There are a variety of reasons that men may be unable to orgasm and ejaculate, a condition known as delayed ejaculation (DE) or ejaculatory delay. DE is defined as the inability to orgasm and ejaculate within a period of time that seems reasonable to you and your partner. This doesn’t mean just 2 or 3 minutes, but if you find that you’re going on much longer than usual, you may be experiencing DE.
Here are some of the most common reasons for DE, and what you can do about it:
1. Use of anti-depressant medication (any that affect serotonin reuptake). These medications slow down your neurological response to stimulation, making it harder to kick off the orgasm response. In fact, some doctors use these drugs to help men who ejaculate more quickly than they’d like (see next column, Eager Ejaculation).
If you think your medication may be causing your DE, you have a couple of options. First, you can change medications to one that does not have this effect (Wellbutrin, for example). However, if the medication is working well for you, you may instead want to try adding more stimulation to see if that helps. Vibration is an effective type of stimulation; you might wear a vibrating erection ring or hold a vibrator on any sensitive areas on your penis, scrotum, or perineum. You could also add prostate stimulation by inserting a prostate stimulator (vibrating or not) into the anus so that it rubs the prostate.
Some men report that mental stimulation is also helpful; this could be erotic talk with a partner or fantasizing about something that is a powerful turn-on.
2. Longer recovery period needed, caused by frequent masturbation (or other sexual play), or aging. Some men may need to decrease the frequency of self-pleasure or other sex play if they struggle with DE. Also, as men get older, they may need more time in between ejaculations before they are able to have another orgasm or ejaculate again. They may be able to get erections, but find that they just cannot get enough stimulation to have an orgasm. If this is the case for you, you could either continue the same level of sex play as before, but with added stimulation as described above, or you could decrease the frequency of your orgasms until you find the right balance.
3. Stress, distraction, or inability to stay focused and present in the body. These are the most common reasons for DE, particularly in this era of cell phones, stressful jobs, and busy lives. If you find yourself unable to keep from thinking about work or your to-do list, this may be what’s happening for you. The best way to address this is to turn off your phone, practice letting go of the lists in your head, and concentrate on the sensations you are enjoying during your sexual play. Some find it easier to focus on sensations by using a blindfold or even ear plugs. Others try erotic talk with a partner as a way to stay focused on the sexual encounter. Consider taking a class in meditation or other stress-reduction techniques. Taking a brisk 30 minute walk before sex will also help; it increases your blood flow (which in turn increases your ability to get aroused) and can help you clear your mind.
Changes in arousal and ability to reach orgasm are completely normal, though often very frustrating, experiences. While many physiological and psychological factors contribute to our ability to feel pleasure and allow arousal to build, below are some things to consider.
First, have you started taking any medications, or had any changes in your health? If so, this is the place to start. Some medications have a dampening effect on the libido and/or orgasmic response; antidepressants like Prozac (Zoloft, Effexor, Luvox, Paxil, etc.) are one of those. Birth control pills can also cause a decrease in libido. If this applies to you, it’s worth talking with your health care practitioner or pharmacist about the possible side effects of any medication you might be taking, and whether you can switch to a different prescription that would possibly not have the same side effects.You should also think about strengthening your pelvic floor muscles by doing your Kegel exercises. Since the pelvic floor muscles are the muscles that we feel spasm during an orgasm, if they are weak, our orgasms are weak or harder to feel. So doing your Kegels will help strengthen those muscles, and help you have stronger orgasms.The next thing to think about is that sexual desire and energy decreases over time in all relationships. When one falls in love, there is a state you experience called “limerance”. It includes intense lust, and makes your early sexual encounters incredibly powerful. Limerance goes away after a while, which is a good thing, since being in limerance makes it difficult to get other life tasks done! (Remember how, at first, you wanted to have sex several times a day, everyday, and didn’t care if you went to work or not?). This state of limerance also allows you to be more easily aroused and the novelty of having sex with a new partner can mean that your arousal during sex is higher than it is after the buzz wears off.Once limerance calms down, you experience a more realistic state of being, both during sex and during the rest of your time. What you are describing to me suggests that you are not as powerfully aroused as you were at first. I also wonder if you are giving sex less time and maybe less attention than you did when you were first falling in love. That is very common as well.So, what can you do about it? Well, first of all, understand that over your lifetime, sex will vary in its intensity. Sometimes you will have rockets-and-fireworks sex; other times you will have comforting, “gosh, we love each other and know each other well” sex. It’s not possible to have peak sexual experiences all the time; nor is it desirable. In fact, the way you know they are peak sexual experiences is that they happen only rarely, and in comparison to your normal sexual experiences they are unusual.
The fact that you are still having two orgasms during sex is a good sign. What you can do to increase your pleasure is to extend the amount of time that you are aroused before heading toward orgasm. You can also increase your arousal by stimulating more and different parts of your body so that the number of nerve endings you stimulate is increased, which will increase the intensity of your orgasms. You can also try bringing a vibrator into your sex play, which often allows women to have more orgasms in sequence than they can with manual or oral stimulation. Finally, you can play with your head; use fantasies to increase your arousal and excitement. Fantasies are a normal and healthy way to increase your pleasure. If you want some good fantasy material, try renting an erotic movie or reading a collection of erotic stories.
We all have to learn how to deepen our sexual experiences over time. While good sex is easy when we’re first falling in love (those hormones make a huge difference in the intensity of our sexual experiences when a relationship is new), good sex over the life of a relationship takes work.
