Premature ejaculation and other ejaculate-related issues

Ejaculation is the organic process that controls the discharge of semen from the seminal vesicles to outside the body. Substances of nutritional and maintenance value are added along the route in order to guarantee vitality and comfort as the spermatozoon travels on its journey to outside the body. This journey can be affected in a number of ways, particularly in terms of duration (premature or retarded ejaculation), destination (retrograde ejaculation) or an absence of ejaculation (anejaculation). Abnormalities in ejaculation are associated with issues when discharging and depositing semen in the vagina. Therefore, the link to fertility issues is clear.

DSM-IV defines premature ejaculation as ‘persistent or recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it.’ Characteristically in these cases, ejaculation always, or almost always, occurs before or after approximately 1 minute following vaginal penetration; the person is unable to delay ejaculation in all or almost all cases of sexual intercourse; and there are negative personal consequences such as distress, worry, frustration and/or a tendency to avoid sexual intimacy which itself has a very negative impact on the patient’s quality of life. It is common in young men and there is a link to erectile dysfunction in up to 30% of patients who experience premature ejaculation.

One of the main causes is a decrease in the frequency of sexual intercourse (a prolonged period of abstinence), as well as psychological abnormalities associated with frustrating or traumatic sexual experiences. It is commonly linked to sexual issues such as anorgasmia and vaginismus in the patient’s partner and involving partners in the treatment process is highly recommendable.

Anejaculation is an absence of ejaculation. It is the most serious of all cases because there is no semen and biopsies or a testicular TFNA are required in order to obtain spermatozoa. The causes of this issue are neuronal and psychological (avoiding sexual encounters).

Retrograde ejaculation is delivery of semen towards the bladder rather than to outside the body. The main causes are pharmacological (use of alpha blockers) and also anatomical abnormalities (further to surgical treatment of prostate pathologies). Spermatozoa can be retrieved from urine using a microscope following ejaculation in these cases. However, the results and quality of the sample are not always as expected.

Retarded ejaculation is late discharge of semen. This can turn into an infertility issue if discharge is so late that the male partner ejaculates outside the vagina.

Treatment in all cases is multi-modal using a combination of pharmacological tools alongside conduct and couple therapy.

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