Ejaculation Problems: A Complete Guide

For almost every stage of sexual activity, there exist peculiar issues that can stand in the way of completing the process enjoyably.

Low libido may prevent the initiation of intercourse, as can erectile dysfunction. This dysfunction may also interfere with your ability to sustain an erection during sex.

In certain instances, even the last phase of the act may witness its fair share of difficulty. It isn't uncommon for some men to experience ejaculation problems during sex. These problems may hinder satisfaction or the seamless completion of sexual activity.

We'll be focusing on ejaculatory dysfunction, its causes, symptoms, and the ways to manage and treat these conditions.

What Is Ejaculatory Dysfunction?

Ejaculatory dysfunction is perhaps the most common sexual dysfunction experienced by men. It spans a range of disorders that run through quick ejaculation, delayed ejaculation, no ejaculation at all, and the misdirection of ejaculate.

These disorders are premature ejaculation, delayed ejaculation, and retrograde ejaculation, and painful ejaculation.

Premature Ejaculation

Premature ejaculation is the most common disorder that may negatively affect a man's sexual health. If you deal with PE and are feeling alone, don’t — approximately 30 percent of all men experience premature ejaculation.

Put simply, premature ejaculation occurs when a man frequently reaches orgasm, and ejaculates semen more quickly than he would like during sexual activity. This is not to say that you have an automatic PE diagnosis if you've ever ejaculated quickly. Just about every man has experienced that. Occasionally experiencing quick ejaculation normal, and no cause for alarm.

Where such instances are routine/frequent however, it is likely to be a diagnosis of premature ejaculation. The World Health Organization defines it as, “persistent or recurrent ejaculation with minimal stimulation before, on or shortly after penetration and before the person wishes it over which the sufferer has little or no voluntary control which causes the sufferer and/or his partner bother or distress…”

Although there is no definitive time-stamp to mark ejaculation as premature, a study carried out on 500 heterosexual couples proposed that men with an intravaginal ejaculatory latency time (IELT) of less than one minute have definite premature ejaculation. Those with IELTs between 1 and 1.5 minutes have probable PE. For context, it takes an average of five to seven minutes for a male to ejaculate during sex.

However, despite being commonplace, premature ejaculation is not a normal sexual occurrence. It may be the result of a number of physical or psychological factors.

What Are the Causes of Premature Ejaculation?

Researchers have been stumped in attempts to discover an exact cause of premature ejaculation. There are however several factors, physical and psychological, which may contribute to its occurrence.

Performance anxiety, nervousness, developmental issues and relationship stress, are some of the psychological factors that can contribute to instances of premature ejaculation during sex.

Physically, among other health conditions, endocrine issues like diabetes and hyperthyroidism may lead to PE. Likewise, increased penile sensitivity, or the use of recreational drugs like cocaine, may bring about early ejaculation during intercourse.

How Is Premature Ejaculation Treated?

Because there is no one cause of premature ejaculation, healthcare professionals have formulated different ways to manage individual cases of PE by taking into consideration the leading factors that may be causing it.

These treatments typically incorporate pharmacological, psychological and behavioral therapy to manage premature ejaculation.

If you head to your healthcare professional with a premature ejaculation complaint, you may get a prescription for a medication from the class of drugs known as selective serotonin reuptake inhibitors (SSRIs). SSRIs like paroxetine and fluoxetine have been shown to have positive effects in lengthening ejaculation time. 

Topical creams and gels may also be recommended to reduce the sensitivity of the shaft during sex.

Psychotherapy could address any negative thoughts or emotions that may cause a strain in a relationship and sex life.

Likewise, behavioural therapy may help to manage PE. Therapy can help in training the mind to delay ejaculation when it is imminent.

Our guide on how to stop premature ejaculation offers more details on medications and other strategies to help you combat PE.

Delayed Ejaculation

Delayed ejaculation is a fairly uncommon ejaculatory problem affecting about one percent to four percent of the male population. It happens when extended amounts of sexual stimulation are required before ejaculation can occur. If you suffer from his condition, you may even find yourself unable to ejaculate at all.

This condition can be frustrating to deal with for a number of reasons — it may complicate the process when partners are looking to conceive. It can lead to disappointment and stress in men, and can be tiring for their partners who have to deal with lengthy sessions to get to ejaculation.

There's also a tendency for it to make sex physically uncomfortable, as factors necessary for enjoyable intercourse like vaginal lubrication, may run out during extended sessions. 

