Ejaculatory Dysfunction/Anejaculation

    This is a normal Sexual Response Cycle in any human being.

Usually ORGASM coincides with EJACULATION in males. Any sort of disjunction results in Ejaculatory disturbances.

Ejaculatory Poblems are also frequently encountered now a days with all stress in the air getting onto nerves in the present day’s rat race.

The wide spectrum of EjD ranges from

  • Premature or rapid ejaculation
  • Ejaculatory dysfunction( delayed ejaculation)
  • Anejaculation (complete inability to ejaculate)
  • Retrograde ejaculation
  • Painful ejaculation.

Premature Ejaculation- Most commonly encountered problem seen in 5 to 40% of sexually active males that too in youngsters.

Defined as the inability to control ejaculation for a "sufficient" length of time for a few coital thursts or even before vaginal penetration.

Slackly defined, this particular problem arises whenever ejaculation is taking place when both the partners are all set. From a medical viewpoint, doctors explain it as ejaculation that takes place in barely 1 minute of penetration. Though if it happens occasionally there is nothing to worry about but when it takes place on a frequent basis,it could be a serious matter and should be shared with the doctor concerned.

Primary PE(problem for as long as the man has been sexually active)

Acquired PE (development of the condition after having had previous satisfying sexual relationships without problems.) This Categorisation of the disorder helps in proper management of the problem and is often done by proper history from the patient.

Treatment Options include

  • Behavioural Therapy
  • Psychological counselling
  • Pharmocological Therapy (Oral Medication/Injectables)

Ejaculatory Dysfunction/Anejaculation- Delayed ejaculation (DE), or ejaculatory insufficiency, is defined as the inhibition of the ejaculatory reflex, with absent or reduced seminal emission and impaired ejaculatory contractions, possibly occurring concomitantly with reduced or absent orgasm. Delayed ejaculation affects approximately 4% of sexually active men.3If it takes a very long time to orgasm while having sex, you might be suffering from delayed ejaculation,also known as ejaculatory dysfunction. For the males who have experienced premature ejaculation, delayed ejaculation might be very surprising and a dream come true. But truly speaking when delayed ejaculation becomes persistent, it can cause anxiety, nervousness, relationship complications, and makes sex a burden and could be quite a lot of work.

          The diagnostic evaluation of delayed ejaculation or anejaculation usually focuses on

  • Physical causes
  • Psychological causes
  • Acquired causes

A medical examination and patient history are crucial, that might uncover physical anomalies, pathophysiologies and/or iatrogenically induced conditions (e.g. treatment with antihypertensive, antipsychotic or antidepressant drugs, surgical procedures such as retroperitoneal lymphadenectomy or aortoiliac or colorectal surgery) associated with delayed or absent ejaculation.
It is always fetching to give particular attention to identifying reversible urethral, prostatic, epididymal and/or testicular infections.
A complete evaluation should be able to differentiate this sexual dysfunction from other sexual problems (e.g. pain causing interruption of intercourse), and by reviewing the conditions under which the patient is able to ejaculate (e.g. during sleep, with masturbation, with manual or oral stimulation). This way one should identify all possible predisposing, precipitating and maintaining factors for the dysfunction, such as issues of religiosity, coital and masturbatory patterns and/or performance anxiety.

Treatment Options

  • Psychosexual ounselling
  • Oral Medication
  • Vibrostimulation/Electroejaculation especially for patients with Anejaculation.
  • Surgical Retrieval of Sperms as the Final option.

Retrograde Ejaculation

A diagnosis of retrograde ejaculation can be made by eliciting an appropriate history of previous surgical procedures and drug consumption. Retrograde ejaculation can be confirmed by demonstrating presence of sperms in postcoital urine.

A differential diagnosis should always be kept in mind especially for patients who present with absent or low-volume ejaculates (such as anejaculation, obstruction of an ejaculatory duct or seminal vesicle, or congenital anomalies of the accessory sex organs), which includes a complete physical examination and transrectal ultrasonography.
Only after exclusion of a spinal cord injury, urethral anomalies or drug consumption, pharmacological treatment can be offered as a treatment option to men suffering from retrograde ejaculation.
In few cases who do not respond to medications or in those with contraindication for pharmacologic management, spinal cord injuries, or when other medications that induce retrograde ejaculation cannot be suspended, Sperm collection from the urine is considered.

Painful Ejaculation :

Painful Ejaculation is pain during orgasm or ejaculation.

Various causes responsible are

Inflammation of testicles, urethra or prostate

Sexually transmitted infections

Nerve damage in the penis

Chronic Pelvic Pain

Ductal Blockages in the Ejaculatory System

Pelvic Radiation

Prosate Cancer

Psychological causes

Certain Prescription medications

Thorough Medical examination and proper psychosexual history from the patient usually gives the clue to the cause of painful ejaculation thus helping to treat the same. Few Reversible causes like infections, Usage of medications can be promptly treated whereas the rest of conditions need their own protocol to be followed.

Men who have painful ejaculation because of damage to the Nerve to Penis usually recover slowly over a period of 2 to 3 years.

Psychosexual counselling might prove helpful in few cases.