Sex Made Easy (20 page)

Most men will experience erectile problems at some point or another; that's a given. Men cannot perfectly control their penises or “will themselves” to get or keep an erection whenever they want. Erectile difficulties, then, are a fact of life, and something we would all do better to accept rather than feel anxious or upset about when they happen.

Some men are prone to erection problems in specific circumstances, such as when they use condoms.
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It's not well understood why this happens to some men when they use condoms and not others. Researchers have long speculated on this, wondering if some men have condom-related erection difficulties because they're nervous about using a condom, more likely to be having sex with someone they don't know well, or because the condom doesn't fit or feel comfortable on their penis. It may even be that men are simply distracted by the act of putting a condom on their penis, and instead of focusing on the many things that would strengthen their erection (such as looking at or touching their sexy partner) they are instead having to focus on opening a condom package, carefully removing a condom, and putting it on their penis correctly.

If your partner has erectile difficulties with condom use, don't let that stand in the way of having safer sex. This is no reason to throw condoms by the wayside; you
can
work it out together. Tackle the issue head-on by talking about it. Offer to brainstorm viable solutions together. You might offer to put the condom on your partner's penis yourself so that he can focus on kissing and touching you and checking you out, while you focus on the mechanics of getting the condom out and on him. Once the condom is on his penis, put some water-based lubricant on your fingers and seductively stroke his condom-covered penis, spreading the lube up and down his shaft. Not only might this feel arousing to him (and thus help to firm up his erection), but the lubricant will also likely make penetration more comfortable and pleasurable once intercourse begins.

It's also the case that some men truly need a larger or differently sized condom. If your partner is larger than average, then look for a larger than average-sized condom such as Trojan Magnum XL. The Trojan Ecstasy line of condoms is also worth looking into. The shaft of Ecstasy condoms is baggier and shaped almost like a baseball, with more room for larger-sized men and for men who simply want enhanced sensation during sex (baggier condoms may enhance sensation because they're less likely to constrict the nerve endings of a man's penis). In one independent condom survey I conducted for
Men's Health
magazine, a number of men indicated that they felt the Ecstasy condoms made sex feel more natural and as if they weren't even using a condom (even though they were). Pleasure Plus and Inspiral condom brands also offer a little more room in their design. Finally, although these condom types are roomier in the shaft and/or head, the base of the condom is still snug in order to stay on securely during sex. No one wants a condom to slip off during sex!

A man who has persistent erectile problems should always mention this to a health care provider who can then examine him, run any necessary tests, and help determine the likely cause of his erectile difficulties or erectile dysfunction. If his ED is physical in nature, then a prescription
medication may help. However, there is another important reason that men should mention erectile problems to their health care provider and that is because sometimes such problems are among the early symptoms of cardiovascular disease, such as heart or circulatory problems. Some research has found that ED may precede coronary artery disease by as many as two to five years, meaning that ED may be an important early warning sign to notice rather than ignore.

A man might also be referred to a sex therapist to help manage his erectile difficulties. After all, many young and/or healthy men have erectile difficulties that are caused or made worse by performance anxiety: the feeling of stress or anxiety about being a “good enough lover” and pleasing one's partner. Sex therapy has helped millions of men and their partners overcome or otherwise manage erectile problems.

When a man feels as though he's having an orgasm but little to no semen spurts out of his penis (a “dry orgasm”), he's often said to be experiencing retrograde ejaculation. This is when semen goes backward into a man's bladder rather than ejaculating through the urethra and out of the penis. It's a relatively uncommon condition but when it happens, many men are taken aback and feel alone or unusual, so it's important to talk about it so that men and their partners don't feel this way. There is nothing necessarily bad or unhealthy about retrograde ejaculation and it doesn't bother everyone who experiences it. In fact, some men and their partners like that there's no “mess” or “cleanup” involved in their orgasms.

On the other hand, some men and their partners are turned on by the look or feel of ejaculation and may wish for a fix to the situation so that they can experience their own at-home, in-bed geyser in action. For some men and their partners, retrograde ejaculation becomes a fertility issue. If they wish to become pregnant, they need the sperm to get out of the penis, and thus they need to get him to ejaculate. Men who would like to kick their ejaculation into gear should let their health care provider know that they have been experiencing dry orgasms. If retrograde ejaculation has
been caused by medications (such as some medications used to treat hypertension or depression), then stopping those medications—under the advice or supervision of a health care provider—may correct the problem.