In books and movies, our culture glorifies the mad, passionate rush to intercourse as the ultimate sexual experience. Unfortunately, frenzied sexual experiences can sometimes be unsatisfying and difficult to control. If ejaculation occurs before either partner wishes, it is often called “premature ejaculation.”
This makes it sound like a medical disorder, but it’s not. Even the fastest ejaculation isn’t a problem if both partners prefer it that way. Partners who are not particularly fond of intercourse, for instance, may prefer orgasm through oral sex or a vibrator, and may look forward to the fastest draw in the West.
The key is satisfaction, not endurance. That said, you can learn to work with your arousal and gain more control over when and how often you ejaculate, so that you can have prolonged, slow-to-climax interludes, “quickies,” or anything in between! It’s a great opportunity to expand your sexual repertoire.
Things NOT to try.
Some folk remedies that don’t work very well:
Men sometimes drink alcohol to slow themselves down. Alcohol can slow responses, but it may also make it difficult to get or keep an erection.
Some men’s partners take a hands-off approach, hoping that a lack of caressing and touching will allow their mates to last longer. But if touching is not allowed, what’s the point of having sex?
Some men try to dissociate themselves by reciting baseball statistics or all 50 states in their heads. This “focus-on-something-else” approach doesn’t take into account that arousal is an involuntary response. Involuntary responses are nearly impossible to consciously control. Think of what happens when someone asks you to stop focusing on your nose: if someone makes you think of your nose, it’s tough to focus on anything else!
All of these solutions can take you away from what you are doing and feeling, and are veryunlikely to lengthen your sexual experience or heighten your pleasure.
In some cases, your doctor might prescribe an SSRI (Selective Serotonin Reuptake Inhibitor;commonly used as an antidepressant) to delay ejaculation. Studies show that some SSRIs can delay ejaculation by about a minute, which gives you enough time to begin using the techniques explained here. A word of caution: when you stop taking the SSRI, you may experience a quicker ejaculation than you did while you were taking it. Be patient, and stay with it; the practice you gained while taking the medication can help you continue to work with and learn about your arousal levels.
What exactly happens in arousal?
Arousal is actually a part of our every moment. Arousal keeps us breathing, increases when we need to concentrate on something important, and calms down to let us sleep. The arousal system even has its own neurological pathway (the autonomic nervous system), separate from the nerves that make your fingers move. But arousal cannot be controlled directly. For instance, your heart beats without you deciding to make it beat. Although you can slow your heart rate a little bit by thinking about it, it’s impossible to control your heart rate entirely with conscious thought.
Likewise, during sexual arousal, any person has room to tinker, particularly in the early stages. However, one may reach the “point of no return”–the brink of the orgasmic threshold when it is no longer possible to slow down and delay orgasm. Learning how to finesse your personal arousal is the key to choosing the satisfying sexual experiences you desire.
In men, it’s often assumed that orgasm and ejaculation are one and the same. That’s not quite the case. There are two stages of a man’s orgasm: the cognitive awareness of pleasure, and ejaculation. These events happen two or three seconds apart. During the contractions of the prostate gland, the arousal system sends pleasure feedback to the brain, which is experienced as an orgasm. Men may experience the prostatic contractions as a pleasant fluttering or throbbing sensation. The second stage, ejaculation, occurs as stronger muscle contractions propel semen down the urethra and out the tip of the penis. The “point of no return” actually happens after the first part–the pleasure–and before the second part–the ejaculation.
Path One: Come and Come Again!
One strategy is to have a whole bunch of orgasms, rather than just one. Who wrote that “only one” rule, anyway? This is your sexual pleasure we’re talking about, and no one else decides when the curtain goes down on your party. It’s okay to accept what is and have fun the way you are. Does it have to mean the end of everything because someone ejaculates? Nope! Sometimes, it’s helpful to give yourself permission to have a big, long sexual session.
The multiple orgasms and multiple ejaculations technique is probably the easiest to learn. The idea is to focus very consciously on the sensations that are arousing to you, do exactly what arouses you most, and don’t hold anything back. Play around, and if you want to ejaculate again, go for it. If you need a toy like a dildo or vibrator to increase the intensity of your erotic play, consider investigating the possibilities rather than holding back.
Having trouble getting an erection after ejaculating? Try using a cock ring. Cock rings are great when your body says “not yet,” but your desire is still flowing. A cock ring is a flexible strap that can be secured around the base of the penis. It works by allowing blood to flow into the penis, but not out. You can put a cock ring on when you are soft or after you’ve gotten another erection. While you shouldn’t leave one on for more than 30 minutes, there’s a lot you can do in that amount of time.
The major drawback to multiple ejaculations is that it can be hard to avoid post-ejaculatory stupor. With several ejaculations, your arousal system will have exhausted itself, and you might not have the energy to go on without some sleep.
Path Two: Multiple Orgasms without Ejaculation
It’s possible to learn to stop every orgasm before ejaculating, and to orgasm several times without ejaculating at all. Interestingly, it’s the ejaculation itself that is often experienced as exhausting, and some men who experience multiple orgasms without ejaculation notice an energizing effect.
The technique described below is essentially a prolonged session of playing “faster-slower.” The goal is to stay somewhat aroused while you manipulate your arousal level. Enjoy the feelings of both decreasing and increasing arousal.
Once you can do this, try masturbating to orgasm, and concentrate on the sensations of the prostate.
