Ejaculation problems
Ejaculation seems a simple, automatic business right up to the day it stops working the way it should.
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Medicines commonly prescribed for Ejaculation problems
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 50 mgActive substance: sildenafilManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: CAPSULE, 30 mgActive substance: duloxetineManufacturer: Neuraxpharm Spain S.L.U.Prescription requiredDosage form: CHEWABLE TABLET, 100 mgActive substance: sildenafilManufacturer: Neuraxpharm Spain S.L.Prescription required
Ejaculation seems a simple, automatic business right up to the day it stops working the way it should. It is in fact a chain involving nerves, the pelvic floor muscles, the prostate, the bladder neck and the mind, and it can break at any link. Men run into three situations above all: everything finishes too soon, it never finishes at all, or the orgasm arrives without the usual release of semen. None of them says anything about strength of character, and almost none of them means that something is over. Most of these stories are sorted out in a single appointment, and a good share of them without a single tablet. What usually gets in the way is not the problem itself but the years of silence around it.
Three different faults that get mixed up constantly
They are best told apart by what exactly is going wrong.
- Too soon. Ejaculation happens earlier than the man or his partner would like and barely responds to control. This is the commonest of the three.
- Too late, or not at all. Arousal is there, the erection is normal, and the finish does not come after ten minutes or after forty. Sometimes it is only reachable in one particular way, and with a partner it does not happen at all.
- Orgasm without semen. The sensations are where they should be, yet little or nothing comes out, because the semen travels backwards into the bladder. This is called retrograde ejaculation.
It is worth saying what does not belong on this list. Erection and ejaculation are separate mechanisms and should not be confused: a normal erection with no finish exists, and so does a finish on a poor erection. There is a link between them all the same, and it deserves attention: a man who is afraid of losing his erection tends to hurry the finish, and what looks like premature ejaculation turns out to be erectile dysfunction in disguise. In that case it is the erection that needs treating.
When everything finishes too soon
Isolated episodes happen to everyone: after a long break from sex, with a new partner, after drinking, in unfamiliar surroundings, with nerves involved. That is not a diagnosis and needs no treatment.
It becomes a problem when three things coincide: ejaculation regularly arrives very shortly after things begin, delaying it is next to impossible, and this genuinely distresses the man or the couple. The third is the decisive one. There are couples for whom everything is quick and nobody minds, and there is nothing there to cure. And the other way round: a number of minutes that a textbook would call normal can make somebody's life miserable, and that alone is reason enough to ask for help.
Two scenarios need separating. If it has been this way from the very start of a man's sexual life, what usually lies behind it is an inborn sensitivity of the nervous system together with a habit of hurrying learned very early. If it never used to happen and has started now, there is nearly always something concrete and correctable behind it:
- anxiety, stress, exhaustion, depression;
- strain in the relationship or, conversely, sky-high expectations in a new one;
- early erectile dysfunction and the fear of not holding an erection;
- inflammation of the prostate, particularly where there is pain in the perineum or discomfort on passing urine;
- an excess of thyroid hormone;
- alcohol and drugs, stimulants included;
- abruptly stopping a medicine that had been slowing things down.
What genuinely helps take the hurry out of it
The starting point is the simple things, and very often that is where it ends.
- Control techniques. The best known are stop-start and the squeeze method. The idea behind both is the same: to learn to recognise the point beyond which the process cannot be called back, and to stop before reaching it. They are practised alone first and with a partner afterwards. It is tedious and takes weeks of persistence, but it works and costs nothing.
- Pelvic floor training. The same muscles that hold urine. Strengthening them helps a substantial share of men; the technique is best learned with a professional, because working blind, half of people tighten the wrong thing.
- Reducing sensation. A thick condom, a change of position, a brief encounter shortly before the main one. Straightforward measures that people are somehow embarrassed to ask about.
- Local anaesthetics. Sprays and creams containing an anaesthetic are applied to the glans in advance and then wiped off, or a condom is used: otherwise the product transfers to the partner and dulls sensation for her. They are not for unsupervised use, and if a partner is pregnant or a pregnancy is being planned it is worth asking a doctor first.
- Tablets. Ejaculation is delayed by antidepressants of the selective serotonin reuptake inhibitor group; for this purpose they are often prescribed outside their licensed indications, and only a doctor should choose them. There is also a short-acting drug from the same family created specifically for this: it is taken a few hours in advance and never more than once a day. It does not suit everyone, it has restrictions in heart, liver and kidney disease, and it clashes with a number of other medicines. Nausea, headache and light-headedness are the commonest side effects.
- Treating the erection. Where the fear of losing an erection is the root of the matter, phosphodiesterase-5 inhibitors help — the same drugs used for erectile dysfunction. They are prescription medicines, and the rules differ from country to country.
- Talking therapy. Especially where the problem is recent and bound up with anxiety or with the relationship. Combining techniques with therapy gives a more durable result than tablets alone, because tablets stop working the moment they are stopped.
When ejaculation does not come
Delayed ejaculation is less common but harder to live with: sex drags on, turns into work, both people end up worn out, and pleasure is the first thing to go. It counts as a problem when the finish cannot be reached on more than half of occasions, with desire present and the erection intact.
The causes fall into two large groups, and both need going through.
Physical. Nerve damage from diabetes, multiple sclerosis, spinal cord injury, or surgery on the prostate or bladder. Low testosterone. And the changes in sensitivity that come with age: past a certain point ejaculation naturally takes longer, and on its own that is not an illness.
