Reasons for ejaculatory disorders

There are several ways in which the ejaculatory process can become dysfunctional, leading to a partial or complete loss of ejaculation4. These may be of either psychogenic or organic origin, and several drugs are also implicated.

Types of ejaculatory disorders and their possible causes:

• Never any ejaculate: Congenital structural disorder or acquired (radical prostatectomy, post-infectious state, posttraumatic, spinal cord neuropathy)

• Retrograde ejaculation: Transurethral resection of the prostate (25%). Surgery on the neck of the bladder, or extensive pelvic surgery. Retroperitoneal lymph node dissection for testicular cancer (also may produce failure of emission). Neurologic disorders (e.g., multiple sclerosis) and some drugs.

• Retarded ejaculation: Rarely may be caused by an underlying painful disorder (e.g., prostatitis, seminal vesiculitis). May be psychogenic as part of erectile dysfunction. Sympathectomy (e.g., spinal cord injury). Some drugs may impair ejaculation (e.g., certain analgesics, antidepressants, NSAIDs, opiates, alcohol).

• Premature ejaculation: Sexual inexperience. High level of sexual arousal and/or long interval since last ejaculation. Anxiety, guilty feelings about sex, or interpersonal maladaptation (e.g., marital problems, unresponsiveness of partner). Lack of privacy.