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This Week - E : Ejaculation Problems

Ejaculation problems are common sexual problems in men.

The 3 main types of ejaculation problems are:

• premature ejaculation
• delayed ejaculation
• retrograde ejaculation

If you have a persistent problem with ejaculation, visit your GP, who will discuss the problem with you and may examine you or refer you to a specialist.

Premature ejaculation

Premature ejaculation is a common ejaculation problem. It's where the male ejaculates sooner than he or his partner wishes during sexual arousal.

Occasional episodes of premature ejaculation are common and are not a cause for concern. However, if you're finding that it happens more than you'd like, and it's a problem for you, it might help to get treatment.

Causes of premature ejaculation

Various psychological and physical factors can cause a man to suddenly experience premature ejaculation.

Common physical causes include:

• prostate problems
• thyroid problems - an overactive thyroid or an underactive thyroid
• using recreational drugs

Common psychological causes may include:

• depression
• stress
• relationship problems
• anxiety about sexual performance (particularly at the start of a new relationship, or when a man has had previous problems with sexual performance)

It's possible for a man to have experienced premature ejaculation since becoming sexually active. A number of possible causes for this are:

• conditioning - it's possible that early sexual experiences can influence future sexual behaviour. For example, if a teenager conditions himself to ejaculate quickly to avoid being caught masturbating, it may later be difficult to break the habit
• a previous traumatic sexual experience - this can range from being caught masturbating to sexual abuse
• a strict upbringing and beliefs about sex

Treating premature ejaculation

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant, but they also delay ejaculation. SSRIs used for this purpose include:

• paroxetine
• sertraline
• fluoxetine (Prozac)

Another type of antidepressant called clomipramine is also sometimes used.

Some men may experience an improvement a few days after treatment begins. However, you'll usually need to take the medicine for 1 to 2 weeks before you notice the full effects.

Side effects of SSRIs are usually mild and should improve after 2 to 3 weeks. They include:

• feeling sick and being sick
• diarrhoea
• excessive sweating (hyperhidrosis)

Read more about the side effects of SSRIs.

Dapoxetine (Priligy)

An SSRI specifically designed to treat premature ejaculation, known as dapoxetine (Priligy), has been licensed in the UK. Local NHS authorities can choose to prescribe it on the NHS.

It acts much faster than the other SSRIs used for premature ejaculation and can be used "on demand". You'll -->"on demand". You'll usually be advised to take it between 1 and 3 hours before sex, but not more than once a day.

Your response to the treatment will then be reviewed after 4 weeks (or after 6 doses), and again every 6 months.

Dapoxetine is not suitable for all men diagnosed with premature ejaculation. For example, it is not recommended for some men with heart, kidney and liver problems. It can also interact with other medicines, such as other antidepressants.

Common side effects include:

• headaches
• dizziness
• feeling sick

Phosphodiesterase-5 inhibitors

Phosphodiesterase-5 inhibitors, such as sildenafil (sold as Viagra), are a class of medicine used to treat erectile dysfunction. Research has found that they may also help with premature ejaculation.

You can get sildenafil on prescription, or buy it from a pharmacy after a discussion with the pharmacist to make sure it's safe for you to take.

Read more about sildenafil including information on how and when to take it.

Topical anaesthetics and condoms

The use of topical anaesthetics such as lidocaine or prilocaine can help but may be transferred and absorbed into the anus of your partner, causing him decreased sensation. Condoms can also be used and are effective, particularly when combined with local anaesthesia.

Things you can try yourself

There are also a number of things you can try yourself. It can sometimes help to:

• masturbate an hour or 2 before having sex
• use a thick condom to help decrease sensation
• have sex with your partner on top (to allow them to pull away when you are close to ejaculating)

Psychosexual counselling

You may benefit from having psychosexual counselling, where a therapist can help you, and a partner if you have one, with sex related problems. During these sessions, the therapist will:

• encourage you to explore any relationship issues you may have, and give advice about how to resolve them
• show you techniques that can help you "unlearn" the habit of premature ejaculation (these include the "squeeze" and "stop-go" techniques)

In the squeeze technique, you masturbate but stop before the point of ejaculation and squeeze the head of your penis for between 10 to 20 seconds. Then let go and wait for another 30 seconds before resuming masturbation. This process is carried out several times before ejaculation is allowed to occur.

The stop-go technique is similar, but you do not squeeze your penis. Once you feel more confident about delaying ejaculation, you could try this technique during sex, stopping and starting as required.

These techniques may sound simple, but they require lots of practice.

Delayed ejaculation

Delayed ejaculation (male orgasmic disorder) is classed as either:

• experiencing a significant delay before ejaculation
• being unable to ejaculate at all, even though the man wants to and his erection is normal

You may have delayed ejaculation if you're unable to ejaculate more than half the times you have sex.

