Holistic Treatment to Prevent Premature Ejaculation

Ejaculation By Command

Everything is explained here in clear, concise and easy-to-understand instructions. The insights, tools and techniques in this program have been rigorously tried, tested and proven effective not only by me, but by thousands of other men who are now enjoying lovemaking that lasts so much longer than before. Here's a Very partial list of what you're going to learn inside this exciting new program: How to overcome mental barriers to sexual endurance develop iron-clad stamina and confidence by using these 9 specific techniques I am going to give you. A primal sexual technique that adds massive control to your arousal. and puts a woman over the edge with sexual excitement. she'll have to have you Right Then And There. and nothing will be able to stop her. 4 powerful breathing strategies that will amplify your staying power and prolong your orgasm for as long as you desire (97% of men screw up their breathing and end up ejaculating too soon) Specific guided love muscle exercises to skyrocket your ejaculatory control and your ability to withstand intense sexual stimulation (The secret is in the step-by-step process, which you'll learn in detail) The Pleasure Acclimatizing technique to train and condition your ejaculation reflexes so that you will Automatically last longer without tipping over in a hurry (this is one of the stamina secrets that Top porn actors use All The Time ) Have you ever blown your load even Before penetration starts. and wondered how the hell that happened? Here's the little-known and closely-guarded Total Immersion technique you can use to Outlast her during sex (it's much easier than you think. when you know the secret) Continue reading...

Ejaculation By Command Summary


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I've really worked on the chapters in this ebook and can only say that if you put in the time you will never revert back to your old methods.

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The biological analysis of sexual behavior in the context of evolution and natural selection

Considering the third assumption, the evidence in favor is mixed. Sometimes evolution seems to have been quite efficient. A rabbit, for example, shows a very efficient sexual behavior - one single intromission, always associated with ejaculation. It is all a question of about one second. Very efficient in time and in effort. Moreover, the doe is a reflex ovulator. She displays lordosis, making vaginal penetration possible, only when in estrus and when in estrus she is always fertile. Shortly after copulation, the female will ovulate and fertilization is almost certain since the male deposited semen a few hours earlier. After ovulation, the propensity to show lordosis will soon be reduced and finally absent. It would seem that evolution has done a good job, assuring that sex behavior in rabbits is fast, almost effortless, and frequently fertile. It is not so easy, though. A male rabbit may spend hours mounting an unfertile female if given the opportunity to do so. Although his sex...

General Health Benefits

Studies examining the benefits of sexual activity on physical health have suggested sexual activity improves physical and psychological health in a number of domains. Sexual activity (1) Increases longevity Men with increased orgasmic frequency (i.e., had sex at least two times per week) had a 50 lower risk of mortality at a 10-year follow-up (Davey Smith et al, 1997) (2) Lowers the risk of chronic disease (e.g., heart disease and cancer) Among men, frequency of sex was associated with a lower risk of fatal coronary heart disease (Ebrahim et al, 2002). Furthermore, a national survey of US men found high ejaculation frequency (i.e., 21 ejaculations per month) was associated with decreased risk of total prostate cancer (Leitzmann et al,

Male copulatory behavior

Here I will present a description of the behavior. The neural and endocrine mechanisms involved are the subjects of a later chapter. Male copulatory behavior is a sequence of stereotyped motor patterns ending in ejaculation, the expulsion of seminal fluid. Some species may make several ejaculations in a row. During the time when I worked with rabbits, our champion once made 17 ejaculations during a 30-minute test. He had received no treatment whatsoever. It was his spontaneous level of sexual activity he had shown for us. Rats are less active and normally become unresponsive to a female after 5-10 ejaculations. They normally require several hours to achieve that. The human is still less active. In fact, most men stop copulatory activity after the first ejaculation. Occasionally, a second or even a third ejaculation may be achieved before abandoning copulatory activity, but that seems to be quite unusual. Although there may be a substantial variability between species with regard to...

Female copulatory behavior

A sexually receptive female rat will quietly approach a male and within a rather short distance of him (about one body length) she will turn away and make a short, fast run and then suddenly stop with her hind quarters raised. This behavior pattern is called solicitation (McClintock et al., 1982 McClintock and Anisko, 1982). It is a very important part of the female's copulatory behavior in seminatural conditions, like those used by Martha McClintock in her very elegant studies. A most interesting observation is that more than 90 of sexual interactions are initiated by a female solicitation (McClintock and Adler, 1978). The male initiated only 3 of the interactions. In the remaining 7 it was unclear who the initiator was. This is true not only for the initial mounting episode, but also for the entire sequence of mounts with and without intromissions leading to ejaculation. It appears, then, that the female is in control of the pace of copulatory interactions from the first mount until...

Ultrasonic vocalizations in rats

Abundant 22 kHz vocalizations following ejaculation in the male rat were the first high frequency sounds described in association with rat sexual behavior (Barfield and Geyer, 1972). The poetic spirit of Ron Barfield made him coin the expression 'post-ejaculatory song'. This song has been much studied and many functions have been attributed to it. The song is essentially limited to the absolute refractory period, the time following an ejaculation during which it is impossible to reactivate male sexual behavior. This interval constitutes about 75 of the post-ejaculatory interval. During the remaining 25 the male does not sing and it is possible to reactivate his behavior by stimuli heightening his arousal, like pinching his tail or applying electric shocks to his skin. Since the song coincides in time with a period where the male is unresponsive to the female, it was suggested that its function was to inhibit female sexual behavior and to maintain the female at some distance and...

