Ejaculation problems – how to tackle them

Ejaculation problems are very common in men, but can usually be treated. Find out what can cause them, and the ways you can get your sex life back.

What are the symptoms?

What are the causes?

How are ejaculation problems diagnosed?

What are the treatments?

Where to get support

The 3 most common ejaculation problems are premature ejaculation, delayed ejaculation, and retrograde ejaculation. If you're experiencing 1 of these issues, try not to be embarrassed – there are some simple and effective treatments. 

Ejaculation problems can affect men of all ages. These issues can lead to feelings of shame, embarrassment, and anxiety. But they’re very common, so if you’re affected, you’re not alone. 

The main types of problems with ejaculation (after sexual arousal when semen leaves the penis) include:

__Premature ejaculation__
Also known as rapid or early ejaculation, it means you ejaculate sooner than you or your partner would like during sexual activity. 

It's normal to experience the occasional episode of premature ejaculation, but it can cause issues in your relationship if it happens more than you and or/your partner are comfortable with.

__Delayed ejaculation__
It takes a long time, and a lot of sexual stimulation for you to ejaculate. Or you may not ejaculate at all, even if you want to, and are having normal erections. 

Again, the occasional episode of delayed ejaculation is normal, but it can become a problem if it keeps happening. Delayed ejaculation is thought to affect 5-10% of men. 

__Retrograde ejaculation__
Also known as 'dry orgasm', this is a less common ejaculation problem. You still experience the feeling of an orgasm, but semen travels back up the urethra into the bladder instead of out through your penis. This can mean it’s more difficult for you to father a child. 

Whatever your ejaculation problem, it’s important to see a healthcare professional. If it’s happening often, it may cause a lot of anxiety, and put pressure on your relationship.



## What are the symptoms?

__Premature ejaculation: __
- you tend to ejaculate sooner than you or your partner wants. This could be ejaculating in foreplay or having intercourse for not enough time to satisfy you or your partner
- you experience it about half the time you try to have sex
- you may feel distressed and frustrated, and tend to avoid sexual intimacy because of this problem.

__Delayed ejaculation:__
- you cannot ejaculate more than half the times you have sex 
- delayed ejaculation is affecting your libido, and you may lose interest in sex 
- you or your partner may feel unattractive, inadequate, and frustrated. 

Some people only experience delayed ejaculation with a partner, others only when they masturbate. And some may experience it during any type of sexual activity.

__Retrograde ejaculation__
- you have cloudy urine after having sex, because it contains semen
- you produce very little or no semen during orgasm
- you and your partner may have fertility issues 
- you may have other sexual problems, like erectile dysfunction or [delayed ejaculation.](https://www.livehealthily.com/health-library/conditions/erectile-dysfunction)


Get help with this

## What are the causes?

### Psychological causes of premature ejaculation 
These may include:
- [stress](https://www.livehealthily.com/mind/effects-of-stress-on-body)
- [depression](https://www.livehealthily.com/health-library/conditions/depression)
- [anxiety](https://www.livehealthily.com/health-library/conditions/anxiety) – this could be about sexual performance, or feeling pressure to please your partner, for example
- relationship problems
- traumatic early sexual experiences, such as sexual abuse 
- guilt, due to a strict upbringing or cultural beliefs about sex
- behavior you learned when you were young — for example, as a teenager you may have learned to masturbate quickly to avoid being caught. 

### Physical causes of premature ejaculation 
These may include:
- prostate problems
- [erectile dysfunction](https://www.livehealthily.com/health-library/conditions/erectile-dysfunction) – around 1 in 3 people with premature ejaculation also have erectile dysfunction (ED) 
- [thyroid problems](https://www.livehealthily.com/self-care/thyroid-disease) – either an over- or underactive thyroid gland
- problems with the hormones that play a role in sexual function 
- low levels of brain chemicals, including serotonin or dopamine
- an extra-sensitive penis
- a genetic condition that can affect the signals between nerves
- using alcohol or recreational drugs can make the symptoms of premature ejaculation worse.

### Psychological causes of delayed ejaculation 
These include:
- stress or depression
- relationship problems
- traumatic early sexual experience
- feeling guilty, due to a strict upbringing or religious background 
- anxiety – this might be related to pleasing your partner, the pressure of infertility treatment, fears of hurting your partner or getting them pregnant.

