EJACULATION DYSFUNCTION

There are three main ejaculation dysfunctions:

Delayed (Retarded) Ejaculation - when ejaculation is slow to occur.

Retrograde Ejaculation - the ejaculate (semen) is directed  back into the bladder rather than through the urethra and out of the penis. It is typically caused by malfunction of the bladder sphincter  semen  is relatively rare and does not normally affect a man's ability to have sex. This condition is unusual for the general population but does occur for men on certain medications or after prostate surgery. Retrograde ejaculation typically doesn't require treatment unless it interferes with fertility.

Premature Ejaculation(PE) - when ejaculation occurs too quickly.

Premature ejaculation is, by far, the most common of the three ejaculation dysfunctions and a main interest to most of our website visitors. This page will focus on understanding ejaculation from a view point of someone concerned about PE.

What Triggers Ejaculation?

Male ejaculation is complex and not altogether fully understood neurobiological process (1).  It involves ducts, muscles, glands, fluids and the nervous system. When the concern is premature ejaculation, however, the most important issue is what gets the ejaculation process started. Unfortunately, the exact ejaculation trigger mechanism is not well understood.

Initiating ejaculation is the function of the nervous system, involving the brain, the spinal cord and genital nerves. Although the pleasure from sex and the euphoria of orgasm occurs in the brain, ejaculation is a spinal reflex and can occur without the brain's involvement. Studies have shown that men with spinal cord injuries can still ejaculate. Nevertheless, the connection between the brain and genitals is critical for successful orgasmic and ejaculatory function.  However, brain imaging studies taken during orgasm have not determined a specific location of the brain that triggers ejaculation.

Delaying ejaculation has been successfully accomplished by altering the two ends of the nervous system -  the brain and penis. Selective serotonin reuptake inhibitors (SSRIs) alter brain chemistry to delay ejaculation  For years, topical desensitizers have been used to increase time to ejaculation. New formulas with absorption technology show improved ejaculation control with minimal loss of sexual pleasure, providing further evidence of the complexity of the ejaculatory response.

Ejaculation Point of No Return

Once a man reaches the so-called "point of no return", even stopping sexual stimulation won't prevent a man from ejaculating. Ejaculation occurs in two stages, the emission stage and the expulsion stage. During the emission stage, the prostate gland and seminal vesicles contract and push their fluids into the urethra. Once this occurs, there's no turning back - pulsatile contractions within the pelvis and urethra force the fluid out of the urethra during the expulsion phase of ejaculation, also called ejaculation proper.

Most men can sense their bodies starting to prepare for emission long ahead of that time so that they can slow or stop sexual stimulation (start/stop method).

questioning the psychological cause of premature ejaculation

Although this may delay ejaculation, it can greatly decrease sexual pleasure for the man and his partner.

Is Premature Ejaculation Causes Psychological or Biological?

Just like with erectile dysfunction prior to the introduction of Viagra(r), most people still believe  that premature ejaculation has psychogenic, rather than biogenic, root causes.

The following is a quote from Dr. Chris McMahon's article in the Journal SexualMedicine: "The initial premise that PE has solely a psychogenic basis is slowly disappearing."

With continued research and success of SSRIs and topical agents, the perception that PE is a mental process is changing in the both the medical community and public. However, just like with impotence, most sex therapists and psychologists continue to hang on to old beliefs about the psychological origins of premature ejaculation and continue to recommend mind over matter therapies. However, we have not found a clinical study to show the success of such therapy for PE.

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