Everything You Need to Know About Premature Ejaculation.
NOTICE: This article is for educational and medical purposes only. It does not contain explicit or adult content.
Premature ejaculation (PE) is one of the most common sexual concerns affecting men worldwide. It occurs when a man ejaculates sooner than desired during sexual activity, often causing stress, frustration, and relationship challenges. Understanding the causes, symptoms, and available treatments can help men regain control, improve sexual satisfaction, and strengthen their intimate relationships. learn Everything You Need to Know About Premature Ejaculation.
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| Everything You Need to Know About Premature Ejaculation. |
1. Premature Ejaculation
Quick Facts
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Premature ejaculation happens when ejaculation occurs too soon—usually before or shortly after penetration.
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The most common causes are anxiety, psychological factors, or increased penile sensitivity.
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Behavioral therapy, including techniques to delay ejaculation, can help most men.
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(See also: Overview of Male Sexual Function and Sexual Dysfunction.)
Understanding Premature Ejaculation
Premature ejaculation often creates stress and tension within a couple. Many specialists believe that the condition is almost entirely linked to anxiety or psychological causes. Others argue that it may result from heightened sensitivity of the penis.
Having sexual activity less frequently than desired may worsen the issue by making sensitivity even higher.
In rare cases, premature ejaculation can be triggered by a medical disorder—such as prostate inflammation, overactive thyroid (hyperthyroidism), or neurological conditions—but these situations are uncommon.
2. Treatment for Premature Ejaculation
Behavioral Therapy
Behavioral therapy can help many men overcome premature ejaculation. A trained therapist provides reassurance, explains the causes of premature ejaculation, and teaches men practical strategies to delay ejaculation.
Other methods can also help, including medications such as selective serotonin reuptake inhibitors (SSRIs) — fluoxetine, paroxetine, sertraline — or the tricyclic antidepressant clomipramine.
Topical treatments that reduce penile sensitivity, such as lidocaine cream or condoms, may also help delay ejaculation.
In some cases, a combination of medication and behavioral therapy is needed. When premature ejaculation is linked to deeper psychological issues, psychotherapy may be especially beneficial.
Learning to Delay Ejaculation
Two well-known techniques are commonly used to treat premature ejaculation. Both approaches also reduce anxiety, which often increases the severity of the problem.
Each technique trains men to reach high levels of arousal without ejaculating. These methods involve either self-stimulation (during masturbation) or stimulation by a partner until ejaculation feels imminent. When practiced with a partner, stimulation begins manually and later progresses to stimulation before or during intercourse.
1. The “Start–Stop” Technique
Stimulation is paused as soon as ejaculation feels close. Once the urge decreases, stimulation resumes.
2. The Squeeze Technique
The man or his partner squeezes, for 10–20 seconds, the area where the head of the penis meets the shaft. This helps prevent ejaculation and slightly reduces the erection. Stimulation can start again after about 30 seconds.
With consistent practice, over 95% of men learn to delay ejaculation by 5–10 minutes or more.
When Delayed Ejaculation Is the Problem
Delayed ejaculation (sometimes called “difficulty ejaculating”) is another timing-related sexual dysfunction. Men with this condition require prolonged stimulation to reach ejaculation. Some need 30 minutes or more. Others may stop due to fatigue, frustration, skin irritation, pain, or may be completely unable to ejaculate.
In many cases, delayed ejaculation is linked to psychological factors, but physical causes can contribute as well — such as erectile dysfunction or specific medications (notably SSRIs).
Treatment for Delayed Ejaculation
Treatment typically involves correcting underlying erectile dysfunction and using psychosexual therapy. Certain medications — such as cabergoline and bupropion — may also offer relief for some men.
Retrograde Ejaculation
What Is Retrograde Ejaculation?
Retrograde ejaculation happens when semen flows backward into the bladder instead of exiting through the penis during orgasm.
(See also: Overview of Male Sexual Function and Sexual Dysfunction.)
Normally, the bladder neck closes tightly during ejaculation to prevent semen from entering the bladder. In retrograde ejaculation, the bladder neck stays open, causing semen to move backward into the bladder.
One of the most common causes is prostate surgery performed for benign prostate enlargement. Other frequent causes include:
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Diabetes
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Spinal cord injuries
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Certain medications
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Major abdominal or pelvic surgery
Symptoms and Effects
Men with retrograde ejaculation still experience orgasm, but the amount of semen released from the penis is greatly reduced. In some cases, no visible semen comes out at all.
