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Ejaculation problems

NHS Direct Online Health Encyclopaedia

Introduction
Ejaculation is the squirting out of semen from the penis during an orgasm. Problems with ejaculating occur quite commonly and these include premature (early), delayed or absent ejaculation. Other problems include unusual discharge, pain upon climax, or a dry ejaculation.

Most men experience some form of erection or ejaculation problem during their lifetime. For example, around 3 out of 10 men have had a problem with premature ejaculation.(1) Such problems often cause anxiety and self-doubt which can make the problem worse. Fears and worries can also lead to abstinence or a decrease in frequency of intercourse or masturbation; again aggravating the problem.

Many ejaculation problems can be resolved with simple self-help techniques, but you should see your doctor if you feel it is severe or ongoing. It is important to remember that these problems happen to a lot of men occasionally.

Studies such as that by Dr Alfred Kinsey have found that 75% of men reach orgasm within two minutes of penetration, and that the average duration of a mans orgasm is 3-5 seconds. However, it is important to note that there is no rule defining how soon is too soon (see Symptoms).

Symptoms
There are different symptoms depending on the type of ejaculation problem:

Premature ejaculation. There are no precise rules about how soon ejaculation should take place after intercourse or masturbation begins. Instead, the general principle is that ejaculation is premature if it happens more swiftly than the individual or the couple would prefer. It may occur a few seconds into intercourse, or even prior to penetration, and it may not provide satisfaction for the man, or for his partner.
Delayed ejaculation. There are no clear rules, but if it seems to take a long time or if a man feels that he is ready but cannot climax , there may be a problem.
Absent ejaculation - an inability to ejaculate.
Dry orgasm. This is when a man experiences the feeling of climax but no semen comes out.
Pain in the pelvic area, upon ejaculation or intercourse.
Discharge. The penis has an unusual smell or appearance; semen is unusually thick or discoloured; or there is blood in the fluid.
Anxiety or worries about performance will often accompany physical symptoms.
Causes
Causes of ejaculation problems vary, depending on the person involved and the type of problem. Problems can be complicated by having multiple causes.

Causes include:

Physiology (natural body shapes). Some men simply take longer than others to climax. This can be related to their shape and size, lack of technique, or sexual positions used. Discomfort can also be caused by the physiology of a female partner, who may not be sufficiently aroused or lubricated.
Impotence. Some ejaculation problems are connected to inability to get or maintain an erection (erectile dysfunction).
Other medical conditions may cause ejaculation problems, which can be temporary or permanent. These include diabetes, prostate disease, cancer of the testicle, and benign proslastic hyperlasia (BPH). Dry or delayed ejaculation is often caused by conditions such as diabetes, or after surgery (for example on the prostate gland).
Sexually-transmitted infections (STIs) such as gonorrhoea may cause smelly or discoloured discharge. If blood appears in the semen it could be the result of an infection or inflammation in the urethra or prostate gland, but you should also check whether it might have come from your partner (for example, a female partner may be having her menstrual period).
Medication - delayed ejaculation is a side-effect of some medicines such as anti-depressants.
Alcohol abuse often leads to sexual problems including delayed ejaculation and erectile dysfunction..
Psychological reasons - among the most common for ejaculation problems. It is common to ejaculate prematurely when having sex for the first time, or with a new partner due to intense arousal or worry about performance. Other psychological problems may stem from negative comments about performance from previous partners, from worries about cultural or religious taboos (such as sex outside marriage), distraction because of stress or a busy day at work, or fear of being overheard making love.
Conditioning is a particular form of psychological cause. A man who is used to masturbating with a very fast motion may not feel satisfied with the slower process of intercourse, and thus find it difficult to climax. In the case of young men, they may initially be trying to reach orgasm in a short space of time, because they do not have a comfortable or safe location in which to have sex, and this can condition them to climax quickly, even when they reach a more stable environment.
A combination of the above - particularly psychological causes. Once a problem has occurred, even on a single occasion, worrying about it can cause it to re-occur. A man may face delayed ejaculation because he is worried that he did not climax last time and is thus distracted from taking pleasure in the sensations. He may avoid or abstain from sex if he is worried about his performance .
Diagnosis
In most cases a man initially becomes aware that there is a problem through observation of his own behaviour, or in discussion with his partner or others. The next step is to visit your GP, who will discuss the problem with you, and either examine you or refer you to a specialist.

Depending on the nature of your problem, you may be asked questions about family medical history and conditions such as diabetes, heart disease, and high blood pressure, and about your sexual and emotional health. The doctor may ask if you have had an injury or surgery to the pelvic area, check what medications you are taking, and ask about aspects of your lifestyle such as alcohol intake.

A rectal examination may be done to check for an enlarged prostate gland, check the nerves of the penis for any damage and perhaps blood and urine samples taken to test for hormone and cholesterol levels. They may also carry out a visual examination of the pelvic area to check for injury or conditions such as gonorrhoea.

Treatment
If the problem is caused by an underlying condition such as prostate cancer, erectile dysfunction, or a sexually transmitted infection (STI), then treatment may well clear up the ejaculation problem as well. An awareness of the effects of conditions such as diabetes will enable the man to control his performance more, and prevent him from worrying that he is at fault. This may relax him and enable him to enjoy the experience and thus overcome the difficulties naturally.

If medications such as anti-depressants are thought to be the cause, it may be possible to change to a different medicine to avoid that particular-side effect.

Varying the duration or type of foreplay, or using different sexual positions can also be helpful. Other techniques to delay ejaculation can be used while masturbating (making yourself come) or sex with a partner. One technique is to stimulate the man to the brink of ejaculation, stop for around 30 to 60 seconds, and then begin stimulation again. This is done several times before ejaculation is allowed to take place, and can be effective in prolonging intercourse. A variation is the squeeze technique, where during the pauses in stimulation, the penis is squeezed in a particular way. These techniques are best used as part of a regular programme and you should see a doctor for advice.

Medicines that delay ejaculation can be prescribed. In addition, a local anaesthetic spay, available from pharmacies, is available to spray on to the penis before intercourse. This spray can be effective especially in conjunction with training such as the stop-go and squeeze techniques described above, but may cause loss of sensitivity for the female partner.

Abstaining from sex for a short period can be helpful for those who have dry orgasms. Unless the condition is caused by a medical condition, it will allow the fluid to build up. However, when the condition is caused by factors such as prostate surgery, the quantity of semen cannot be increased. Conversely, having sex more often can help those who prematurely ejaculate.

It can be helpful to talk over the problem with a partner or counsellor, because by bringing worries out into the open, they may be resolved. If the underlying problem is stress then relaxation techniques, and solutions for the situations causing stress, will be of help.

© Queen's Printer and Controller of HMSO, 2005

Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland.

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