Sometimes prescription medications are used to help a man to ejaculate out of his penis (these medications often work by helping keep the bladder neck muscle closed so that semen doesn't enter the bladder and instead leaves the body via ejaculation). In some cases, such as when retrograde ejaculation is caused by past surgical complications, medications may not be effective. If a man and his partner wish to become pregnant, a fertility specialist may be able to help recover semen from a man's bladder, process it, and use the sperm to help impregnate his partner. If your partner has dry orgasms and you want to become pregnant together, encourage him to see his health care provider, as in most cases some form of treatment is successful and men are able to impregnate their partners.

Men who ejaculate but who don't experience pleasurable sensations associated with it are sometimes described as having “ejaculatory anhedonia” or ejaculation without orgasm. Some men have always experienced ejaculation without any accompanying feelings of orgasm. Other men start out by having orgasmic ejaculations only to later notice a change in how it feels to ejaculate. Again, it's wise to see a health care provider to rule out medical conditions or medication side effects that may be causing this issue—especially if this is a sudden change that a man is experiencing. However, this issue is also often helped by seeing a sex therapist.

Men who experience pain during ejaculation should let their health care provider know. Painful ejaculation is a rare problem, affecting about 1 to 5 percent of men. However, for those who experience ejaculatory pain, it's often a serious problem, as it can interfere with a man's relationships,
love life, and sex life. Painful ejaculation is a rare side effect of some medications. The solution, therefore, may be as easy as stopping the medication under the advice or supervision of one's health care provider. However, there are a number of reasons why a man may experience pain during ejaculation, including prostate issues, obstruction of the ejaculatory ducts, and psychological issues. The first stop, then, is one's health care provider, such as a urologist, and the second stop (if still needed) is a sex therapist.

Many men aren't told about the normal aspects of aging. If he was proud, in his twenties or thirties, about being able to shoot semen distances of several feet, he may feel disappointed that he no longer has the same “thrust” to his orgasms as he ages. Men can try to maintain muscle tone and thrust by doing Kegel exercises. Like women, they can do this by squeezing their pelvic floor muscles (the same ones that they can use to playfully make their penis “dance”), holding the contraction and then releasing it, repeating over and over again for several minutes per day. By exercising his pelvic floor muscles regularly, a man may be able to regain some ejaculatory distance. However, I know of no research on the topic, only anecdotal stories, so consider this a “can't hurt, might help” strategy. To a large extent, men, like women, often benefit from learning more about normal age-related changes. Some men feel reassured to know that there's not necessarily anything wrong with them or different about them for having less distance to their ejaculation than when they were younger. We're all aging—and our wonderful private parts age too, in their own way.

Just as many men notice less distance to their ejaculation as they age, it is also common for men to experience less semen volume with age. Although it's not usually a noticeable decrease until later in years, scientific research has found that men's semen volume begins to decrease little by little in their twenties and keeps decreasing throughout life.

There has been strikingly little research on this phenomenon. In 2011,
the topic came up on a sexual medicine–related email listserv that I am on and I was struck by the number of physicians who recommended that men who want to increase their semen volume do things like drink more water, eat certain foods, or take certain vitamins. In fact, I know of no research that suggests that drinking extra water or taking any of the vitamins actually works to help men produce more semen. I know of another man (who works in the porn industry) who firmly believes that eating celery is what helps him produce large amounts of semen. Again, though, I know of no scientific evidence to suggest that celery has anything to do with semen volume.

What we do know is this: men who smoke cigarettes tend to have less semen volume than men who don't smoke. Quitting smoking might help a man restore some of his lost semen volume or at least help slow down the rate of decrease. Also, men with larger waistlines are more likely to have less semen volume than thinner men. This may mean that adopting healthy lifestyle behaviors (like eating smaller portion sizes, choosing healthy foods, and exercising) may help men have or maintain more semen as well.