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Ejaculation Problems

What are these?

Ejaculation refers to the process whereby semen (sperm) is released from the penis at the time of the male orgasm. It is brought about by a combination of mental and physical stimulation. These cause rhythmic contractions of the muscles of the penis that close off the internal opening to the bladder, leading to the release of semen to the outside. The two common ejaculation problems are premature and retrograde ejaculation.

  • Premature ejaculation is the achievement of orgasm and release of semen well before the couple would wish this to happen during the act of intercourse. This could be during foreplay before penetration takes place, at or soon after penetration, or in the early stages of intercourse earlier than the couple would wish.
  • Retrograde ejaculationis the flow of released semen (often at the appropriate time) backwards rather than forward along the urethra to end up in the bladder.

What causes them?

Premature ejaculation can be due to stress, nervousness and tension. Some men may become accustomed to quick ejaculation because they have been used to hurried masturbation or intercourse due to fear of discovery. Psychological problems in the relationship may contribute to the problem, for instance if the male has some fear of the female partner. The male partner may come to fear that he will always ejaculate prematurely, ensuring he will.

Retrograde ejaculation can occur in any situation where the internal end or sphincter of the urethra (the urine tract in the penis) is damaged. This causes the urethra to lose the ability to close off at the time of ejaculation. It can be caused by birth defects of the penis, surgery to the urethra including removal of the prostate gland (prostatectomy), and disorders of the nerves supplying the area that can occur in multiple sclerosis and diabetes.

What problems can they cause?

The problems with premature ejaculation could be two folds:

  • Ejaculation is not delayed long enough for the female partner to have adequate sexual fulfillment and orgasm.
  • If it occurs before penetration it can lead to infertility (difficulty with conceiving.

Premature ejaculation can thus cause a great deal of frustration and be a source of sexual and relationship difficulties, as well as childlessness. Furthermore, if premature ejaculation continues for a prolonged period it may result in male impotence.

Retrograde ejaculation may come to light because of a complaint of absence of semen after ejaculation or it may be picked up during investigations for infertility. The major problem that this causes is infertility because no semen is deposited in the female vagina to allow pregnancy to begin. The problem is usually confirmed by showing the presence of sperm in a urine sample obtained after ejaculation.

What treatment is available?

Psychosexual counselling has a big role to play in the treatment of premature ejaculation. The appropriate place for this sort of treatment is in a clinic that specialises in such matters and has some experience dealing with it. The affected couple will be educated on the known facts about the ‘sexual response cycle’ and guided towards pacing their sexual activity. Clinics will teach couples how to practice masturbation of the male by the female to a point just before ejaculation. This will be repeated several times over in sessions to reinforce the art of controlling ejaculation in the male. Once this is achieved, penetrative sex may be resumed initially with some guidance.

Recovering sperm from urine after an act of sexual intercourse can treat retrograde ejaculation. The sperm is then washed in a special fluid before it is injected directly into the womb of the female partner (artificial or intra-uterine insemination) around the time of ovulation. Sometimes fertility medicines to improve ovulation are used at the same time. Up to 1 in 5 couples treated in this way may be able to achieve a pregnancy.

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