You need to learn what it feels like to experience the orgasm (for most men, the prostate fluttering) before you can know when to hold back from ejaculation. Focus on the sensations, and see if you can experience the orgasm separate from ejaculation.
Next, you will need to become aware of your personal arousal and orgasmic cycle. It’s helpful to rate your arousal on a scale from 0-10, with 9 or 10 indicating the point of no return. Start by choosing a number in the middle, like 4 or 5, then practice masturbating to a fever pitch and slowing down as you reach that number. You will still be aroused with minor stimulation, and you will learn what it feels like to be aroused to a 4.
Then, pick a slightly higher number on the scale–say, a 7. It’s a little trickier here, but you really want to focus on lower arousal. One thing to try is to take long slow breaths in, and let the breaths out quickly in a couple of bursts. This helps disperse your sexual energy and take the tension out of your spine and lower back.
Another arousal-slowing technique is contracting your pelvic floor muscles. Contract these by squeezing the muscles that run from your tailbone, around your anus, and all the way forward to the base of your penis. When you are contracting correctly, the base of your penis will bob up and down slightly. Next, incorporate pelvic floor contractions into your masturbation play. Masturbate up to a 5, then contract for two seconds. Slow and speed your self-play, and work on incorporating this PC flex into the ups and downs of your arousal cycle.
Similarly, you can control your ejaculation by pressing firmly on the perineum–the area between your scrotum and anus–while contracting your PC muscles. This helps delay ejaculation by refocusing your attention on your arousal and interrupting the ejaculation reflex.
Perineal massage can be quite pleasurable, and some men think that it’s the greatest sexual technique they’ve ever experienced. Perineal massage can be done by yourself or your partner, and can be performed at any time during self-play or penetration.
Okay, I’m having a blast here, but what about my partner?
With increased awareness of sexual arousal and physical cues, you can expand your practice to include partners. With a partner involved, you might have to relearn most or all of your cues. Why? Because it’s one thing to stop your hand, or turn off your vibrator when you need to ease off, but it’s a much greater task to communicate to your partner where you are on the arousal scale.
Fortunately, most couples report that the process of talking is in itself very satisfying, because they feel more connected than when they are silent. Also, all of the techniques that you’ve been practicing work with partners, because none of them require that you pull out from penetration. Your partner will have fun playing with you and your arousal, pressing your perineum and practicing your breathing techniques with you. Learn more about your and your partner’s responses to sensation and practice expressing yourself.
It’s important to distinguish between someone who has never experienced an orgasm (called primary anorgasmia), and someone who used to have orgasms, but now cannot have them as frequently, or at all (secondary anorgasmia). For people who have never experienced an orgasm, often it takes learning more about yourself, your anatomy, and how your personal arousal cycle functions.
The experience for people who once experienced orgasms, but later cannot, is a very frustrating one. There are many possible reasons for secondary anorgasmia. Often something has changed physically, emotionally, or medically, or certain medications/herbs are taken.
For you, it’s possible that the antidepressant you take is a contributing problem. Call your pharmacist, and ask if the medication that you are taking is a “SSRI” antidepressant. Trade names of some popular SSRIs are Prozac, Zoloft, or Paxil, to name a few.
In the medical literature, SSRIs are described as a potential cause of male impotence, but for women this side effect is more often manifest by difficult in achieving orgasms, although they may become quite aroused. Why? We speculate that there is a lengthening of time of the arousal cycle (probably in men and women), so it may take more time, stimulation, and patience to achieve orgasm.
If you think that this is complicating your pleasure, there are a couple of strategies that we can recommend. First, consult the person who has prescribed this medication for you, and ask whether you still need to be on it, and if so, whether you need to be on this particular dose. Some women notice that their orgasms are easier to achieve with lower dosages of SSRIs.
If you and your health care provider think it’s still a good idea for you to take it, don’t give up. You may find that you can have wonderful orgasms with more intense stimulation than you may have needed in the past. You may want to consider beginning to use a vibrator, or using a stronger vibrator than before. Sometimes trying a more intense vibrator is helpful; the consistent vibration may increase your arousal over your orgasmic threshold. Finding the right strategy for you may be trial and error, but we suggest that you take it on as a pleasant opportunity to learn more about yourself.
What do you do when you’ve never had an orgasm? Or if you’ve had them in the past, but can’t get here anymore?
These are some straightforward answers, yet many women can’t find enough information about their bodies to learn how to give themselves an orgasm. Often we expect our partners to know how to stimulate us, or think that we should easily have orgasms during vaginal penetration.
First, some information about women’s anatomy. Many sexually responsive tissues are located in the lips surrounding the vagina (the labia), the first two inches of the vagina, and the clitoris. A woman’s clitoris is about four inches long, but you can only see a tiny bit of it. The clitoris extends from the skin folds just under the pubic hair to as far back as the bottom of the vaginal opening, on both sides of the opening. The parts of the clitoris you can see are the tip and the protective hood, both at the top of the vulva. You may or may not be able to see your clitoris peeking out from its hood when you’re sexually aroused.
With adequate stimulation, a woman may arouse herself to a high enough level that her body will release into an orgasm. We first perceive an orgasm in our brains, which sends electrical signals to our genitals. This signal triggers an intensely pleasurable spasm of the muscles in the pelvic floor, which can last for 10 to 15 seconds.
