The more satisfied a man is with a relationship, the better the sex tends to be. Men who reported being satisfied with their relationship were half as likely to report sex that wasn’t pleasurable.

 A large sexual survey funded by the National Institutes of Health was recently published.  Adults ages 57 to 85 were asked about their sexual problems. Key take away points include that a healthy sex life can extend well into the 80s and the important link between overall health to sexual health.  

Harder to perform with age:Men ages 75 to 85 were 2.4 times as likely to report being unable to orgasm and 1.9 times as likely to report difficulty maintaining an erection as men ages 57 to 64. The good news: The older men didn’t report significantly less interest in sex or pleasure during sex. 

Married men have more bad sex: Lack of pleasure during sex was reported by significantly fewer widowed or never married men. These men were one tenth as likely to report sex as not pleasurable as were men in married or cohabiting couples.  Divorced or separated men were twice as likely to report performance anxiety as married or cohabiting couples.

The British Medical Association estimates that smoking increases the risk of erectile dysfunction by about 50 per cent for men in their thirties and forties, and they suggest that there are 120,000 men in this age group in the UK who are impotent purely because they smoke. Premature ejaculation, however, is usually caused by anxiety, and since getting married is sixth on the list of the top ten most stressful life events, this problem is bound to improve once you both stop worrying about seating arrangements and vegetarian options.  

Smoking, in the short and long term, increases impotence and reduces penile rigidity. In men whose erections are already beginning to falter, smoking may complete their decline. In the long term it can cause atherosclerosis of the arteries leading to the penis. As they become furred up, the blocking of the blood supply to the penis may cause an inadequate erection or impotence.  In the short term, smoking may cause temporary constriction of the penile arteries so rapidly that the effect of the last cigarette smoked by a randy lover becomes obvious within moments.

Smokers are also more likely to suffer premature ejaculation and a reduction in the amount of semen produced. An average non-smoker in the 30 to 50 age group produces around 3.5ml of semen, about three-fifths of a large teaspoonful.

Smokers of the same age group produce on average only 1.9ml of semen, well under half a large teaspoonful. This is the amount of semen produced by an average 60 to 70-year old man, and the fertility may be reduced accordingly. It is not only the quantity of the semen that suffers but also the number, activity, vitality and sense of direction of the swimming sperm. The number of deformed sperm is also increased.

The most important thing to do is to give up smoking so that you break the psychological link you have created between cigarettes and coming too quickly.  

Premature ejaculation (PE) is a common, embarrassing and significantly under treated medical condition that affects men and their partners. Dapox­etine, a new short lasting selective serotonin reuptake inhibitor (SSRI), has demonstrated clinical efficacy in clinical trials when used immediately before in­tercourse. However, Dapoxetine has not yet been approved by the regulatory agency in part because of concern of risk and benefit ration of a SSRI in this quality of life condition. 

We became interested if Hypericum perfo­ratum, a natural supplement that has demonstrated pharmacologically to inhibit serotonin reuptake and can be formulated to help men last longer during sexual intercourse. In a rat model of ejaculation dura­tion, hyperforin extract from Hypericum perforatum can delay time to ejaculation. 

Ten male volunteers took the rapid release formulation of hyperforin for 8 weeks and assessed their sexual intercourse duration and sexual satisfaction. In 5 men with mean ejaculatory duration at baseline of less than 90 seconds (mean age 39 years old), 4 reported lasting longer - mean time to ejaculation before and after treatment, 58 ± 12 seconds to 131 ± 23 seconds, respectively (p < 0.01). Equally interesting, the mean sexual intercourse duration increased from 266 ± 39 to 391 ± 34 sec­onds (p=0.02) after Hyperforin extract treatment in 3 of 5 men with ejaculation greater than 3 minutes at baseline (mean age 43 years old). No adverse ef­fect on sexual function and no systemic side effects were reported. Seven of 10 couples reported subjective global sexual satisfaction improvement for both the men and his partner after hyperforin. Five couples reported more frequent female orgasm. Rapid onset of action, ease of use and safety make hyperforin extract an option for men who wish to last longer.

Nils Beckman and colleagues from the University of Gothenburg in Sweden, studied attitudes to sex in later life among four groups of  70 year olds in Sweden, who they interviewed in 1971-1972, 1976-1977, 1992-1993, and 2000-2001. In total, over 1,500 people aged 70 years were interviewed about different aspects of their sex lives including sexual dysfunctions, marital satisfaction and sexual activity. The authors found that over the thirty year period the number of 70 year olds of both sexes reporting sexual intercourse increased: married men from 52% to 68%, married women from 38% to 56%, unmarried men from 30% to 54%, and unmarried women from 0.8% to 12%.  In addition, the number of women reporting high sexual satisfaction increased, more women reported having an orgasm during sex and fewer reported never having had an orgasm.  While the proportion of women reporting low satisfaction with their sex lives decreased, the proportion of men reporting low satisfaction increased. The authors suggest that this might be because it is now more acceptable for men to admit “failure” in sexual matters.  Interestingly, both men and women blame men when sexual intercourse stops between them. This finding replicates the results of other studies in the 1950s and 2005-2006.  They also note that the number of men reporting erectile dysfunction decreased, whereas the proportion reporting ejaculation dysfunction increased, but the proportion reporting premature ejaculation did not change.  This study shows that most elderly people consider sexual activity and associated feelings a natural part of later life.  It will hopefully highlight the need for doctors to be trained to ask all patients, regardless of age, about their sexual concerns.

