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Ejaculation Problems: Types & Treatment Options

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Geoffrey C. Whittaker

Published 01/27/2021

Updated 04/15/2024

If you frequently finish faster or slower than you enjoy, it may be because you experience an ejaculatory issue.

Ejaculation problems are a common experience among men of all ages. Premature ejaculation is the most often-discussed, but there are other types of ejaculatory disorders as well, such as delayed ejaculation and retrograde ejaculation.

Sometimes, these issues are associated with male infertility, problems with the nervous system and other sexual health difficulties. But symptoms of an ejaculatory disorder aren’t necessarily a reason to panic — instead, it’s a signal to ask questions.

Below, we explore the most common ejaculatory disorders and issues that can complicate men’s sexual function, as well as their causes, symptoms and possible treatments.

If you have a disorder of ejaculation, it means that you regularly experience difficulty ejaculating when you want to or even an inability to ejaculate.

There isn’t necessarily a certain amount of time to ejaculation that signals there’s a problem. Rather, it depends on whether the time it takes a man to ejaculate is either:

  • Ideal and pleasant for both parties (in other words, not a problem)

  • Causing distress because ejaculation isn’t happening as expected (read: a problem)

But that’s not all. For the issue to be considered an ejaculatory disorder, it also must happen often, or as part of a pattern.

That’s because all men experience some difficulty lasting long enough or finishing quickly enough during sex at some point in their lives — in other words, a one-off isn’t a disorder. So if you’ve come here wondering whether you’re struggling with premature ejaculation because of something that happened for the first time last night, you may not need to worry at all.

If, however, something has felt “off” on a regular basis recently (or for a very long time), then that may indicate an issue.

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According to some research, ejaculatory dysfunctions are the most common type of sexual dysfunction for men. The five main ejaculatory problems that men face are:

  • Premature ejaculation

  • Delayed ejaculation

  • Retrograde ejaculation

  • Anejaculation

  • Weak ejaculation

Some of these categories may appear to overlap, and indeed there’s some discussion in the medical community about whether to reexamine the diagnostic criteria. But if you’re wondering how to differentiate the various problems ejaculating that men may encounter, these are the essential details to consider.

Let’s take a look at each ejaculation problem in closer detail.

Premature Ejaculation (Problems Ejaculating Too Soon)

Premature ejaculation occurs when a man frequently reaches orgasm and ejaculates more quickly than he would like to during sexual activity.

The Encyclopedia of Reproduction defines premature ejaculation as follows: “Persistent or recurrent occurrence of ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it.” Further, the person may have “little or no control” over it, which causes distress both for them and their partner.

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.

Delayed Ejaculation (Trouble Ejaculating Soon Enough)

Delayed ejaculation (DE) happens when extended amounts of sexual stimulation are required before ejaculation can occur.

This is a relatively 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.

Delayed ejaculation can be frustrating to deal with for a number of reasons. For instance, it may:

  • Complicate the process when partners are looking to conceive

  • Lead to disappointment and stress in men

  • Make sex physically uncomfortable, as lubrication may run out

Diagnosing DE unfortunately requires more than numbers. A population survey has pegged complaints about sex lasting longer than 22 minutes as theoretically sufficient to qualify for a DE diagnosis.

But according to The World Journal of Men’s Health, if you experience a delay or fail to ejaculate 75 to 100 percent of the time over a period of six months, you're very likely dealing with delayed ejaculation.

Difficulty ejaculating may be experienced in several ways:

  • Every time sex is attempted, known as generalized DE.

  • Only in specific scenarios or with certain people, referred to as situational DE.

  • As lifelong, when difficulty ejaculating is experienced from the very first sexual experience. Men with this condition have always had difficulty achieving an orgasm and ejaculating.

  • As acquired DE, when issues begin to happen later in life or suddenly.

Retrograde Ejaculation (Ejaculating Backward)

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

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, known as a dry orgasm.

Though it’s very uncommon, this dysfunction can sometimes cause infertility in men.