For the majority (more than 95 percent) of women, the vulva and the clitoris require direct stimulation to achieve orgasm. Although vaginal stimulation can be pleasurable and important for some, deep vaginal penetration is less important for orgasmic arousal than often thought. The vulva, clitoris, and vaginal opening also need consistent stimulation for a woman to have an orgasm. For some women, this can mean 20 to 40 minutes or more of continuous rubbing, vibration, or pressure. Taking this long to reach orgasm does not make you abnormal! Many, many women require lengthy periods of direct stimulation to reach orgasm.
With intercourse (vaginal penetration), many women find that they experience more pleasure, and have orgasms more easily, when the clitoris and vulva are directly stimulated by a hand, mouth, or vibrator before, during, or after intercourse. During sexual intercourse, the vagina and vulva get stimulation, but often the clitoris does not. This lack of stimulation occurs because, for many women, the clitoris is not in a position to get adequate stimulation for orgasmic arousal during intercourse. Many women don’t have orgasms during intercourse unless they, or their partner, provide addiitonal, direct stimulation to the vulva and clitoris.
Where do I start?
The first task is for you to locate the places on your body that give you the most pleasure when they are touched. The best way to determine what you like is to experiment with yourself first, without the social pressure of your, or a partner’s, expectations. Set aside time when you can be alone and both relax and concentrate on stimulating yourself with your hands.
We encourage you to use a small amount of a sexual lubricant when you are exploring how you like to be touched. This will allow your fingers to move more smoothly, and increases how much sensation you are able to feel. It also allows you to rub the skin without irritation. Any water-based lubricant is fine. Experiment for yourself to see what YOU like. Don’t use oil or Vaseline, though, as these can irritate your skin and may lead to yeast infections in some women.
Some women find it difficult to relax and let their bodies have orgasms. Orgasms can feel to some of us like we are losing control over our bodies, and this can be scary. If this describes you, make sure you are in a safe place, where you will not be disturbed. Also, allow yourself to control how far you go each time you pleasure yourself. Allow yourself to get a little closer to a building of tension and sensation each time. Your leg muscles may get tense — this is okay, it’s part of the process. Focus on what feels good to you, and let pleasure happen.
Hand Stimulation Techniques
The types of hand stimulation that many women enjoy are long strokes on the lips of the vulva, stroking or rubbing in and around the vaginal opening, and stroking or rubbing the clitoris. Touching the clitoris is really something to explore. Do you like stroking the side of the tip and shaft, or do you like touching directly on the tip? Some women like long strokes of these areas; others like short, quick touches in a circular pattern that gets faster as they become more aroused. Try lots of different pressures and speeds. When you find something that feels good, continue touching yourself that way. If it stops feeling good, try one of your other favorite touches for awhile.
How do I use a vibrator?
If you aren’t able to have an orgasm from hand stimulation, or your hand gets tired, try using a vibrator. Vibrators can provide the consistent stimulation you need, and they don’t get tired. If you haven’t experienced a vibrator for sexual pleasure, choose one with variable vibrations.
First, focus on using it on your vaginal lips. Then as you become more aroused, find the spots on and around your clitoris that feel best to you. Try all positions “around the clock” of the clitoral tip — some women report very different responses at “4 o’clock” versus “2 o’clock”. When you find an area where the vibration feels particularly good to you, hold the vibrator in that position. Some women will orgasm quickly, while other women find that with practice, they can follow a strong, nice sensation to orgasm.
If a vibrator works well for you, introduce it to your partner and find ways to incorporate it into your sex play. Try using it on your partner — both men and women enjoy the sensations produced by vibrators, and this is a fun way to add some variety to your sexual play.
But what would my mother say?
Many of us are told that it is not okay to give ourselves pleasure, but experiencing pleasure and orgasm are important to our health and overall sense of wellbeing. Studies have found that orgasms boost your immune system and help fight depression. Orgasms are one of the most effective ways to strengthen your pelvic floor muscles, which can reduce the risk of urinary incontinence. Self-pleasure is also the best way to learn what you like so you can teach these techniques to your partner(s). For many women it is easier to have an orgasm with a partner after discovering what “works” by themselves!
If you’d like some books to help you in your journey, we recommend:
The Elusive Orgasm by Vivienne Cass, PhD– an excellent book about how to have orgasms more reliably, how to have yor first orgasm, or what to do if you used to have orgasms more easily than you do now.
For Yourself by Lonnie Barbach — an excellent tool to help you learn more about yourself and your orgasmic potential.
I Heart Female Orgasm, by Dorian Solot and Marshall Miller — an excellent book packed with information all about female pleasure.
Getting Off, by Jayme Waxman — an informative book with a fun attitude.
For DVDs on self-pleasuring, we recommend:
Celebrating Orgasm, by Betty Dodson — Dodson helps five women explore their first orgasms.
Carol Queen’s Great Vibrations, by Carol Queen — one woman’s exploration into the world of vibrators!
Orgasmic Woman, by Betty Dodson — lots of women of various shapes, sizes, ages and ethnicities talk about how they masturbate, then demonstrate their favorite self-pleasuring techniques.