Causes of delayed ejaculation

Like premature ejaculation, delayed ejaculation can be caused by psychological and physical factors.

Possible psychological causes of delayed ejaculation are similar to those of premature ejaculation - for example, relationship problems, stress or depression.

Physical causes of delayed ejaculation include:

• diabetes
• spinal cord injuries
• multiple sclerosis
• surgery to the bladder or prostate gland
• increasing age

Many medicines are known to cause delayed ejaculation, including:

• antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
• medicines to treat high blood pressure, such as beta-blockers
• antipsychotics, used to treat episodes of psychosis

Delayed ejaculation can suddenly start to happen after previously having no problems, or (less commonly) the man may have always experienced it.

Treating delayed ejaculation

Sex therapy

Sex therapy is a form of counselling that uses a combination of psychotherapy and structured changes in your sex life. This can help to increase your feeling of enjoyment during sex and help make ejaculation easier.

Some integrated care boards (ICBs) provide a sex therapy service on the NHS. Availability can vary widely depending on where you live.

You can also pay privately. The College of Sexual and Relationship Therapists website provides information about private sex therapists and how to find a therapist in your local area.

The relationship counselling service Relate also offers sex therapy at a number of its centres. You'll need to pay for each session.

During sex therapy, you'll have the opportunity to discuss any emotional or psychological issues related to your sexuality and relationship, in a non-judgemental way.

Activities may also be recommended for you to try at home while you're having sex with your partner (you should never be asked to take part in any sexual activities during a session with the therapist).

These may include:

• erotic fantasies and "sex games" to make your lovemaking more exciting
• using sexual aids, such as vibrators, to increase pleasure

Read more information about what a sex therapist can do.

Switching medicine

There are a number of medicines that can be used if it's thought SSRIs are responsible for causing delayed ejaculation. These include:

• amantadine - originally designed to treat viral infections
• bupropion - usually prescribed to help people quit smoking
• yohimbine - originally designed to treat erectile dysfunction

These help block some of the chemical effects of SSRIs that may contribute towards delayed ejaculation.

Alcohol and drugs

Alcohol misuse and recreational drug use can be separate underlying causes of delayed ejaculation, so addressing these problems may help.

Read more about getting help with alcohol misuse and drug use.

Pseudoephedrine

Pseudoephedrine tablets may be tried, but these will need to be prescribed "off-label". This means the medicine shows promise in treating delayed ejaculation but it has not been licensed for this particular use (pseudoephedrine is normally used as a decongestant).

Retrograde ejaculation

Retrograde ejaculation is a rarer type of ejaculation problem. It happens when semen travels backwards into the bladder instead of through the urethra (the tube that urine passes through).

The main symptoms of retrograde ejaculation include:

• producing no semen, or only a small amount, during ejaculation
• producing cloudy urine (because of the semen in it) when you first go to the toilet after having sex

Men with retrograde ejaculation still experience the feeling of an orgasm and the condition does not pose a danger to health.

Causes of retrograde ejaculation

Retrograde ejaculation happens when the neck of the bladder does not close and semen passes into the bladder.

Usually when you ejaculate, semen is pushed out of your urethra. It is prevented from entering your bladder by the muscles around the neck of the bladder, which close tightly at the moment of orgasm.

However, damage to the surrounding muscles or nerves can stop the bladder neck closing, causing the semen to move into the bladder rather than up through the urethra.

Causes of retrograde ejaculation include prostate gland surgery, bladder surgery, diabetes, multiple sclerosis, and a class of medicines known as alpha blockers, which are often used to treat high blood pressure (hypertension).

Treating retrograde ejaculation

Most men do not need treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not have adverse effects on their health, but if treatment is required there are options to try.

For example, pseudoephedrine (commonly used as a decongestant) has proved effective in treating retrograde ejaculation caused by diabetes or surgery.

If retrograde ejaculation is caused by using a certain medicine, then normal ejaculation will usually return once medicine is stopped. Speak to your GP before stopping any prescribed medicine.

However, if the retrograde ejaculation has been caused by significant muscle or nerve damage, treatment may not be possible.

Involve your partner

If you're having problems with your sex life and are seeking treatment, it is usually recommended you involve your partner as much as possible.

Communicating your concerns can often go a long way to helping to resolve them. And, in some cases, your partner may also have their own problems that are contributing towards problems with your sex life.

Blood in your semen

Finding blood in your semen can be alarming. However, in most cases it's not serious and will pass within a few days.

It can be caused by an infection of your urethra (urethritis) or prostate (prostatitis).

See your GP if you have blood in your semen. They can check if you need further tests or treatment.

Read more about blood in the semen.

If you want to find out more about this week's subject you can visit the Original article on the NHS website. If you are worried by any aspect of your health make sure you go and see your doctor or book an appointment at your local clinic.