Ejaculation problems

Page last reviewed: 13/07/2011

Ejaculation is where semen is squirted out of the penis during an orgasm (sexual climax).

Ejaculation problems are quite common, with an estimated 20-30% of men experiencing at least one episode during their lifetime.

The three main types of ejaculation problem are:

  • premature ejaculation
  • retarded ejaculation
  • retrograde ejaculation

These are described in more detail below.

Premature ejaculation

Premature ejaculation is the most common type of ejaculation problem. It is where a man ejaculates too quickly during sexual intercourse.

Many men are unsure about how long 'normal' sex should last before ejaculation. A study that looked at around 500 couples from five different countries found that the average time between a man putting his penis into his partner's vagina and ejaculation was just under five-and-a-half minutes.

However, in reality, it is up to the individual and his partner to decide whether or not they are happy with the time that it takes for him to ejaculate.

Retarded ejaculation

Retarded ejaculation is a persistent, or recurring, delay in achieving ejaculation, or an inability to achieve ejaculation during sexual activity, even though the man wants to and the erection is normal.

Retarded ejaculation is sometimes known as delayed ejaculation or male orgasmic disorder.

Retrograde ejaculation

Retrograde ejaculation is a rarer type of ejaculation problem. It occurs when instead of the sperm squirting out of the hole at the end of the urethra (the tube that passes from the bladder through the penis and through which urine passes) it travels backwards into the bladder.

If a man have retrograde ejaculation, he will experience the feeling of an orgasm, but produce no, or very little, semen. The condition does not pose a danger to health, but it can affect the ability to father a child.

How common are ejaculation problems?

Premature ejaculation is the most common type of ejaculation problem. It is estimated that 20-30% of men iwill experience at least one episode of premature ejaculation.

Retarded ejaculation is less common than premature ejaculation, but it is certainly not rare. It is estimated that 3-4% of men will experience at least one episode of retarded ejaculation.

Both premature and retarded ejaculation can be caused by both physical and psychological factors.

Physical factors can include:

  • medications that can affect normal ejaculation, such as certain anti-depressants
  • alcohol misuse
  • inflammation of the prostate

Psychological factors can include:

  • stress
  • anxiety
  • unresolved issues relating to previous traumatic sexual experiences

Although retrograde ejaculation is a rare condition within the general population, it can be a common complication of certain types of surgery, such as prostate surgery, or in men with certain health conditions that can damage the nerves, such as diabetes or multiple sclerosis.

Outlook

With treatment, the outlook for both premature and retarded ejaculation is generally good. There are a range of treatments and medication that can be used to restore normal ejaculation.

A common difficulty with both premature and retarded ejaculation is that many men are reluctant to speak to their GP and seek treatment. This is often due to a mistaken assumption that there are no treatments available, or it is the result of a misplaced sense of embarrassment.

The outlook for men with retrograde ejaculation will depend on the underlying cause. If the condition is caused by muscle weakness, it may be possible to use medication to tighten the muscles. However, if the condition is due to nerve damage, treatment may not be possible.



Useful Links

Page last reviewed: 13/07/2011

Premature ejaculation

The characteristic symptom of premature ejaculation is the inability to control and delay ejaculation for as long as both partners would like.

There are two sub-types of premature ejaculation:

  • acquired - where the symptoms of premature ejaculation either gradually, or suddenly, develop, with ejaculation previously being normal before the onset of symptoms
  • lifelong - where the symptoms of premature ejaculation develop during a man's first sexual experience and remain a problem afterwards

Lifelong premature ejaculation is a less common form of the condition, affecting an estimated 2-5% of men. In most cases of lifelong premature ejaculation:

  • ejaculation takes place before the man inserts his penis into the vagina, or one to two minutes afterwards
  • there is an inability to delay ejaculation in all, or almost all, episodes of penetrative sex
  • the condition impacts on the man's quality of life and causes feelings of shame or frustration, and may lead to a pattern of avoiding sexual intimacy

Retarded ejaculation

Retarded ejaculation is characterised as either experiencing a significant delay before ejaculation is possible, or being totally unable to achieve ejaculation.

There is no set definition to describe 'how long is too long', but a persistent (and unwanted) delay of ejaculation that lasts for 30 to 60 minutes may suggest that you have retarded ejaculation. Alternatively, if you are unable to achieve ejaculation during at least half the times that you have sex, you may have retarded ejaculation.