The pelvic floor is a group of muscles that forms a supportive sling in the lower pelvis. This sling, made up of 14 different muscles arranged in three layers, attaches to the pelvic bones. In a man’s body, these muscles surround the urethra, the area beneath the prostate gland, and the anus. Click here for a diagram of the male sexual anatomy. In addition to keeping the pelvic organs in place and the pelvic bones stable, these muscles are also responsible for:
1. The pleasurable muscle contractions felt during orgasm. Orgasms feel bigger and stronger when the pelvic floor muscles are strong. Some men are able to learn to separate their orgasm from ejaculation, partly by flexing their pelvic floor muscles. This allows a man to choose how long to experience sexual pleasure, rather than have his ejaculation end the experience.
2. More forceful ejaculations.
3. Keeping urine inside the bladder at moments of unexpected belly pressure (laughing, coughing, lifting, sneezing, jumping).
4. Keeping stool inside the rectum until you consciously relax your pelvic floor to allow it to pass.
A healthy pelvic floor is strong and flexible, and can contract and relax easily. Pelvic floor strength and flexibility vary from person to person. Some people go through life without problems, while others experience troublesome symptoms because their pelvic floor muscles are too weak, too tense, too inflexible, poorly coordinated, or a combination of these. Pelvic floor problems can be divided into two broad categories: Low Tone Pelvic Floor Dysfunction (weakness of the pelvic floor), and High Tone Pelvic Floor Dysfunction (painful, tense pelvic floor). There are concrete steps you can take to prevent and/or treat either type of problem.
Low Tone Pelvic Floor Dysfunction occurs when the pelvic floor muscles are weak from disuse, or stretched or damaged by surgery. When this happens, the muscles are not strong enough to sufficiently hold up the pelvic organs and hold in urine and stool. Orgasms feel weaker, and the muscles tire more easily.
• People who have had pelvic surgery, particularly with access through the perineum
• People who do not have regular orgasms, because orgasmic contractions help keep the pelvic floor strong
• People who carry a lot of body weight, which can stress the pelvic floor muscles
• Athletes who experience injury to the perineum from water-skiing, bicycling, or equestrian sports
• Men after prostate surgery
• People who have had radiation treatment to the pelvic region
• Weak or absent orgasms
• Stress incontinence (losing urine or stool when you sneeze, laugh, cough, lift, or exercise)
• Weak ejaculations
Whether you are trying to treat symptoms of a weak pelvic floor, prevent them from occurring in the future, or increase sexual pleasure, learning to do Kegel exercises will help. These exercises, named Kegel exercises after the doctor who developed them, are designed to increase the strength of the pelvic floor muscles by intentionally contracting and relaxing them in a series of repetitions.
First, Find the Muscles:
For some men, finding the correct muscles to contract and feeling them respond can be challenging. To tighten your pelvic floor muscles, think of pulling your testicles up into your body. If you’re contracting the correct muscles, your penis will rise when you tighten, and fall again when you relax your muscles. This is more noticeable when your penis is erect, but you should still be able to feel the movement when soft. You may also be able to feel the subtle lifting of muscles in your perineum–the area between the scrotum and anus–by placing a hand there and then contracting. This is easiest to do lying on your side.
If you are unsure that you are contracting the correct muscles, or are not able to make the muscles respond, contact a Pelvic Floor Therapist who can teach you how to do this correctly and effectively. There are tools available to help you do Kegel exercises. Some are also prostate massagers, but anything that is designed for anal insertion, whether or not it stimulates the prostate, can help you feel and identify your pelvic floor muscles more easily. This allows you to strengthen more effectively, especially at first. Some men choose to use a tool, others feel confident exercising without tools. One way is not better than another; as long as you’re doing the exercise as outlined below, you can do them however works best for you.
If you choose to use a tool, you’ll also need some lubricant. Use only water-based lubricants if your tool is made of silicone, but any lubricant is fine with plastic and stainless steel. Many men prefer a thicker lubricant to provide extra cushion for anal skin.
1. Lie down on your back in a comfortable place, with your knees bent. If you are using an exercise tool, coat it with lubricant, relax and gently insert it into your anus.
2. Contract your pelvic floor muscles. It will feel like you’re pulling up and in toward your belly button. Do not push out—imagine that you are pull in your testicles. If you’re using a tool, you should feel it rise a bit or, if it’s curved, nudge your prostate. Try to keep your leg, buttock, and abdominal muscles relaxed, and remember to breathe normally throughout the exercise.
3. Hold the lift for a count of 5. Again, remember to breathe!
4. Relax your muscles. You may notice your penis moving as you tighten and release your pelvic floor muscles.
5. IMPORTANT: After each Kegel, take a deep belly breath. Inhale deeply then gently blow out the air while you relax your pelvis completely. This deep relaxation is just as important as the other steps, because the deep breath relaxes the muscles that are not under your conscious control.
6. Congratulations, you have just done one Kegel.
• If you forget to do your exercises for a few days, don’t fret—just get back to them when you can.
• If you have any pain in your pelvis or genitals that feels worse when doing this, STOP, and contact your health care provider.
• If there’s no improvement in your symptoms after a month, contact a Pelvic Floor Therapist. It’s not uncommon to think you’re doing Kegels correctly but are actually contracting your buttock or abdominal muscles instead, or pushing out rather than pulling up. If you think this might be the case, a Pelvic Floor Therapist can help you do them correctly.
Start out doing 2 sets of 5 twice a day, holding each for 5 seconds. Gradually increase the time until you can hold each contraction for 10 seconds. Next, increase the number you do each time until you can do 2 sets of 10, holding each for 10 seconds. It would go like this: contract and hold for 10 seconds (while breathing normally), and then relax for 10 seconds (while taking a deep belly breath). Then, repeat the sequence until you have completed 10 exercises. Next, rest for a few minutes and then do another set of 10 in the same way. Repeat this entire sequence again later in the day.