Visual incentive stimuli

In primates, the situation may be quite different. We know that visual sexual incentive stimuli are of paramount importance in the human and there is a small amount of data suggesting that visual stimuli may enhance sexual arousal also in a non-human primate. The human data will be discussed at length in Chapter 4. Here I will briefly mention a couple of studies made in the chacma baboon, Papio ursinos. This species attracted scientists' attention because the females show an unusually large swelling of the genitals and the perineum during estrus. Genital swelling around estrus is known to occur in females of many primate species, but zoologists have suggested that the swelling in the chacma baboon is far larger than that of any other primate species. Because of that, it was quite natural to imagine that this conspicuous visual stimulus might have some effects on sexual arousal in males. In a very creative study, individually caged males were exposed either to estradiol-treated females...

Richard S Foster Md Richard Bihrle Md John P Donohue Md

Low-stage disease was 5 to 7 days currently, it is 3 to 5 days. Currently, as nerve-sparing technique in conjunction with the complete removal of lymphatic tissue should be mandatory in cases of low-stage disease, loss of emission and ejaculation (such loss being due to the interruption of retroperitoneal sympathetic fibers) should not occur (Figure 10-2). Furthermore, in selected postchemotherapy patients who are candidates for RPLND, nerve sparing is also possible, and emission and ejaculation can be maintained at a level of 70 to 80 . Finally, the perioperative management of pain has improved with the introduction of the intrathecal administration of narcotics and local anesthetics and the routine use of patient-controlled analgesia at the bedside. Therefore, not only has the morbidity of chemotherapy diminished over the last two decades, the morbidity of surgery has decreased while the efficacy of surgical removal of metastatic testicular cancer has been maintained. As noted, this...

Extent Of Postchemotherapy Surgery

Full bilateral-template and operative RPLNDs are shown in Figure 11-1 for the right side and in Figure 11-2 for the left side. The modified bilateral RPLND avoids the contralateral dissection below the level of the origin of the inferior mesenteric artery, in order to try to preserve ejaculation (Figure 11-3). Unilateral

Studies on knockout mice

But they rarely perform intromissions and ejaculation is almost never seen (Rissman et al., 1997 Wersinger et al., 1997 Ogawa et al., 1998). These mice have blood androgen concentrations above normal (Eddy et al., 1996 Rissman et al., 1997), so their deficient copulatory behavior cannot be a consequence of reduced availability of androgens. The differences in blood androgen concentrations between the knockout and the wild type was, in fact, eliminated in some of the behavioral studies by using castrated males given testosterone replacement. What the data show is that the estrogen a receptor is necessary either for the organization of brain circuits involved in sex behavior or for the activational effects of gonadal hormones in post-pubertal animals or for both the organizational and activational effects of these hormones. They do not provide us with any information that we did not already have from experiments with neonatal or adult castration or neonatal or adult administration of...

Gedske Daugaard Md Mikael R0rth Md

The stage distribution of nonseminomatous germ cell tumor (NSGCT) has changed over the last two decades, apparently as the result of a shift of patients with low-volume disseminated disease to patients with stage I disease.1 About one-half of patients with NSGCT have clinical stage I disease at first presentation. The management of such patients has generated considerable interest and some controversy over the last 20 years. Adjuvant abdominal irradiation and retroperitoneal lymph node dissection (RPLND) after orchiectomy have both been commonly practiced in the past, and the latter is still popular in North America (Table 12-1). Both of these management policies do, however, have disadvantages, including a 10 to 15 failure rate in patients with subclinical thoracic disease and also including specific toxicities, such as bone marrow suppression after radiotherapy and failure of ejaculation after surgery.

The medial preoptic area motivation or execution

In the male, the medial preoptic area is essential for male sexual behavior. This has been shown in several vertebrate species (Hillarp et al., 1954 Heimer and Larsson, 1966 Slimp et al., 1978 Koyama et al., 1984 Lloyd and Dixson, 1988) and it is most likely that equivalent structures in men are involved (see Paredes, 2003 and Paredes and Baum, 1997 for excellent reviews). Lesion of the medial preoptic area eliminates all sexual behavior irreversibly, provided the lesion includes most of the area. The dramatic deleterious effects are not due to damage to passing axons. Axon-sparing lesions of the medial preoptic area have the same effects as electrolytic or radiofrequency lesions (Hansen et al., 1982). Thus, cell bodies located within the medial preoptic area are necessary. Electrical stimulation of this structure produces intense sexual behavior that lasts as long as stimulation continues (Schmidt, 1968 Merari and Ginton, 1975 Satou, 1984). This effect has consistently been observed...

A note on lordosis in male rats and the influence of the medial preoptic area and of the ventromedial nucleus of the

The ventromedial nucleus of the hypothalamus is best known for its role in lordosis behavior in females of many rodent species as we will see in the next section. However, it also plays a role in lordosis behavior in the male rat. Indeed, lesion of the ventromedial nucleus completely eliminates this behavior (Chateau et al., 1987). It would appear, then, that the neural control of male rat lordosis is identical to that of female lordosis. A question that immediately comes to mind regards the possible effects of ventromedial nucleus lesions on male behavior in male rats. If preoptic lesions facilitate female behaviors, then it could be expected that ventromedial nucleus lesions would facilitate male behaviors. This is exactly what happens. Bilateral lesion of this nucleus stimulates most aspects of copulatory behavior. The latencies to mount and intromit were reduced while the number of mounts, intromissions and ejaculations displayed during tests was enhanced (Christensen et al.,...

The potential role of the prefrontal cortex

Of cortical tissue removed was the factor determining the effect on sexual behavior (Beach, 1940). This observation suggested that all cortical areas were equally important, or perhaps unimportant, for this behavior. This hypothesis was tested in a few experiments (Larsson, 1962, 1964). Results showed that the effects of localized lesions were modest, but suggested that frontal ablations might have larger effects than dorsolateral or posterior ablations. An interesting experiment in hamsters revealed that ablation of the cingulated and retrosplenial cortices enhanced the threshold for sexual arousal (Bunnell et al., 1966). This observation was followed by a study of the effects of large ablations of the medial and dorsomedial prefrontal cortex (Soulairac and Soulairac, 1972). This kind of lesion seemed to have a reliable and quite peculiar effect on male rat sexual behavior. We confirmed these preliminary results in a quite extensive study of the consequences of extensive destruction...