Retrograde ejaculation is harmless, but it can cause infertility because sperm does not exit the body normally.
Diagnosis
Doctors diagnose retrograde ejaculation by finding a high concentration of sperm in a urine sample collected shortly after orgasm.
Treatment for Retrograde Ejaculation
Medications
Most men do not need treatment unless they are trying to conceive.
About one-third of men improve with medications that help close the bladder neck, such as:
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Pseudoephedrine
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Imipramine
However, these medications can increase heart rate and blood pressure, so regular medical supervision is essential. Because of these risks, such treatments are usually limited to men who are experiencing infertility.
Assisted Reproductive Options
If medications and infertility treatments are unsuccessful, sperm can be collected directly from the urine for use in artificial insemination.
Overview of Male Sexual Function and Dysfunction
Normal Male Sexual Function
Male sexual function refers to the ability to engage in sexual activity and experience sexual satisfaction. Sexual dysfunction describes difficulties in performing sexual activities and can affect various aspects, including:
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Sexual desire (libido)
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Ability to achieve or maintain an erection (erectile dysfunction or impotence)
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Ability to ejaculate
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Ability to achieve an erection without penile deformity
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Ability to reach orgasm
Causes of Sexual Dysfunction
Sexual dysfunction may result from physical factors, psychological factors, or a combination of both.
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A physical problem may lead to psychological issues such as anxiety, depression, or stress, which in turn can worsen the physical condition.
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Men may experience performance anxiety, feeling pressure to achieve a certain sexual standard for their partner. Performance anxiety can become overwhelming and reduce sexual pleasure.
Ejaculation Disorders
Ejaculation problems are the most common sexual dysfunctions in men and include:
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Premature ejaculation: ejaculation occurs before or shortly after vaginal penetration
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Retrograde ejaculation: semen flows backward into the bladder
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Anorgasmia: inability to ejaculate
Erectile Dysfunction and Libido
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Erectile dysfunction is common in middle-aged and older men.
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Decreased libido also affects some men, reducing sexual interest and activity.
Normal Male Sexual Function
How Normal Male Sexual Function Works
Normal sexual activity results from a complex interaction between the mind and body. The nervous system, endocrine (hormonal) system, and circulatory system work together with the brain to produce a sexual response. In men, sexual response relies on a delicate balance among these systems.
Sexual desire (also called libido) is the drive to engage in sexual activity. It can be stimulated by thoughts, words, sights, smells, or touch. Desire leads to the first stage of sexual response: arousal.
Arousal and Erection
During arousal, the brain sends nerve signals to the spinal cord and penis. Arteries supplying blood to the erectile tissues (corpora cavernosa and corpus spongiosum) dilate, increasing blood flow. The erectile tissues fill with blood, expanding in size, which compresses veins to slow blood outflow, raising pressure within the penis and producing an erection. Muscle tension throughout the body also increases.
Plateau Phase
At this stage, arousal and muscle tension intensify, preparing the body for orgasm.
Orgasm and Ejaculation
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Orgasm is the peak of sexual excitement. Muscle tension rises further, and pelvic muscles contract just before ejaculation.
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Ejaculation occurs when nerves trigger contractions in male reproductive organs, including the seminal vesicles, prostate, epididymis, and vas deferens. These contractions push semen into the urethra. Muscles around the urethra propel semen out of the penis, while the bladder neck contracts to prevent semen from flowing backward into the bladder.
Although ejaculation and orgasm usually occur together, they are separate events. Occasionally, ejaculation can occur without orgasm, and orgasm can occur without ejaculation, especially before puberty, as a side effect of certain medications (e.g., antidepressants), or after surgery (such as colon or prostate surgery). Orgasm is generally highly pleasurable.
Recovery After Orgasm
After ejaculation or orgasm, arteries in the penis constrict, and smooth muscles in the erectile tissues contract. Blood outflow increases, causing the penis to become flaccid (detumescence). Men experience a refractory period during which they cannot achieve another erection, typically about 20 minutes, shorter in young men and longer in older men. This interval tends to increase with age.
Sexual Activity and Heart Conditions
Sexual activity is generally less strenuous than moderate or intense physical exercise and is not prohibited for men with heart disease. The risk of a heart attack during sexual activity is slightly higher than at rest but remains very low.
Men with cardiovascular conditions — including angina, high blood pressure, heart failure, arrhythmias, or aortic valve obstruction — should consult their doctor before resuming sexual activity.
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Sexual activity is usually safe if the heart condition is mild, symptoms are minimal, and blood pressure is normal.