Anejaculation (Inability to Ejaculate)

Anejaculation, or the inability to ejaculate despite reaching orgasm, occurs in a smaller percentage of men. 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.

Sometimes, anejaculation occurs alongside a similar disorder, anorgasmia, which is the inability to achieve orgasm.

Weak Ejaculation (A Potential Symptom of Another Disorder)

Weak ejaculation occurs when reduced volumes of ejaculate are produced, and/or the ejaculate is propelled from the body with a reduced force.

Although weak ejaculation is not technically a medical disorder, several of the previously discussed ejaculation problems can contribute to weak ejaculation during sex, including delayed ejaculation and retrograde ejaculation.

Weak ejaculation also can be beginning signs of delayed or retrograde ejaculation, though it might also simply be the result of too many prior ejaculations over a small period of time. In other instances, there may be a more serious underlying cause.

Causes of ejaculatory distress may be neurological or psychological, or they can result from a medication you’re taking or problems with the prostate gland, thyroid, testicles or other organs.

Furthermore, for some ejaculatory issues, there isn’t a single explanation.

If you’re experiencing PE, DE or another ejaculatory problem, consider whether any of the below causes might help explain your circumstances — and then share that with a healthcare professional.

Causes of Premature Ejaculation

Currently, experts don’t believe in a singular underlying cause of premature ejaculation. Instead, several physical and psychological factors may contribute to its occurrence:

  • Sexual performance anxiety

  • Nervousness

  • Developmental issues

  • Relationship stress and other psychological issues

  • Diabetes

  • Hyperthyroidism

Likewise, increased penile sensitivity, the use of recreational drug use and other physical health conditions may bring about early ejaculation during sexual intercourse.

Causes of Delayed Ejaculation

Delayed ejaculation may stem from physical factors, psychological influences or pharmacologic effects. Sometimes, a combination of these factors can be to blame.

Psychological causes of delayed ejaculation may include:

  • A fear of intimacy

  • Fear of pregnancy

  • Concerns about hurting your partner

  • Sexual orientation conflicts

  • Relationship problems

  • Low self-esteem

  • Fear of abandonment

  • Performance anxiety

  • Strong religious convictions that may cause sexual guilt

  • Depression

  • Diabetes

  • Multiple sclerosis

  • Spinal cord injury

  • Hormone conditions

Additionally, medications like antidepressants, SSRIs, antipsychotics, diuretics and alpha-blockers are other common causes of increasingly delayed ejaculation.

Causes of Retrograde Ejaculation

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:

  • Medications, such as alpha-blockers or psychotropic drugs

  • Medical conditions like spinal cord injuries, diabetes and multiple sclerosis

  • Nerve damage

  • A side effect of prostatectomy to treat benign prostatic hyperplasia (BPH)

  • A result of colorectal and aortic aneurysm surgeries

Causes of Anejaculation

Anejaculation’s potential causes largely overlap with those of delayed ejaculation. But typically, the reason for an inability to ejaculate falls into one of the following two categories:

  • As a result of psychological causes, ranging from a lack of connection with your own body to performance anxiety or relationship problems

  • Due to physical causes, such as a lack of adequate sexual arousal, a spinal cord injury, diabetes or multiple sclerosis

However, these causes are all theorized, as no single direct cause of the disorder has been pinpointed.

As you may have already guessed from the above, seeking treatment for ejaculatory problems requires you to first understand the underlying cause (or causes) of your ejaculation issues. After all, it makes little sense to treat someone with psychotherapy who experiences DE due to a spinal cord injury.

However — and this is an important point — don’t rule out the possibility that multiple factors could be contributing to the sexual problems you’re dealing with.

Premature Ejaculation Treatment

The treatments for premature ejaculation typically incorporate pharmacological, psychological and behavioral therapy to manage symptoms.

A healthcare provider may prescribe a medication from the class of drugs known as selective serotonin reuptake inhibitors (SSRIs). SSRIs like sertraline, 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. Occasionally, erectile dysfunction medications like sildenafil also can help some men increase their stamina.