The pelvic floor is made up of two kinds of muscle fibers: slow-twitch (70%) and fast-twitch (30%). Slow-twitch fibers respond best to slow, step-by-step engagement like we have described. If you only do fast ones, you are not strengthening the majority of the muscle fibers. So it’s important to learn to do the “hold” as described above.
The other 30% of muscle fibers are important too, so once you’re comfortable with the Kegel “hold”, you can learn “flicks.” To do these, tighten your pelvic floor muscles the same way as before but more quickly, then relax. The entire cycle should take about 3 seconds, and you should breathe normally and keep the rest of your body relaxed throughout. Do about 20 twice a day, and finish each set with the deep belly-breath. Doing more would just overwork the muscles, and can lead to poor technique that compromises your progress or leads to other problems.
If you began by using a tool, now is the time to learn to contract your pelvic floor muscles without the tool. Once you have mastered holding for 10 seconds without the tool and without involving your buttock or abdominal muscles while lying down, the next step is to do your exercises sitting up, and after that, standing. You can eventually build up to doing them while you do functional tasks like lifting, walking up stairs, jumping, etc. It’s important to make sure you’re able to contract and relax your pelvic floor muscles without involving other muscles in your body, and while breathing normally, so don’t rush the process. If you’re not sure if you’re doing them correctly, check with a Pelvic Floor Therapist.
If you want to do more advanced exercises, you can add weight (resistance) while you do your exercises. Once you have mastered doing the exercises lying down, the next step is to use a tool and hold it with your hand and pull slightly outward on it at the same time as your muscles work to hold it in. Once you can hold for 10 seconds, still using good technique (not involving other muscles, remaining relaxed, breathing normally) you may try it while standing. Or try hanging a light towel over your erect penis while doing the exercises as another way of adding resistance. The weight of the towel can be increased over time. Another method is to use weighted anal tools, such as those made by Njoy, first lying down then standing, while allowing the weight of the tool to provide resistance.
High Tone Pelvic Floor Dysfunction occurs when the pelvic floor muscles are overly tense, inflexible, or in spasm. The muscles are unable to move and stretch easily with daily activities. This causes uneven stress on the bones where the muscles attach, as well as discomfort of the muscles themselves. The term “high tone” refers to the presence of high tension in the muscles. This can occur with either strong or weak pelvic floor muscles, and can cause a wide range of problems.
• People who do a lot of Kegels without adequate relaxation both during and in between exercises.
• Athletes, gymnasts, and Pilates enthusiasts who work out with a focus on core strength without adequate focus on relaxation.
• People with high-stress lifestyles and/or difficulty coping with stress who carry their tension in their pelvis.
• People who have had trauma to their pelvic floor from surgery or sexual abuse.
• Pain as sexual arousal builds
• Pain with orgasm
• Pain in the penis, testicles, or perineum
• Constipation and/or pain with bowel movements
• Painful urination and/or increased frequency of urination
• Ache in the pelvis from constant muscle stress on the lower spine and tail bone
• Incorrect diagnosis of prostatitis, or prostatitis that is resistant to medical treatment over a period of months or years
There are many conditions that are easily confused with High Tone Dysfunction, so we recommend you start by seeing your health care provider to obtain an accurate diagnosis. Once a medical diagnosis of pelvic floor dysfunction is made, a Physical Therapist (PT) or Occupational Therapist (OT) who specializes in the pelvic floor can do a thorough assessment and determine the exact portions of the pelvic floor that need attention. The therapist can perform treatment as well as teach you a series of individualized exercises you can do at home, either alone or with the help of a partner, to help facilitate normal coordination and flexibility of pelvic floor muscles. We recommend working with a therapist rather than attempting to treat this condition on your own.
• the inability to become hard at all,
• becoming hard only briefly,
• becoming only half-hard, and
• only occasionally becoming hard.
No matter your level of current function, this article can:
• help you understand what’s happening in your body,
• give you the information you need to make sure your erection problems aren’t a sign of something more serious, and
• give you some ideas of steps you can take to improve the health, strength and duration of your erection.
Increasing focus on rehabilitation techniques for ED can also improve sexual function for men without ED. Some men want harder erections or for their erections to happen faster and/or last longer.
Beyond sexual penetration, penile erections are a simple, elegant indicator of overall health and well-being. This is because the formation of erections relies on healthy physical systems and mental processes. When any part of that combined system is ill or not maintained, erections can become much harder to have or maintain.
Think of sexual arousal as a collaboration between the mind and body. When medical conditions, trauma or surgery changes structure or function, or the mind is overcome with anxiety, it is hard for the whole system to work together.
The process of becoming sexually aroused with an erection includes several types of nerves, the penile clitoris (aka corpus cavernosa) and small blood vessel function. Having an orgasm further tests the neural system, and experiencing ejaculation relies on yet another nerve system. The whole sexual system isn’t complicated, but does require many sections to work together for sexual arousal to fully develop.
There are two ways to consciously initiate penile erections. One is to physically massage the penis which causes blood flow to be released into the caverns of the clitoris. When this blood swells the caverns, the penis enlarges (mostly sideways, but also makes the penis a little longer), and traps the blood inside the caverns. The other way is to allow or create sexual thoughts or arousing ideas in the mind. The brain will translate these ideas into sexual arousal, and when the nerve impulses reach the genitals, blood flow will release into the caverns. Most men use some combination of both the direct stimulation and cognitive sexual arousal (mental) pathways to sexual arousal, and vary their techniques depending on their individual circumstances. Read this article about Erectile Function to learn more.
