sexual partners, and mutual interests in reversing their established sexual dysfunction, every marital unit, regardless of the ages of the partners involved, should consider the possibility of clinical therapy for sexual dysfunction in a positive vein. The old concept “I’m too old to change” does not apply to the symptoms of sexual dysfunction.

Aging,Male,Ejaculation,Aging Male,Male Ejaculation,Aging Male EjaculationCategoriesAging Male Sex

Aging Male Ejaculation

Probably the most important psychophysiological alteration of sexual patterning to develop during the 50 to 70 year period is the human male’s loss of high levels of ejaculatory demand.

So many men in the older age groups consider themselves too old to function sexually, yet cannot explain how they have arrived at this conclusion.

As the male ages, he not only enjoys a fortuitous increase in ejaculatory control but also has a definite reduction in ejaculatory demand.

For Example:

If a man 60 years of age has intercourse on an average of once or twice a week, his own specific drive to ejaculate might be of the major moment every second or third time there is coital connection.

This level of innate demand does not imply that the man cannot or does not ejaculate more frequently. He can force himself and/or be forced by the female-partner insistence to ejaculate more frequently, but if left to resolve his own individual demand level he may find that an ejaculatory experience every second or third coital connection is completely satisfying personally.

Explicitly his own subjective level of ejaculatory demand does not keep pace with the frequency of his physiological ability to achieve an erection or to maintain this erection with full pleasure on an indefinite basis.

This factor of reduced ejaculatory demand for the aging male is the entire basis for effective prolongation of sexual functioning in the aging population.

If an aging man does not ejaculate, he can return to an erection rapidly after prior loss of erective security through distraction or female satiation.

The older man can easily achieve and maintain an erection if there is no ejaculatory threat in the immediate offing. The uninformed woman poses an ejaculatory threat. She believes that she has not accomplished a woman’s purpose unless her coital partner ejaculates.

How many women in our culture feel they have fulfilled the feminine role if their partner has not ejaculated? Whether he likes it or needs it, she must be a good sexual partner. “Everybody knows that a man needs to ejaculate every time he has intercourse” and so goes the refrain.

The message should reach both sexes that after members of the marital unit are somewhere in the early or middle fifties, demand for sexual release should be left to the individual partner.

Then coital connection can be instituted regularly and individual male and female sexual interests satisfied. These interests for the woman can range from demand for multi orgasmic release to just desiring vaginal, penetration, and holding, without any effort at tension elevation.

If the male is encouraged to ejaculate on his own demand schedule and to have intercourse as it fits both sexual partners’ interest levels, the average marital unit will be capable of functioning sexually well into the 80 year age group, presuming for both man and woman a reasonably good state of general health and an interested and interesting sexual partner.

Effective sexual function for any man in the 50 to 70 year age group depends primarily upon his full understanding of the sexual involutional processes that he may encounter. Effective sexual function for most women also depends upon their knowledge of male sexual physiology in the declining years. Men and women must understand fully the alterations of sexual patterning that may develop if they are to cope effectively with their aging process.