Ejaculatory Dysfunction

Ejaculatory Dysfunction or Problems with Ejaculation is a common Sexual Health Problem in Men.

It can be divided into:

• Premature Ejaculation (PE)
• Delayed Ejaculation (DE)
• Retrograde Ejaculation (RE)
• Anejaculation (AE)

Premature Ejaculation

Ejaculating in less than 1 minute from start of intercourse or before intercourse. This is the most prevalent form of Male sexual Dysfunction. Definition of what constitutes Premature Ejaculation varies but most agree that ejaculation before penetration is troublesome. Most ejaculatory problems are hormonally mediated and involve neurotransmitters like dopamine and serotonin.

Delayed Ejaculation

Delayed Ejaculation is characterized by a man’s inability to ejaculate in a reasonable period under normal sexual stimulation.

Retrograde Ejaculation

Retrograde Ejaculation occurs when the semen intended for propulsion out the urethral meatus is directed backwards into the urinary bladder. This is most commonly due to intrinsic problems with the internal sphincter of the bladder.

Anejaculation Ejaculation

Anejaculation specifically refers to the lack of ejaculation that may or may not be coupled with an orgasm.

Pharmacologic treatments for PE exist, and off-label therapy with selective serotonin reuptake inhibitor (SSRIs) is currently the most favoured clinical approach. SSRIs exhibit the well-established side effect of delaying ejaculation and, at higher doses, causing AE and anorgasmia.

It is also important to understand that EJD coexists with Benign Prostatic Hypertrophy (BPH) and Lower Urinary Tract Symptoms(LUTS) in men. The drugs used to treat BPH like Tamsulosin are notorious in causing Retrograde Ejaculation.

Anejaculation can be treated with Sympathomimetic drugs, vibrators and electroejaculation. The penile vibrator acts by providing a strong stimulus for a long duration to the penis. Vibrator stimulation results in ejaculation in about 60% of men suffering from a neurological (spinal cord) injury. This is a simple and quite effective way of retrieving semen in people with anejaculation.In electroejaculation, an electrical current is applied through the rectum under anaesthesia in normal individuals and without anaesthesia in people with neurological injuries.

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