Ejaculation disorders

The ejaculation The total can vary between 5 and 15 ml, depending on age, arousal and previous abstinence. The expulsion of sperm is not constant but through contractions, the first being the most intense and in which a greater volume is expelled

Ejaculation is a complex mechanism that begins with the stimulation of the pudendal nerves to the spinal cord that sends a stimulus to transport sperm from the epididymis, vas deferens, seminal vesicles, and prostate to the urethra. The internal urethral sphincter closes and the external sphincter relaxes, so that with the rhythmic contractions of the bulbocavernosus muscles the sperm is forced out through the urethra (compressed in turn by the blood-swollen corpora cavernosa) with great momentum and at high speed.

If there is an alteration of this complex mechanism, either at the level of sexual arousal and psychological relaxation to enjoy sex, or of the physical mechanisms involved in the process, an ejaculation disorder will occur.

How do ejaculation disorders occur?

The ejaculation it can be altered in different ways. The main ejaculation disorders are:

• Premature ejaculation, which consists of the lack of control over the ejaculation reflex that occurs earlier than desired, generally between 30 seconds and 7 minutes from the start of sexual activity. It is a common problem that affects 25-40% of men at some point in their life. Most of the time it is due to psychological causes, although there may be organic factors, such as urethral infections, hormonal imbalances or alterations neurological.
• Retrograde ejaculation, in which, at the time of ejaculation, the sperm is expelled into the bladder and not through the urethra. Most of the time it is due to a defect in the bladder neck, which in normal situations contracts and causes the semen to go towards the area of ​​least pressure, the exterior. It is usually due to neurological alterations, prostate surgery or, rarely, to some drugs such as risperidone or tamsulosin.
• Delayed ejaculation, which is the one that occurs later than expected, even not having ejaculation. Most of the time it is due to psychological causes, although it can be due to neurological injuries or the use of certain substances. It does not usually occur during masturbation.

Symptoms of ejaculation disorders

The symptoms of ejaculation disorders are obvious. In premature ejaculation this occurs before its time; in retrograde ejaculation, semen is not expelled upon orgasm, but is subsequently eliminated with urine; and in delayed ejaculation there is no ejaculation or it takes a long time to have sexual intercourse.

Diagnosis

The diagnosis is based on the symptoms that the patient explains. It is possible to differentiate, especially in delayed and sometimes premature ejaculation, if the disorder occurs only when maintaining relationships and disappears when masturbating, which suggests a psychological cause, or if it occurs in both situations, which indicates that there may be a physical origin.

In retrograde ejaculation the alteration will occur both during intercourse and with masturbation. The presence of semen in the urine could be observed after having an orgasm.

Treatment

Treatment of the ejaculation precocious will be based on relaxation measures and psychological therapy. The use of anesthetic lubricants can delay ejaculation and therefore give the patient more confidence. Certain antidepressants (paroxetine, fluoxetine, sertraline) have been shown to prolong the latency period of ejaculation. There is a drug, dapoxetine, which, taken a few hours before sexual intercourse, delays the moment of ejaculation, but its real efficacy, despite being already on the market, is still under study.

Retrograde ejaculation does not have a definitive treatment, although improvements have been described with the use of pseudoephedrine or imipramine. Treatment of delayed ejaculation will be based on psychological therapy.

Precautionary measures

There are no specific preventive measures for the prevention of ejaculation retrograde except to avoid certain drugs that can cause it. With regard to premature or delayed ejaculation, it is advisable to try to enjoy sex without pressure or an excessive emotional charge that can affect ejaculation.