The Ins and Outs of Gay Sex (28 page)

“About an hour, hour and a half.”

According to one medical definition, premature ejaculation occurs when you ejaculate before entering or just upon entering a woman’s vagina.
If you go by this definition, most of us have nothing to worry about.
Another medical definition states that premature ejaculation occurs when you ejaculate before you desire or before your partner desires.
Given this definition, most gay men have plenty to worry about.
Many of us place too much emphasis on going forever before we finally come.
We take drugs, use cock rings, jerk off before a date—anything to keep it up and going strong for as long as possible.
Porn films intercut the same scene multiple times to make it seem that a real stud screws for hours and reinforce our false expectations.
I say stop watching movies and get a date!

The average man should reach orgasm after anywhere from three to five minutes of steady intercourse.
The operative
word here is “minutes,” not “hours.”
Premature ejaculation happens to all of us and, like impotence, becomes a problem only when it is the norm and not the exception.
To understand premature ejaculation, you first need to understand the normal process.
Ejaculation occurs in three phases:
emission, closure of your bladder, and forward propulsion of semen.
Emission, commonly called pre-cum, begins during sexual excitement when your prostate, seminal vesicles, and smaller accessory glands secrete fluids into your urethra.
(Don’t forget that pre-cum, while not rich in sperm, can still cause pregnancy and, more important, carries HIV.
) Fluid seeps from your penis, it is not propelled as in ejaculation.
Some men produce a lot of this fluid, while others may barely notice it at all.
You have the most willful control over this phase of ejaculation and can prolong it with intermittent stimulation or rush right through to orgasm.
With continued stimulation, the cycle moves beyond your willful control.
Semen floods your urethra, your bladder closes off (so you don’t shoot backward), and vigorous rhythmic muscular contractions shoot your load (ejaculatory reflex).

For most men, premature ejaculation has a strong psychologic component and is often variable and unpredictable.
In some cases it can happen only with intercourse and not masturbation or with gay sex and not heterosexual experiences.
Tackling the problem often requires examining your issues of self-worth and gratification as well as possible internalized homophobia.

Premature ejaculation was traditionally treated through a combination of sex therapy and desensitization.
Desensitization works to prolong your emission phase and delay the onset of your ejaculatory reflex.
It can be practiced with an understanding partner or during masturbation when you bring yourself to the brink of climax and then stop.
Some men combine this with the “squeeze technique” popularized
by William H.
Masters and Virginia E.
Johnson, who reported that squeezing the head of the penis or tightening pelvic muscles helped abort ejaculation.
Repeat the process several times, gradually lengthening the interval until you allow yourself to climax.
With time and practice you may desensitize your penis and achieve better control.
Desensitization works in 60 to 95 percent of men, but after three years its success rate falls to only about 25 percent.

For men with mild premature ejaculation there are simpler methods of desensitization.
A condom definitely dulls sensation and helps you go longer (and let’s not forget the added safety benefit).
Some men also use anesthetic creams to deaden sensation.
Higher concentrations of these anesthetics are more effective and available only with prescription, but weaker over-the-counter preparations may be strong enough.
They are marketed under a wide variety of names, including the catchy Sta-Hard and Stud 100.
Read the ingredients before you try one to be sure that it doesn’t contain anything that can damage latex condoms.
Unfortunately, oils are frequent components.
Topical anesthetics also can cause allergic reactions, so you might end up with an itchy, red penis.
If you put any anesthetic on your penis and your partner sucks away, he’ll end up with a numb mouth.
Likewise, if you don’t protect him by wearing a condom, his anal sensations will markedly diminish.

Prescription medications now effectively treat premature ejaculation without causing decreased sensation.
Most are antidepressants, which, when taken in low doses, help prolong your emission phase.
(They really do increase the time it takes you to come and don’t just make you feel less depressed about how quick you shot your load!
) The undesirable side effect (impotence) that sometimes occurs at high doses of these medications is modified by lowering the dose.
Clomipramine (Anafranil), fluoxetine (Prozac), and sertraline (Zoloft) are some of the medications with proven
effectiveness.
But these powerful drugs have many potential side effects and should not be taken without a genuine need.
(Not just because you want to pound him senseless!
) Side effects are minimized when you take the drug on an as-needed basis as much as twelve to twenty-four hours before anticipated sex.

Antianxiety medications (Valium, Xanax) are also effective in delaying ejaculation—particularly if there is an associated component of performance anxiety.
Talk to your urologist.

