It happens sooner or later

    5 May 2016

    As the Ayrshire poet wrote: ‘The best-laid schemes o’ mice an’ men gang aft agley.’ He could have been talking about sex. In fact, he frequently was. And it’s a sad fact of life that a man’s complicated sexual machinery often goes a bit wrong. If it happens to you, don’t be traditionally British and remain ‘strong and silent’. A stiff upper lip is no use when what you need is stiffness elsewhere.

    So what are the bedroom troubles which affect many males at some time in their lives?

    First, of course, there’s difficulty in getting a good enough erection. This happens occasionally to nearly all men. Causes range from nervousness or too much alcohol to moral guilt or prescribed medication. In the over-50s it’s often due to narrowing of the tubes which supply blood to the male organ.

    Whatever the cause, you should do two things: talk to your partner and (if it persists) consult an expert. These days, doctors and therapists have ways of helping you to achieve fine, upstanding erections again.

    The second most common problem is climaxing too soon, known as premature ejaculation or just ‘PE’. This is widespread in young men but can occur in the middle-aged too. It’s a cause of considerable frustration to both the sufferers and their partners.

    Some say it occurs because of the fact that during furtive teenage sex a young man is ‘conditioned’ to finish as quickly as possible — before his girl’s parents get home. We found no real evidence for this. It just seems to us that some men are explosively triggered, especially when nervous or excited.

    Fortunately, there are ways of sorting this out so a man can ‘last’ for half an hour if necessary. Our favoured technique is the famous Masters-Johnson grip, administered by the partner. However, this grip must be taught to the couple by an expert; all too often people get it hopelessly wrong.

    Other treatments include the use of local anaesthetics on the skin of the penis, but it’s not very effective and liable to lead to painful sensitivity reactions. Some doctors are willing to prescribe antidepressant drugs such as clomipramine, which delay ejaculation, but these can have side-effects.

    A similar medication appeared around 13 years ago called dapoxetine. Now being enthusiastically promoted by private clinics, it is taken a couple of hours before sex and (with luck) may help to delay an orgasm somewhat. But side-effects include nausea, dry mouth, headache and dizziness.

    What about the opposite problem, which is delayed ejaculation (DE)? Often the sufferer may be able to reach orgasm through manual stimulation, but simply cannot do while inside his partner. This is not common in older men but can happen at any age. It’s especially distressing for couples who are trying to have a baby.

    Men with lifelong DE can be rigid, controlled personalities who find it difficult to ‘let go’. But when it develops in mid-life it is often due to drugs such as anti-depressants, high blood pressure medication or diuretics. In older males it may be a symptom of being run down, tired or ill. So a full check-up from your family doctor is often a good idea.

    Treatment of DE not caused by medication is difficult. Claims have been made for various drugs and for hypnosis. Male vibrators may possibly be of use. But, in our experience, gentle, commonsense advice is often the most help. The idea is to gradually accustom the man to the idea that ejaculation inside his partner is acceptable, and is nothing to be afraid of. In one variant, we encourage him to orgasm nearer and nearer the partner’s body until he can manage it inside. But this is far from an instant cure.

    Then there’s retrograde ejaculation — an entirely different condition in which the seminal fluid does not emerge but shoots back into the bladder. This almost never occurs except after prostate surgery. In the unlikely event that the patient still wishes to father a child, sperm can be extracted from his urine and used for artificial insemination.

    We cannot over-emphasise how helpful partners can be when you confide in them. Failure to communicate usually makes things worse. Why? It leads to men avoiding sex, especially when their erections are poor, which makers their partners fear they are no longer attractive. Of course if a partner’s appearance really is off-putting, you probably need to say so — and that’s not an easy conversation. But in most cases, the man really wants to make love and is hugely embarrassed and frustrated that he can’t.

    Only a very inexperienced partner will fail to notice if you have DE. Sex will last much longer than normal and at first this may be welcome. But eventually these long sessions become tiring, unromantic and even painful. If you hope to have a child together, she needs to know how difficult this may be. And if your DE is simply age-related, it would be wise to confess that you need the odd break to regather your strength before giving intercourse another go.

    As for PE, using the Masters and Johnson technique will require your partner’s help. But if you prefer to just live with it then you should ensure you can pleasure your partner with other techniques.

    The important thing to remember is that partners can deal with what they know. Ignorance of what’s going on makes them uneasy. And when they understand, mostly they are kind.

    Silent stoicism will not improve your performance, and may well heap sadness on to an already difficult situation. It could even kill your relationship.