ALTHOUGH PREMATURE ejaculation (PE) is by far the most common ejaculatory disorder in men, there are other less common but important ejaculatory disorders to consider.
Generally, disorders of ejaculation fall into one of three categories:
1. disorders of timing of which there are two PE (see articles September 25 & October 2) and retarded (or delayed) ejaculation;
2. disorders of associated pleasure of which there are two absence of pleasure (ejaculatory anhedonia) and painful ejaculation and
3. disorders of partial or complete absence of ejaculation which may be due to retrograde ejaculation, failure of emission, or congenital (existing from birth) or acquired obstruction in the genital tract.
Retarded or delayed ejaculation is the inability to ejaculate despite desire, erection and adequate stimulation except after a prolonged period. It is the least common of the ejaculatory disorders. Some men may believe that this would be an ideal sexual dysfunction to have in terms of sexually satisfying one's partner but in reality it causes significant frustration both in the man and his partner.
Sex is frustrating for the man because the pleasure of orgasm during intercourse is elusive, while in the female partner's case sexual intercourse oftentimes results in soreness and bruising of the genitals because of prolonged intercourse. Moreover, the woman may blame herself, erroneously believing that it is her fault why the man is unable to have an orgasm or she may believe that he no longer finds her sexually appealing.
Retarded ejaculation may be situational (occurs with only one partner) or global (occurs with all partners) and is usually the result of psychological issues but may result from being on prescription medication, recreational drugs or from nerve diseases resulting from trauma or diabetes. Treatment involves identifying and removing any contributing drugs, optimising treatment of any underlying diseases and psychosexual counselling and therapy, where appropriate.
Painful ejaculation manifests as pain either during or immediately after ejaculation and is usually felt at the tip of the penis, along the shaft, in the perineum (region between the scrotum and anus), in the scrotum or deep within the pelvis or 'belly bottom'. It may be associated with blood in the semen (haematospermia) and is usually a consequence of inflammatory or obstructive disorders affecting the genitourinary tract, such as prostatitis, urethritis, epididymitis or urethral strictures. Rarely, tumours such as prostate cancer may cause it. Ejaculatory anhedonia or non-pleasurable ejaculation is believed to be usually the result of some deep-seated emotional / psychological disturbance which requires in depth psychosexual analysis and psychosexual therapy.
If orgasm (the peak in pleasurable sensations accompanying the release of mounting sexual tension) occurs but no ejaculate is propelled from the penis that is referred to as aspermia or a 'dry ejaculate' and may be the result of retrograde flow of semen from the urethra (urine passage) into the urinary bladder as a consequence of an incompetent bladder neck or it may be the consequence of obstruction of the ejaculatory ducts or a failure of emission, that is, no transport of sperm cells along the vas deferens and no seminal fluid secreted from the seminal vesicles.
Retrograde ejaculation may be caused by drugs, operations on the prostate or bladder neck or diseases such as diabetes mellitus which may affect the nerves controlling closure of the bladder neck.
If no orgasm or ejaculation takes place despite adequate arousal and stimulation, that is referred to as an ejaculation and is invariably the result of a failure of nerve transmission due to surgical or accidental trauma to the spinal cord or more peripheral nerves. Treatment is by giving electrical stimulation usually by a probe placed in the rectum to effect ejaculation. This is usually necessary to maintain fertility in the couple.
Thankfully, these ejaculatory disorders are uncommon, nevertheless it is useful to be aware of them so that early recognition and treatment may be instituted should they occur.
Dr. William D. Aiken, consultant urologist, University Hospital of
the West Indies
