Anejaculation, Premature/Delayed & Retrograde Ejaculation Disorders


Ejaculatory Disorders can have severe impact on a couple’s sex life and relationship. But with the right medical intervention, ejaculatory issues can be alleviated.

Ejaculatory dysfunction is actually pretty common and is a common cause of male infertility and the most crucial step in addressing the ejaculatory dysfunction is knowing the “what and why” of it.

There could be factors that can be reversed with medicine, and there could be surgical solutions as well. In this article, we look at the common ejaculatory dysfunctions.

Ejaculatory dysfunction can be classified into the following types:

  • Premature Ejaculation
  • Delayed Ejaculation
  • Retrograde Ejaculation
  • Anejaculation

Premature Ejaculation

The most common cause of ejaculation dysfunction is premature ejaculation (PE). This is a condition where a man ejaculates earlier than the norm. In technical terms, it means ejaculating within a couple of minutes after penetration. Premature ejaculation is one of common sexual health condition that affects men, with one individual out of three said to be affected by it.


Some of the common causes of premature ejaculation include

  • Erectile dysfunction
  • Psychological stressors such as depression or anxiety
  • Metabolic or hormonal conditions
  • Medications or drugs


A detailed physical examination, as well as patient history can help in determining whether the dysfunction is lifelong (primary) or acquired (secondary). Thorough evaluation includes a comprehensive assessment of the medical issues, medications, as well as sexual and lifestyle habits.


Premature ejaculation can be treated through the following methods:

  • Use of oral medications such as antidepressants (e.g., SSRIs)
  • Use of drugs such as sildenafil, tadalafil, or vardenafil to assist in erection stability.
  • Topical anesthetics to reduce over-sensitivity.
  • Undergoing sex education with a counselor. This includes learning various relaxation techniques as well as skills that can help in controlling and prolonging sexual stimulation. This type of treatment is typically curative.

Delayed Ejaculation

Affecting nearly 1 – 4 % of US male population, delayed ejaculation, also known as impaired ejaculation, occurs when a man requires a prolonged period of stimulation to ejaculate. In a few rare cases, men might either ejaculate infrequently or not ejaculate at all.


A few common causes of delayed or impaired ejaculation include:

  • Use of medications like antipsychotics or antidepressants.
  • Prolonged use of alcohol and drugs.
  • Medical conditions like nerve damage, multiple sclerosis, or spinal cord injury.
  • Hormonal disorders such as low testosterone or hyperprolactinemia.
  • Surgery
  • Psychological conditions like anxiety or depression.


A detailed physical exam, as well as a comprehensive assessment of medical history, is required for diagnosing delayed ejaculation. Your healthcare provider might order further tests if required.


The following methods help in treating delayed ejaculation:

  • Switching, reducing, or stopping medications that impair sexual function.
  • Counseling to address the psychological issues impacting the sexual performance.
  • Learning alternative masturbation techniques to help in sexual stimulation.

Retrograde Ejaculation

A person is said to have retrograde ejaculation when the semen flows back into the bladder instead of coming out through the urethra. In ideal conditions, the bladder neck (the meeting point of urethra and bladder) closes when a man has an orgasm.

However, in cases where bladder neck muscles or nerves are weakened or damaged, the bladder neck might not be able to close correctly. This results in the ejaculate coursing back into the bladder. While this is not a medical emergency, having a dry orgasm can be very upsetting.


Common causes of retrograde ejaculation include:

  • Certain medical conditions such as diabetes, spinal cord injury, or multiple sclerosis.
  • Surgery on the bladder, prostate gland, or lower abdomen.
  • Use of psychiatric medications, pills for hypertension, or other medications.


A detailed physical examination and comprehensive review of medical history is required for diagnosis of retrograde ejaculation. Reproductive healthcare experts can also order a post-ejaculate urine sample. The presence of sperm in urine after ejaculation can also indicate retrograde ejaculation.


Some standard treatment options include:

  • Oral therapy for closing the bladder neck to prevent semen from coursing back into the bladder after ejaculation.
  • Discontinuing medications that induce retrograde ejaculation.
  • If the couple is trying to conceive, then healthcare providers can offer sperm harvesting for use in assisted reproductive treatments (ART).


Anejaculation is the inability of a man to ejaculate semen. In such cases, a man might produce semen and also get orgasms, but he is unable to ejaculate. Despite his best efforts and normal erections, a man with this condition is severely limited in his ability to ejaculate.


Common causes include:

  • Spinal cord injury
  • Use of medications such as antipsychotics and antidepressants
  • Any surgery on bladder or prostate
  • Psychological factors
  • Diseases afflicting the nervous system


Anejaculation can be diagnosed based on a comprehensive medical history assessment and detailed physical examination. Anejaculation can either be lifelong (primary) or acquired (secondary) in nature.


Treatment options for anejaculation include:

  • Abstaining from medications that might cause the condition.
  • Sex therapy and education with a counselor.
  • Use of penile stimulator or rectal probe electroejaculation for harvesting sperm for IVF or IUI.
  • Surgical retrieval of sperm.


Another ejaculatory disorder, though not very common, is hematospermia. In simple terms, hematospermia means the presence of blood in the semen. This is self-limited and mostly painless. The ejaculate might be brown, bright red, or chocolate.


Some common causes of hematospermia include

  • Urethritis (inflamed urethra), prostatitis or urinary tract infection.
  • Sexually transmitted diseases.
  • Anatomical conditions such as ejaculatory duct obstruction or urethral stricture.
  • Urethral, testicular, or prostate injury or surgery.
  • Prostate cancer (in rare cases)


A reproductive healthcare expert can conduct a detailed physical examination of the genitalia and comprehensive medical history analysis is performed. Diagnostic tests such as semen and urine testing, PSA blood test, STD tests, and transrectal ultrasound might also be ordered.


Hematospermia is often harmless and can be treated using antibiotics and anti-inflammatory drugs.


If you suffer from ejaculatory dysfunction, it is important to meet your healthcare provider, who can advice proper treatment and guidance.

A retired, board-certified Kimberly OB/GYN, Dr Langdon has clinical experience of two decades. She specializes in sexual dyfunction, infertility, STI and contraception among others. For AndrologyForum she writes articles on fertility topics focused on Semen parameters.