Ejaculatory Disorders 

Ejaculation involves coordinated muscular and neurological events that involve deposition of semen in the urine channel (emission) and ejection of the fluid from the urethral meatus (ejaculation proper). Emission is accomplished by contraction of the vas deferens, seminal vesicles, and ejaculatory ducts. This process is under adrenaline control. Ejaculation proper results from the rhythmic contractions of the muscles around the urethra, which causes the forcible ejection of the ejaculate. Within the spinal cord lies the ejaculation center which is the area involved in the coordination of signals from the brain and penis that eventually lead to ejaculation

There are 4 main ejaculatory disorders that are seen in clinical practice (i) retrograde ejaculation (ii) premature ejaculation (iii) retarded ejaculation (orgasm) and, (iv) failure of ejaculation (anejaculation).

Retrograde ejaculation is the process whereby the semen is passed in a retrograde fashion into the bladder as opposed to out the urethra. There are 3 potential causes to this problem; anatomic (following bladder neck surgery or from a congenital process), neurologic (due to disorders that interfere with the ability of the bladder neck to close during emission, such as diabetes mellitus, retroperitoneal surgery) and pharmacologic (due to paralysis of the bladder neck by certain medications). This process is diagnosed by the finding of seminal fluid and/or sperm within a urine specimen obtained immediately after orgasm.

Premature ejaculation, also known as rapid ejaculation, lacks a definition that is agreed upon by all practitioners but essentially is the condition whereby a patient ejaculates with minimal sexual stimulation and before he wishes it to occur. It can be life-long (primary) or secondary. There are numerous theories as to the cause but most cases are probably multi-factorial with a contribution from both psychological and physical factors. This is believed to be the most common sexual dysfunction in males with almost 30% of men of all ages suffering from this condition. Interestingly however, the quality of life of these patients is not negatively affected by their condition.

Retarded orgasm is a very difficult sexual dysfunction to treat. This condition involves the inability of the patient to achieve orgasm (ejaculation) in a timely manner and in severe cases men fail to achieve orgasm on any occasion. As men age, there is an increase in the time it takes to achieve ejaculation, however, in some men this increase may lead to the inability to ejaculate within a 30 minute time period from the initiation of sexual stimulation.