The man can be prone to different types of sexual dysfunctions. Among them, ejaculation disorders. There are different types of premature ejaculation problem and each of them has different causes, consequences and solutions. Here we will try to understand the difference between each ejaculation disorder and how to diagnose them. Thereafter, we will offer you a non-exhaustive list of the various existing treatments.
1 What is an ejaculation problem?
2 The different ejaculation problems
3 How is an ejaculation disorder diagnosed?
4 Potential Ejaculation Disorder Treatments and Solutions
What is an ejaculation problem?
In general, it is possible to define a normal ejaculation as (source):
– An expulsion of 1.5 to 4.5 ml of semen from the penis. – An orgasm concomitant to the process of expulsion of sperm. – A delay of an average of 5 minutes between the start of sexual intercourse and ejaculation.
Thus, it can be defined as ejaculation disorder, ejaculatory phenomenon or at least one of these 3 characteristics is found to be out of the norm. Of course, it is important to consult a health professional in the slightest doubt.
Indeed, he will be able to diagnose you or not an ejaculation disorder but also define with certainty the nature of your problem and offer you an adequate treatment.
The different ejaculation problems
There are several types of ejaculation disorders, here is a quick overview of the most common disorders concerning an ejaculation problem.
Premature ejaculation: the most common ejaculation problem
Premature ejaculation is characterized by a delay between erection and ejaculation which is less than one minute (source). It is possible to distinguish two types of premature ejaculation, namely (source):
– Primary: the disorder is present in every relationship, with different partners and throughout life. – Secondary: also called acquired premature ejaculation, this appears spontaneously during an individual's sexual life. It can be punctual or chronic and is often associated with an underlying disease such as prostatitis, a neurological or psychological disorder.
The causes of this ejaculation problem can be (source):
– Biological: hypersensitivity of the glans, hyperexcitability of the ejaculation reflex, etc. – Pathological: neurological disorder such as multiple sclerosis, prostatitis, hyperthyroidism, etc. – Psychological: depression, anxiety, hormonal disorder (such as a lack of serotonin), etc.
Anejaculation: the complete absence of ejaculation
Anejaculation is an ejaculation disorder characterized by a total absence of ejaculation during sexual intercourse. It is possible to differentiate between three types of ejaculations (source).
– Aspermia or dry orgasm: orgasm is present but no sperm is ejected during intercourse. – Retrograde ejaculation: orgasm is present, no sperm is ejected or in reduced quantity but sperm can be found in the urine after intercourse. – Anejaculation without orgasm: no sperm is ejected and orgasm is not present despite a normal erection.
The reasons for these disorders can be varied and are among others (source):
– Congenital abnormalities : cysts, abnormality of the ejaculatory ducts, epididymo-deferential agenesis, etc. – Post-traumatic causes: vascular surgery, lymph node dissection, colorectal surgery, etc. – Infections: genital infection, urethritis, genital tuberculosis etc. – Neurological problems: myelopathies and neuropathies. – Endocrine causes: hypoandrism, hyperprolactinemia, etc. – Iatrogenic origins: drug treatments such as serotoninergic antidepressants, benzodiazepines, MAOIs, etc. – Psychological causes: problems with self-confidence, unusual masturbation technique, interpersonal problems, stress, etc.
In some cases, sperm is present during the expulsion phase but in a smaller quantity (less than 1.5 ml) this can then lead to drooling ejaculation.
Anorgasmia: an ejaculation without an orgasm
Anorgasmia is an anomaly that can be associated with an ejaculation disorder. Indeed, in this case, the sperm is expelled following sexual intercourse but the orgasm is absent. This disorder is above all psychological and reported in the DSM 3 (Diagnostic and Statistical Manual of Mental Disorders) (source).
Delayed ejaculation or delayed ejaculation
In the case of delayed ejaculation is characterized by difficulty in achieving ejaculation despite:
An erection without anomaly A completely normal sexual arousal phase.
There are two types of delayed ejaculation which are:
– Primary: exists since the beginning of sexual life. – Secondary: occurs punctually or chronically during sexual life.
Thus, the causes of this ejaculation problem are varied and of several different natures. Among others you will find (source):
– Drug treatments: antidepressants, antipsychotics or antihypertensives. – Psychological causes: post-traumatic stress, very rigid personality, maternal representation, difficulty in expressing one's emotions, exaggerated preoccupation with doing well, etc. – Physiological reasons: sensitivity of the glans, threshold of the ejaculatory reflex, refractory period between two relationships that are not long enough, etc. These factors can change over time and may explain the appearance of delayed ejaculation with age. – Neurological disorders: multiple sclerosis, diabetic neuropathy, bone marrow damage, etc.
painful ejaculation
Pelvic-perineal pain may occur after triggering ejaculation or orgasm in men. Its prevalence remains around 1 to 4% of the general population and the pain generally lasts less than 5 minutes.
Nevertheless, this type of ejaculation problem remains too unstudied and there is still no scientific consensus to define, diagnose and treat painful ejaculation (source).
How is an ejaculation disorder diagnosed?
If you notice an abnormality during your ejaculation such as a low quantity of sperm, an absence of this liquid, a problem with orgasm or even premature or delayed ejaculation, it is advisable to consult your doctor..
This will begin by carrying out a questionnaire to determine whether or not you are subject to an ejaculation disorder. If this is the case, he will be able to carry out an in-depth questionnaire in order to determine the type of problem with ejaculation you are suffering from and its potential cause.
If your doctor judges that his knowledge is not sufficient to help you, he can refer you to a specialist such as a urologist for physiological causes or a psychologist or a sexologist for causes of psychological origin.
Among the potential diagnostic tests, you could undergo:
– A summary of your clinical history: this step is essential to define the physiological cause or not of your ejaculation disorder. During this phase, particular attention will be paid to the primary or secondary nature of the problem, but also to the existence of risk factors or genetic predisposition to this type of disorder. – A complete clinical examination: this step includes a classic perineal examination but may also include a digital rectal examination and a neurological examination to determine the physiological origin of the illness. – A biological assessment: this examination includes the evaluation of the fasting glycemic level, a spermogram to check the integrity of the spermatozoa, a search for spermatozoa in the urine and a dosage of total and bioavailable testosterone at the start of the day. This last test will be repeated several days apart to check your body's hormonal balance. – A morphological assessment: this step may include an ultrasound or, in rarer cases, a pelvic MRI. – A psychological evaluation: in order to rule out or not the relationship with a psychological disorder. In general, this examination is carried out when the physiological causes are excluded from the diagnosis.
Potential Treatments and Solutions for an Ejaculation Disorder
It is difficult to list all possible treatments for each type of ejaculation disorder. Indeed, there are almost as many possible solutions as there are causes.
In general, if the cause of a problem with ejaculation is due to drug treatment, the doctor will seek, where possible, to modify your treatment. If your problem is of psychological origin, therapy with a sex therapist is often the most recommended.
Finally, if the ejaculation disorder is of physiological origin, the treatments vary enormously depending on the exact cause and the type of ejaculation problem. Thus, drug treatment or surgery may be prescribed.
To conclude, ejaculation problems are many and varied. It can be interesting to know how to differentiate each disorder in order to be able to help your general practitioner during his diagnosis.
Nevertheless, if you notice a recurring ejaculation disorder (happening during several sexual intercourses in a row), it is strongly recommended to consult a health professional. Indeed, the latter will be able to offer you a diagnosis and an appropriate solution.