Reproductive biology

Information on the patterns of sigmodontine copulatory behavior is sparse. Calomys, however, is a relatively well known genus in this regard. There is information on three of the 11 species of the genus. They display intravaginal penile thrusting and multiple ejaculations, in combination with single or multiple pre-ejaculatory intromissions. Locks are either rare or absent. In addition, C. musculinus, a non-monogamous species, undergoes a stereotyped precopulatory behavior composed mostly of agonistic behaviors in which the female and the male play the aggressive and submissive roles, respectively (Laconi and Castro-Vasquez, 1998).

Effects of other brain lesions on male sexual behavior

A lesion with quite interesting effects has been performed in a small cluster of lumbar spinothalamic cells. These cells are specifically activated with ejaculation but not with other components of male sexual behavior (Truitt et al., 2003). Destruction of these cells eliminates ejaculation without affecting any other aspect of male rat sexual behavior (Truitt and Coolen, 2002). Only further studies can determine the exact function of this structure in the activation of ejaculatory mechanisms.

The Sexual Response Cycle

Takes place more slowly in women and is characterized by the production of lubricating fluid in the vagina, an increase in the diameter of the clitoris, and increased congestion of the labia with blood. For both sexes, phase II (plateau) is marked by a rise in the blood congestion of the pelvis and a strong feeling of sexual tension. A sex flush colors the forehead, neck, and chest, sometimes extending to the abdominal area. Phase III (orgasm) occurs in two stages in men a preejaculatory contraction of the muscles involved in ejaculation, and actual ejaculation. The same muscles are involved in the orgasms of women as those of men. During phase IV (resolution), which is usually completed more quickly in men than in women, the congestion of the blood vessels that occurred during the previous phases of the sexual response cycle decreases. After a time, the cycle can be repeated. The duration of this recovery, or refractory period, is generally longer for men than for women some women...

Indirect estimations of nervous activity in association with sexual behavior

Rather than lesioning or electrically stimulating parts of the brain or implanting gonadal hormones with the purpose of determining the involvement of these parts in the control of sexual behavior, more indirect procedures can be employed. Some years ago it became a kind of fashion to study the expression of the c-fos gene after exposing animals to sexually relevant events, such as the odor or the sight of a conspecific of the opposite sex, or allowing the subjects different amounts of sexual activity, ranging from performing or receiving one mount to several ejaculations. There is, as I mentioned somewhere, abundant evidence showing that the immediate early gene c-fos is activated whenever neural activity is heightened.

On the importance of other brain sites inferred from studies of copulationinduced brain activation

Following intromission and ejaculation (Guarraci et al., 2004). This was interpreted as suggestive of an increased impact of vaginocervical stimulation in lesioned animals, a conclusion already reached in a similar study from another laboratory a few years earlier (Yang and Clemens, 2000). The important point here is that the destruction of structures showing intense fos expression following copulation does not alter copulatory behavior. It seems quite reasonable to suggest, then, that these structures are not of any particular importance for that behavior. Furthermore, it should also be evident that, exactly as I stated many lines ago, activation of a brain structure during a behavior does not by itself imply that the structure is crucial or even important at all for the behavior. This annoying conclusion should be remembered when interpreting the very popular imaging studies in human subjects.

Studies in nonhuman mammals

As is so frequently the case with phenomena of sexual behavior, there are very few data on a Coolidge effect in females. One study (Krames, 1971) exposed females to a new male when the original male had ceased to copulate, with the purpose of determining if the female accepted as many ejaculations from the new partner as she had with the original one. She did. The authors did not care much about the females' behavior, since they were interested in finding out whether the Coolidge effect in males could be attributed to changes in female behavior rather than to exhaustion habituation of the male. They reasoned that the male might stop copulating because of reduced sexual motivation on the part of the female. This reasoning could be tested by replacing the original male with a new one. If the new male performed as many ejaculations as the original male had done, then it could be concluded that changes in female behavior was not the cause of cessation of male behavior. This observation is...

The positive affect behavioral data

Some people would even say that few things cause a positive affect as intense as that experienced at orgasm. This positive affect produced by the execution of copulatory behaviors is what we understand with sexual reward. The role of affect shall not be underestimated. It is generally believed that positive incentive stimuli activate approach behavior because they induce some fraction of the affect produced by the event they predict. The odor of a receptive female rat, for example, activates approach behaviors in most male rats. Approach to the incentive is normally followed by copulatory acts culminating in ejaculation. Ejaculation is associated with a rather long-lasting positive affect in the male and in the female receiving it, as we soon will see. The female's odor predicts a proximate positive affect. The quality of predictor of positive affect is fundamental for all positive incentives. Even if the rewarding properties of the exposure to a sexual...

The positive affect neurotransmitters

Dopamine is released from the moment a male or a female is exposed to an individual of the opposite sex until ejaculation. Thereafter release declines rapidly (Pfaus et al., 1990, 1995 Pleim et al., 1990 Phillips et al., 1991 Mermelstein and Becker, 1995). Dopamine is also released in rats subjected to tail pinch, foot-shock, aggressive encounters and similar unpleasant events (Doherty and Grattton, 1992 Tidey and Miczek, 1996 Takahashi et al., 1998 Ferrari et al., 2003). The variety of events able to enhance dopamine release in the accumbens was shown in an elegant experiment in 1986. Aggressive encounters, tail pinch and encounters with a female shared the capacity to release accumbens dopamine (Louilot et al., 1986). The fact that dopamine is released in all situations enhancing arousal and general activity, regardless of the kind of affective reaction associated with the enhanced arousal, suggests that dopamine in the nucleus accumbens subserves motor mechanisms. This notion stems...

