Many men suffer from problems with ejaculation, and premature ejaculation is considered one of the most common sexual problems in the world.  Other ejaculation problems include retrograde ejaculation, anejaculation, and delayed ejaculation.

PREMATURE EJACULATION

There are several definitions of this, but a fairly standard one is ejaculation within 1-2 minutes of beginning intercourse which causes bother/distress to the man.  Men often have a predisposition to this that may be worse because of other health issues, anxiety, sexual habits, etc.  It is often associated with ED.  Treatments are varied but include a variety of medications, coupled with sex or couples therapy. [?link to Malan website, may need them to link to ours as well]

RETROGRADE EJACULATION

In this case, ejaculation occurs but, instead of coming out the end of the penis, the ejaculate goes backwards (“retrograde”) into the bladder and comes out later in the urine.  The man often notices very little or no fluid come out his penis during ejaculation.  This often occurs in the setting of medications (especially those used for enlarged prostate or BPH [link]), surgery (especially on the prostate for enlarged prostate or BPH [link]), or neurologic disease (spinal cord injury or diabetes).  This is difficult to treat, particularly if it is due to surgery, but there are medications that may be successful.

ANEJACULATION AND DELAYED EJACULATION

In these cases, ejaculation takes an abnormally long time or does not occur at all, even if the patient has the sensation of orgasm.  There are many variations of this, including men who neither have orgasm nor ejaculation, men who have orgasm without ejaculation, or even men who have ejaculation without orgasm.  Sometimes, it depends on the situation.  For example, a man may be able to ejaculate during masturbation but not during intercourse.

This may occur because of aging, psychological issues, medications (especially “SSRIs” which are often used for depression and other conditions), neurologic diseases (spinal cord injury, diabetes, multiple sclerosis), or surgery (radical prostatectomy for prostate surgery, retroperitoneal lymph node dissection for testicle cancer).  Treatments are varied depending on the situation and the cause.  Sometimes, stopping medications may resolve the problem.  Sex/couples therapy, devices such as high-speed vibrators, and certain medications may be helpful.