As with premature ejaculation, retarded ejaculation can be either acquired or lifelong, with lifelong premature ejaculation being less common and affecting an estimated one in every 1,000 men.

Retarded ejaculation can also be classified as:

  • global - where it occurs in all sexual situations
  • situational - where it only occurs in certain situations

For example, a man may be able to ejaculate normally when masturbating, but not when having sexual intercourse. Situational retarded ejaculation usually suggests that the condition is the result of psychological causes.

Retrograde ejaculation

Apart from the absence of semen, the main symptom of retrograde ejaculation is producing cloudy urine when urinating (pass water) after having sex. The urine appears cloudy due to the presence of semen in it.

Glossary

Discharge
Discharge is when a liquid such as pus oozes from a part of your body.
Anxiety
Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Useful Links

Blood in the semen

Finding blood in semen (hematospermia) can be alarming. However, in most cases, the causes are not serious, and the condition will pass within a few days without the need for treatment. The most likely cause is non-specific inflammation (a general bodily reaction to infection, such as swelling, or pain) of the urethra and prostate.

If the symptoms persist, one should see their GP, or visit the local genito-urinary medicine (GUM) clinic because the causes may be more serious.

Other possible causes of blood in semen include trauma, such as a kick to the genital area, and sexually transmitted infections (STIs), such as gonorrhoea and chlamydia.

Prostate disease could also be a cause, particularly if over 40 years of age. In some cases, blood in the semen is a symptom of prostate cancer, although this a rare cause of haematospermia.

Page last reviewed: 13/07/2011

The causes of ejaculation problems vary depending on the person involved and the type of problem. Sometimes, problems can be complicated by having multiple causes.

An ejaculation problem can often have both physical and psychological causes. For example, if a man has previously had a health condition that made it difficult to maintain an erection, it may now cause anxiety, leading to premature ejaculation.

Premature ejaculation (lifelong)

Lifelong premature ejaculation is almost always the result of psychological factors. A number of possible psychological factors that can cause lifelong premature ejaculation are discussed below.

Conditioning

Many doctors believe that early sexual experiences can condition (influence) future sexual behaviour. For example, if a teenager conditions himself to ejaculate quickly in order not to be caught masturbating, or having sex, it may later be difficult to break the habit.

Traumatic sexual experiences

A traumatic experience at an early age, involving sex, can sometimes lead to life-long sexual anxiety and premature ejaculation. Experiences can range from being relatively mild, such as being caught masturbating, to the more serious, such as sexual abuse.

Upbringing

Men who have had a strict upbringing, where sexual activity is only considered appropriate in certain circumstances, such as after marriage, may find it difficult to relax during sex, or be unable to not regard sex as being wrong or sinful.

Premature ejaculation (acquired)

Acquired premature ejaculation can be caused by both psychological and physical factors.

Common physical causes of acquired premature ejaculation include:

  • diabetes - where the body is unable to produce insulin, or the insulin does not work in the right way
  • multiple sclerosis - a condition where nerve fibres become damaged
  • prostate disease - a condition where the prostate gland becomes swollen
  • high blood pressure (hypertension) - where blood pressure is pumped around the body at too high a level
  • under-active thyroid gland (hypothyroidism)
  • drinking more than the recommended limits of alcohol (see below)
  • using recreational drugs

The recommended limits for alcohol consumption are 17 standard drinks a week for men and 11 for women. A standard drink of alcohol is equal to about half a pint of beer, a small glass of wine or a pub measure of spirits

Common psychological factors include:

  • depression
  • stress
  • unresolved problems, conflicts, or issues within a sexual and emotional relationship
  • anxiety about sexual performance (this is often a contributory factor at the start of a new sexual relationship, or when a man has had previous problems with sexual performance)

Retarded ejaculation

Like premature ejaculation, retarded ejaculation can be caused by both psychological and physical factors. The possible psychological causes of delayed ejaculation are similar to those of premature ejaculation - for example, early sexual trauma, strict upbringing, relationship problems, stress, and depression.

