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Male Ejaculation Disorders and Treatments

  • 4.7 (7 Votes)
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Male ejaculation disorder includes premature ejaculation, delayed ejaculation, retrograde ejaculation, an ejaculation and erectile dysfunction. Male ejaculation disorders can be treated by ejaculation behavioral therapy, oral therapy, local therapy or pseudoephedrine therapy.

Ejaculatory problems often create a feeling of shame and embarrassment amongst men who are struggling with this problem. But when does ejaculation problem become a disorder? This article helps in understanding the types of ejaculation problems and the treatments available for them. It is always better to stop shying away from this change in your body and address it to your doctor. This will help you to get your medical problems treated before it’s too late. But before that, let us just understand some basics of ejaculation. Also check out sperm optimization factors to rule out male infertility.

What is Normal Ejaculation Process?

People take it as a single event but ejaculation is basically two separate processes namely Emission and Ejaculation

Emission is a process where semen is loaded into the penis chamber near the prostate. After this, the forcible expulsion of semen from the penis is known as ejaculation. Though, ejaculation is different from orgasm, which is centered in the brain and is linked with ejaculation.

Components of Male Ejaculation

The normal ejaculate at least has a volume of 1.5 to 2 ml. This volume is made up of:

  • Prostate Fluid:  It is 10% in volume
  • Vas deferens or sperm: It is 10% of the total quantity
  • Seminal vesicles: It is 80% in volume
  • Cowper’s glands fluid: There are minimalistic traces of secretions from Cowper’s gland.

The first part of ejaculation contains sperm and high amount of prostatic glands, zinc and citrate; basically, it is composed of mainly fluid from vas deferens and prostate. In the second half of ejaculate, fructose levels are quite high i.e. largely from seminal vesicles.

Seminal Fluid pH Level

The normal pH of ejaculate ranges between 7.2 pH and 8.0 pH. While a low pH on semen analysis indicates there might be an obstruction in the system. And lack of fructose in semen means seminal vesicle blockage.  Seminal Analysis is valuable in evaluating the ejaculatory disorders. Also get to know more facts on semen color and health.

Seminal Fluid PH Level

What is ejaculatory disorder evaluation?

The important part of the evaluation of ejaculatory disorders is a detailed patient history. It is helpful in understanding whether the patient ever had a normal ejaculation and describes whether the problem is acquired or congenital. In physical examination, testicles and genitalia are assessed to ensure all necessary organs are present along with vas deferens. The patient is asked to produce a semen sample for analysis as a part of the evaluation. If there is no ejaculation then post-ejaculate a urine sample is obtained and examined to check the sperm presence.

Other tests include blood tests in which FSH and Testosterone are assessed. Imaging with transrectals ultrasound (TRUS) defines structural abnormalities in seminal vesicles or prostate.

Ejaculatory Disorders and Treatments

1- Premature Ejaculation: It is described as a condition when a man ejaculates a bit sooner than his partner wishes. It takes place nearly within a minute of vaginal penetration. The causes of premature ejaculation are both physical and psychological. Physical causes include prostate problems, usage of recreational drugs or thyroid problems. It is usually due to overactive or underactive thyroid gland. Common psychological causes are depression, stress, relationship problems and anxiety regarding sexual performance.

Treatments available for premature ejaculation include behavioral technique, oral medications, pelvic floor exercises, usage of condoms and proper counseling.

2- Delayed Ejaculation: It is also known as male orgasmic disorder and is classified into two sections-

  • Experiencing delay before ejaculation
  • Unable to ejaculate at all even when a man wants to and his erection is normal

The possible physical causes of delayed ejaculation include diabetes, increasing age, spinal cord injuries, multiple sclerosis and surgery of the bladder or prostate gland. The treatments for delayed ejaculation include Sex Therapy, medications such as Periactin and Pseudoephedrine

3- Retrograde Ejaculation: In this disorder, you might not see any fluid (Semen) after orgasm. It occurs when semen travels back into the bladder instead of passing through the urethra. There are different causes of this disorder such as-

  • Diabetes mellitus
  • Multiple sclerosis
  • Spinal cord injury
  • Tethered spinal cord
  • Spina bifida
  • Congenital unilateral absence of the vas deferens
  • Cloacalexstrophy
  • Imperforate anus
  • Extropy/epispadias

Retrograde Ejaculation

Treatment for retrograde ejaculation include

  • Psychiatric Medications- Paroxetine, fluoxetine
  • Blood pressure pills- Phenoxybenzamine, thiazides, clonidine
  • Prostate pills- Alpha-blockers, imipramine
  • Anti-Inflammatories-Naproxen
  • Muscle relaxants- Baclofen
  • Cloacalexstrophy/epispadias repair

4- Anejaculation: It is a disorder when a man gets the sensation of ejaculation but doesn’t ejaculate in real. It is uncommon. The main cause of this problem is neurological damage, which is a result of spinal cord injury, diabetes, multiple sclerosis or lymph node surgery. A psychological problem can also be one of the reasons. Anejaculation can be treated if infertility was an issue.  If the person is unable to cope with it, then sex therapy can benefit him.