Oxytocin and Vasopressin Information from Animal Models

Ejaculation in males, and formation of long-term pair bonds in those species when monogamy is typical (for reviews, see Carter, 1998 Insel and Young, 2001). During and after pregnancy, oxytocin functions to advance labor and uterine contractions and is involved in initiation of most maternal behaviors including breast feeding, nest building, licking, and warm contact with offspring. Oxytocin is involved in many basic non-reproductive social behaviors as well, including the simple act of socially recognizing a familiar individual (Young, 2002). Oxytocin knockout mice, lacking the gene to produce oxytocin, are less able to recognize a formerly familiar con-specific despite having no deficits in underlying learning or sensory functions. This lack of social recognition disappears if oxytocin is administered to the animal's medial amygdala, while the behavioral deficit can be mimicked in normal mice by administering an oxytocin antagonist to the same region (Ferguson et al, 2000, 2001).

Adverse Effects and Toxicity

Clinical studies have reported very few adverse effects that are of a mild nature (usually gastric distress or headache) following saw palmetto administration at normal doses. One randomized, double-blind study of finasteride, tamsulosin, and saw palmetto for 3 months observed no differences among the three treatments in terms of the effectiveness measures and no change in sexual function in those individuals receiving saw palmetto, though ejaculation disorders were noted as the most common side effect in those individuals receiving either tamsulosin or finasteride (26).

The Azoospermia Phenotype

The complete absence of sperm cells from semen may seem like a simple phenotype, unambiguously ascertained by an examination of semen, but sperm count can be affected by many factors (such as time since the last ejaculation, substance abuse, frequency of hot baths, and even dental caries) and can, thus, vary considerably in a single individual (2). A discussion of this variation lies outside the scope of the present chapter here we note that sperm count can be regarded as a continuous trait (Fig. 1) with azoospermia grading into oligozoospermia (few sperm) and the normozoospermic state, and will not distinguish between the first two, so that the phenotype under consideration here would more accurately be described as azoo- or oligozoospermia. Although azoospermia, in the strict sense, leads to infertility under natural conditions (this can sometimes be overcome by assisted reproduction), the relationship between oligozoospermia and fertility (producing offspring) is complex but can...

Female snow monkeys like to have sex with other females

The snow monkey is the last example of same sex preferences in unmanipulated animals I will mention. It is so because I know of no other mammalian species where this kind of preferences has been described in a scientifically acceptable way. We might find it amusing to consider the fact that in the two species where we have solid data showing that a significant proportion of a population shows a sexual preference for the same sex, the execution of copulatory acts (mounting) with individuals of the same sex leads to a sexually rewarding and reinforcing event (intromission ejaculation in the ram, clitoral stimulation in the snow monkey).

Continence mechanisms

The bladder neck or internal urinary sphincter is automatic and unlike the external urinary sphincter are not under voluntary control (Fig. 19.2). For normal voiding, both these sphincters must relax. If the external sphincter is damaged it is possible to remain continent with the internal sphincter alone. The operation of transurethral resection of the prostate (TURP) removes the prostatic adenoma obstructing the prostate urethra, and it is common for the bladder neck and the internal sphincter to be resected as well. This leads to retrograde ejaculation following TURP

Empirical support for an explanation of samesex preferences in incentive motivational terms

Sambia is a rather unknown tribe, at least to me, living somewhere on New Guinea. A peculiarity of that tribe is that all boys are isolated from women and housed in a kind of clubhouse from the age of 7-10 until marriage. Before that age, the boys have interacted with their parents and siblings in a way similar to other boys throughout the world. In the male clubhouse, the boys are told that they need to ingest sperm in order to mature and become men capable of impregnating women. The most efficient way to ingest fresh sperm is to fellate other boys or adult men. It appears that not all boys engage in fellatio voluntarily. In that case, they are coerced. The boys have to persist with frequent fellatio for a few years. When puberty arrives, their role changes from fellator to recipients of fellatio. The preceding fellator period does not seem to be associated with any sexual reinforcement since the boys never experience orgasm or even genital stimulation while fel-lating. On the...

A short note on nonhuman mammals

The only normality criterion that may be applied to non-human mammals is probably that of close to average. This criterion seems to be used rather frequently in the scientific community. It is not unusual to read about rats displaying a 'subnormal level of sexual behavior' or 'having abnormally short ejaculation latencies'. These statements mean that the rats displayed fewer mounts, intromissions and ejaculations than the average of the control rats, and that the average of the ejaculation latency was much below that of the control group, respectively. This is perhaps a legitimate use of the concept of 'normal', although it certainly would be preferable simply to describe the rats' behavior in comparison to other rats without employing any reference to normality or abnormality.

Spinal cord compression

Neurological dysfunction of the bladder (the neurogenic bladder) is particularly important to recognize. In the early phases, there is failure fully to empty the bladder such that the bladder enlarges, eventually building up back pressure on the ureters and kidneys. Finally, the patient goes into urinary retention which is often painless due the involvement of the sensory pathways. In the male, neurogenic bladder is accompanied by failure of penile erection and ejaculation.

