Sex is a central part of the human experience and to deny this is to deny our humanity. Whilst some people make a choice to remain celibate and clearly enjoy wholly fulfilling lives, for the vast majority sex remains important to them throughout their adult lives.
Traditionally, ED has been the almostexclusive preserve of the urologist and psychiatrist. In the past 20 years, a new discipline of sexual medicine has evolved, as our scientific understanding of human sexuality has evolved. Read the rest of this entry »

Mode of action: Apomorphine is a centrally acting drug for the treatment of ED; it is not approved in the United States, although it is available in Europe. CNS control of sexual function is thought to be maintained through a balance of inhibitory and excitatory systems, influenced by androgens and by erectogenic stimuli from centers of the brain concerned with sight, sound, smell, touch, and cognition. A variety of neurotransmitters are involved but, simplistically, the primary neurotransmitter of central sexual inhibition is serotonin, and of central sexual excitation, dopamine. Apomorphine activates dopamine D2 receptors in the hypothalamus and has the potential to both initiate an erection and enhance responsiveness to erectogenic stimuli.
Use in practice: Proper counseling about the use of any therapy is vital to a successful outcome, but particularly so with ED therapy. Apomorphine is taken sublingually and it is essential that the patient be told to pop it under the tongue, and to allow it to dissolve slowly rather than suck or swallow it. If it is swallowed, it will probably be ineffective, because of the very high proportion of drug metabolized on the first pass through the liver. The 2’mg tablet is pentagonal, and the 3’mg, triangular. Read the rest of this entry »

Basic sex education: This is the vital first step in effective treatment, leading to a successful outcome, in which the indi’ vidual or couple can enjoy ‘a satisfactory sexual experience’, rather than just get erections. Do not underestimate its impor tance and do not omit it.
Many men, including a large number of doctors, have a lamentably poor understanding of their sexuality and sexual function. Personal sex education is frequently delegated by parents to schools and tends to concentrate on reproductive biology, sexually transmitted diseases, and preventing unwanted pregnancy. We are not educated in how to enjoy our own sexual feelings, or in understanding our partner’s sexual needs and how we might best help them to fulfil them. Read the rest of this entry »

“You never know a man until you know how he loves.”
Sigmund Freud
Stimulated by the hormone testosterone, men have been driven to populate the earth, planting their seed wherever they could at every opportunity. No small part of this drive is the intense sensation of pleasure derived from the simple act of ejaculating. Reaching a peak of sexual excitement, spewing ejaculate from the tip of their wand of light, and collapsing in a swoon of energy and tension release commonly takes only a matter of minutes for most men. As the simple diagram illustrates, this experience is a little bit like stepping off a precipice and flying into an abyss. The urge to do this repeatedly seems to be almost irresistible and becomes an obsession with many men. A typical male between the ages of fifteen and thirty can scarcely think of anything else day and night. Read the rest of this entry »

When the Prince of Wales, later to be King Edward VII, said to his mistress, Lily Langtry, during a quarrel, that “I’ve spent enough on you to buy a battleship,” she replied, “And you’ve spent enough in me to float one.”
Ejaculation Orgasm
You have probably been regularly experiencing the pleasure of ejaculation since early adolescence. During an orgasm accompanied by ejaculation, a man’s whole body tenses while contractions of the prostate gland vigorously propel semen out the tip of the penis in a forceful shooting stream. For a few seconds there is intense pleasure, restricted almost exclusively to the genitals. Almost immediately (usually within one or two minutes) the erection subsides and a refractory (recovery) period sets in. The entire body relaxes (not just the penis) and most men experience a complete loss of interest in further sexual activity. Sleepiness also commonly follows an ejaculation. How long it takes before energy (capacity for another erection) and libido (sexual desire) are restored depends on the man’s age, health, and frequency of ejaculation. Some younger, stronger men are able to retain an erection in spite of ejaculation by maintaining rapid, continuous thrusting. Read the rest of this entry »

“The degree and kind of a man’s sexuality reach up into the ultimate pinnacle of his spirit.”
Friedrich Nietzsche – Beyond Good and Evil
Is this an all too familiar scenario? Hot and heavy loving with hungry kisses and tender caresses that promise orgasmic bliss for both you and your eager partner when all of a sudden you’re one thrust past the edge, the dam bursts and it’s over. You’re finished, “spent” and ready for sleep. She’s still waiting for more, perhaps wistfully contemplating a purchase of that acrylic-vibrating dildo her friend has been raving about.
Most ordinary men believe that ejaculation is the best part of sex. But there is something better—orgasms without any ejaculation at all. It is possible to have many orgasms in a single session of lovemaking, none of which includes an ejaculation. Furthermore, if you end lovemaking while you still have desire, in other words without ejaculating, you will super-boost your immune system and increase your physical energy, mental creativity, emotional resilience and spiritual quickening. Read the rest of this entry »