For most men, failure to ejaculate and failure to achieve orgasm are synonymous.
Medically speaking, however, they are two entirely separate functions that usually occur simultaneously.
Thus it is possible to ejaculate without orgasm or achieve orgasm without ejaculation.

Retrograde ejaculation is the most common cause of orgasm without ejaculation.
In essence, the body produces semen, but the bladder does not close off during orgasm.
Semen shoots back into the bladder instead of out the penis.
Although the condition obviously produces infertility, for gay men the main problem is psychological.
Most of us need to fire away to feel like we’ve really come.
Anything less threatens our feelings of virility.

Retrograde ejaculation most commonly occurs as a side effect of surgery.
Men who have their prostate removed for benign disease can develop retrograde ejaculation.
(See
Chapter 8
.
) Prostate cancer surgery, which removes the entire prostate and pelvic lymph nodes, often destroys nerves that control erection and ejaculation, leaving men with either retrograde ejaculation or no ejaculation whatsoever.
If faced with this type of cancer surgery (radical prostatectomy, certain colon resections, or lymph node removal),
ask your surgeon about the risks.
As with postsurgical impotence, the problem seems trivial until after you are cured of your cancer.
Often there is no effective treatment alternative, so obtain counseling to adjust to this difficult problem.

Diseases including diabetes, multiple sclerosis, and spinal cord injury, which affect nerves, also can diminish your ability to ejaculate.

For most men, failure to ejaculate goes hand in hand with failure to achieve orgasm.
Orgasm is normally followed by a refractory phase during which you cannot climax again.
Refractory phases vary from minutes, to hours, to days, depending on the individual.
Aging prolongs the refractory phase.
(Remember those teenage days when you were a walking bundle of testosterone and there was no such thing as a refractory phase?
)

Failure to climax is often rooted in deep-seated psychological problems.
Some men can reach orgasm through masturbation but not with a partner; more often, they can climax only during a wet dream (nocturnal emission).
Some gay men climax with women (a culturally less threatening choice) and not men.
I have known guys who don’t have a problem with casual sex but can’t function in a relationship.
Unfortunately, no medication treats this problem, and you must rely on sex therapy and counseling.

If you only have a problem climaxing with a partner and not during masturbation, the cause might be that your partner just doesn’t know how to satisfy you.
Both of you climb out of bed thinking you’re to blame.
In these situations, tell your partner what you like.
We all respond differently to each type of stimulation, and you should never be embarrassed to voice your desires.
You may like a gentle touch, while he likes to know there’s a firm grip around his dick.
Just because the old tricks that drove your last boyfriend wild don’t work on your latest love (or conquest),
don’t think you’re a poor lover.
Ask if there is something else you can try.
If he tells you there is, it’s not a criticism, just a suggestion so you both can be fulfilled.

If you are just venturing into the gay world, your first sexual experiences may be too threatening for you to climax, which adds to your anxiety and worsens the problem.
Start slow—perhaps just cuddling or undressing together without physical contact.
(The old “look but don’t touch.”
) Try masturbating side by side and gradually progress to touching and more intimate contact.

Fatigue (physical and mental), debilitating illness, and drugs are other common causes of failure to reach orgasm.
Any depressant (alcohol, barbiturates, tranquilizers) or psychiatric medication can make it impossible to achieve an orgasm.
All drugs that cause impotence also can prevent climax.

Remember, even though the problem may be in your head, it doesn’t make it any less real.
Help is out there; just ask for it.
An appointment with a urologist is always a good place to start.
Even if your problem turns out to be psychological, a good urologist will direct you to the appropriate therapist.
Whether you choose a male or female, straight or gay urologist, be sure that you’re treated in an environment free from embarrassment and homophobia.
That’s your right.
(See
Chapter 12
.
)

Most of us will know the embarrassment of sexual dysfunction at some point in our lives.
But embarrassment should never prevent you from seeking treatment.

Impotence in men over fifty usually is caused by a physiological problem.


Even physiological impotence may have a psychological component.


Medications are the best first-line treatment for impotence, but they may not work.


Viagra is not the only drug to treat impotence, and it may not work.


A penile prosthesis should be tried after medications fail.


Premature ejaculation can also be treated with medication.


Various medications and treatments doctors recommend can cause sexual dysfunction.


Abusing medications used to treat impotence can be dangerous.