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For moderate or complex conditions, tests may be needed to confirm safety.
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In severe cases, such as obstructive cardiomyopathy, sexual activity should be postponed until treatment reduces symptoms.
Men should ask their doctor how soon after a heart attack it is safe to resume sexual activity. The American Heart Association recommends returning to sexual activity within a week if light-to-moderate physical activity does not cause chest pain or shortness of breath.
Important: Medications like sildenafil, vardenafil, avanafil, or tadalafil are dangerous for men taking nitroglycerin, as blood pressure can drop to unsafe levels.
A common test for sexual activity safety involves monitoring the heart while the man exercises on a treadmill. If the heart receives sufficient blood flow during exercise, a heart attack during sexual activity is very unlikely.
Low Libido in Men
Low libido refers to a decreased sexual desire in men.
Causes
Common causes include:
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Psychological factors: depression, anxiety, relationship problems.
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Medications that affect sexual function.
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Low blood testosterone levels (hypogonadism).
Depending on the cause, doctors may recommend psychological counseling, medication changes, or testosterone replacement therapy.
Variability and Age
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Libido varies among men and may temporarily decrease during periods of fatigue or stress.
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It tends to decline gradually with age.
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Persistently low libido can strain relationships.
Some men may have low libido throughout life, sometimes due to childhood sexual trauma or deliberate suppression of fantasies. Most often, however, low libido develops after years of normal sexual desire, typically linked to psychological factors, depression, anxiety, or relationship issues.
Chronic kidney disease and certain medications (e.g., for depression, anxiety, or advanced prostate cancer) can also reduce libido by lowering testosterone levels. Low testosterone is common in older men.
Symptoms
Men with low libido:
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Think less about sex and have fewer fantasies.
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Engage in sexual activity less often.
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May still perform sexually, often to satisfy a partner, but without interest or desire.
Diagnosis
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Blood tests measure morning testosterone levels (before 10 a.m.), as testosterone peaks early in the day.
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Low morning testosterone combined with symptoms confirms hypogonadism.
Treatment
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Psychological causes: cognitive-behavioral therapy and couples counseling may help.
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Low testosterone: replacement therapy via patch, gel, or injection.
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Testosterone therapy may reduce testicular function, leading to reduced sperm production and potential infertility.
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Only men with objectively low testosterone (<300 ng/dl) should consider treatment.
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Erectile Dysfunction (ED)
ED is the inability to achieve or maintain an erection sufficient for sexual activity.
Types
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Primary ED: never achieved a functional erection.
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Secondary ED: develops later in life after previously normal erections. Secondary ED is more common.
Causes
Erections require:
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Adequate blood flow to the penis and proper venous occlusion.
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Proper nerve function.
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Sufficient testosterone.
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Adequate libido.
Most ED cases are due to vascular or nerve problems. Other causes include:
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Hormonal disorders (e.g., low testosterone).
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Structural issues in the penis (e.g., Peyronie’s disease).
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Certain medications (e.g., for blood pressure, depression, or prostate issues).
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Psychological factors (stress, anxiety, performance pressure).
Common contributors: atherosclerosis, diabetes, prostate surgery, medications affecting the nervous system.
Evaluation
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ED can be temporary, but persistent issues warrant medical evaluation.
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Doctors assess symptoms, medical history, medications, vascular health, neurological and hormonal status, and psychological factors.
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Tests may include blood tests, hormone levels, diabetes evaluation, and penile ultrasound.
Treatment
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Address underlying conditions (e.g., change medications, manage diabetes or vascular disease).
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Lifestyle changes: weight loss, smoking cessation, reduced alcohol intake.
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Education and counseling: include partner involvement, stress reduction, and sexual therapy.
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Medications: oral phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil, avanafil) are first-line therapy.
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Other medications: injectable prostaglandins or urethral suppositories if oral therapy fails.
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Mechanical devices: vacuum erection devices, constriction rings.
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Surgery: penile implants (rigid or inflatable) for severe ED not responsive to other treatments.
Key points: ED increases with age but is treatable at any age. Most men respond well to oral PDE5 inhibitors, and mechanical or surgical options are highly effective for severe cases.
Inability to Ejaculate (Anejaculation)
Anejaculation is usually caused by inability to reach orgasm (anorgasmia) and is often linked with ED.
Causes
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Prostate surgery: nerves may be damaged or seminal vesicles removed, preventing sperm production.
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Nerve damage from other conditions.
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Medications or psychological factors can also interfere.
Ejaculation retrograde (semen flows into the bladder) may cause an apparent lack of semen.