About 30 percent of men climax sooner than they want. For some it only happens once in a while; for others it occurs every time they have sex.   To make matters worse, the more anxious men get about the problem, the less control they have.  Coming early is not always an issue in a relationship. In fact, some men have told me that they have always been quick to ejaculate, and it was never a big deal with a past partner, but that with their current partner, the problem can’t be ignored.
There are several different techniques to treat PE.  Many men say that they think about baseball scores to distract themselves in order to last longer. This is the wrong thing to do. Instead of trying to distract themselves, they need to start focusing on their sensations and learn to monitor their sexual arousal and how close they get to ejaculating.  It’s a skill that’s usually not acquired overnight, but one that’s possible to learn. The start–stop technique is something men can do to help on their own.   It’s a masturbation exercise where a man learns to monitor his sexual arousal more closely. He starts masturbating but stops stimulating him when he has reached a point near ejaculation. Once he has “cooled down” sufficiently, he starts masturbating again.

The International Society for Sexual Medicine (ISSM) convened a meeting of the world
s leading experts on sexual dysfunction in

While an evidence-based definition of premature ejaculation can come only from studies of men with lifelong premature ejaculation engaging in vaginal intercourse, the following definition is likely to apply to men with premature ejaculation who engage in sexual activities other than vaginal intercourse. The panel concluded that there are insufficient objective data to propose an evidence-based definition of acquired premature ejaculation. By the end of the meeting, there was unanimous agreement on the following evidence-based definition of premature ejaculation.

ISSM Definition of Premature Ejaculation: Premature ejaculation is a male sexual dysfunction characterized by ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration; and, inability to delay ejaculation on all or nearly all vaginal penetrations; and, negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.

Dr DK Kim and Associates reported in the International Brazil Journal of Urology that hyperforin, a natural supplement can be formulated to help men last longer during sexual intercourse.  Ten male volunteers took the rapid release formulation of hyperforin for eight weeks and assessed their sexual intercourse duration and sexual satisfaction.  In five men with mean ejaculatory duration at baseline of less than 90 seconds (mean age 39 years old), four reported lasting longer (mean time to ejaculation before and after treatment, 58±12 seconds to 131±23 seconds, respectively (p<0.01)).   Equally interesting, the mean sexual intercourse duration increased from 266±39 to 391±34 seconds (p=0.02) after Hyperforin extract treatment in three of five men with ejaculation greater than 3 minutes at baseline (mean age 43 years old).  No adverse effect on sexual function and no systemic side effects were reported.  Seven of 10 couples reported subjective global sexual satisfaction improvement for both the men and his partner after hyperforin.  Five couples reported more frequent female orgasm.  Rapid onset of action, ease of use and safety make hyperforin an option for men who wish to last longer. 

We received an interested question:  Can active relaxation of the penile and pelvic floor muscles delay the ejaculation response by inhibiting the ejaculation reflex? 

One doctor expressed the opinion that the ability of an individual to control a given group of muscles and thereby control the tension (contraction as well as relaxation) is extremely difficult and will need the special skills of the therapist to master this control.  Another expert in the field, with experience in pelvic floor rehabilitation stated that, contraction as well as relaxation exercises are routinely a first step in the treatment of premature ejaculation. His experience is a high improvement on the ejaculatory control soon after treatment but at 1 year the cure rate is around 30%. The younger the age the greater is the chance to be cured.

We asked three experts in the field of sexual medicine about a condition we been asked recently and seek help for.  The problem is retarded ejaculation or the difficulty and inability to ejaculate during sex.

One doctor noted that he uses Buproprion 150mg x 2 or x 3 daily off label, which seems more consistently to improve arousal and interest over time, with additional sex therapy techniques in a couple based task-oriented format wherever possible, or masturbation tasks in single patients.

Another expert mentioned that his experience with sympathomimetics such as pseudoephedrine has only been successful in the neurogenic population (taking care of blood pressure increase). He has not found Viagra helpful unless there was altered genital sensation. Minor improvement with Viagra was observed among women with multiple sclerosis). He added that the other often missed etiology of delayed ejaculation especially with aging, is lowered testosterone, which had good results on replacement.
 

Finally a third doctor reported that he found bupropion, buspirone and yohimbine valuable in anorgasmia in clinical practice, while the use of sympathomimetics were valuable in inhibited/delayed ejaculation. He added that any cause of peripheral neuropathy must be excluded in both conditions.