Ejaculation problems

Ejaculation problems, such as premature ejaculation, are common sexual problems in men.

The three main problems are:

• premature ejaculation 
• delayed ejaculation 
• retrograde ejaculation 

These are described in more detail below.

Premature ejaculation

Premature ejaculation is the most common ejaculation problem. It is where the male ejaculates too quickly during sexual intercourse.

Many men are unsure about how long ‘normal’ sex should last before ejaculation. A study looking at 500 couples from five different countries found the average time between a man putting his penis into his partner’s vagina and ejaculation was around five-and-a-half minutes.

However, it's up to the individual and his partner to decide whether or not they're happy with the time it takes for him to ejaculate. There is no definition of how long intercourse should last.

Occasional episodes of premature ejaculation are common and not a cause for concern. However, if you're finding that around half of your attempts to have intercourse result in premature ejaculation, it might help to get treatment.

Most men with this problem won't have always had it – they'll have previously ejaculated normally. This may be referred to as 'secondary' premature ejaculation.

It's less common for the man to have always experienced premature ejaculation (since becoming sexually active) – this is known as 'primary' or lifelong premature ejaculation. It affects around one in 50 men in England. In most cases of lifelong premature ejaculation:

• there is an inability to delay ejaculation during sex every time or most times
• the condition causes feelings of shame or frustration and impacts on quality of life, causing the man to avoid sexual intimacy

Delayed ejaculation

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

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

There is no set definition to describe ‘how long is too long’, but a persistent (and unwanted) delay of ejaculation that lasts for 30 to 60 minutes may suggest delayed ejaculation.

Alternatively, if you are unable to achieve ejaculation at least half the times you have sex, you may have delayed ejaculation.

As with premature ejaculation, delayed ejaculation can be either acquired or lifelong. Lifelong delayed ejaculation is less common and affects an estimated one in 1,000 men.

Delayed ejaculation can occur in all sexual situations, or just in certain situations – for example, you may be able to ejaculate normally when masturbating, but not during sex. When delayed ejaculation only happens in certain situations, there's usually a psychological cause.

Retrograde ejaculation

Retrograde ejaculation is a rarer type of ejaculation problem. It happens when sperm travels backwards and enters the bladder instead of coming out of the end of the urethra (the tube through which urine passes).

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. However, it can affect the ability to father a child (read about infertility).

Treating ejaculation problems

Premature ejaculation can be treated with medication, such as the selective serotonin reuptake inhibitors (SSRIs) type of antidepressant, which can help delay ejaculating.

Couples therapy, a form of counselling, can be useful in coming up with techniques for partners to practice to help delay ejaculation.

Recommended treatments for delayed ejaculation depend on the underlying cause. If it is thought to be a side effect of medication, switching to an alternative medication will help. However, if the cause is thought to be psychological, counselling may be recommended.

Most men do not require treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not affect their health. In some cases, medication may be used to help restore normal ejaculation.

However, if you want to have children, you may need fertility treatment to extract a sample of sperm.  

What causes ejaculation problems?

Ejaculation problems are complex and can be caused by a number of things, including:

• stress
• relationship problems
• anxiety – such as a man being anxious that he will lose his erection (erectile dysfunction), causing him to ‘rush’ the intercourse
• previous traumatic sexual experiences
• depression
• some medical conditions or medicines – for example, diabetes can cause delayed ejaculation

Some researchers think certain men are more prone to premature ejaculation because of their biological make-up, such as having an unusually sensitive penis.

Retrograde ejaculation is caused by damage to nerves or muscles that surround the neck of the bladder (the point where the urethra connects to the bladder). This damage can often occur as a complication of prostate or bladder surgery.

Who is affected

Premature ejaculation is the most common type of ejaculation problem.

A number of surveys have found around one in three men reported being affected by premature ejaculation. The true figure is probably much higher as many men are reluctant to admit they have this problem.

While less common, delayed ejaculation is probably more of a problem then most people realise. One study found around one in 20 people had problems achieving an orgasm over the course of a month during the past year.

Although retrograde ejaculation is rare, it can be a common complication of some types of surgery, such as prostate surgery, or in men with certain health conditions that can damage the nerves, such as diabetes or multiple sclerosis.

Involve your partner

If you are 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.

For example some women are unable to reach climax during ‘normal’ intercourse and require manual or oral stimulation.