Ejaculation problems

About ejaculation problems

The three main ejaculation problems are:

• premature ejaculation
• delayed ejaculation
• retrograde ejaculation

These are described in more detail below. There is also a section discussing ‘blood in your semen’.

Premature ejaculation

Premature ejaculation is the most common ejaculation problem. It's where ejaculation happens too quickly during sex. Occasional episodes of premature ejaculation are common and aren't a cause for concern. If around half your attempts at sex result in premature ejaculation, it might help to get treatment.

Causes of premature ejaculation

Various psychological and physical factors can cause a man to suddenly experience premature ejaculation.

Common physical causes include:

• prostate problems
• thyroid problems – an overactive or underactive thyroid gland
• using recreational drugs

Common psychological causes include:

• depression
• stress
• relationship problems
• anxiety about sexual performance

It's possible but less common, for a man to have always experienced premature ejaculation since becoming sexually active.

Treating premature ejaculation

There are a number of things you can try yourself before seeking medical help, see information on the NHS website.

If you're in a long-term relationship, you may benefit from having couples therapy. During these sessions, the therapist will encourage couples to explore any relationship issues they have. They will also give couples advice about resolving them.

There is also medication that can be used to help treat the condition. See your GP who will be able to discuss the problem with you and discuss treatment options with you.

Delayed ejaculation

Delayed ejaculation (male orgasmic disorder) is classed as either:

• experiencing a significant delay before ejaculation lasting for 30 to 60 minutes
• being unable to ejaculate at all, even though the man wants to and his erection is normal at least half the times you have sex

Causes of delayed ejaculation

Delayed ejaculation can also be caused by psychological and physical factors.

Possible psychological causes of delayed ejaculation are similar to those of premature ejaculation.

Physical causes of delayed ejaculation include:

• diabetes (usually only type 1 diabetes)
• spinal cord injuries
• multiple sclerosis (MS)
• surgery to the bladder or prostate gland
• increasing age

Many medicines are known to cause delayed ejaculation, including:

• antidepressants, particularly SSRIs
• medications to treat high blood pressure, such as beta-blockers
• antipsychotics
• muscle relaxants
• powerful painkillers

Delayed ejaculation can suddenly start to happen after previously having no problems, or the man may have always experienced it.

It may occur in all sexual situations or only in certain situations, such as during sex but not during masturbation. When ejaculation only occurs in certain situations, there's usually a psychological cause.

Treating delayed ejaculation

Sex therapy is a form of counselling that uses a combination of psychotherapy and structured changes in your sex life.

Find information about psychosexual services:

• Belfast Health and Social Care Trust - Psychosexual service
• Relate NI

Availability can vary depending on where you live. You can also pay privately. 

The relationship counselling service Relate also offers sex therapy at a number of its centres. You’ll need to pay for each session. There are a number of alternative medications that can be used if it's thought medication you are currently taking is responsible for causing delayed ejaculation. Your GP can recommend if switching medication is suitable for you.

Alcohol misuse and drug use can be separate underlying causes of delayed ejaculation, so addressing these problems may help.

Retrograde ejaculation

Retrograde ejaculation is a rarer type of ejaculation problem. It happens when semen travels backwards into the bladder instead of through the urethra (the tube that urine passes through).

The main symptoms of retrograde ejaculation include:

• producing no semen, or only a small amount, during ejaculation
• producing cloudy urine (because of the semen in it) when you first go to the toilet after having sex

The condition doesn't pose a danger to health. It can affect the ability to father a child.

Causes of retrograde ejaculation

Retrograde ejaculation is caused by damage to the nerves or muscles that surround the neck of the bladder where the urethra connects.

Usually when you ejaculate, semen is pushed out of your urethra. It’s prevented from entering your bladder by the muscles around the neck of the bladder, which close tightly at the point of orgasm.

Damage to the surrounding muscles or nerves can stop the bladder neck closing, causing the semen to move into the bladder rather than up through the urethra.

The most common causes of retrograde ejaculation include:

• prostate gland surgery
• bladder surgery

Other potential causes include:

• diabetes
• multiple sclerosis
• medicines known as alpha blockers often used to treat high blood pressure (hypertension)

Treating retrograde ejaculation

Most men don’t need treatment for retrograde ejaculation because they’re still able to enjoy a healthy sex life and the condition doesn’t affect their health.

But if treatment is required, your health professional will discuss treatment options with you.

Men who want to have children can have sperm taken from their urine for use in artificial insemination or in-vitro fertilisation (IVF).

Involve your partner

If you're having problems with your sex life and are seeking treatment, it’s usually recommended you involve your partner as much as possible. Communicating your concerns can often help to resolve them. In some cases, your partner may also have their own problems that are contributing towards problems with your sex life.

• Read more about why talking about sex is important.

Blood in your semen

Finding blood in your semen (haematospermia) can be alarming. In most cases it's not serious and will pass within a few days.

The most likely cause is infection of your urethra (urethritis) or prostate (prostatitis).

See your GP or visit your local genitourinary medicine (GUM) clinic if the symptoms persist, because the causes may be more serious.

• Read more about blood in the semen

• Find out more about ejaculation problems on the NHS website

More useful links

• How to use your health services