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Reviewed by Vicky Davis, FNP
Written by Our Editorial Team
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 the main types of ejaculatory disorders, their causes, symptoms, and the ways to manage and treat these conditions.
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Ejaculatory dysfunctions (ejaculatory disorders) are perhaps the most common type of sexual dysfunction experienced by men, according to an article published in the journal, Translational Andrology and Urology.
These disorders vary from premature ejaculation to delayed ejaculation, retrograde ejaculation, weak ejaculation and anejaculation (no ejaculation at all.)
Our article on ejaculation without erection answers whether or not a man with ED can still climax.
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 Encyclopedia of Reproduction 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 published in the Indian Journal of Urology 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.
Researchers have been stumped in attempts to discover an exact underlying cause of premature ejaculation. There are however several factors, physical and psychological, which may contribute to its occurrence.
Sexual performance anxiety, nervousness, developmental issues, relationship stress and other psychological issues, are some of the mental health factors that can contribute to instances of premature ejaculation during sex, according to an article published in the Asian Journal of Urology.
Physically, among other health conditions, endocrine issues like diabetes and hyperthyroidism, or high blood pressure, may lead to sexual problems like PE.
Likewise, increased penile sensitivity, or the use of recreational drugs like cocaine, may bring about early ejaculation during sexual intercourse.
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, according to a study published in the journal, Therapeutics and Clinical Risk Management.
Topical creams and gels may also be recommended to reduce the sensitivity of the shaft during sex, according to an article published in the journal, Andrologia.
Talking to a sex therapist could address any negative thoughts or emotions that may cause a strain in a relationship and sex life.
Likewise, behavioral therapy may help to manage PE. Therapy can help in training the mind to delay ejaculation when it is imminent.
Delayed ejaculation is a fairly uncommon ejaculatory problem affecting about one percent to four percent of the male population, according to an article published in the journal, Translational Andrology and Urology.
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 (anejaculation.)
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.
There are notable identifiers to determine a case of delayed ejaculation.
According to an article published in The World Journal of Men’s Health, 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 six months, you're very likely dealing with delayed ejaculation — especially where this delay causes you significant distress.
Men diagnosed with DE typically have difficulty reaching sexual climax 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 by a urologist or other healthcare provider, it may be lifelong 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 an 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.
There's no one psychological or physical 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, relationship problems, low self-esteem 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.
Medications like antidepressants, SSRIs, antipsychotics, diuretics and alpha-blockers are another common cause of increasingly delayed ejaculation.
Like premature ejaculation, treating delayed ejaculation may require psychological, pharmacological or behavioral therapy.
Psychological interventions like cognitive behavioral therapy, masturbatory training, couples' sex therapy, or counseling targeted 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 is a form of ejaculatory dysfunction where, rather than sperm traveling forward through the urethra during ejaculation, it moves backward into the bladder instead.
If you live with this condition, you may notice only a small amount of sperm ejaculated when you reach orgasm, according to an article published in the journal, Translational Andrology and Urology. 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.
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 prostatectomy to treat BPH, according to an article published in the American Journal of Men’s Health.
Colorectal surgeries and aortic aneurysm surgeries may also lead to retrograde ejaculation, according to a study published in the journal, Reproductive Medicine and Biology.
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, which may help.
These medications help in closing the urethra sphincter to permit the regular flow of semen. Antimuscarinics, another class of medications 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.
Anejaculation, or the inability to ejaculate despite reaching orgasm, occurs in a somewhat small population of men. However, according to a study published in the Indian Journal of Psychological Medicine, over 12,000 new cases of anejaculation are reported annually.
Men who suffer from this disorder can often still maintain normal and regular erections and may even be able to ejaculate during masturbation, but may have issues ejaculating when engaging with a partner.
This erection problem can have psychological causes, ranging from a lack of connection with one’s own body to performance anxiety or relationship problems.
Physical causes may be linked to a lack of adequate sexual arousal or certain health disorders, such as spinal cord injury, diabetes or multiple sclerosis. However, these causes are all theorized, and there is no one direct cause of the disorder.
According to the same study published in the Indian Journal of Psychological Medicine, proven treatments for anejaculation include sex therapy and vibrator stimulation.
Although weak ejaculation is not technically a medical condition, several of the previously named ejaculation problems can contribute to weak ejaculations during sex, including delayed ejaculation and retrograde ejaculation.
Age, overall health and wellness habits and prostate gland issues also may play a role. Signs of weak ejaculation include reduced amounts of ejaculation and reduced force behind the ejaculation.
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, misdirected, weak ejaculation or missing 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.
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Dr. Vicky Davis is a board-certified Family Nurse Practitioner with over 20 years of experience in clinical practice, leadership and education.
Dr. Davis' expertise include direct patient care and many years working in clinical research to bring evidence-based care to patients and their families.
She is also an active member of the American Academy of Nurse Practitioners.