Diagnosis
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Based on symptoms, physical exam, and urine analysis after orgasm.
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No semen in urine confirms anejaculation; semen in urine suggests retrograde ejaculation.
Treatment
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Depends on cause: stopping causative medications, psychotherapy, or medications like pseudoephedrine or imipramine.
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For fertility purposes: penile vibrators or electro-ejaculation may be used.
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Surgical removal of prostate and seminal vesicles prevents natural sperm production; sperm may be retrieved directly from testes for IVF or ICSI.
Male Sexual Dysfunction: Low Libido, Erectile Dysfunction, and Inability to Ejaculate
Meta Description: Discover the causes, symptoms, and treatments for male sexual dysfunction, including low libido, erectile dysfunction (ED), and anejaculation. Learn how medical treatments, therapy, and lifestyle changes can help restore sexual health.
Introduction
Male sexual dysfunction affects millions of men worldwide, impacting relationships, confidence, and overall quality of life. Common conditions include low libido, erectile dysfunction (ED), and inability to ejaculate (anejaculation). Understanding the causes and treatment options is essential for men and their partners.
Low Libido in Men
Low libido is a decreased desire for sexual activity.
Causes
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Psychological factors: depression, anxiety, or relationship issues.
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Medications: antidepressants, prostate cancer treatments, and other drugs affecting hormones.
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Hormonal deficiencies: low testosterone levels (hypogonadism).
Symptoms
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Reduced sexual thoughts or fantasies.
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Less frequent sexual activity.
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Possible sexual performance only for partner satisfaction without personal interest.
Diagnosis and Treatment
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Blood tests measure testosterone in the morning (before 10 a.m.) to detect deficiencies.
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Psychological causes: therapy, stress management, and couples counseling.
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Low testosterone: patches, gels, or injections may help, but may affect fertility.
Internal Link Suggestion: Link to Dysfunction Erectile (ED) when discussing sexual performance.
Erectile Dysfunction (ED)
Erectile dysfunction is the inability to achieve or maintain an erection suitable for sexual activity.
Causes
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Vascular problems: atherosclerosis, diabetes, or poor blood flow.
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Neurological issues: nerve damage from diabetes, surgery, spinal injury, or multiple sclerosis.
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Hormonal disorders: low testosterone.
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Psychological factors: anxiety, stress, or performance pressure.
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Medications and lifestyle: certain drugs, alcohol, and smoking.
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Structural issues: Peyronie’s disease (penile curvature).
Evaluation
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Medical history, medications, and physical examination.
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Blood tests for testosterone, diabetes, and cholesterol.
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Imaging or specialized tests for severe cases.
Treatment
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Lifestyle changes: weight management, stop smoking, reduce alcohol.
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Medications: oral PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil).
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Mechanical devices: vacuum erection devices, constriction rings.
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Injectables: alprostadil injections or urethral suppositories.
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Surgery: penile implants for severe cases unresponsive to other treatments.
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Psychological support: therapy, stress management, and partner counseling.
Tip: ED increases with age but is treatable at any age. Early consultation improves outcomes.
Inability to Ejaculate (Anejaculation)
Anejaculation is the inability to ejaculate, often associated with ED or inability to reach orgasm.
Causes
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Surgery: prostate or pelvic surgery can damage nerves or remove seminal vesicles.
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Nerve disorders: from injury or certain medical conditions.
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Medications and psychological factors affecting orgasm.
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Retrograde ejaculation: semen flows into the bladder instead of out through the penis.
Diagnosis
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Urine analysis after orgasm differentiates anejaculation from retrograde ejaculation.
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Physical exam and symptom evaluation guide treatment.
Treatment
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Medication adjustments or discontinuation.
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Psychotherapy for psychological causes.
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Stimulation techniques: penile vibrators or electro-ejaculation for fertility purposes.
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Assisted reproduction: sperm retrieval from testes for IVF or ICSI if natural ejaculation is impossible.
Conclusion
Male sexual dysfunction is common and treatable. Whether the issue is low libido, ED, or anejaculation, early evaluation by a healthcare professional is essential. Treatments range from medications and mechanical devices to therapy and lifestyle interventions, allowing men to restore sexual health, satisfaction, and quality of life.
References (Medical Sources)
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Jimbo M, Gomella LG. Presentation of Male Sexual Function and Dysfunction. Thomas Jefferson University Hospital. Reviewed Sept. 2024.
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Mayo Clinic. Erectile Dysfunction.
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Merck Manuals. Low Libido in Men.