Physical causes of delayed ejaculation include:

  • diabetes (usually only type 1 diabetes)
  • spinal cord injuries
  • multiple sclerosis
  • surgery to the bladder or prostate gland
  • increasing age

Many medicines are known to cause delayed ejaculations including:

  • antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
  • medications that are used to treat high blood pressure (hypertension), such as beta blockers
  • antipsychotics, which are medications that are used to treat episodes of psychosis (a mental condition where it is difficult for a person to distinguish between reality and their imagination)
  • muscle relaxants, such as balcofen, which is widely used to treat motor neurone disease and multiple sclerosis
  • powerful painkillers, such as naproxen, tramadol and methadone (which is also widely used to treat people who are addicted to heroin)

Retrograde ejaculation 

Retrograde ejaculation is caused by damage to the nerves or muscles that surround the neck of the bladder (the point where the urethra connects to the bladder).

Usually when you ejaculate, semen is pushed out of your testicles and up through your urethra (the tube that semen and urine passes through). It is prevented from entering your bladder by the muscles around the neck of the bladder, which close tightly at the moment of orgasm.

However, damage to the surrounding muscles or nerves can stop the bladder neck closing, causing the semen to move into the bladder rather than up through the urethra.

Prostate gland or bladder surgery is the most common cause of retrograde ejaculation. Other causes are diabetes, multiple sclerosis, and a class of medicines that are known as alpha blockers, which are often used to treat high blood pressure (hypertension).

Glossary of terms

Discharge
Discharge is when a liquid such as pus oozes from a part of your body.
Testicle
Testicles are the two oval-shaped reproductive organs that make up part of the male genitals. They produce sperm and sex hormones.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Benign
Benign refers to a condition that should not become life-threatening. In relation to tumours, benign means not cancerous.
Urethra
The urethra is a tube that carries urine from the bladder to the outside of the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Useful Links

l

Page last reviewed: 13/07/2011

If a man has an ejaculation problem, hewill usually become aware of it through his own sexual behaviour or through discussion with his partner. The next step is to visit the GP who will discuss the problem with him, and either examine him or refer him to a specialist.

Family and medical history

Depending on the nature of the problem, he may be asked questions about family medical history, and any underlying health conditions that he may have, such as diabetes, heart disease, or high blood pressure (hypertension).

He will also be asked about his sexual and emotional health. Although he may find it embarrassing to talk about, answering questions about the type and pattern of his symptoms is an important step towards confirming a diagnosis, and making sure that he receives the most effective treatment.

For example, if he is experiencing premature ejaculation, the GP, or specialist, will want to know whether the symptoms are lifelong ,or whether they have recently started, or if he is experiencing retarded ejaculation, whether the symptoms are global or situational. See Ejaculation problems - symptoms for further details about this.

Your GP, or specialist, may ask about an injury, or surgery, to the pelvic area, check what medications are prescribed, and ask about aspects of lifestyle, such as alcohol consumption.

Further testing

A rectal examination may be carried out to check for an enlarged prostate gland, and to check the nerves of the penis for any damage.

Blood and urine samples may also be taken to check hormone and cholesterol levels. The GP, or specialist, may also carry out a visual examination of the pelvic area to check for injury or infection.

Glossary

Cholesterol
Cholesterol is a fatty substance made by the body that lives in blood and tissue. It is used to make bile acid, hormones and vitamin D.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
High blood pressure
Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.
Heart
The heart is a muscular organ that pumps blood around the body.

Useful Links

Page last reviewed: 13/07/2011

Premature ejaculation

If a man has premature ejaculation that is caused by physical conditions, his GP should be able to suggest possible treatment options.

Treating premature ejaculation that is caused by psychological factors can be more challenging, but most men who persevere with treatment have successful outcomes.

There are a number of self-help techniques that a man may want to try before seeking medical help. These include:

  • masturbating an hour or two before having sex
  • using a thick condom to help decrease sensation
  • taking a deep breath to briefly shut down the ejaculatory reflex (an automatic reflex of the body during which ejaculation occurs)
  • having sex with the partner on top (to allow them to pull away when the man is close to ejaculating)
  • taking breaks during sex and thinking about something boring

Couples therapy

If a man is in a long-term relationship, he may benefit from having couples therapy. The purpose of couples therapy is two-fold. Firstly, couples are encouraged to explore any issues that may be affecting their relationship, and are given advice about how to resolve them.

Secondly, couples are shown techniques that can help the man to 'unlearn' the habit of premature ejaculation. The two most popular techniques are the 'squeeze technique' and the 'stop-go technique'.