### Physical causes of delayed ejaculation 
These may include: 
- prostate surgery
- trauma or injury – even riding a bike with a narrow saddle can cause nerve damage 
- health conditions that affect the nervous system, like [diabetes](https://www.livehealthily.com/health-library/conditions/diabetes) or [multiple sclerosis](https://www.livehealthily.com/health-library/conditions/multiple-sclerosis)
- low testosterone or thyroid hormone levels
- injuries to the spinal cord 
- alcohol or taking recreational drugs
- problems with your reproductive system 
- aging – ejaculation naturally [takes longer as you get older](https://www.livehealthily.com/sexual-health/sex-as-you-get-older).

### Causes of retrograde ejaculation
In retrograde ejaculation, the muscle around the neck of the bladder (the sphincter) doesn’t close properly. So the sphincter stays open rather than closing tightly when you orgasm, and semen goes into the bladder instead of up and out of the urethra. 

Issues that can affect the sphincter include:
- prostate or bladder surgery
- nerve damage from a health condition like diabetes, multiple sclerosis or stroke
- radiation therapy to treat prostate or testicular cancer
- taking certain medications for high blood pressure, an enlarged prostate or depression.


## How are ejaculation problems diagnosed?
Many men avoid discussing ejaculation problems with their doctor — fewer than 1 in 4 men get medical help for premature ejaculation, for example. But there’s no need to feel uncomfortable or embarrassed.

Your healthcare professional will start by asking questions about your symptoms and medical history. They may carry out a physical examination, and blood and urine tests to check for underlying conditions. 

To diagnose retrograde ejaculation, your doctor may ask you to provide a sample of semen, to check the volume, and a sample of urine, taken soon after orgasm, to look for the presence of semen. 


## What are the treatments?
### Premature ejaculation
Premature ejaculation is usually treated with a combination of psychological, behavioral, and medical support, and there are tips you can try at home, too:

- your doctor may prescribe medicines, such as certain types of antidepressants and painkillers known to delay ejaculation. If worry about keeping your erection makes you rush to ejaculate, they may prescribe medicines for erectile dysfunction (ED) 
- a psychosexual (psychological and sexual) therapist can help you work out any underlying sexual or relationship issues.They may also teach you different techniques to help ‘unlearn’ the habit of premature ejaculation
- self-help treatments include masturbating 1-2 hours before having sex, wearing a thicker or ‘climax control’ condom to reduce sensitivity, and [pelvic floor exercises](https://www.livehealthily.com/self-care/do-premature-ejaculation-exercises-work) – these can help train the muscles you need to delay ejaculation.

### Delayed ejaculation
Finding the best treatment for delayed ejaculation will depend on the cause. It may include:
- medicines normally prescribed to treat other conditions, such as antihistamines, medications for viral infections, or smoking cessation
- a review of other medicines you may take for different conditions – some can cause ejaculation problems, such as certain antidepressants
- sessions with a [psychosexual therapist](https://www.livehealthily.com/sexual-health/what-does-a-sex-therapist-do). You and your partner will be supported to talk about any issues in your relationship and to try different techniques during sex, such as using vibrators for extra stimulation.

### Retrograde ejaculation
Retrograde ejaculation isn’t harmful or painful, and you can still enjoy a healthy sex life – if you don’t want children, your doctor might suggest you don’t need any treatment. But if you do, there are a number of different treatments available, including:

- medications to help the sphincter close properly
- self-help techniques for retrograde ejaculation, like ejaculating when you have a full bladder, or training your pelvic floor muscles
- [fertility treatment](https://www.livehealthily.com/health-library/treatments/infertility-treatment), if you want to start a family. This includes taking sperm from your urine (pee), to use for artificial insemination or IVF.


## Where to get support
Experts agree that involving your partner in treatment for ejaculation problems is key to fixing them. If you need help to start having those conversations, working with a relationship counselor or sex therapist can give you both the support you need. 

Find one near you:
- [American Psychological Association](https://locator.apa.org/) 
- [College of Sexual and Relationship Therapists](https://www.cosrt.org.uk/therapists-nearest-me-search-results/)
- [National Register of Health Service Psychologists](https://www.findapsychologist.org/)
- [Relate](https://www.relate.org.uk/what-we-do/counselling/sex-therapy) 


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References

Roz Ryan

Charlotte Haigh

Dr Tamer T Malak

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