male fertility

Ejaculation Failure Causes, and Treatment of Different Types of Ejaculation Disorders

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Ejaculation failure causes are urinary infections, thyroid problems, low testosterone levels and anti-anxiety drugs. Ejaculation disorder treatment includes oral medications, pelvic floor exercises, condoms, and muscle relaxants. Ejaculatory disorders are premature, delayed, retrograde, and anejaculation.

Erectile dysfunction and ejaculatory problems are common sexual difficulties among men. However, with the advancement of medical technology, problems of erectile dysfunction are treated easily. (1)

An ejaculation problem becomes a disorder when a man needs more than 30 minutes of sexual stimulation to reach orgasm and ejaculate. Ejaculatory problems are usually followed by anxiety, depression, and reactions to medications. Almost 31 percent of men suffer from sexual dysfunction and the severity varies from one individual to another. (3)

Even though there are no specific medications discovered for Ejaculation disorders, medications used for treating conditions like Parkinson’s disease have shown to help. While ejaculation can be a temporary problem for some men but for others, it may be a lifelong problem. Although these type of disorders does not pose any serious health issues, it should not be overlooked because it can be a source of stress and problematic in a person’s sex life and personal relationships. (2)

Causes of Ejaculation Disorder

Physical causes include the following(4):

  • Prostate problems
  • Thyroid problems
  • Urinary infection
  • Heart disease
  • Low testosterone levels
  • Birth defects that affect the ejaculation process

Medical conditions: Medical conditions can sometimes have an adverse effect on male ejaculation. A person can have delayed ejaculation if he is dependent on the following medications:

  • Antidepressants like fluoxetine
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Anti-anxiety drugs
  • Diuretics
  • Blood pressure medication such as propranolol
  • Painkillers

If a person smokes, consumes alcohol or uses certain recreational drugs, it can decrease the sensitivity of the penis for sexual stimulation, damage the nerve, causing severe diabetes, stroke, spinal cord injury and cause abnormal ejaculatory problems.

Ejaculation problems can be sometimes attributed to psychological or biological causes. Some psychological factors can include the following:

  • Early life history of sexual abuse
  • Stress and depression
  • Relationship problem with a partner
  • Negative sexual upbringing
  • Unexpressed anger
  • Unwillingness to enjoy the pleasure
  • Religious belief
  • Fear of pregnancy

Components of Male Ejaculation

The average amount of semen produced by a male during ejaculation is 1.5 to 6.8 ml. This volume is made up of the following (5):

  • Prostate Fluid: 10%
  • Vas deferens or sperm: 10%
  • Seminal vesicles: 80%
  • Cowper’s glands fluid: There are minimal traces of secretions from Cowper’s gland.

The first part of ejaculation contains sperm and high amount of prostatic gland secretion, zinc and citrate. It is composed of fluid from vas deferens and prostate. In the second half of ejaculation, fructose levels are quite high i.e. largely from seminal vesicles. 

Seminal Fluid pH

The normal pH level of ejaculation ranges between 7.2 pH and 8.0 pH. A low pH on semen analysis indicates lack of fructose in semen or a seminal vesicle blockage. Seminal fluid analysis provides valuable information while evaluating ejaculatory disorders. (6)

Ejaculatory Disorder Evaluation

The evaluation of ejaculatory disorder involves a detailed study of a patient’s history. This study is helpful for providing information if the patient had normal ejaculation before and describes whether the problem is acquired or congenital. During the physical examination, the testicles and genitalia are assessed to ensure all necessary organs are present along with vas deferens. The patient is asked to produce a sample of the semen and if there is no ejaculation a urine sample is examined to check the presence of sperms. Other tests include blood tests in which FSH (Follicle Stimulating Hormone) and Testosterone hormones are tested. Imaging with transrectal ultrasound (TRUS) defines structural abnormalities in seminal vesicles or prostate. (7)

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. Both physical and psychological factors can be the cause of premature ejaculation. Physical causes include prostate problems, usage of recreational drugs or thyroid problems. It is usually due to the 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. (8)

2. Delayed Ejaculation:

It is also known as male orgasmic disorder and is classified in to two sections (9):

  • 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, a person 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 (10):

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

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
  • Cloacal exstrophy/epispadias repair

4. Anejaculation:

It is a disorder when a man gets the sensation of ejaculation but does not ejaculate in real. Anejaculation is a very rare disorder and the main cause of this problem is neurological damage because of spinal cord injury, diabetes, multiple sclerosis or lymph node surgery. A psychological problem can also be one of the reasons. 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:

  • When the prostate and seminal ducts fail to release semen into the urethra 
  • Partial blockages to the urethra
  • When there is an injury in the spinal cord 
  • Conditions that affect the nervous system examples: Parkinson's disease, multiple sclerosis, diabetes and spina bifida
  • Traumatic injury or infection in the pelvis or groin area
  • If a person had a surgical treatment for testicular cancer, which required the removal of lymph nodes, located in the groin area.
  • Surgeries that may cause damage to a pelvic area such as abdominal surgery, prostate that can damage or traumatize nerves
  • Hormonal and psychological factors such as anxiety, marital problems, stress, etc.
  • Anejaculation can also occur due to both the anatomical natures of the anomaly (imperforate anus, cloacal exstrophy) or associated with surgical procedures (bladder neck reconstruction, exstrophy/ epispadias repair) for correcting the defect.

Treatment of Anejaculation

Depending upon the spinal injury level, patients with an ejaculatory 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 the penis for several minutes for achieving ejaculation. It helps in inducing ejaculation painlessly in a 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 electroejaculation 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, there is a 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 a doctor if you are facing any difficulties concerning ejaculation on a regular basis. This will help you to get treated successfully at an initial level of the disorder and normalize your life like before.

If you are looking for ways to boost sperm count naturally, you can consult an OVO fertility specialist. ICSI or IMSI treatment can be done to cope with male infertility. For more updates, follow OVO Fertility blog. For complete information on fertility treatment in Delhi, you can call us on the given number +918268260808.

 

SOURCES AND REFERENCES:

  1. ^ Ejaculation | Wikipedia En.wikipedia.org, 20 July 2019
  2. ^ How Often Should a Man Ejaculate? Daily, Weekly, Risks, Benefits, More Healthline.com, 20 July 2019
  3. ^ Erection & Ejaculation | Cleveland Clinic My.clevelandclinic.org, 20 July 2019
  4. ^ Premature Ejaculation: Symptoms, Causes, Treatment, & Prevention Webmd.com, 20 July 2019
  5. ^ Male Reproductive System Information | Cleveland Clinic My.clevelandclinic.org, 20 July 2019
  6. ^ pH Of Human Semen | NCBI Ncbi.nlm.nih.gov, 20 July 2019
  7. ^ Ejaculatory Disorder Evaluation | NCBI Webmd.com, 20 July 2019
  8. ^ Premature Ejaculation - Symptoms and Causes | Mayo Clinic Mayoclinic.org, 20 July 2019
  9. ^ Delayed Ejaculation: Causes, Symptoms, and Diagnosis | Healthline Healthline.com, 20 July 2019
  10. ^ Retrograde Ejaculation | WebMD Webmd.com, 20 July 2019
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7 Comments

Tilak Bahadur

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

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

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

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

Nikhil Pratap

I have Hematospermia, what should I do now?

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

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

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

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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