EJACULATORY PROBLEMS

DESCRIPTION

Ejaculatory dysfunction occurs when a man has a problem properly ejaculating his semen, either ejaculating too soon, too late, back into his own bladder or not at all. These situations can result in poor sexual satisfaction by the man and his partner, ineffective reproduction and emotional trauma.

Ejaculation disorders, also called aspermia, can be caused by a problem at birth (primary) or by acquired dysfunctions (secondary) after birth (often much later in life), such as disease, injury and adverse drug reactions. The four types of ejaculation dysfunction are premature ejaculation, delayed ejaculation, retrograde ejaculation and anejaculation.

DIAGNOSIS

Asking a patient about his personal history is generally the first step a physician takes in diagnosing and evaluating ejaculatory dysfunctions. This can reveal if the problem has always been present, which may indicate if it is due to a birth defect or to an acquired condition.

Elements of evaluation include:

  • Physical exam of the genitalia and testicles for structural problems
  • Semen sample for evaluation of sperm presence and health
  • Post-ejaculate urine sample if no ejaculate was produced
  • Hormonal testing
  • Transrectal ultrasound (TRUS) to look for structural problems.
  • Following are the four different types of ejaculation disorders, along with their causes, symptoms and treatments.

TREATMENT

Treatment for delayed ejaculation
Psychotherapy can deal with underlying mental health and psychological issues. Some mental health counselors are specially trained to deal with sexual issues. Counseling can involve just the male or he and his partner.

A few medications are also used to treat delayed ejaculation. These are not specifically approved for treatment of delayed ejaculation but are approved for treatment of other conditions. This is referred to as “off-label” use.

Treatment for retrograde ejaculation
It’s usually not necessary to treat retrograde ejaculation unless it is causing infertility that the male wishes to reverse. Stopping medications that can cause retrograde ejaculation is one form of treatment.

Off-label drugs can help the bladder neck muscle remain closed during ejaculation, preventing ejaculate from going into the bladder.

Assisted reproductive technologies, such as intrauterine insemination (one form of artificial insemination), may be used to work around retrograde ejaculation. This can involve procedures to retrieve the sperm from the male’s body and place it in the female’s uterus or inject it directly into an egg in her ovary (intracytoplasmic sperm injection).

Treatment for anejaculation
The most common treatment for anejaculation is psychological counseling to address underlying causes and sexual therapy. Sexual therapy can involve sex education for a clearer understanding of the arousal process by the affected person. It can also involve therapy to encourage pleasurable reaction to touching and progression toward orgasm and ejaculation.

Treatment of anejaculation to overcome infertility includes sperm retrieval and placement options through what’s known among doctors as assisted reproductive technologies.

For men experiencing anejaculation as a result of spinal cord injury, a therapy known as penile vibratory stimulation can result in ejaculation. This treatment utilizes a vibrating device designed to make the penis erect and help achieve ejaculation.