Ejaculation problems

Ejaculation problems, or ejaculatory dysfunction, can be classified into three main types: premature ejaculation (coming too fast), delayed ejaculation and anejaculation (no ejaculation). Some men struggle to climax from oral sex, masturbation or with a partner masturbating them. In this article, we discuss all these ejaculation problems and offer possible solutions.

Ejaculation

Before we proceed to discuss ejaculation problems in more detail, let's look at the mechanism of ejaculation. In most men, orgasm (sexual climax) and ejaculation (the expulsion of semen from the penis) happen simultaneously. Up to 300 million sperm cells are released per ejaculation. Sperm cells are produced in the testes and mature in the epididymis. Each ejaculation contains sperm cells (1-3%) and liquid, which is produced in the prostate and in the seminal vesicles. This mixture of sperm cells and liquid is called semen.

The ejaculatory reflex consists of two separate phases: emission and expulsion. In the first stage, emission, sperm are moved from the testes and the epididymis (where the sperm are stored) to the beginning of the urethra. In the second stage, expulsion, the neck of the urethra closes, so that no urine reaches the sperm. The semen is moved through the urethra and expelled from the body by contractions of the bulbocavernosus muscle, which encircles the structure in the penis that encloses the urethra.

Premature ejaculation

Premature ejaculation (PE) is common, especially in young men. In this condition, a man ejaculates without control before or shortly after penetration during sexual intercourse, with minimal penile stimulation. If a man has a problem with the fact that he ‘only’ lasts 20 minutes instead of 30 minutes, this is not considered premature ejaculation. Although the definition of premature ejaculation varies, most sex therapists define ejaculation as 'premature' if:

• It occurs within 30 to 120 seconds of having sex.
• It causes distress to either one or both partners.

Causes of premature ejaculation

Various psychological and physical factors can cause a man to suddenly experience premature ejaculation. Common causes include:

• Conditioning. Early sexual experiences can influence future sexual behaviour, like when a teenager conditions himself to ejaculate quickly to avoid being caught masturbating.

• Performance anxiety. This emotion can make men overly excited, causing them to ejaculate prematurely.

• Low serotonin levels. This so-called neurotransmitter acts as a chemical messenger between nerve cells in the brain. If levels of serotonin in the brain are low, the brain doesn't get the right information about when to ejaculate.

• Inflammation of the prostate gland (prostatitis). Some studies have shown that between 25 and 75% of men with this condition ejaculate prematurely.

Treatment methods

There are several treatment options for premature ejaculation problems.

• Psychological therapy. Psychological therapy is a way to work through the feelings and emotions (e.g., fear of failure, performance anxiety) that may lead to ejaculation problems. There are also exercises to help build tolerance to delay ejaculation.

• Medical treatments. There are a number of medications (serotonin reuptake inhibitors) that may slow ejaculation in men with PE.

• Kinesis physical therapy. This type of treatment aims to improve control of the pelvic floor muscles to postpone ejaculation.

Delayed ejaculation

Delayed ejaculation, sometimes called impaired ejaculation, is a condition in which it takes an extended period of sexual stimulation for men to reach orgasm and ejaculate.

Causes of delayed ejaculation

Delayed ejaculation disorders can have various causes. It can be a side effect of certain medications. For example, some antidepressants are known to slow down the ejaculatory reflex. Delayed ejaculation can also have psychological causes (e.g., depression, anxiety or other mental health conditions.) Some men can only ejaculate through masturbation and not through sexual intercourse, or vice versa. Also, it may take a lot of effort to ejaculate.

Treatment methods

Delayed ejaculation can result from medicine use. If this is the case, it may help to switch to a different brand or medicine with different active ingredients. Of course, this should always be done in consultation with a GP.

If delayed ejaculation appears to be caused by underlying psychological factors, psychological counselling or sexual therapy can offer a solution.

It is also possible that a man can reach and achieve orgasm but cannot ejaculate semen. This failure to release semen can be due to two things:

• The semen is redirected back into the bladder (retrograde ejaculation).
• An inability to ejaculate semen (anejaculation).

Retrograde ejaculation

Retrograde ejaculation is a condition where the semen is redirected backwards into the bladder rather than forwards to the urethra and out the penis. This happens when the bladder neck muscle doesn't tighten properly, allowing the ejaculate to take the path of least resistance into the bladder. Retrograde ejaculation is also called dry orgasm: an orgasm without ejaculating at all.

Anejaculation

Anejaculation is defined as the inability to ejaculate semen.

Causes of retrograde ejaculation and anejaculation

Retrograde ejaculation is caused by damage to the muscles that surround the neck of the bladder due to medicine use, or prostate or bladder surgery. Retrograde ejaculation may also result from diabetes or neurologic problems.

Anejaculation is typically seen in men with neurologic problems such as spinal cord injury, diabetes mellitus and multiple sclerosis. In rare cases, anejaculation can result from psychological causes.

Treatment methods

Retrograde ejaculation or anejaculation is not harmful, but it can cause infertility. In both cases, treatment is aimed at remedying fertility problems.

In the case of retrograde ejaculation, it is possible to retrieve ejaculated live sperm cells from urine for insemination or test-tube fertilisation. For this, the acidity of the urine must first be increased with medication. In addition, the bladder can be rinsed with a sperm-friendly buffer solution. The solution is inserted into the bladder with a small catheter.

Penile vibratory stimulation (PVS) and electroejaculation (EE) are methods for sperm retrieval in men with an inability to ejaculate. PVS is an easy procedure that can be done at home. Electroejaculation must be done in a hospital. With EE, a semen analysis can be done to measure the amount and quality of a man's semen and sperm. Viable sperm cells can then be harvested for the purpose of artificial insemination.