Ejaculation is a complex process involving coordinated muscular and neurological events that allow semen to be deposited into the urethra (emission) and propelled out of the urethral opening (ejection).
Common ejaculatory disorders include:
- Premature Ejaculation (PE): ejaculation occurs with minimal stimulation, often within less than a minute of penetration (lifelong PE) or following a noticeable reduction in latency time (acquired PE) - this affects up to 30% of men, making it one of the most common sexual dysfunctions
- retrograde ejaculation: Semen flows backward into the bladder instead of forward through the urethra, and is often referred to as a "dry orgasm"
- delayed ejaculation: difficulty or inability to ejaculate within a reasonable time during sexual activity
- anorgasmia: a complete inability to achieve orgasm despite sufficient stimulation
Causes and Risk Factors for Ejaculatory Disorders
Causes for ejaculatory disorders are dependent on the type of disorder that is present.
- Premature ejaculation: may be lifelong or acquired, with physical and psychological factors playing a role
- Retrograde ejaculation:
- Anatomic causes: congenital conditions or prior prostate surgery
- Neurologic causes: diabetes or pelvic surgery affecting nerve function
- Pharmacologic causes: certain medications that relax the bladder neck
- Delayed ejaculation/anorgasmia: may result from insufficient stimulation, psychological distress, relationship issues or medical conditions - contributing factors include sensory nerve damage (e.g., from diabetes) or medications such as antidepressants
Symptoms of Ejaculatory Disorders
- Premature ejaculation: ejaculation occurs too quickly, with minimal control, causing distress or avoidance of intimacy
- Retrograde ejaculation: normal orgasm sensation but little to no semen is expelled; diagnosis is confirmed by detecting sperm in post-orgasm urine
- Delayed ejaculation/anorgasmia: difficulty or inability to achieve orgasm, often taking longer than 30 minutes of stimulation
Evaluation and Treatment for Ejaculatory Disorders
A thorough medical and sexual history, along with a focused genital exam, is key to diagnosing ejaculatory dysfunction. Blood tests, such as testosterone levels, may also be helpful.
Treatment options depend on the type of ejaculatory disorder.
Premature Ejaculation
- Behavioral techniques: squeeze or stop-start methods combined with psychotherapy
- Topical anesthetics: applied to the glans 5–10 minutes before sexual activity to reduce sensitivity
- Medications: off-label use of SSRIs (e.g., paroxetine, sertraline) or clomipramine - Dapoxetine, a short-acting SSRI, is approved in some countries for PE
Retrograde Ejaculation
- Anatomic causes: sperm harvesting for fertility purposes
- Neurologic or pharmacologic: medications may help achieve forward ejaculation
Delayed Ejaculation/Anorgasmia
- Penile vibratory stimulation: can enhance stimulation and help achieve orgasm
- Medications: preliminary studies suggest dopamine agonists (e.g., cabergoline) or bupropion may be effective in some cases
Would You Like an Appointment?
To request an appointment or learn more about our program, please call our office at (646) 962-4811. Our phone staff is available Monday through Friday, 9 a.m. to 5 p.m. (EST).
If you’d like to learn more about our provider who specializes in ejaculatory dysfunction, please refer to Our Care Team.