Ejaculation problems are common sexual problems in men and those with a penis. There is no shame in experiencing sexual problems related to ejaculation. 

The 3 main types of ejaculation problems are: 

  • premature ejaculation 
  • delayed ejaculation 
  • retrograde ejaculation 

Premature ejaculation 

Premature ejaculation is a common ejaculation problem. It's where the individual ejaculates quickly during sexual arousal. 

Occasional episodes of premature ejaculation are common and are not a cause for concern. However, if you're finding that it happens more than you'd like, and it's a problem for you, it might help to get treatment. 

Causes of premature ejaculation  

Various psychological and physical factors can cause a man or penis owner to suddenly experience premature ejaculation. 

Common physical causes include: 

  • prostate problems 

  • thyroid problems – an overactive thyroid or an underactive thyroid 

  • using recreational drugs 

Common psychological causes may include: 

  • depression 

  • stress 

  • relationship problems 

  • anxiety about sexual performance (particularly at the start of a new relationship, or when a man has had previous problems with sexual performance) 

It's possible for a man or person with a penis to have experienced premature ejaculation since becoming sexually active. Several possible causes for this are: 

  • Conditioning: it's possible that early sexual experiences can influence future sexual behaviour. For example, if a teenager conditions himself to ejaculate quickly to avoid being caught masturbating, it may later be difficult to break the habit 

  • A previous traumatic sexual experience: this can range from being caught masturbating to sexual abuse 

  • Strict upbringing or beliefs around sex  

Treatments

Antidepressants 

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant, but they also delay ejaculation. SSRIs used for this purpose include: 

  • paroxetine 

  • sertraline 

  • fluoxetine 

  • Another type of antidepressant called clomipramine is also sometimes used. 

Some men and penis owners may experience an improvement a few days after treatment begins. However, you'll usually need to take the medicine for 1 to 2 weeks before you notice the full effects. 

Side effects of SSRIs are usually mild and should improve after 2 to 3 weeks. They include: 

  • feeling sick and being sick 

  • diarrhoea 

  • excessive sweating (hyperhidrosis) 

Dapoxetine (Priligy) 

An SSRI specifically designed to treat premature ejaculation, known as dapoxetine (Priligy), has been licensed in the UK. Local NHS authorities can choose to prescribe it on the NHS. 

It acts much faster than the other SSRIs used for premature ejaculation and can be used "on demand". You'll usually be advised to take it between 1 and 3 hours before sex, but not more than once a day. 

Your response to the treatment will then be reviewed after 4 weeks (or after 6 doses), and again every 6 months. 

Dapoxetine is not suitable for all men and people with a penis diagnosed with premature ejaculation. For example, it is not recommended for some men, and penis havers with heart, kidney and liver problems. It can also interact with other medicines, such as other antidepressants. 

Common side effects include: 

  • headaches 

  • dizziness 

  • feeling sick 

Phosphodiesterase-5 inhibitors 

Phosphodiesterase-5 inhibitors, such as sildenafil (sold as Viagra), are a class of medicine used to treat erectile dysfunction. Research has found that they may also help with premature ejaculation. 

You can get sildenafil on prescription or buy it from a pharmacy after a discussion with the pharmacist to make sure it's safe for you to take.

Delayed ejaculation 

Delayed ejaculation (male orgasmic disorder) is classed as either: 

  • experiencing a significant delay before ejaculation 

  • being unable to ejaculate at all, even though the man wants to and his erection is normal 

You may have delayed ejaculation if you're unable to ejaculate more than half the times you have sex. 

Causes of delayed ejaculation 

Like premature ejaculation, delayed ejaculation can be caused by psychological and physical factors. 

Possible psychological causes of delayed ejaculation are like those of premature ejaculation – for example, relationship problems, stress or depression. 

Physical causes of delayed ejaculation include: 

  • diabetes 

  • spinal cord injuries 

  • multiple sclerosis 

  • surgery to the bladder or prostate gland 

  • increasing age 

Many medicines are known to cause delayed ejaculation, including: 

  • antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) 

  • medicines to treat high blood pressure, such as beta-blockers 

  • antipsychotics, used to treat episodes of psychosis 

Delayed ejaculation can suddenly start to happen after previously having no problems, or (less commonly) the man or penis haver may have always experienced it. 

Retrograde ejaculation 

Retrograde ejaculation is a rarer type of ejaculation problem. It happens when semen travels backwards into the bladder instead of through the urethra (the tube that urine passes through). 

The main symptoms of retrograde ejaculation include: 

  • producing no semen, or only a small amount, during ejaculation 

  • producing cloudy urine (because of the semen in it) when you first go to the toilet after having sex 

Men and people with a penis with retrograde ejaculation still experience the feeling of an orgasm and the condition does not pose a danger to health. However, it can affect the ability to procreate. 

Causes of retrograde ejaculation 

Retrograde ejaculation happens when the neck of the bladder does not close and semen passes into the bladder. 

Usually when you ejaculate, semen is pushed out of your urethra. It is prevented from entering your bladder by the muscles around the neck of the bladder, which close tightly at the moment of orgasm. 

However, damage to the surrounding muscles or nerves can stop the bladder neck closing, causing the semen to move into the bladder rather than up through the urethra. 

Causes of retrograde ejaculation include prostate gland surgery, bladder surgery, diabetes, multiple sclerosis, and a class of medicines known as alpha blockers, which are often used to treat high blood pressure (hypertension). 

Treating retrograde ejaculation 

Most men and people with a penis do not need treatment for retrograde ejaculation because they are still able to enjoy a healthy sex life and the condition does not have adverse effects on their health. 

But if treatment is required (usually because of wanting to procreate) there are options to try. 

For example, pseudoephedrine (commonly used as a decongestant) has proved effective in treating retrograde ejaculation caused by diabetes or surgery. 

If retrograde ejaculation is caused by using a certain medicine, then normal ejaculation will usually return once medicine is stopped. Speak to your GP before stopping any prescribed medicine. 

However, if the retrograde ejaculation has been caused by significant muscle or nerve damage, treatment may not be possible. 

Men and people with a penis who want to have children can have sperm taken from their urine or testicles for use in intrauterine insemination or in-vitro fertilisation (IVF). 

Commonly asked questions:

'Can you orgasm without ejaculating?' 

Male ejaculation happens when a man or penis with a penis shoots semen from the penis. This is usually as an end result of the muscular contractions that happen during an orgasm. 

It’s perfectly possible for men and people with a penis to have an orgasm without ejaculation. 

You can also ejaculate without having an orgasm.