Retarded ejaculation: A condition in which erection is normal, or prolonged, but ejaculation does not occur

Retrograde ejaculation: The valve at the base of the bladder fails to close during ejaculation and the ejaculate is forced backward into the bladder. Erection and sexual pleasure are usually not diminished.

System(s) affected: Reproductive, Nervous

Genetics: No known genetic pattern

Incidence/Prevalence in USA: Premature ejaculation is common (particularly in the adolescent)

Predominant age: All age groups

Predominant sex: Male only

Signs and symptoms

Ejaculation occurring before individual wishes

Ejaculation does not occur following normal erection (including masturbation)

Causes

• Never any ejaculate
  • Congenital structural disorder (Mullerian duct cyst, Wolffian abnormality)  
  • Acquired (radical prostatectomy, postinfectious, post-traumatic, T10-12 neuropathy)

• Retrograde ejaculation
   

  • TURP (25%)  
  • Surgery on the neck of the bladder  
  • Extensive pelvic surgery  
  • Retroperitoneal lymph node dissection for testicular cancer (also can produce failure of emission)  
  • Neurologic disorders, eg, multiple sclerosis  
  • Drugs, eg, amoxapine, desipramine, imipramine

• Retarded ejaculation
   

  • Rarely may be due to underlying painful disorder, eg, prostatitis, seminal vesiculitis  
  • May be psychogenic as part of erectile dysfunction  
  • Sympathectomy, eg, spinal cord injury, diabetes mellitus  
  • Some drugs may impair ejaculation, eg, certain MAO inhibitors, SSRIs, alpha-blockers, antipsychotics, tricyclic antidepressants

• Premature ejaculation
   

  • Sexual inexperience  
  • High level of sexual arousal  
  • Fear of sexually transmitted disease  
  • Anxiety  
  • Guilty feelings about sex  
  • Interpersonal maladaptation (marital problems, unresponsiveness of mate)  
  • Lack of privacy

Risk Factors
Listed with Causes

Diagnosis

Differential Diagnosis: N/A

Laboratory

Laboratory test results are usually normal

Post-ejaculate urinalysis will confirm retrograde ejaculation when infertility is a concern

Drugs that may alter lab results: N/A

Disorders that may alter lab results: N/A

Pathological Findings: N/A

Special Tests
Look for diabetes, multiple sclerosis, spinal cord injury

Imaging: N/A

Diagnostic Procedures
Detailed sexual history

Treatment

Appropriate Health Care
Outpatient

General Measures

Identification of any medical cause (even if not reversible) helps patient accept condition

Improve partner communication

Reduce performance pressure through reassurance

Use sensate focus therapy

Techniques to learn ejaculatory control, e.g., coronal squeeze technique or start-and-stop technique

Use of a variety of resources may be necessary, e.g., psychiatrists, psychologists, sex therapists, vascular surgeons, urologists, endocrinologists, neurologists

If drugs are a possible cause, consider discontinuing or changing dosage

Retrograde ejaculation may be helped if intercourse occurs when bladder is full

Surgical Measures: N/A

Activity
No restrictions

Diet
No special diet except for diabetics

Patient Education
See General Measures

Medications

Drugs of Choice

Premature ejaculation may respond to topical anesthesia gel applied under a condom for 30 minutes prior to intercourse. Clomipramine or sertraline have been shown to delay ejaculation for 4-6 minutes.

Switching antidepressants to bupropion, nefazodone, or mirtazapine or possibly trazodone often eliminates drug-induced ejaculatory disturbance

Retarded orgasm and ejaculation in patients who must continue SSRI drugs may respond to sildenafil

Contraindications: N/A

Precautions: N/A

Significant possible interactions: N/A

Alternative Drugs: N/A

Followup

Patient Monitoring
As needed depending on type of therapy

Prevention/Avoidance
Better sexuality education may reduce problems

Possible Complications
Psychological impact on some males - signs of severe inadequacy, self-doubt, additional anxiety and guilt

Expected Course/Prognosis
Often improves with therapy and counseling

Miscellaneous

Associated Conditions

Neurological disorders, e.g., multiple sclerosis

Prostatitis

Psychological disorders

Interpersonal disorders

Age-Realted Factors

Pediatric: N/A

Geriatric: Age alone does not cause ejaculation problems

Others: N/A

Pregnancy: N/A

Synonyms

Premature ejaculation

Retarded ejaculation

Retrograde ejaculation

Inhibited orgasm in males

ICD-9-CM
608.89 Other specified disorders of male genital organs, other
306.59 Physiological malfunction arising from mental factors, genitourinary, other
302.75 Psychosexual dysfunction with premature ejaculation

See Also: N/A

Other Notes: N/A

Abbreviations: N/A

Author(s)
Bruce Block, MD