Secondary or acquired Anejaculation

This type has multiple identifiable causes. Medications causing retrograde ejaculation can also cause anejaculation in some men. The other reasons behind acquired anejaculation are medical conditions like diabetes, spinal cord injury and multiple sclerosis. In such a situation, for retrieving the fertility- penile vibratory stimulation, rectal probe ejaculation or surgical sperm retrieval technique is utilized. Below are the causes of Anejaculation:

  • Anejaculation can finally occur with the help of surgical procedures. It affects the nerves, which control the ejaculation such as retroperitoneal lymph node dissection and radical prostatectomy.
  • Another anejaculation that can occur later in life is a Pediatric Congenital defect of the pelvis. Anejaculation can also occur due to both anatomical nature of anomaly (imperforate anus, cloacalexstrophy) or associated with surgical procedures (bladder neck reconstruction, exstrophy/ epispadias repair) for correcting the defect.

Anejaculation

Treatment of Anejaculation

Depending upon the spinal injury level, patients with anejaculatory spinal cord injury can be helped in ejaculation by two processes. Penile Vibratory Stimulation is the simplest form of ejaculatory stimulation. Here, a high frequency and high amplitude vibrator is placed on penis’ bottom tip for several minutes for achieving ejaculation. It helps in inducing ejaculation painlessly in the majority of patients along with the cord injuries above the T10 level.

Men with low spinal cord lesions and who did not respond well to penile vibratory therapy can go for rectal probe electro ejaculation procedure. The sperm retrieved with this method is sufficient to use for low levels of ART such as IUI.

Blood in Ejaculate (Hematospermia)

Blood in ejaculation is termed as hematospermia. It is actually painless and ejaculation is red or brown in color. There are chances of formation of blood clots in the semen. It is usually common in young and sexually active males. This can resolve over time without taking any therapy. There can be ejaculatory duct obstruction if it appears with pain. In such situations, evaluation is recommended. If males below 50 years of age experience recurrent hematospermia, painful hematospermia or hematospermia then there is requirement of further diagnosis for finding anatomical and infectious causes. There are chances of cancer such as sarcoma, prostate cancer, bladder cancer. In some situations, seminal vesicle cancer is more prevalent. 

Thus, ejaculatory disorders need to be treated on time with proper treatment measures. It is highly recommended to consult your doctor, if you are facing any difficulties concerning ejaculation on a regular basis. This will help you to get treated successfully at the initial level of the disorder and normalize your life like before.

If you are looking for the ways to naturally boost sperm count, then feel free to explore our article on increase male fertility. ICSI or IMSI treatment can be done to cope with male infertility.

Dr. Kavita Jaggi Agrawal

About The Author

Infertility Specialist, Obstetrician Dr. Kavita Jaggi Agrawal
Agra

Dr. Kavita Jaggi Agrawal is an obstetrician, gynecologist and infertility specialist who is providing her valuable expertise in the field of gynecology and infertility issues. She ensures that the patients receive the required fertility treatments well on time. Dr. Kavita specializes in the treatments like High Risk Pregnancy Care, In Vitro Fertilization (IVF) and Reproductive Medicine. Currently, she is practicing at Amit Jaggi Memorial Hospital, Vibhav Nagar, Agra.

SOURCES AND REFERENCES:

  1. Five important things that optimize sperm quality sperm optimization factors, Elawoman - 2017
  2. How to achieve master orgasm and increase sperm volume orgasm, Elawoman - 2017
  3. Facts on semen color and semen health semen color and health, Elawoman - 2017
  4. Top 10 useful tips that boost fertility in men ejaculatory disorders, Elawoman - 2017
  5. How does age affect male fertility? Testosterone, Elawoman - 2018
  6. Thyroid and how it affects pregnancy thyroid, Elawoman - 2017
  7. How stress affects pregnancy stress, Elawoman - 2017
  8. What are the uses and benefits of inositol supplements? diabetes, Elawoman - 2017
  9. How to increase sperm count - causes and treatments Anejaculation, Elawoman - 2017
  10. Best ways to boost sperm count and increase male fertility increase male fertility, Elawoman - 2017

7 Comments

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Tilak Bahadur

I can't distinguish which ejaculation disorder I have? Please help!

Oct. 11, 2018, 4:22 p.m. 4.5

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Raghav Nandan

The pH of my semen is increased i.e 8.0, what should I do to fix this? Please suggest!

Aug. 10, 2018, 9:19 p.m. 5.0

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Lalit Sahdev

I always assume what this male ejaculation disorder is? Thanks for sharing this, It was descriptive and informative.

Aug. 7, 2018, 10:43 p.m. 5.0

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Nikhil Pratap

I have Hematospermia, what should I do now?

July 12, 2018, 4:14 p.m. 4.5

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Abhay Rohtagi

Thanks for the information on delayed ejaculation. Mostly, men feel hesitation in discussing ejaculatory disorders.

June 4, 2018, 4:20 p.m. 5.0

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Somnath Tripathi

It was new to know about male ejaculation disorder and it looks pretty bad.

May 30, 2018, 7:13 p.m. 4.5

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Vijay Alias Dadarao Narayanrao Mate (Patil)

I know one of my friends having this problem. He conceived with IVF.

May 27, 2018, 10:55 p.m. 4.5

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