Maternal effects on HPG function and mating behavior

Solicitation behaviors in the female rat are highly dependent on context. In smaller confines, the most common pattern of paracopulatory (or pro-ceptive) behavior is that of hopping, darting, and ear wiggling. However, when a receptive female is tested in a larger area that affords the opportunity to retreat from the male, the approach-withdrawal pattern prevails and reveals the females ability to pace the mating with the male (Erskine, 1989). Female rats pace the rate of male intromissions and thus ejaculation by withdrawal from the male following each intromission. The latency to return to the male is longer after ejaculation than after an intromission, which in turn is longer than after a mount with an intromission (Erskine et al., 2004 Yang and Clemens, 1996). As testing proceeds over the courses of multiple ejaculatory sequences, the interintromission interval increases (Coopersmith et al., 1996). Testing in the pacing chamber revealed considerable differences in sexual behavior...

Bladder Bowel and Sexual Disturbances

Sexual symptoms are also common among MS patients. Men most often experience erectile dysfunction, but may also suffer from problems with ejaculation (135,144). These symptoms typically accompany abnormal micturition. Women most typically experience difficulty in achieving orgasm, but may also complain of problems with lubrication (145). Both men and women may also complain of diminished libido. In contrast, a recent case of episodic hyperlibidinism has been reported (146).

Some rat data supporting the incentive motivationlearning model and a note on the relationship between desire and

After this excursion into the fascinating world of conceptual confusion, we can now approach some rat data relevant for the topic of learned modifications of sexual incentive motivation. It is known that the association of an aversive event with the execution of copulatory behavior eventually will lead to the disappearance of the behavior. In a series of ingenious studies, male rats were injected with LiCl shortly after ejaculation. This injection causes the stomach to be upset for a short while and is believed to constitute an aversive experience. After several pairings of copulation until ejaculation with the LiCl injection, copulatory behavior was extinguished (Peters, 1983 Koch and Peters, 1987 Peters et al., 1989). Disappearance of copulatory behavior was not due to reduced blood androgen concentration (Koch and Peters, 1992). Based upon these observations, I did a funny little experiment some years ago (Agmo, 2002). Male rats were allowed to copulate until ejaculation with...

Psychotherapeutic procedures

Another feature of the later phases of the program is the improvement of male self-control. This means that the male partner should learn to delay his ejaculation until the woman has experienced at least one orgasm. In fact, as part of the treatment, the couple signs a contract where one of the clauses establishes that the woman is entitled to orgasm in every copulatory encounter, and that her orgasm should precede that of the man. This, in fact, is nothing more than an application of the old gentlemanly principle the ladies come first. It is permissible for the woman to obtain her orgasm in any way she likes, including but not limited to self-masturbation, masturbation by the partner, and cunnilingus. Finally, they are taught how to enhance the likelihood of obtaining orgasm through penile-vaginal intercourse. Employment of the coital alignment technique is suggested (Eichel et al., 1988). In this technique, the woman lies on her back with the man positioned between her legs. In...

General conclusion

Sooner or later, in the same way as homosexuality was removed from the list when society was ripe for that move. New diagnoses will be added, just as hyperactive sexual desire disorder was added a couple of years ago. All diagnostic categories of sexual dysfunctions, perhaps except the arousal disorders, anorgasmia and premature ejaculation, are social constructions and not entities of nature.

Male Reproductive System

Sperm Leyding Cells

Growth and development of wolffian ducts into epididymis, ductus deferens, seminal vesicles, and ejaculatory ducts Spermatozoa that enter the head of the epididymis are non-motile. This is partially due to the low pH of the fluid in the epi-didymis and ductus deferens, produced by the secretion of H+ by active transport ATPase pumps. During their passage through the epididymis, the sperm undergo maturational changes that make them more resistant to changes in pH and temperature. The pH is neutralized by the alkaline prostatic fluid during ejaculation, so that the sperm are fully motile and become capable of fertilizing an ovum once they spend some time in the female reproductive tract. Sperm obtained from the seminiferous tubules, by contrast, cannot fertilize an ovum. The epididymis serves as a site for sperm maturation and for the storage of sperm between ejaculations. The ductus deferens carries sperm from the epididymis out of the scrotum into the pelvic cavity. The seminal...

Sexual motivation theoretical framework

Tail Withdrawal Rat

FIGURE 2.1 A model for sexual incentive motivation. The text in italics represents the example of the male rat. (a) A reciprocal excitatory relationship functioning in such a way that the central motive state enhances the sensory system's sensibility to stimuli with sexual significance. When such stimuli are perceived, the sensory system excites the central motive state which, in turn, further sensibilizes the sensory system, i.e. the relationship is one of reciprocal positive feedback. (b) At a certain threshold level of activity, the central motive state engages a series of viscerosomatic activities preparing the subject for sexual interaction. (c) The appropriate environmental stimuli activate motor patterns that bring the subject in contact with the source of stimulation. During approach, additional incentive stimuli may be encountered. These will be centrally represented and enhance the central motive state through (a). (d) and (e) Provided that approach behaviors have been...

The high cost of the imposed association between sexual behavior and reproduction

Sexual activity among lesbians and gays as well as that of menopausal women becomes illegitimate as a result of the obligatory association between sex and reproduction. A corollary of this principle is that only penile-vaginal penetration is a morally and biologically acceptable sex behavior. Indeed, social learning has convinced most humans that this sexual activity not only is morally superior to other sexual activities, but also that the satisfaction it produces is superior to that offered by any other sexual activity. Both these notions contribute to deprive several human groups besides gays, lesbians and menopausal women of sexuality. One such group is men suffering from impotence. They could easily satisfy their female partners with masturbation or cunnilingus and their male partners with masturbation and fellatio. They could receive sexual satisfaction by being masturbated or fellated. Both activities can easily induce ejaculation orgasm in the absence of erection. In fact,...

