Premature Ejaculation

Premature Ejaculation describes the experience of reaching orgasm either before or shortly after the beginning of sexual contact with a partner. Premature ejaculation can occur with vaginal or anal penetration, oral sex and, for some men, with manual stimulation by their partners.

Typically, premature ejaculation is considered to be an involuntary or uncontrolled experience of ejaculation, which may or may not be accompanied by orgasm (ejaculation can occur without experiencing heightened sexual arousal). It can occur with either a soft or stronger erection.

While the causes of premature ejaculation vary, most men who experience it report high levels of stress, anxiety about their sexual performance or high conflict relationships with their partners. For others, infrequent ejaculations or experiencing unusually long periods of time in between sexual activity is associated with premature ejaculation.

With treatment, you can develop a better understanding of why you might experience premature ejaculation. You can also develop strategies, both cognitive and behavioural, to develop the ability to better control when you experience ejaculation.

Performance Anxiety

It can be hard to experience sexual pleasure if you are constantly worrying about getting and maintaining an erection or if you don’t feel confident that you are able to satisfy your partners.

Performance anxiety can be frustrating and difficult to make sense of for many men.  While some men experience anxiety during a sexual encounter, others find themselves  worrying about their performance hours or days ahead of time.

Performance anxiety can be very difficult to talk about with partners and challenging to work through even with the most patient of partners. As a result, some men find themselves avoiding sexual encounters, even if they have consistent relationships or partners. Other men find themselves questioning themselves, their sexuality or their capacity to have relationships.

The causes of performance anxiety vary from person to person. Men who are vulnerable to anxiety are more likely to experience worries particular to their sexual performance. Men that experience traumatic or difficult relationships that negatively impact their ability to feel confident sexually often experience anxiety about their performance. Others may become anxious if their partners react with disappointment or criticism when they experience erectile dysfunction.

The good news is that there are effective strategies to treat performance anxiety. Many of the same approaches used to treat more generalized forms of anxiety are effective interventions. Other strategies involve developing comfort and confidence in talking about your worries with your partners.

Understanding  why you might experience anxiety about your sexual performance is the first step in developing effective strategies to manage its symptoms and to develop confidence that you can experience sex that is satisfying to both you and your partners.

Loss of Desire

Mainstream culture teaches us that men should be constantly desiring and pursuing

sexual contact with their partners.  Not experiencing consistent interest in sex can cause confusion and worry, and make men vulnerable to making judgements against themselves. Moreover, it can make their partners more vulnerable to feeling unattractive or undesirable.

The reality is that as we mature, desire often becomes less spontaneous and is more responsive to dynamic factors in relationships. For some men, connection and intimacy are important factors that create desire.

Desire can also be affected by extraneous factors as well such as substance use, mental health issues, medical issues, or conflicted feelings about sexuality.

Like erectile dysfunction, a medical assessment by your family physician is an important first step in your treatment process. A physical exam can identify any potential medical issues that may be negatively impacting your desire for sex.

Understanding why you might be experiencing a loss of desire is key to developing strategies to cope. There is good reason to be hopeful that, with the help of a skilled therapist, you will be able to develop a better understanding of what helps both promote, and put the ‘brakes on’, desire for you in your relationships.