There are two types of erections in men:
Erections for oxygenation (puff erections).
The blood vessels that lead to the inside of the clitoral structure need routine blood flow for oxygen and nutrition. The body accomplishes this (without effort or awareness from the man) by lightly flooding the clitoris three to six times daily. Morning erections and slight “puff” erections during the day and evening are simply the body’s way of taking care of the genital structures. While this is not related to sexuality, the lack of these “puff” erections is a strong indication that something is disrupted and needs attention. These puff erections are not related to sexual arousal itself, since the blood flows through the clitoris rather than being trapped as it is in penetration erections.
Erections for sexual arousal.
When the blood flowing into the caverns increases at a rate greater than the outflow, the penis becomes stiff because the blood is trapped, causing an erection. When a man wants to use his penis for sexual penetration, he needs this hardness to hold his penis straight. Penetration can occur with softer erections, but the man needs to be careful not to bend the penis, since the elastic/fibrous clitoris can be broken when bent at an angle.
Today we know that physical causes (heart disease, diabetes) of ED are more common than psychological causes. In fact, more than 80% of erectile dysfunction is an early physical manifestation of medical illness. The connection is so strong that early erectile problems are known to precede heart attacks by an average of 3-5 years in men, many of whom never had symptoms of heart problems. For men diagnosed with diabetes, more than 90% have erectile dysfunction.
Men’s erectile function is very similar to the canary in the coal mine. If the canary is having problems, something is wrong in the system somewhere and needs close medical evaluation. Until you know better, always consider a change in erectile function as a meaningful medical event that requires the attention of a health professional.
We strongly recommend that you start with a visit to your health care provider for a physical assessment, and that you not put it off. Make sure you mention your erection difficulties at that visit, so your health care provider will have the information necessary to arrive at an accurate diagnosis. This is no time to be shy; you really need to tell it like it is. But don’t just accept a prescription for Viagra: you need to know if your heart, nerve and metabolic system is having trouble and if your early signs of erectile dysfunction are a dangerous symptom, not just an inconvenience.
Once your health care provider has evaluated you for physical causes of ED, look also at what emotional, psychological, or relationship issues you have. These may be either a cause of your ED, or have arisen from the experience of having ED. It can be very disturbing to have your body stop functioning as it has all of your life, and can make relationship problems difficult to solve.
You can find a professional who is particularly knowledgeable about sexual issues by going to the web site of the American Association of Sex Educators, Counselors and Therapists (www.aasect.org). On their web page you will find information for the public on how to find a sex counselor or therapist in your area. It might be helpful to see a counselor alone, with your partner, or some of each, but you should decide what is most helpful for you.
With or without a medical diagnosis, most men can increase their hardness by making lifestyle changes. Although making these kinds of changes can take some time, the positive effects on your erections will likely be noticeable sooner than you might expect, particularly if you really commit to the change. Steven Lamm’s book The Hardness Factor (see resources) explains specific lifestyle changes that can increase your firmness noticeably in as little as a week, and impressively in six weeks. Staying with those changes for the rest of your life will help you be able to become erect and stay that way well into old age.
Eat the Good Sex Diet.
There are many chemical processes in the body that contribute to your erections and orgasms, and they need good building blocks, in the form of the foods you eat, to function smoothly. Truly, eating a healthy diet (a low-carb version of the Mediterranean Diet) can revolutionize your sex life. Avoid white foods (refined grains and sugar), focus on lean proteins (beans & nuts), and lots of deeply colored vegetables and fruits.
Get more exercise.
Thirty to sixty minutes of moderate exercise every day (walking hard enough to make you sweat a bit) makes a big difference to most men’s erections, sexual performance, and libido. When you make your heart work hard, it gets better at working hard and becomes better able to meet the demands of sex. When you fatigue your muscles, your body makes more small blood vessels to carry oxygen to your tissues, which results in stronger erections. Exercise also increases sexual desire, decreases depression, and increases feelings of well being. Taking a 20 minute walk before sexual activity can prime your sexual arousal system for a perkier performance, too.
Anything that reduces your blood vessel health reduces your sexual potential. If you smoke, you can increase your hardness significantly by quitting, and some men notice a difference in as little as two weeks. Smoking stiffens blood vessels, and lowers HDL (good cholesterol) and raises LDL (bad cholesterol), which is exactly the opposite of what you want for prevention of heart problems, and ED.
Keep your alcohol use moderate.
Having more than three alcoholic drinks a day inhibits both erections and orgasms by decreasing production of nitric oxide. Nitric Oxide is the neurotransmitter molecule necessary for relaxing the blood vessel walls in the erectile tissue of the penis. Over time, use of alcohol causes nerve damage that can permanently affect your ability to become erect. Although the relaxation effect of alcohol may feel beneficial to your sexual relaxation, it is a leading cause of soft erections in men.
Don’t use street drugs.
Cocaine, LSD, marijuana, amphetamines and barbiturates all decrease your ability to become hard and stay hard. Sexual arousal is a unique balance between relaxation and excitement, and when you use substances that interfere with one part, the other components are often inhibited as well.
Refine your prescription medications.
