Delayed ejaculation is less common in men than premature ejaculation. It happens in men under 65 only 3 to 4% of the time.

Delayed ejaculation may occur during all years of a man’s life or it can show up in a specific period. It can happen during sexual intercourse with various partners or it can be intermittent in special occasions. Approximately 75% of men with delayed ejaculation may masturbate and reach orgasm, but many cannot climax even then.

Similar to other cases os sexual dysfunction, men with delayed ejaculation may report high stress levels, sexual disinterest and sexual performance anxiety. Many men with delayed ejaculation, however, do not have difficulty maintaining erection, but are still unsatisfied with their sex life.

Known causes of delayed ejaculation:

• Psychogenic;


• Congenital;


• Anatomic causes: the ability to ejaculate lowers in patients with spinal cord injury and it depends on the injury level and degree;


• Neurogenic causes;


• Infection;


• Endocrine problems;


• Medication side effects;


• Cultural and/or religious matters;

To treat it, the biological causes of the dysfunction may be identified and can be medication, diabetes mellitus or recent pelvic surgery. Had the causes identified, treatment can be optimized.

An indicator of such problem is when the man cannot ejaculate after 20 or 30 minutes of sex or ends up stopping it due to tiredness and irritability. After all possible organic causes are studied, it might be necessary to bring in sexual therapy support to solve the issue.

Retrograde ejaculation happens when a man reaches orgasm and ejaculates on the inside of the bladder as a consequence of bladder neck failure to close during ejaculation and may have diverse origins:

Anatomic Causes – congenital factors or acquired, e.g: endoscopic drying of the prostate.
Neurologic Factors – spine injury, multiple sclerosis, neuropathy as result of diabetes.
Pharmacological Causes – side effects to some medication.

This type of erectile disorder may be confirmed by surgical procedure history, as well as by sperm proof in a simple urine exam done post ejaculation. According to the origins of the problem, a pharmaceutical or surgical treatment may be recommended. Reference: Standard Practice in Sexual Medicine – Hartmut Porst and Jacques Buvat. Medical treatment aims to provoke bladder neck contraction during ejaculation.

Anorgasmia is relatively rare. In case it is primary, it is almost surely psychogenic, but secondary anorgasmia may happen in patients with spine injury or other neurological diseases.

The lack of ejaculation may occur due to abnormalities in sperm production or stocking, or conditions that affect the expulsion process. Psychological causes are usual, but if a man has never ejaculated, an organic cause might be the reason. Congenital anomalies such as lack of seminal vesicles or prostatic gland might also be responsible, although very rare. There are cases in which this absence is a consequence of surgical side effects (as in cancer surgery) with damage to the sympathetic trunks. Radical prostatectomy almost always results in ejaculation loss, although paraurethral gland discharge may cause small emissions. Orgasmic sensations are normal, however there is no semen expelling. Patients with distal neuropathy, specially diabetics and those with neuromuscular diseases such as multiple sclerosis, may have aspermia for lack of epididymis, deferential, seminal vesicles and prostate contraction. The absence of ejaculation might also be due to lack of formation of the necessary material for it. In the case of material absence or decrease, retrograde ejaculation must be considered.

The presence of blood in the ejaculation usually worries the patient, though it is often benign. In young men, under 40, it may be a genital tract infection that should be treated accordingly. In older men it may be associated to cysts, stones in seminal ways, polyps in the ejaculating ducts and seminal vesicles. Fortunately, the detected prostate adenocarcinoma with hemospermia index is of only 1 to 3%.