Ejaculatory dysfunction occurs when a man has a problem properly ejaculating his semen, either ejaculating too soon, too late, back into his own bladder or not at all. These situations can result in poor sexual satisfaction by the man and his partner, ineffective reproduction and emotional trauma.
Ejaculation disorders, also called aspermia, can be caused by a problem at birth primary or by acquired dysfunctions secondary after birth often much later in life , such as disease, injury and adverse drug reactions.
The four types of ejaculation dysfunction are premature ejaculation, delayed ejaculation, retrograde ejaculation and anejaculation. Normal ejaculation involves an emission step, when semen is positioned in the penis near the prostate, and an ejaculation step, when the semen is forcefully expulsed from the penis.
Ejaculation occurs at sexual climax, or the expulsion of the sperm. Climax is different from an orgasm, which is centered in the brain and associated with ejaculation. The mechanics of ejaculation are similar to a sneeze: both are reflexes with a point of no return. The average time from sexual penetration by the male to ejaculation is nine minutes.
Asking a patient about his personal history is generally the first step a physician takes in diagnosing and evaluating ejaculatory dysfunctions. This can reveal if the problem has always been present, which may indicate if it is due to a birth defect or to an acquired condition. Following are the four different types of ejaculation disorders, along with their causes, symptoms and treatments.
Premature ejaculation PE is when the man ejaculates within a minute of vaginal penetration or, more generally, when he ejaculates sooner than he or his partner would like.
PE occurs in about 30 percent of men and is the most common type of ejaculatory dysfunction. Most cases of PE are treatable. Causes of premature ejaculation are erectile dysfunction, anxiety, heightened sensitivity and neurological problems. Medications, physical therapy and psychotherapy are tools for treating PE.
Oral medications can delay ejaculation for many men. Urologists may prescribe one of several medications for men with PE. The choice depends on whether the PE is primary or secondary. Another medication is a topical lidocaine-prilocaine cream applied to the penis before intercourse to reduce sensitivity and delay ejaculation. Some cannot ejaculate at all.
A lifelong problem with DE is very different from a problem that develops later in life. Some men have a generalized problem in which DE occurs in all sexual situations. For other men, it only occurs with certain partners or in certain circumstances. In rare cases, DE is a sign of a worsening health problem such as heart disease or diabetes.
There are many potential causes of DE, including psychological concerns, chronic health conditions, and reactions to medications. Psychological causes of DE can occur due to a traumatic experience. Cultural or religious taboos can give sex a negative connotation. Anxiety and depression can both suppress sexual desire , which may result in DE as well.
Relationship stress, poor communication, and anger can make DE worse. Disappointment in sexual realities with a partner compared to sexual fantasies can also result in DE. Often, men with this problem can ejaculate during masturbation but not during stimulation with a partner. Certain chemicals can affect the nerves involved in ejaculation. This can affect ejaculation with and without a partner. These medications can all cause DE:. A temporary ejaculation problem can cause anxiety and depression.
This can lead to recurrence, even when the underlying physical cause has been resolved. A physical examination and explanation of your symptoms are necessary to make an initial diagnosis.
If a chronic health problem is suspected as the underlying cause, more testing may need to be done. This includes blood tests and urine tests. These tests will look for infections, hormonal imbalances, and more. Testing the reaction of your penis to a vibrator may reveal if the problem is psychological or physical.
Treatment will depend on the underlying cause. Your physician can determine if a medication is the cause. If so, adjustments will be made to your medication regimen and your symptoms will be monitored.
Some medications have been used to help DE, but none have been specifically approved for it. According to the Mayo Clinic , these medications include:. Treating illicit drug use and alcoholism , if applicable, can also help DE. Some men can ejaculate only when masturbating. These categories help in diagnosing an underlying cause and determining what might be the most effective treatment.
Your primary care doctor is a good place to start when you have delayed ejaculation. See your doctor if:. Delayed ejaculation can result from medications, certain chronic health conditions and surgeries. Or it might be caused by substance misuse or a mental health concern, such as depression, anxiety or stress.
In many cases, it is due to a combination of physical and psychological concerns. For some men, a minor physical problem that causes a delay in ejaculation might cause anxiety about ejaculating during a sexual encounter. The resulting anxiety might worsen delayed ejaculation.
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Overview Delayed ejaculation — sometimes called impaired ejaculation — is a condition in which it takes an extended period of sexual stimulation for men to reach sexual climax and release semen from the penis ejaculate. Request an Appointment at Mayo Clinic.
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