Ejaculation Problems

As is the case with many sexual health issues, people who suffer are often reluctant to talk about it. It is reported that sexual dysfunction of some sort is experienced by 31% of men at some point in their lives, but some men are afraid to speak about their ejaculation problems. Fortunately, ejaculation related problems are often treatable.

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Premature ejaculation

Premature ejaculation is the most common ejaculation issue, the problem being that the male ejaculates too quickly during sexual intercourse.

The question may be how quick is too quickly? This will vary from person to person. It may be that a man who tends to ejaculate too quickly can bring his partner to the brink of orgasm before penetration, and they both climax at the same time, and everybody's happy! However, it may be that they would like the pleasure to last longer for both of them.

Causes of premature ejaculation

Both physiological and psychological factors can cause premature ejaculation. Most cases of premature ejaculation are down to an inability to control the ejaculatory response with some men ejaculating early as they are in fear of losing their erection

Some physical conditions in older men may cause issues:-

Prostate problems
Atherosclerosis
Diabetes
Neurological disorders
Thyroid problems
The use of recreational drugs.
A less common cause would be an oversensitive penis

Early sexual experience may be involved in forming future ejaculatory patterns, for instance, the initial nervousness and hurry in the fumblings of youth such as fear of discovery and other unsatisfactory early sexual encounters.

Psychological causes include depression, stress, relationship problems, and performance anxiety. In addition, there may have been some past conditions such as having been caught masturbating as a child, sexual abuse, or a strict religious background that is the underlying reason behind premature ejaculation.

Self-help

There are measures that can be trialed before seeking medical help:-

Masturbate a couple of hours before having sex
Wear a thick condom to reduce sensation
Take a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex in the body during which ejaculation occurs)
Have sex with the partner on top which allows them to pull away when you are close to ejaculation
The start-and-stop method - you or your partner will stimulate your penis until you feel like you are about to have an orgasm. Then stop the stimulation for about 30 seconds. Once you regain control of your response, stimulation begins again. Repeat the process 3 or 4 times before you allow yourself to reach orgasm.

Medication

Antidepressants - Selective Serotonin Reuptake Inhibitors (SSRI's) are designed to treat depression, but they also delay ejaculation
Dapoxetine - this is an SSRI that is specifically designed to treat premature ejaculation. It is now licensed in the UK and acts more quickly than other SSRI's and so can be used on demand
Phosphodiesterase-5 inhibitors - this group of drugs includes the sildenafil, otherwise known as Viagra. We know this as a drug designed to encourage erections, but it has also been found to delay ejaculation
Topical anesthetics and condoms - Topical anesthetics such as Lidocaine may help with the ejaculation problem, but as it can also be transferred to the walls of the vagina, it may reduce sensation for the woman.

Delayed ejaculation

In delayed ejaculation, the sufferer finds it very difficult to ejaculate even though he wants to, and he is receiving sufficient stimulation to facilitate this. The ejaculation will either be significantly delayed or won't happen at all.

Causes of delayed ejaculation

Causes may be physical or psychological in origin or a mixture of both.

Physical causes include:-

Severe diabetes
Drug therapy such as beta-blockers, antidepressants, antipsychotics, muscle relaxants and powerful painkillers
Neurological issues such as spinal cord injury, pelvic surgery, multiple sclerosis or alcoholism
Older age

Psychological causes are likely to be very similar to those for premature ejaculation, such as early sexual experience, childhood traumas, strict upbringing, relationship problems, depression, anxiety, and stress.

Treatment

Currently, there are no drug therapies approved for the treatment of delayed ejaculation, but if the sufferer finds the condition distressing, then they may benefit from sex therapy.

Retrograde ejaculation

Retrograde ejaculation is a rare type of ejaculation problem, and it occurs when semen travels back into the bladder instead of down through the urethra. The main symptoms include the production of no or very little semen during ejaculation and producing cloudy urine when first going to the toilet after intercourse (as a result of there being semen in the urine).

Causes of retrograde ejaculation

Nerve or muscle damage around the neck of the bladder. These nerves and muscles usually prevent semen from traveling into the bladder as they close during orgasm. If they are damaged, they may not close during orgasm, and so the semen never makes its way to the urethra.

Prostate gland or bladder surgery are common causes of retrograde ejaculation, but it may also be caused by diabetes and multiple sclerosis along with alpha-blockers, which are used to treat hypertension (high blood pressure).

Treatment

As men with retrograde ejaculation can still enjoy a healthy sex life, they may not choose to seek treatment, and it has no ill effects on the general health of the sufferer. However, if the sufferer wants to father a child he may choose treatment; there are several options:-

Pseudoephedrine (commonly used as a decongestant) is proving to be effective in treating retrograde ejaculation that has been caused by prostate or bladder surgery
If prescription drugs are causing the problem, then alternatives may be suggested by your GP
If muscle and nerves damage is too great to be helped by the administration of pseudoephedrine, semen can be extracted from the urine and used for artificial insemination

Anejaculation

Anejaculation occurs when the sensation of ejaculation is felt, but no ejaculate is produced at all. This is a rare condition, and the leading causes are:-