Selection Of Patients For Primary Rplnd

Behind nerve-sparing RPLND in this population is that the surgical removal of metastatic disease is curative 50 to 75 of the time, depending on the amount of metastasis. Similarly, since nerve-sparing technique is used, the morbidity of the procedure does not include the loss of emission and ejaculation. The morbidity of the procedure is essentially that of a laparotomy and includes an approximate 1 to 2 chance of a small-bowel obstruction related to postoperative adhesions and an approximate 2 to 5 chance of developing an incisional hernia.9 In patients with clinical stage II nonseminoma, the main advantage of primary RPLND is that it is therapeutic 50 to 70 of the time (depending upon the volume of metastasis) and that treatment with chemotherapy is thereby avoided. Nerve-sparing techniques can usually be used in clinical stage II patients, and there is therefore no postoperative loss of emission and ejaculation. Furthermore, there is a false-positive rate of 15 to 23 for clinical...

A curious observation of some consequence

An ancient study of sexual arousal in men suffering from low desire, impotence, or premature or retarded ejaculation yielded results somewhat different from those mentioned in the preceding paragraph. The penile response to a pornographic audiotape was smaller in the patient group than in healthy controls of about the same age (Heiman and Rowland, 1983). The interest of this observation in the context of disorders of sexual desire is limited, since more than half of the participating men complained of impotence. The responses of the two subjects with low desire probably disappeared among those of the nine impotent men. I mention this study only because it is all we have with regard to men. By doing so I expect to avoid all possible accusations for promoting sexual inequality.

Copulatory behavior in men and women

Stages Coital

When erection and vaginal lubrication have been obtained, the third stage of sexual interaction, coitus, may begin. This stage starts with the insertion of the penis into the vagina, reaches culmination in the ejaculation of semen and in the orgasm in both partners, and finally ends with penile withdrawal. The 'sexual tension' increases stepwise from the introduction of the penis until orgasm in both the man and the woman. van de Velde illustrates the degree of 'sexual tension' in a series of figures, which 40 years later were employed by Masters and Johnson (1966) in their important book on human sexuality. The Kinsey studies as well as Ford and Beach's (1951) account are basically descriptions of general motor patterns of copulatory behavior. The information contained in terms like intercourse with rear entry, anal intercourse etc. is not sufficient if we are looking for quantitative information on aspects of copulatory behavior. Questions like the latency from penile insertion to...

Functions of the vomeronasal organ in relation to sexual behavior

If size indeed were of importance, then we would expect the vomeronasal organ in a rodent to have profound influences on sexual behavior. Let us start with an examination of its role in the male rat. Removal of the organ has, in reality, very small effects. A rather radical intervention, consisting of complete deafferentation of the accessory as well as the main olfactory bulb, failed to reduce partner preference. Please note that the procedure left the bulbs themselves essentially undamaged. It was only the sensory input to them that was eliminated. Furthermore, measures of copulatory behavior, like the number of mounts and intromissions as well as the latency to mount, were unaffected, although the proportion of tests with ejaculation was somewhat reduced and the ejaculation latency somewhat enhanced. Anogenital investigation was reduced after deafferentation (Edwards et al., 1996). It is impossible to determine if these effects were caused by the lack of the accessory or the main...

Rams sometimes prefer to have sex with other rams

Several later studies have confirmed that some rams exclusively mount other rams even when receptive ewes are available. Data from a total of 584 rams show that the proportion exclusively mounting other males was 9.5 . About 12 did not show any sexual behavior at all, while 55.6 exclusively mounted ewes. The remaining 22 copulated both with rams and ewes (Roselli et al., 2004b). It is not surprising that several attempts to find the cause of the preference for mounting other males rather than females have been made. One quite evident possible cause is hormonal alterations. In fact, it has been reported that rams exclusively mounting other rams have lower plasma concentrations of estradiol, estrone and testosterone (Resko et al., 1996). The differences do not seem to be particularly reliable, since a subsequent study failed to replicate these observations. Males exclusively mounting other males were no different from males exclusively mounting females (Pinckard et al., 2000). In view...

Presentation with Symptoms from Metastases

Complication that is more likely with right-sided tes-ticular tumors and that presents with either bowel obstruction or gastrointestinal bleeding. Ejaculation and antegrade seminal emission in the male are dependent on the sympathetic nervous system and, in particular, the postganglionic nerve fibers that lie anterior to the abdominal aorta and in the aortocaval groove. Patients with testicular GCT have presented with loss of ejaculation and anorgasmia, owing to compression of these nerves (Figure 5-14). Figure 5-14. Computed tomography scan showing a massive retroperitoneal nodal mass from testicular teratoma that initially presented with loss of ejaculation secondary to sympathetic nerve fiber compression. Figure 5-14. Computed tomography scan showing a massive retroperitoneal nodal mass from testicular teratoma that initially presented with loss of ejaculation secondary to sympathetic nerve fiber compression.

Effects On Fertility

The issue of fertility in the patient with testicular cancer is a complex topic. Patients with testicular cancer often have testicular dysfunction and infertility prior to the diagnosis of the tumor and before the commencement of any therapy. Some (but not all) patients have persistent dysfunction after the completion of treatment. The variables to be considered when discussing this issue are baseline (pretreat-ment) semen characteristics, exposure to chemotherapy, the type and amount of chemotherapy, and the availability of experienced surgeons to perform a nerve-sparing retroperitoneal lymph node dissection (when feasible), to preserve ejaculation. It must also be realized that oligospermia does not translate into Moreover, the impairment in patients who have undergone nerve-sparing RPLND (without chemotherapy) is not always due to an inability to ejaculate as the patients in this series had 98 normal ejaculation after surgery.

