Male ejaculation is a complex process. To ejaculate correctly, a man’s central and peripheral nervous systems must work together. During ejaculation, the bladder neck must close and sperm must be forced from the vas deferens into the ejaculatory ducts, along with fluid from the seminal vesicles. Rhythmic contractions of the muscles around the urethra in the penis help to move the ejaculate through the urethra and out of the body.
Causes of Ejaculation Disorders
- Prostate/pelvic surgery
- Spinal cord injury
- Congenital defects (i.e. spina bifida)
- Psychological disorders
Types of Ejaculation Disorders
- Retrograde ejaculation
- Delayed Ejaculation
- Premature Ejaculation
In this case, ejaculation occurs but, instead of coming out the end of the penis, the ejaculate goes backwards (retrograde) into the bladder and comes out later in the urine. Retrograde ejaculation is caused by bladder neck dysfunction due to medications (especially those used for enlarged prostate or BPH), surgery for an enlarged prostate, or neurologic disease (spinal cord injury or diabetes).
A simple test called a post-ejaculatory urinalysis can often diagnose this condition. This test involves providing a semen sample followed by a urine sample to see if there is sperm in the urine. If sperm is found, it can be banked and used for assisted reproduction.
Treatment for Retrograde Ejaculation
Retrograde ejaculation can be difficult to treat, particularly if it is due to surgery, but there are medications that may be successful. If a medication is the cause, retrograde ejaculation typically stops after discontinuing the medication.
Anejaculation & Delayed Ejaculation
In these cases, ejaculation takes an abnormally long time or does not occur at all, even if the patient has the sensation of orgasm. There are many variations of this, including men who neither have orgasm or ejaculation, men who have orgasm without ejaculation, or even men who have ejaculation without orgasm. Some men are able to ejaculate during masturbation but not during intercourse.
- Hormonal abnormalities
- Psychological disorders
- Medications (i.e. antidepressants)
- Neurologic diseases (i.e. spinal cord injury, diabetes, multiple sclerosis)
- Surgery (i.e. radical prostatectomy for prostate cancer, retroperitoneal lymph node dissection for testicular cancer)
Treatments vary depending on the situation and the cause. Discontinuing medications with sexual side effects can sometimes resolve the problem. Other treatments include sex/couples therapy, high-speed vibrators, and certain medications.
Premature ejaculation (PE) is one of the most common male sexual disorders. It is defined as ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners. PE may be associated with other health problems, such as anxiety. It is often associated with erectile dysfunction (ED).
Treatment of Premature Ejaculation
Treatment for PE range from psychological and behavioral therapies to medications, such as antidepressants and topical numbing spray/cream.