In the squeeze technique, the woman begins masturbating the man. When the man feels that he is almost at the point of ejaculation, he signals to the woman. The woman stops masturbating him, and squeezes the head of his penis for between 10 to 20 seconds. She then lets go and waits for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur.

The stop-go technique is similar to the squeeze technique except that the woman does not squeeze the penis. Once the man feels more confident about delaying ejaculation, the couple can begin to have sexual intercourse, stopping and starting as required.

The techniques described above may sound simple, but they do require a lot of practice.

Medication

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are primarily designed to treat depression, but they also have the useful side effect of delaying ejaculation. Although SSRIs are not licensed to treat premature ejaculation, they are increasingly being prescribed for this use.

SSRIs that are sometimes used for this purpose include:

  • paroxetine
  • sertraline
  • fluoxetine

Research suggests that SSRIs can increase the time before ejaculation more than ten-fold.

Some men with premature ejaculation may experience an improvement in their symptoms as soon as treatment begins. However, one may need to take the medication for one to two weeks before the full effects of the treatment are noted.

Common side effects of SSRIs include:

  • fatigue
  • drowsiness
  • yawning
  • nausea
  • vomiting
  • dry mouth
  • diarrhoea
  • excessive sweating

However, these side effects are usually mild and should improve after two to three weeks.

PDE-5 inhibitors

PDE-5 inhibitors are type of medication that are used to treat erectile dysfunction (impotence), and they are also used to treat some cases of premature ejaculation.

PDE-5 inhibitors increase the blood flow to the penis, improving the quality of the erection. This may be helpful if a man has a history of erectile dysfunction, and anxiety over his ability to maintain an erection is contributing to his symptoms.

Retarded ejaculation

As with premature ejaculation, the physical causes of delayed ejaculation can usually be treated. For example, if prescription medication is causing the problem, your GP may be able suggest alternatives.

There are also a number of alternative medications that can be used if it is thought that SSRIs are responsible for causing delayed ejaculation. These include:

  • amantadine  - a medication that was originally designed to treat viral infections
  • buproprion - a medication that was originally designed to help people stop smoking
  • yohimbine - a medication that was originally designed to treat erectile dysfunction

These medications help block some of the biological and chemical affects of SSRIs that are thought to contribute towards the symptoms of retarded ejaculation.

Sex therapy

Sex therapy uses a combination of psychotherapy and structured interventions (changes) in the sex life. This can help to increase a man's feeling of enjoyment during sex, and help make ejaculation easier.

During sex therapy, he will have the opportunity to discuss any emotional or psychological issues that are related to his sexuality and relationship, in a non-judgemental way.

Activities may also be recommended to try at home while having sex (a man should never be asked to take part in any sexual activities during a session with the therapist). These may include:

  • viewing erotic material prior to having sex, such as videos and magazines, in order to increase the feeling of sexual stimulation
  • erotic fantasies and 'sex games' in order to make lovemaking more exciting
  • using lubricating creams, or gels to make the physical act of sex more comfortable and relaxing
  • using sexual aids, such as vibrators, to increase pleasure

Retrograde ejaculation

Most men do not require treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not have any adverse effects on their health.

If treatment is required (usually due to the man wanting to father a child) medicines can be used to strengthen the muscles around the bladder neck. Pseudoephedrine (a medicine commonly used as a decongestant) has proved to be effective in achieving this.

However, if the retrograde ejaculation has been caused by significant muscle or nerve damage, treatment may not be possible. Men who want to have children can have sperm taken from their urine for use in artificial insemination or in-vitro fertilisation (IVF).

Glossary

Local anaesthetic
A local anaesthetic is a drug that is injected by needle or applied as a cream, which causes a loss of feeling in a specific area of the body.

Useful Links

Buying medication on the internet

Many of the medications mentioned here are available from websites belonging to private firms on the internet, including medications, such as dapoxetine, that have not yet been licensed for use. However, using these types of websites to purchase medication is not recommended for two main reasons.

Firstly, medication such as SSRIs can have a wide range of potential side effects, ranging from seizures (fits), to having hallucinations (seeing and hearing things that do not really exist).

Therefore, it is important that one only take these types of medication under the supervision of a healthcare professional. Their guidance about whether the medication is suitable, the correct dosage, possible side effects, and any harmful interactions with other medications, is crucial.

Secondly, medications ordered on the internet from an unregistered website could also be out-of-date, diluted, or fake, making them dangerous to health.


 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z