Actual climax and ejaculation are preceded by a distinct inner sensation that orgasm is imminent (ejaculatory inevitability). Just after this the man senses that ejaculation cannot be stopped.
The most noticeable change in the penis during orgasm is the ejaculation of semen, even though orgasm and ejaculation are separate functions and may not occur at the exact same time. The muscles at the base of the penis and around the anus contract rhythmically.
Men often have strong involuntary muscle contractions through the body during orgasm and can also have involuntary pelvic thrusting. The hands and feet show spastic contractions and the entire body may arch backward or contract.
Immediately following ejaculation, the male body begins to return to its prearousal state. About 50% of the erection is lost immediately, and the remainder of the erection is lost over a longer period of time.
Muscular tension usually is fully relaxed within five minutes after orgasm, and the man feels relaxed and drowsy.
Resolution is a gradual process that may take as long as two hours.
Between 10-52% of men at some point in their lives will experience some type of sexual dysfunction. One recent study in the Journal of American Medical Association (1999) found sexual dysfunction common in 31% of men age 18 to 59.
Treatment must be individualized to the factors that may be inhibiting sexual interest.
Many couples will need relationship enhancement work or marital therapy prior to focusing directly on enhancing sexual activity.
Hypoactive Sexual Desire Case Formulation Hormones: Testosterone / Estrogen History of sexual activity Aschematic Sexual Self View Few positive romantic relationships / sexual encounters Low Desire Protective: Partner Factors Hormone Supplements Cognitive Restructuring
Couples counseling may help resolve discord in a relationship.
Psychotherapy may be needed for people who have experienced sexual trauma.
Behavioral therapy in which a person is gradually exposed to sexual activity, beginning with nonthreatening activities and progressing to full sexual expression, may also be effective.
Drugs may help relieve panic attacks associated with sexual activity.
Sexual Aversion Disorder Case Formulation Negative Sexual Self-Schema Traumatic Event (e.g. rape) Sexual Anxiety / Fear Response Avoidance Low arousal / sexual satisfaction Cognitive Restructuring Relaxation Training Exposure
The nerves responsible for the signal for ejaculation are most commonly injured after spinal trauma resulting in paraplegia or quadriplegia, major bowel or vascular surgery, or surgery for testicular cancer.
If the goal is to produce ejaculation for impregnation, a reflex ejaculation can be produced if the level of injury is not too severe by using a vibrator with a designated frequency and wave amplitude. If injury is too severe, the prostate can be electrically stimulated to ejaculate.