John (it could also be Mark, or Peter, or Steven) has a problem; it is probably most men’s nightmare. On the surface, things have been great for him. He is lucky to work as a consultant and is also successful in his personal life. He constantly meets amazing sexual partners. You know how it is, a drink after work and some small talk. Everything is going unbelievably well. Conversation is flowing great. He eventually brings a lady home, and, after a while, they end up in the bedroom. After some sexy foreplay, she is visibly aroused and very turned on. John wants her and she wants him. But then, John’s fears creep in: What if he ejaculates too fast? Or has a delayed ejaculation? Or doesn’t ejaculate at all?
Does this experience sound familiar? Well, don’t you worry. Ejaculation issues are more common than you may think, and most importantly: they’re treatable! I’ll guide you through some primary causes, key symptoms and share ways to manage the issue, and what signs to be on the lookout for when dealing with this kind of distress. But first, let’s get back to the basics and start by understanding what exactly ejaculation is.
Ejaculation is the process by which sperm moves from epididymis via vas deferens to urethra and finally expelled out through the urethral meatus by the contraction of smooth muscles. A normal ante grade ejaculation consists of emission, expulsion (ejection) and orgasm.
PREMATURE EJACULATION
Premature ejaculation (PE) is also known as rapid ejaculation, premature climax, and early ejaculation.
It is a condition experienced by many men, and it is treatable. The most simple definition of PE is “when a man ejaculates sooner during sexual intercourse than he, or his partner, would like.” It is NOT related to waiting for his partner to reach orgasm. A more technical definition would be: “Ejaculation that nearly always occurs prior to or within, approximately, one minute of penetration, AND that causes distress to the individual in the form of frustration and/or the avoidance of sexual intimacy”. There is usually no specific time when a man should ejaculate during sex, but when one ejaculates and loses his erection very quickly, it may cause distress to one or both partners.
Causes
Premature ejaculation is a common sexual dysfunction affecting all age groups and is commonly associated with other medical conditions such as:
- Stress, depression, anxiety, guilt, relationship problems, and lack of confidence or poor body image, anxiety about sexual performance and negative feelings about the idea of sex.
- Psychological impulses like conditioning, upbringing, and traumatic sexual experience.
- Alcoholism, drug use.
- Unusual hormone levels, and infection in your prostate or urethra.
Symptoms
The main symptom of premature ejaculation is the inability to delay ejaculation for more than one minute after penetration.
Premature ejaculation is usually categorized as lifelong or acquired. Lifelong means you’ve had this issue always or almost always since your first sexual experience while acquired means you have had lasting ejaculations throughout your life but have recently developed premature ejaculation.
Management
There are several different treatment options for premature ejaculation, including behavioral techniques, topical anesthetics, and medication and counseling. A combination of medication therapy and behavioral therapy is likely to be the most effective treatment.
Behavioral techniques involve taking simple steps, such as masturbating an hour or two before intercourse, so that ejaculation can be delayed during sex.
Topical anesthetics, such as anesthetic creams and sprays, contain a numbing agent such as benzocaine or lidocaine and are sometimes used to treat premature ejaculation. These products are usually applied to the penis 10 to 15 minutes before sex to reduce sensation and help delay ejaculation.
DELAYED EJACULATION
Delayed ejaculation is the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation. It is sometimes referred to as impaired ejaculation and can also cause distress.
Causes
Delayed ejaculations are often caused by the following:
1. Physical causes
- Medication side effects like blood pressure medication, painkillers, anti-anxiety drugs, antidepressants, and other medications.
- Alcohol or the use of certain recreational drugs.
- Nerve damage strokes, spinal cord injury, surgery, and severe diabetes.
- Ageing can also decrease the sensitivity of the penis to sexual stimulation.
2. Psychological factors
- Depression, anxiety, or other mental health conditions (such as unexpressed anger)
- Unwillingness to enjoy pleasure
- Religious beliefs. That sexual activity is a sin for example
- Fear of semen or female genitalia or of somehow hurting or defiling a partner through ejaculation
- Fear of pregnancy
- Low confidence or performance anxiety issues
Symptoms
Delayed ejaculation occurs when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate. Some men can only ejaculate with manual or oral stimulation while some cannot ejaculate at all. There is no specific symptom that indicates a diagnosis of delayed ejaculation. Instead, one is probably experiencing delayed ejaculation if the delay is causing distress or frustration, or if one must stop sexual activity due to fatigue, physical irritation, loss of erection or a request from a partner.
Management
There are no drugs specifically approved for the treatment of delayed ejaculation. Medications used to treat delayed ejaculation are primarily used to treat other conditions. Psychological counseling can help by addressing any underlying mental problems causing delayed ejaculations such as depression or anxiety. One may benefit most by seeing a sex therapist or a mental health counselor who specializes in talk therapy for sexual problems.
RETROGRADE EJACULATION
Retrograde ejaculation is a symptom not a diagnosis. This disorder occurs when semen enters the bladder instead of emerging through the penis during orgasm. Although you still reach sexual climax, you might ejaculate very little or no semen which is sometimes called a dry orgasm. This disorder is usually not harmful but can cause infertility. Men with this condition ejaculate small quantities of semen and might not even notice they have the condition.
Causes
Retrograde ejaculation is caused by a physical problem. It can be caused by anything that affects the reflex of the muscle at the opening of the bladder. Typical causes include:
- Medications
It’s a potential side effect of some medications including those prescribed to treat enlarged prostate, high blood pressure, prostate removal, bladder removal, problems with semen production, nerve damage.
- Surgery
The most common causes of retrograde ejaculation are prostate, colon, rectum, and testicular surgeries.
- Damage to the nervous system
Injuries and illnesses that damage the nervous system, such as multiple sclerosis and spinal cord injuries can damage the nerve and muscles of the bladder. Also: diabetes, blood sugar that remains uncontrolled for a long time, can damage the organs and nerves, affecting the muscles of the bladder.
Symptoms
Retrograde disorder doesn’t affect your ability to get an erection or have an orgasm. But when you climax semen goes to the bladder instead of coming out of the penis. Some symptoms include:
- Urine that is very cloudy after an orgasm because it contains semen
- Infertility, or inability to conceive with a female partner.
- Orgasm in which you ejaculate very little or no semen out of your penis (dry orgasms)
Management
Retrograde ejaculation doesn’t really require treatment unless it interferes with fertility.
Medical management aims at increasing the tone of the bladder neck and preventing retrograde flow of semen into the bladder.
Surgical interventions in the management of retrograde ejaculation aims at restoring integrity of the bladder neck.
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About the author: Martin Mūthare is a licensed clinical officer and a public health practitioner.
Special thanks to our Medical Advisor, Kimberly T. Remski, M.D. for reviewing this article.
References:
- Rosen RC, Khera M. Evaluation of male sexual dysfunction. Up To Date. https://www.uptodate.com/contents/epidemiology-and-etiologies-of-male-sexual-dysfunction. Accessed on June 17, 2022.
- Premature ejaculation, https://www.mayoclinic.org/diseases-conditions/premature-ejaculation/symptoms-causes/syc-20354900#:~:text=Premature%20ejaculation%20occurs%20when%20a,this%20problem%20at%20some%20time.