Fact Sheets

Ejaculation Problems

Premature Ejaculation

Introduction

Premature ejaculation (PE) is the commonest male sexual dysfunction and
is defined as ejaculation before the person wishes it, often within 1 to 2 minutes after penetration though it can occur before or on penetration.

PE present since commencing sexual activity is a primary disorder and is associated with a hypersensitive ejaculatory reflex now believed to arise
from serotonin receptor sites in the brain. PE may also arise as a secondary disorder at any stage and can be associated with performance anxiety or psychological trauma. PE resulting from anxiety often has a situational component, such as when starting a new relationship. Men with PE will usually have better control over their ejaculation time with masturbation. Older men who develop erection problems may develop PE as a compensatory mechanism.

Treatement

Treatment to slow down ejaculation time is not always appropriate due to the man's expectation of how long ejaculation time should be. Consideration should be given to these expectations and other factors such as the state of the relationship. Sometimes communication and simple adjustment of the couple's sexual technique is adequate therapy.

An established exercise treatment is Seman's stop-start technique. This involves 3 stages of stimulation of the erection to the point before ejaculatory inevitability and then temporarily withdrawing to allow arousal to subside, when the stimulation is recommenced. The stages involve use of a dry hand, lubricated hand and finally vaginal penetration.

Seman's manoeuvre was modified by Masters and Johnson who devised the squeeze technique. The partner firmly squeezes the frenulum and ridge of the penis for 10 seconds to reduce the ejaculatory sensation. This can occur just before penetration or at any time.

Pharmacological Therapy

SSRI anti-depressants have been successfully used to delay ejaculation. The SSRI is taken daily for a minimum of 6 months. If the PE returns when the medication is stopped, the medication may then be taken on an as required basis before planned intercourse. Whilst delayed ejaculation time is a side effect of SSRI anti-depressant medication, other side effects such as insomnia and anorexia may occur.

Local topical anaesthetics have only limited success. Prostaglandin intra-penile injections can prolong the erection even if ejaculation has occurred. These injections are generally used only when other treatments have failed in difficult cases.

Delayed Ejaculation

Delayed or inhibited ejaculation can be a natural consequence of ageing in men. The presence of conditions such as diabetes or the use of anti-depressant medication may exacerbate the problem. There may be emotional causes in younger men who may have always experienced difficulty ejaculating.

Treatment involves techniques to enhance sexual stimulation as well as counselling.

Retrograde Ejaculation

Retrograde ejaculation involves movement of the semen during ejaculation into the bladder rather than through the penis. This arises from incompetence of the bladder neck that most commonly occurs after surgery for benign enlargement of the prostate. It may also occur from autonomic nerve damage associated with diabetes.

Treatment is difficult for this condition and often involves counselling to accept the changed ejaculation pattern. There are some medications that tighten the bladder neck but their use is not always suitable.