Ask your doctor if you can refine your medication choices towards those with fewer sexual side effects. Some medications are more likely than others to support your sexual health, and some combinations of medications could be making your ED worse. Your health care provider may be able to prescribe comparable medications with fewer sexual side effects.
Address emotional and relationship issues.
Maybe emotional issues weren’t originally any part of the cause of your ED, but if you’ve been struggling with hardness problems for some time, chances are emotional issues are present. If ED is affecting your self-image or altering your intimate relationship(s), you owe it to yourself to get help dealing with any emotional issues involved.
Have regular orgasms.
Many men can orgasm without having a completely hard erection: they just have to know that and not let the softness stop their self-pleasuring. Some men use different techniques for arousal depending on what they need in different settings. You can orgasm alone or with a partner; both ways are effective for keeping the system fit. Regardless, we recommend at least two orgasms a week (with ejaculation if possible) as a healthy sexual maintenance routine.
There are a number of mechanical devices that may help maintain a stronger erection, including erection rings, erection rings combined with vibrators, and penis pumps.
Erection rings are rings of material that fasten around the base of the penis. They help maintain an erection by restricting the blood flow back out of the penis. Some erection rings are stretchy silicone or elastomer, some are rubber O rings, and some are adjustable leather or synthetic bands that close with snaps or velcro. Only use easily removable or adjustable erection rings (not steel rings), and don’t leave them on for more than 30 minutes; keeping blood trapped in the penis for a long period of time can cause permanent damage. Some erection rings include a built in vibrator.
Vibrators activate the mechanism responsible for blood flow into the penile clitoris. Even if nerves responsible for sexual arousal have been damaged, when the penile clitoris and blood vessels are healthy, a vibrator may help you become hard. You need to experiment with different types of vibration and apply it to the base of your penis, along the shaft, or any other sensitive place that arouses. Use it with or without a erection ring, or choose one with a built-in erection ring. Try your vibrator for self-stimulation, or combine it with partner play.
Penis pumps are very helpful for achieving a harder erection, especially if you are able to become partially erect. Pumps work by using a vacuum to stretch the membrane surrounding the erectile tissue of the penis, allowing blood to flow in freely. A pump is often used in combination with a erection ring. First the pump brings partially oxygenated blood into the penis, and then an erection ring (placed around the base of the penis shaft) holds the blood in. Be gentle when using a pump; mild suction is all that’s needed. It is possible to hurt yourself by pumping too vigorously or for too long. Also, to avoid blood blisters, don’t use pumps if you use blood thinning medication.
For men recovering from pelvic trauma, surgery (prostate or rectal), or radiation therapy, a rehabilitative therapy called penile rehabilitation (PR) has been developed. Many men don’t realize that these same techniques are helpful when recovering function for metabolic ED, too, because maintaining the flexibility and ensuring routine oxygenation is good for the penis no matter the cause of ED.
When used for PR, the goal for using a penis pump is to continue blood flow and flexibility during the healing process, when nerves have been damaged by surgery or radiation. If the nerves recover function and re-establish themselves, then the clitoral structure will be ready for action as well. If blood flow stops (without use of a pump), then anoxic damage to the clitoris may be irreversible.
Effective penile rehabilitation often involves a combination of daily medication and use of a pump daily. Ask your health care provider whether a program like PR is right for you. For more information, see this brochure of the Penile Rehabilitation Program.
The Good Sex Diet is a natural, holistic approach to improving your sexual function. The foods recommended include all of the ingredients your body needs to make your sexual arousal system work. It also happens to taste fantastic, so you can enjoy the pleasure of eating, too. This diet looks very similar to the Mediterranean diet and is less expensive than you might think when you realize that your body will be satisfied with the high quality food and taste of what you are eating.
This isn’t a grab-n-go diet, and there is almost no processed food in it at all. However, no need to go all raw food, either. Focus instead on the natural color of your foods, and you’ll be choosing the right foods for your sex life too. Below is a brief guide–you’ll find that the main goal is focus on a variety of organic vegetables and fruits, lean proteins, and healthy fats and oils. Also, chocolate!
Sexual health might seem a tricky concept to define, given how little we hear about it.
Even if your personal perspective of normal adult sexuality is holistic, non-medical and/or allows for some level of personal sexual expression, “normal” was defined back in 1970 by Masters & Johnson. Although their research was groundbreaking, Masters & Johnson utilized persons of relatively high sexual function, so by comparison, most of us have been “abnormal” ever since. So, defining normal sexual expression can be challenging, even for those who research the topic.
Others struggle to incorporate sexuality into a medical health care context by examining sexual problems, rather than by understanding the components of sexual wellness. In this framework, health care providers aren’t attending “Sexual Health” conventions; instead they attend “Female Sexual Dysfunction” or “Male Sexual Dysfunction” seminars. Stepping into this game, pharmaceutical corporations struggle to provide remediation for our abnormalities.
Yet others “ab-sexualize” the topic entirely. Absexualization is the process of moving away (“ab”= away from) any type of sexual activity under any circumstance. This can be an appropriate decision for one to make for oneself; however, making absexual decisions for others has been prominent in Western culture for centuries, and appears to be a never-ending debate.
The (unofficial) 2002 World Health Organization offers an inclusive, helpful definition of Sexual Health:
” … a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.”
This definition characterizes sexual health as something active, rather than something you only have if you don’t think anything is wrong. We advocate for positive and respectful approaches to your own, unique sexuality.