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. Our clockstopper benzocaine wipes and delay spray are great places to start if you’d like to explore these options.

You may also consider different types of therapy. Talking to a sex therapist could address any negative thoughts or emotions that may cause a strain in a relationship and sex life and dampen your sexual desire. Likewise, behavioral therapy may help to manage PE, as it can help in training the mind to delay ejaculation when it’s imminent.

Our guide on how to stop premature ejaculation offers more details on medications (like premature ejaculation pills) and other strategies to help you combat PE, such as the squeeze technique.

Delayed Ejaculation Treatment

Psychological interventions like cognitive behavioral therapy, masturbatory training, couples' sex therapy or counseling targeted at reducing sexual anxiety all may be useful in treating delayed ejaculation.

Though there is no FDA-approved medication to treat DE, off-label remedies can be prescribed to manage delayed ejaculation. Treatment options that fall into this category include drugs like testosterone, cabergoline, bupropion, oxytocin and bethanechol.

Retrograde Ejaculation Treatment

Because RE is not a harmful condition, treatment may not be necessary — especially for men who do not wish to have any more children. That said, because retrograde ejaculation can sometimes cause infections and other complications, men may want to consider their options among retrograde ejaculation treatments.

Certain drugs can help men dealing with retrograde ejaculation, including sympathomimetics like synephrine and pseudoephedrine hydrochloride, among others. These medications assist in closing the urethra sphincter to permit the regular flow of semen.

Antimuscarinics, another class of medications used to treat bladder incontinence, may also be recommended to treat retrograde ejaculation.

Anejaculation Treatment

Anejaculation is a difficult ejaculatory issue to deal with, because in some cases there may not be effective treatments. This is particularly true when the cause is severe neurological damage or other types of physical trauma.

Still, there are options.

Proven treatments for anejaculation include sex therapy and vibrator stimulation, as well as some of the delayed ejaculation treatments listed above.

If you’ve been unable to ejaculate or reach orgasm for some time, it’s a good idea to reach out to a professional and explore your options.

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Navigating the management of an ejaculatory problem could leave you feeling a little alone. Here’s the good news: you’re definitely not.

Premature ejaculation and other ejaculatory issues are more common than you think, though determining the underlying cause and best treatment options for your own needs can be hard to do without a professional.

Seek out professional help, but in the meantime, keep the following in mind:

  • Ejaculatory disorders and problems can be caused by a number of physiological and mental health conditions affecting your health and happiness.

  • There may not be one definitive cause for any ejaculatory issue (premature, delayed, retrograde or otherwise).

  • Luckily, that also means that a mixture of psychological, behavioral and pharmaceutical options can help treat symptoms and underlying conditions.

  • To make sure you get the treatment best-suited to you, consult a qualified healthcare provider to get started managing your condition.

Have more questions? We can help. Our guides offer more information on a range of topics, including how to increase ejaculation, how to manage erectile dysfunction and which erectile dysfunction medications can best help you have the fulfilling sex life you deserve.

22 Sources

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  2. Althof S. E. (2016). Psychosexual therapy for premature ejaculation. Translational andrology and urology, 5(4), 475–481. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001981/.
  3. Anejaculation and anorgasmia. SMSNA. (n.d.). Retrieved November 4, 2022, from https://www.smsna.org/patients/conditions/anejaculation-and-anorgasmia
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  5. Atikeler, et al. (n.d.). Optimum usage of prilocaine-lidocaine cream in premature ejaculation. Andrologia. Retrieved November 4, 2022, from https://pubmed.ncbi.nlm.nih.gov/12472618/
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  22. Shindel AW, Althof SE, Carrier S, Chou R, McMahon CG, Mulhall JP, Paduch DA, Pastuszak AW, Rowland D, Tapscott AH, Sharlip ID. Disorders of Ejaculation: An AUA/SMSNA Guideline. J Urol. 2022 Mar;207(3):504-512. https://www.auajournals.org/doi/full/10.1097/JU.0000000000002392.
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

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. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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