Copulatory behaviors

In the male mammal, the reflexes or fixed action patterns executed during copulation ultimately lead to vaginal penetration and eventually ejaculation. In the female mammal, the reflexes or fixed action patterns essentially allow the male to achieve vaginal penetration. In addition to these fundamental aspects of copulatory behavior, males and females of many species display a varying number of other behaviors during the course of sexual interaction. Most of these other behaviors have unknown or little known consequences for the end point of sperm deposit. Furthermore, there are many instances in which elements of copulatory behavior are displayed in contexts where no sperm deposit is possible. Usually, these behavioral elements are identical to some behaviors normally displayed during the sequence of events leading to sperm deposit. Frequently, these behaviors are heterotypical, i.e. a female displaying elements of typically male copulatory behavior or vice versa. Many examples of...

Sexual maturity

Sexual maturity in many species occurs when body size reaches adult size. However, there are some notable exceptions male least weasels (Mustela nivalis) often seek maternity dens of females and will copulate the newly born females, as soon as 4 hours after birth. At that time, neonates still have their eyes and ears closed, are pink and hairless. This strategy enables females to have a first litter within weeks of birth (least weasels do not exhibit delayed implantation), and then again before the end of their first year. Another example of early sexual maturity is in musk shrews (Suncus murinus) in which mating and repeated ejaculations from males induce puberty and ovulation in virgin females.


The term male menopause is sometimes applied to the structural and functional changes that occur with age-related reductions in the production of testosterone during later life, but there is no scientific justification for this term (Kolodny, Masters, & Johnson, 1979). Changes in the structure and functioning of the sex organs are also typical of older males, but the notion that all men eventually experience a male menopause akin to that in women is inaccurate. Among the changes that occur in older men are a slight shrinkage of the testes, the production of fewer sperm, and an increase in the size of the prostate gland. Older men require longer to achieve an erection, have a softer erection, and lose it more quickly after ejaculation. They experience fewer genital spasms, the force and volume of the ejaculate are less,

Sex Therapy

They had maintained reasonably effective sexual interchange during their marraige. Mr. A. had no difficulty with erection, reasonable ejaculatory control, and . . . had been fully committed to the marriage. Mrs. A., occasionally orgasmic during intercourse and regularly orgasmic during her occasional masturbatory experiences, had continued regularity of coital exposure with her husband until 5 years prior to referral for therapy.

Nonhuman studies

Complicated designs continue to be used in experiments on classical conditioning of sexual responses in rats. A series of studies began with an experiment where an odor was added either to a sexually receptive female or to a non-receptive female before sexual interaction with a male. Other females were unscented. After several trials of this kind, the males were given access to one scented and one unscented female. The males trained with a scented, receptive female preferred to ejaculate with the scented female. Males trained with a scented non-receptive female as well as males trained with an unscented receptive female preferred to ejaculate with the unscented female. There was no difference at all with regard to latencies to mount or intromit the scented and unscented females and the number of pre-ejaculatory mounts and intromissions received was similar for both females (Kippin et al., 1998). The interpretation of these data is not easy. The unconditioned stimulus activating sexual...

Studies in primates

As an example of one of the early studies, I choose to summarize a report by Phoenix and Chambers (1982). Adult ovariectomized pseudohermaphrodites, castrated males and 'normal' ovariectomized females were treated either with testosterone or estradiol. They were then tested with estrogen-treated females. Whereas males increased mounting, intromission and ejaculation in response to testosterone, the females did not, independently of whether they had received prenatal testosterone or not. Treatment with estradiol had no significant effect on copula-tory behavior in any group. These results suggest that prenatal androgen treatment of female rhesus monkeys does not modify their copulatory behavior in response to other females. Their brains do not seem to have been differentiated in a male direction, despite the fact that their external genitalia were manifestly masculinized. An interesting fact is that these same females, when tested as infants and juveniles, had shown male-like behavior...


The epidemiological data show that low sexual desire is the most common of all sexual dysfunctions in women. It is frequently followed by orgasmic disorder and sexual arousal disorder (deficient vaginal lubrication). In men, erectile dysfunction is less common than desire disorders when young, while the reverse is true in old men. Premature ejaculation is the most common dysfunction in young men and almost certainly followed by low sexual desire. The prevalence of premature ejaculation declines with increasing age and, at the time impotence is common, premature ejaculation is rare in those still potent. Nevertheless, while low sexual desire appears to be the major sexual dysfunction in women, it does not appear to be so in men of any age. These epidemiological data justify the fact that female hypoactive sexual desire disorder has received far more attention than the corresponding state in men.

Sexual Functioning

Of all the psychosocial domains affected by testicu-lar cancer and its treatment, sexual function, for understandable reasons, has been among the most frequently studied. Although findings generally indicate that sexual functioning is altered among survivors, careful consideration of this outcome is warranted. The reasons for altered sexual functioning among survivors are varied. Factors such as the physical sequelae of testicular cancer itself, treatment-related side effects, or psychological distress following treatment can affect sexual functioning.38 For example, retroperitoneal lymph node dissection (RPLND), a surgical procedure commonly used in the treatment of testicular cancer, involves the resection of retroperitoneal sympathetic nerves involved in semen emission.38 A common side effect of RPLND is dry ejaculation, which can negatively Schover and colleagues were among the first to describe sexual functioning among survivors of non-seminomatous (n 121) and seminomatous (n 74)...