Medicines and lifestyle. Many antidepressants delay ejaculation, those of the group named above in particular, as do some blood pressure treatments, antipsychotics, drugs for prostate enlargement and opioid painkillers. Alcohol and recreational drugs get in the way considerably. There is also a very common cause that is rarely said out loud: a man's habitual style of masturbation. If it differs sharply from what happens with a partner in rhythm or pressure, or is tied to very particular imagery, the body simply does not recognise the other kind of stimulation. This can be unlearned and does not need medication.
Hence the approach. Medicines are reviewed first, but nothing prescribed is ever abandoned unilaterally: the conversation with the doctor is about whether the dose can come down, the drug can be swapped, or it is worth waiting. Blood sugar, in mmol/L, and hormone levels are checked. Then sex therapy comes in, which helps to retrain habits, take away the demand for a result and give the encounter a purpose other than reaching the end. No medicine reliably speeds ejaculation up at present, and anyone promising otherwise should not be believed.
When semen goes into the bladder
Normally, at the moment of orgasm, a ring of muscle at the neck of the bladder closes tightly and the semen has only one way to go, outwards. If that ring is damaged or has stopped closing in time, the semen follows the path of least resistance and goes backwards. The sensation of orgasm remains, but the emission is scanty or absent.
Two findings together raise the suspicion: a dry or nearly dry orgasm, and cloudy urine at the first visit to the lavatory afterwards. Confirming it is simple — urine collected straight after ejaculation is examined and sperm is found in it.
The usual causes are surgery on the prostate and bladder neck, diabetes with nerve involvement, multiple sclerosis, spinal cord injury, and certain medicines, above all the alpha blockers prescribed for prostate enlargement and sometimes for high blood pressure. The drug-related version is usually reversible: ejaculation returns once the medicine is changed, but the change is the doctor's decision, not the patient's.
Retrograde ejaculation carries no risk to health, and if there are no plans for children it does not have to be treated at all. Where conception is the issue, there are options: withdrawing or substituting the medicine responsible, drugs that raise the tone of the bladder neck (used with caution because of blood pressure and the heart, and not suitable for everyone), and, if none of that works, retrieving sperm from the urine or directly from the testicle for intrauterine insemination or IVF. Where nerve damage is severe, normal ejaculation cannot be restored, but fatherhood remains possible.
Signs that are no longer about ejaculation
Sometimes a fault in this area is not a problem in its own right but the first visible warning of something else. These situations are dealt with separately and without delay.
- A sudden inability to ejaculate together with numbness in the perineum and inner thighs, weakness in the legs, retention of urine or incontinence. This can mean that nerves in the lower spine are being compressed. Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single European number 112 is in use): the timescale here is hours, and waiting leaves lasting damage.
- Pain on ejaculating with a high temperature, shivering, pain in the perineum and difficulty passing urine. This looks like acute inflammation of the prostate and needs a doctor the same day.
- Blood in the semen. In younger men it usually follows inflammation and clears by itself within a few days. But if it comes back, lasts more than a couple of weeks, comes with pain, or appears in an older man, it needs investigating: this is sometimes the first sign of prostate disease, including a tumour, and it is also a reason to have the blood pressure measured.
- The problem started alongside heavy thirst, passing a lot of urine and losing weight. That pattern suggests newly developed diabetes — have the blood sugar checked.
- Desire has gone, tiredness is building, body hair has thinned. Testosterone is worth measuring.
- It began right after a new prescription. Put the two together and tell the doctor: changing the drug frequently settles the whole matter.
Why it goes worse when tackled alone
Ejaculation problems almost always concern two people, and trying to fix things in secret tends to drag the story out. A partner rarely thinks what the man fears; far more often she explains events in her own way — "he has gone off me", "there is somebody else" — and the tension that builds in the relationship makes the problem worse all by itself.
Talking helps for another reason too: part of the difficulty turns out to be shared. Many women do not reach orgasm through penetration alone, and once that is said aloud the question of how many minutes need to be endured loses its edge entirely. Sometimes it emerges that the partner has difficulties of her own, and it makes more sense to work through them together. That is why doctors so often suggest that both come to the appointment; it is not a formality, as a couple gets considerably further than one person with the same problem.
And one more thing worth stating plainly. Age, tiredness and years of living together change the speed and the intensity of responses, and that is ordinary physiology rather than a breakdown. What gets treated is whatever stands in the way of living, not whatever has stopped matching the images circulating online.
Online consultation
For questions of this kind a remote appointment is particularly convenient: there is no reception desk to explain oneself at and no waiting room to sit in. The doctor will ask in detail how long it has been going on, whether it was always this way or started recently, whether the picture differs alone and with a partner, which medicines are being taken, and how erection, urination, mood and sleep are doing — and that conversation alone will separate one problem from another. Next comes advice on which tests to start with: blood sugar, thyroid hormones, testosterone and, where relevant, urine after ejaculation. The exercises get explained, the current prescriptions get reviewed for the one that could have caused the effect, and where indicated a treatment plan is proposed or a referral made to a urologist or a sex therapist. It is equally reasonable to come online simply to ask whether what is happening is normal: very often that answer is all that was needed. The situations in the list above are not assessed on a screen — they call for urgent care straight away.
This material is for information only and does not replace medical advice.
Consult with a doctor about Ejaculation problems
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Online doctors for Ejaculation problems
Discuss your symptoms and possible next steps for Ejaculation problems with a doctor online.
