As different as the symptoms are, so many are the possible causes. Both psychological and physical triggers come into question. Likewise, a combination of several causes is conceivable.
Premature ejaculation
Physicians speak of "ejaculatio precox", when in men the average time between the beginning of stimulation and ejaculation is regularly less than one minute. In addition, the ejaculation can not be controlled and creates a psychological strain in the man. If premature ejaculation is associated with prolonged sexual abstinence, new experiences in sexual life, or drug-related effects, there is no ejaculatory precocox.
The premature ejaculation is predominantly psychological, but can also have physical causes. In a lifelong premature ejaculation, the cause is often physical. If the problem was "acquired" at a later date, psychic triggers are usually present.
Mental causes can be, for example, various fears, communication problems between the partners as well as a technique of ejaculation control that requires optimization.
In addition, physical causes of Ejaculatio praecox are known. Premature ejaculation may also occur due to hypersensitivity of the penis or be a concomitant of prostate or urethritis as well as erectile dysfunction.
Depending on the diagnosed cause and the current course of treatment, premature ejaculation is treated with drugs from the pharmacology (drugs) or methods from the psychotherapeutic field. The success rate of a psychotherapeutic therapy is about 50%. Overall, an estimated 80% of affected men report improvement.
Retrograde ejaculation
In retrograde (backward) ejaculation, the seminal fluid is misdirected and expelled into the bladder. Accordingly, in ejaculation only very little or no ejaculate is detectable. The sperm are excreted in the urine.
In the case of the affected man's orgasm, little or no ejaculate occurs. Also, a turbidity of the urine after the traffic may be an indication of this disease.
The cause of retrograde ejaculation may be congenital or acquired later, as well as following previous medical treatment. The disease is caused by problems in the inner bladder sphincter. Often the retrograde ejaculation is a concomitant of prostatitis or other prostate diseases. Likewise, multiple sclerosis, diabetes or hemorrhoids as a trigger in question. Also, a drug therapy for lowering blood pressure and medications, such as certain antidepressants, can cause this disease. Furthermore, it is possible that the retrograde ejaculation is related to surgery on the abdomen, pelvis or limb. The congenital causes include malformations of the bladder neck or the vas deferens or a disturbed sympathetic nervous system.
The diagnosis "retrograde ejaculation" is made after the examination of a urine sample of the man, which is obtained if possible following sexual intercourse or masturbation. If sperm are detected in the urine, the cause research can be started.
This ejaculation disorder may require lengthy therapy. The success of the treatment is strongly dependent on the trigger of this disease. If the problem was caused by a drug, the doctor should consider possible alternatives. If the drug in question can be discontinued or replaced, ejaculation should soon return to normal. In some patients, an electrical stimulation can be successful. This is especially true for patients with paraplegia. Often, retrograde ejaculations are also treated with antihistamines. This drug is intended to prevent backflow of sperm. However, antihistamine supplements may more or less lead to marked side effects such as fatigue or heart rate and blood pressure problems.
Unfortunately, if the problem was caused by damage to relevant nerves, successful treatment is hardly possible. However, in the case of an unfulfilled desire to have a baby, the sperm can be filtered out of the urine and reused with reproductive medical techniques. Depending on the treatment cycle, the probability of success in this case is about 10-15%.
Painful ejaculation
Among the various sexual ailments, the painful ejaculation for affected men is a particularly incisive experience. This disorder is often associated with prostate disease, but may also have other causes. The symptoms are similar to those of the penis fracture. Depending on the cause, the painful ejaculation can cause urosepsis (infectious disease with bacteria). If this bacterial infection is detected, medical treatment must be performed as soon as possible.
The symptoms are mainly related to the man's orgasm. In ejaculation sufferers feel a sharp and very unpleasant pain in the abdomen, especially in the area between the scrotum and the anus, which is referred to as a dam. In some cases, the sperm may also show a red or brownish discoloration.
In the majority of cases, a painful ejaculation is not innate, but occurs only in the course of life. Pain associated with ejaculation is often caused by prostate disease. The organ, also known as the prostate gland, can either be inflamed or significantly enlarged, which can lead to the sensation of pain during ejaculation. Other triggers include urethritis, closure of one or both injection channels, and dysfunction of autonomic nerves. But also a psychological cause is possible.
As part of a diagnosis, the doctor will ask the man relevant questions about sexual life. It helps to provide the patient with the most accurate description of the pain. Also accidents and other traumatic experiences are important and should be mentioned. Likewise, certain drugs as well as current and past infections may be a possible cause and should be mentioned accordingly. In the course of the cause research, microbiological examinations as well as sonographic imaging of the ureteral system and the testes are usually performed.
To enable the patient to have a pain-free sex life, the doctor must first of all treat the diagnosed cause of the pain. Sex therapy or psychological counseling can be helpful. If the cause is of a physical nature, treatment of the causative disease will be required. If there is an infection, the responsible bacteria are combated with antibiotics. In some patient groups, electrostimulation is often promising. If neurological problems exist, appropriate treatment may also be necessary here.
Late ejaculation
If the orgasm and with this ejaculation greatly delayed, doctors speak of an ejaculatio retarda. If this is completely absent, there is talk of an anechoic. It is not excluded that in rare cases the ejaculation does not occur despite orgasm. The likelihood of suffering from this sexual dysfunction increases with advancing age. Especially affected are men from the age of 40 years.
It is hardly surprising that this situation can be a significant psychological burden for affected men, which means stress for both partners in the relationship. Couples affected by the man often have difficulty naturally fulfilling their desire to have children.
If men are affected by this ejaculation disorder, this is often noticeable by orgasm inhibition. The sexual climax occurs very late or not at all. As a consequence, the ejaculation remains.
Often the cause is diagnosed as a hormonal disorder due to a lack of testosterone (such as hypogonadism) or thyroid dysfunction. Certain medications can also have a negative effect on ejaculation. This is especially true in drugs for the treatment of psychosis, depression and so-called alpha-blockers and some tranquilizers.
An increased risk of this ejaculation disorder is associated with the abuse of drugs. This can affect both heavy drinking and other intoxicants.
Furthermore, this form of ejaculation disorder may also occur due to damaged nerves. Men with spinal injuries as well as persons suffering from multiple sclerosis or diabetes have an increased risk in this respect.
In some men, penile sensitivity decreases at an advanced age or due to intense masturbation, which may also result in an inhibited ability to orgasm.
Finally, mental causes of delayed or absent ejaculation are also considered. It is believed that in these cases, the trigger is found in childhood.
In a first conversation with the patient, the doctor gets a preliminary picture of the extent of the disorder and gets the necessary information on any existing diseases. Subsequent palpation of the penis and testicles clarifies the degree of touch sensitivity present. On the basis of the results the further cause research takes place. Using a urine test and a blood test in the laboratory, the doctor can detect possible triggering illnesses (such as diabetes), diseases of the heart or a reduced testosterone level.
The treatment plan depends on the diagnosed cause. Accordingly, the further procedure may differ individually. In many men, an increase in stimulation already helps reduce the rate of ejaculation delay. Affected couples should therefore talk about the problem and their own sexual preferences and desires. If the man takes ejaculation-inhibiting medication, it can sometimes be helpful to consider switching or reducing the dose after medical consultation.
Basically, it is important to treat the causative disorder. So it is in hypogonadism to increase the testosterone levels by an artificial dose of the hormone. If no specific cause can be found out, various medicines are known which are approved for other indications, but which are also said to promote ejaculation. Since these can have different side effects, men should discuss this option very carefully with the doctor.
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