Because people experience sex differently, it may be impractical to prescribe a blanket time frame to determine delayed ejaculation. However, a population survey has pegged complaints about sex lasting longer than 22 minutes as theoretically sufficient to qualify for a DE diagnosis.

What Are the Symptoms of Delayed Ejaculation?

There are notable identifiers to determine a case of delayed ejaculation. If you experience a delay in ejaculation, or perhaps fail to ejaculate in about 75 percent to 100 percent of the times you engage in sex with your partner over a period of 6 months, you're very likely dealing with delayed ejaculation — especially where this delay causes you significant distress.

Men diagnosed with DE typically have difficulty achieving orgasm and ejaculation. They may however experience both during some instances of self-masturbation, or manual, oral, vaginal or anal stimulation by a partner.

Difficulty ejaculating may be experienced every time sex is attempted (generalized DE), or it may only occur in specific scenarios or with certain people (situational DE). Should you be diagnosed with delayed ejaculation, it may be life long or acquired.

Delayed ejaculation is lifelong where difficulty ejaculating is experienced from the very first sexual experience. Men with this condition have always had difficulty achieving orgasm and ejaculating.

The second classification — acquired DE, occurs where despite having no difficulty ejaculating in the past, men begin to experience delays in ejaculating. 

What Are the Causes of Delayed Ejaculation?

There's no one cause of delayed ejaculation. It may stem from physical factors, psychological influences or pharmacologic effects. Other times, a combination of these factors can be to blame.

Psychological causes of DE may include a fear of intimacy, pregnancy, hurting your partner, sexual orientation conflicts, or even the fear of abandonment.

It may also include performance anxiety, strong religious convictions that may cause sexual guilt, as well as depression.

Physical conditions like diabetes, multiple sclerosis, spinal cord injury or hormone conditions could lead to difficulty ejaculating on time.

Medication like antidepressants, SSRIs, diuretics and alpha-blockers are another cause of increasingly delayed ejaculation.

How Is Delayed Ejaculation Treated?

Like premature ejaculation, treating delayed ejaculation may require psychological, pharmacological or behavioural therapy.

Psychological interventions like cognitive behavioral therapy, masturbatory training, couples' sex therapy, or counselling targretted at reducing sexual anxiety may be useful in treating DE.

Though there is no FDA approved medication to treat DE, off-label remedies may be used in managing delayed ejaculation.

They include drugs like testosterone, cabergoline, bupropion, oxytocin and bethanechol.

Our guide to Delayed Ejaculation: Causes & Treatments to Overcome It goes over these and more treatment options in greater detail.

Retrograde Ejaculation

Retrograde ejaculation is a form of ejaculatory dysfunction where, rather than sperm traveling forward through the urethra during ejaculation, it moves backwards into the bladder instead.

If you live with this condition, you may notice only a small amount of sperm ejaculated when you reach orgasm. In some instances, no sperm may be produced at all, this is known as a dry orgasm.

Though largely an uncommon cause, this dysfunction does cause infertility in men.

What Are the Causes of Retrograde Ejaculation in Men

Retrograde ejaculation may be caused by a number of factors. If you experience a tiny discharge or no discharge at all following orgasm, it may be linked to your medication, a medical condition, nerve damage or previous surgery.

Medications like alpha-blockers or psychotropic drugs may lead to the misdirection of ejaculate.

Medical conditions like spinal cord injuries, diabetes and multiple sclerosis could also affect ejaculation. This condition could also be a side effect of a prostatectomy to treat BPH.

Colorectal surgeries and aortic aneurysm surgeries may also lead to retrograde ejaculation.

How Is Retrograde Ejaculation Treated

First off, because RE is not a harmful condition, treatment may not be necessary. This is especially true for men who do not wish to have any more children.

However, should you be interested in offspring, or perhaps even regular ejaculation, certain drugs may help. These include sympathomimetics like synephrine and pseudoephedrine hydrochloride, among others, may help. These medications help in closing the urethra sphincter to permit the regular flow of semen. Antimuscarinics, another class of medications which are used to treat bladder incontinence can also be recommended to treat retrograde ejaculation.

Our detailed guide, Retrograde Ejaculation: Causes, Treatments & Considerations goes over these treatments and other options in more detail as well as covering RE and its causes in more detail.

In Conclusion

Navigating the management of an ejaculatory problem could leave you feeling a little alone. However, with a mix of psychological, behavioral, and pharmaceutical options available to manage and treat any of the conditions — erectile, premature, delayed and misdirected ejaculation — deciding on the most optimum course of action should be the priority .

To make sure you get the treatment best suited for you, consult a qualified healthcare provider and get started on managing your condition.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.