What Types of Ejaculation Problems are There?

The most common ejaculation problem, premature ejaculation, occurs when a man ejaculates “too quickly”. However, one man’s “too quickly” may be perfectly fine for another, and occasional premature ejaculation is very common and nothing to worry about. Premature ejaculation affects more than 40 per cent of men at one time or another, according to the Sexual Advice Association. It can affect men of any age, but it’s thought to be more common in younger men in their teens and 20s.

If it’s worrying you or your partner and you find that around half of your attempts to have intercourse are affected by premature ejaculation, you might benefit from treatment.

Delayed ejaculation doesn’t affect as many men as premature ejaculation, estimates suggest around 3 per cent of men suffer from the condition.

Delayed ejaculation is either:

• Taking a long time to get to the point of ejaculation
• Being unable to ejaculate at all, despite wanting to and having a normal erection.

Like premature ejaculation, whether the amount of time it takes to achieve ejaculation is “too long” depends mainly on the couple. There is no standard definition but most men consider 30 - 60 mins an unwanted delay to ejaculation.

Delayed ejaculation can be a temporary problem but for some men it is the norm. Some men can’t ejaculate at all, at least not with a partner. Possible causes for the problem include drugs and medication, medical conditions, and surgery. Treatment is possible, depending on the cause.

Retrograde ejaculation is the least common type of of ejaculation problem. It happens when sperm travels backwards into the bladder instead of out of the urethra (the same tube which urine passes through).

Symptoms include:

• Producing little or no semen
• Producing cloudy urine after having sex

Retrograde ejaculation can be caused by nerve damage, drugs, medication or certain types of surgery. It’s only a problem when trying to get pregnant and it doesn’t take diminish the sensation of orgasm.

There is help for men with ejaculation problems and your doctor will be able to advise you on what’s appropriate for you.

A doctor can check for possible physical causes of premature ejaculation and suggest techniques to slow things down. If there is no underlying medical problem, you may be referred to a sexual health specialist or sex therapist.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) can help men with premature ejaculation, in particular the short-acting SSRI dapoxetine (Priligy), taken one to three hours before sex.

Some men whose premature ejaculation is caused by oversensitivity use a desensitising cream like Emla to delay orgasm. Topical anaesthetic creams must be washed off before sex.

The treatment for delayed ejaculation will depend on the underlying cause. There are no drugs specifically approved just for treating delayed ejaculation, but the drugs your doctor might suggest include:

If the condition has been caused by alcohol or illegal drug abuse, you may benefit from counselling. Counselling may also be offered if the problem has its roots in psychological issues. Psychotherapy can help you with any depression or anxiety that might be affecting your sexual performance, and help you to explore any psychological issues that might be affecting your ability to ejaculate.

Retrograde ejaculation doesn’t always need to be treated as it’s considered to be harmless. Most men only seek treatment if their partners are trying to get pregnant.

If it’s caused by surgery such as bladder neck surgery, drug treatments won’t help.

If it’s likely that medication you’re taking could be causing the problem, your doctor may suggest coming off them for a while. There are some drugs used to treat mood disorders, high blood pressure or prostate conditions can cause problems with ejaculation.

As with delayed ejaculation, there are no drugs specifically designed to treat this condition, but some drugs for other conditions may help. These include:

• Imipramine (Tofranil)
• Chlorpheniramine and brompheniramine
• Ephedrine, pseudoephedrine and phenylephrine

These medications work by helping to keep the muscles in the neck of your bladder neck closed during ejaculation. They can be helpful but like all medications they can also cause side effects. It is important that you see a doctor to discuss treatment before taking any medication.

Alcohol, as well as other substances and medications can sometimes be the cause of delayed ejaculation. Other substances that are known to affect ejaculation include some types of:

• Antidepressants
• High blood pressure medications
• Diuretics
• Antipsychotic medications
• Anti-seizure medications

In some men, poor blood glucose control can lead to nerve damage, leading to retrograde ejaculation. Retrograde ejaculation caused by diabetes can sometimes be helped with drugs that strengthen the muscles in the bladder neck. If fertility is an issue, a urologist may be able to help you improve your fertility with techniques such as collecting your sperm from urine for artificial insemination.