Reduced fertility is a frequently reported adverse effect of testicular cancer treatment. In fact, estimates indicate that up to 25 of survivors may have reduced fertility.30 It has also been reported that fertility may be reduced prior to diagnosis, suggesting a shared etiologic factor between testicular cancer and reduced fertility.13 Reduced fertility may result from treatment side effects, such as reduced sper-matogenesis following cytotoxic therapy or such as dry ejaculation following RPLND. However, modern therapeutic techniques have greatly reduced these outcomes.38 In addition, the availability of sperm banking has further increased the ability of survivors to father children. The effects of reduced fertility on the QOL of survivors are not fully understood. Limited evidence does suggest that some survivors report an unfulfilled wish to father children33 and more anxiety about fathering children after cancer treatment than before cancer treatment.40


Shift fantasy when approaching orgasm and that might be difficult to accomplish. By instructing him (exhibitionists are always men) to keep to one single kind of mental representation during the masturbatory episode, this problem was avoided. The reasons for including masturbation accompanied by unacceptable mental representations at all are difficult to understand, but therapists are not always familiar with fundamental principles of learning theory. However, Maletzky (1985) suppressed the sessions with unacceptable mental representations and made his patients masturbate with appropriate mental representations only. This variant is called directed masturbation. The fourth variant, satiation, is rather interesting from a theoretical point of view. Here, the patient is instructed to continue to masturbate for a prolonged period beyond ejaculation. During the post-orgasmic period, he is instructed to activate his favorite mental representations of the unacceptable act (Marshall and...


Object also activated the responses of approach and, in some of the male quails, also copulatory behavior leading to ejaculation. The anatomy of the quail is such that no vagina is required for the execution of copulatory behavior. It so happens that the male has no penis. During copulation, he grabs the back of the female's head or neck feathers, then he mounts and arches back so that his cloaca comes in contact with the female's cloaca. Cloacal contact is typically associated with ejaculation and the end of copulatory interaction. Provided that the male has the opportunity to grab an object at the top and sustain himself on the object, something similar to cloacal contact is possible. Therefore, some quails succeeded in obtaining ejaculation with the artificial object. After conditioning, the males were never again exposed to the female quail but to the artificial object. Those males that regularly achieved ejaculation with the object did not show any signs of extinction. Those who...

On the omissions

I have also omitted vaginismus, dyspareunia, premature ejaculation and anor-gasmia. In all these cases, I had reasons slightly different from those mentioned in the preceding paragraph. Although all these disorders in principle can be treated with behavioral techniques, conditioning to be exact, we do not have many good data with regard to this. In this situation, there were three options available. One was to present an entirely speculative account, the second was to limit coverage to all that which is told in many other books already, and the third was simply to omit these subjects from discussion. The first option seemed intellectually unsatisfactory and the second seemed quite boring. I chose the third. As any choice, it can be criticized, but the same would have occurred if I had chosen option 1, or option 2 for that matter.

Surgical Anatomy

Bifurcated Testicles

Formerly, RPLND for low-stage disease included a full bilateral template, which involved the removal of all lymphatic tissue from the crus of the diaphragm to the bifurcation to iliac arteries, from ureter to ureter. This procedure universally resulted in the loss of emission and ejaculation since no effort was made to preserve sympathetic fibers. Because the aorta and the vena cava are in the field of dissection, they must be adequately mobilized in order to completely remove lymphatic tissue that is posterior to these vessels. Therefore, in the course of RPLND, lumbar arteries and veins, which attach the great vessels to the posterior body wall, must be divided. Thus, in full bilateral RPLND, complete mobilization of the great vessels, the renal artery and vein, and the ureters is performed, followed by the removal of lymphatics from the posterior body wall (Figure 10-3). Donohue has called this concept of the mobilization of structures away from the lymphatic tissue and the...

Human whipworm

They derive their name from the characteristic whip-like shape. Adults are 1.2-2.0 in (30-50 mm) in length, with a thread-like anterior end that becomes thicker at the posterior end. Both sexes have two distinct body regions. Males are 1.2-1.8 in (30-45 mm) in length, while adult females are 1.4-2.0 in (35-50 mm) in length. Females are very attenuated on the anterior three-fifths of the body, and become greatly expanded in the posterior two-fifths. Males are similarly shaped, but the swollen posterior is less pronounced. For most of the body's length, there is an area designated as the bacillary band, which is a combination of hypodermal and glandular tissues. The glandular tissue opens up to the exterior through cuticular pores. They have a mouth with a simple opening, and do not have lips. The buccal cavity is tiny and is provided with a minute spear. The esophagus is very long, occupying about two-thirds of the body length and consists of a...

Trichina worm

Classified as animal (mammal) parasites and the causal organism of the disease trichinosis, they are small roundworms that live mainly in rats and other small mammals such as pigs that pick up the worm while rooting for food. Adults have a length of 0.055-0.158 in (1.4-4.0 mm), with males measuring 0.055-0.063 in (l.4-1.6 mm) in length and females 0.118-0.158 in (3.0-4.0 mm) in length. Males and females have distinct features. Females possess a uterus and vulva. The vulva is located near the middle of the esophagus, which is about one-third the length of the body. Males have a single gonad, but no copula-tory spicule, and have an ejaculatory duct. Structures identifiable on both sexes include the muscular esophagus, stichosome, and intestine. Stichosomes are formed by a single short row of stichocytes, following a short muscular esophagus. The color of the external surface of the adult is translucent and white. Both sexes are more slender at the anterior than at the posterior, but do...

Chest Radiation

Pelvic radiation can damage the autonomic nerves responsible for erection. As a result, erectile dysfunction is common after radiation for prostate, rectal, and anal cancers.43 Improvement often occurs over the first year after treatment but then stabilizes. As important as evaluating the degree of erectile dysfunction is evaluating how much this bothers the patient some patients are untroubled by complete loss of function while others are extremely distressed by even relatively subtle changes in sexual function such as retrograde ejaculation. Erectile dysfunction can be managed with oral agents like sildenafil, tadalafil, and vardenafil, but sometimes requires external suction devices, penile injection therapy, or implantation ofpenile prostheses. Referral to a urologist specializing in male sexual health can be very helpful.

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