Common Ejaculation Problems
Many men suffer from problems with ejaculation — premature ejaculation is one of the most common sexual problems. Other ejaculation problems include:
These conditions can cause sexual dissatisfaction and relationship stress for many men. At University of Utah Health, we will provide you with quality care and support every step of the way until your sexual health is at its best. If you think that you have one of these conditions and would like an evaluation, you can call to schedule an appointment with one of our expert urologists.
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What Is Premature Ejaculation?
The definition of premature ejaculation is when a man ejaculates sooner during intercourse than he wants to, which can be bothersome to him. Some men have trouble controlling their orgasm from the moment they start having intercourse, while other men consider five to 10 minutes of penetration before they orgasm too little time.
However, we do not base our diagnosis for premature ejaculation on how long a man can last. The important factor we keep in mind is whether a man and his partner are satisfied with how long intercourse lasts.
Premature Ejaculation Causes
The exact cause of premature ejaculation is not known yet. However, premature ejaculation can be:
- psychological in nature,
- impacted by varying levels of penile sensitivity, or
- even hormone levels.
Some other potential influences on the speed of a man’s orgasm include:
- Early sexual experiences – Some men have had early sexual experiences that required sex to finish quickly. Though most men learn how to control their orgasms, these habits may persist and result in rapid ejaculation.
- Performance anxiety – Some men put pressure on themselves to adequately perform in the bedroom. This can develop into long-term anxiety regarding sex, which can result in persistent premature ejaculation.
- Missing internal cues – Men who cannot identify the point when their ejaculation cannot be stopped. Men who can last a long time before orgasming can typically identify this point and take corrective action before it has been reached.
- Low sexual arousal or desire – A man can have a good erection without a strong sexual desire and even without being fully aroused. In these cases, a man may need to be more turned on, which will allow him to have more control over his ejaculation.
Premature Ejaculation Treatment
There are a number of psychological, behavioral, and physical therapies that can be used to slow ejaculation. One way is to learn how to identify and control the sensations leading up to an orgasm. The treatments we suggest include:
- Masters and Johnson method,
- Squeeze technique
- Anesthetic topicals,
- Medications, and
- Condoms.
The Masters and Johnson Method
The Masters and Johnson method will help you learn how to identify and regain control over your point of climax. We recommend that you practice this technique by yourself or with a caring partner. As you start this technique, be patient and try not to put too much pressure on yourself. Establishing control over your sexual functioning can take time.
Follow the steps below to learn how the Masters and Johnson technique works:
- Start by engaging in other types of stimulation (like masturbation or oral sex) instead of penetration.
- As you start stimulating your penis, gradually allow yourself to reach the point just before ejaculation.
- When you reach this point, have you or your partner stop.
- Allow yourself to partially lose your erection and relax before starting again.
- Bring yourself closer and closer to orgasm each time until you cannot hold it back any longer.
- Once you are ready to try intercourse, lie on your back and direct your partner to slowly allow you to penetrate.
- As soon as you feel that you are about to climax, tell your partner to stop stimulating you.
- Relax for a couple minutes then start the same process all over again.
The Squeeze Technique
This is a variation of the Masters and Johnson technique. You or your partner will squeeze the tip or base of your penis to stop your orgasm just before you reach the point of climax. The “squeeze” forces blood out of the penis and reduces the erection. This technique can be done alone or in conjunction with the Masters and Johnson method.
Men can also learn how to increase their level of control through other techniques such as:
- masturbation training,
- changing positions during sex, and in some men,
- ejaculation prior to sex to increase how long they last.
Anesthetic Topicals
Over-the-counter gels, creams, and sprays are available to decrease penile sensation and help men last longer. However, many men experience less pleasurable intercourse because these topical treatments decrease penile stimulation. The topicals can also be transferred to a partner during sex, which results in a decreased sensation for her or him.
Medications
Certain medications can be used to delay ejaculation or slow down orgasms such as:
- Antidepressants like selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs),
- Tramadol, a weak narcotic painkiller, or
- Viagra or Cialis (for men diagnosed with both erectile dysfunction and premature ejaculation).
Condoms
Condoms can reduce penile stimulation during sex. If one condom does not work then additional condoms can be used together with desensitizing gels, creams, or sprays. Some condoms even come pre-treated with desensitization.
Treatments to Avoid
There are a number of treatment options men may come across when researching treatments for premature ejaculation on the internet. However, there is little evidence that show they work. These treatments include:
- Hormone therapies,
- Botox injections,
- Penile nerve ablation,
- Acupuncture,
- Herbal medicines, and
- Other drugs such as pseudoephedrine (Sudafed), etc.
Retrograde Ejaculation
In this case, ejaculation occurs, but the ejaculate goes backward (retrograde) into the bladder instead of coming out of the end of the penis. The ejaculate typically comes out later in the urine. The hallmark sign of this condition is when very little or no fluid comes out of the penis during ejaculation.
A urinalysis can help diagnose retrograde ejaculation. We will have you urinate into a cup soon after ejaculation. If retrograde ejaculation is the issue, a large amount of sperm will be seen in the urine.
Retrograde Ejaculation Causes
It is uncommon but it occurs when the opening of the bladder does not close. Some common causes are:
- Diabetes,
- Spinal cord injuries,
- Medications for high blood pressure or mood-altering drugs, and
- Medications or surgery to treat prostate or urethra problems.
Retrograde Ejaculation Treatment
If certain medications are causing retrograde ejaculation, your sexual function should go back to normal once you stop taking these types of medicine. However, it can be difficult to treat retrograde ejaculation, if it is caused by surgery or diabetes, but there are medications that may be successful like pseudoephedrine (Sudafed) or imipramine (a tricyclic antidepressant).
There is typically no need to treat this type of ejaculatory disorder unless you are trying to conceive or do not like how it feels. For men who are trying to have a child, semen can often be removed from the bladder and used for assistive reproductive procedures such as in vitro fertilization.
Treating Premature or Delayed Ejaculation
Anejaculation & Delayed Ejaculation
Men who experience delayed ejaculation, also called anejaculation, typically take an abnormally long time to ejaculate (such as 30 to 45 minutes) or never ejaculate at all. There are many variations of this condition which include men who:
- neither have an orgasm or ejaculation,
- have an orgasm without ejaculation, or
- ejaculate without orgasm.
What Causes Delayed Ejaculation?
This may occur because of:
- Aging
- Hormonal abnormalities
- Psychological issues
- Blocked ducts that semen passes through
- Medications (especially SSRIs, which are often used for depression and other conditions)
- Diabetes
- Neurologic diseases
- Surgery
- Radical prostatectomy — prostate cancer surgery
- Retroperitoneal lymph node dissection — testicle cancer surgery
Delayed Ejaculation Treatment
The treatments that we use or recommend vary depending on the situation and cause. For men who have never ejaculated through any type of stimulation, consult with a urologist to be evaluated for any physical causes. Some helpful treatments include:
- sex/couples’ therapy,
- switching or stopping certain kinds of medications, or
- using devices like high-speed vibrators.
Side Effects of Not Ejaculating
If anejaculation is not treated properly, you may experience:
- avoiding sexual contact,
- inhibited sexual desire,
- stress within the relationship,
- sexual dissatisfaction, and
- difficulty conceiving and getting pregnant.
