| Before trying to understand various disorders pertaining to ejaculation a basic understanding about the mechanism of normal ejaculation can be of great help.
Normal Ejaculation :
Male sexuality begins with interest and desire. Next comes the state of arousal, which results from various combinations of erotic thoughts and sensory stimulation. The impulses of desire are transmitted from nerves in the pelvis to the arteries in the penis, which widen to admit more blood and produce a rigid erection.
The next stage is ejaculation, which is just as complex. It begins with emission, a brief phase that momentarily precedes ejaculation itself. Emission is triggered by the autonomic nervous system , specifically by fibers that originate between the lower thoracic (T10–12) and upper lumbar (L1 and 2) segments of the spinal cord. These nerves cause muscles in the prostate to contract, propelling prostatic secretions into the urethra . Immediately thereafter, muscles in the vas deferens and seminal vesicles spring into action, expelling semen into the urethra.
The culmination is ejaculation. The muscles of the neck of the bladder close, preventing semen from entering the bladder. Simultaneously, muscles in the penis and pelvis begin a series of rhythmic contractions that forcefully expel the semen forward through the urethra, then out from the penis.
Ejaculation is usually accomplished by the pleasurable sensation of orgasm. It is followed by detumescence , when the arteries in the penis narrow and the veins widen, draining blood from the penis and returning it to a flaccid state.
The sex act is instinctive and automatic, but it depends on the complex interaction of psychological functions, the nervous system, blood vessels, and the genital tract itself. With so much involved (and so much at stake), a lot can go wrong. And many of these problems involve abnormal ejaculations.
Premature ejaculation
From a biological point of view, the whole purpose of sex is procreation. In most animals, intercourse is brief, and ejaculation occurs shortly after penetration. In humans, though, sex involves a broad array of psychological and interpersonal factors. As a result, premature ejaculation is defined not by the clock but by the desire and satisfaction of both partners.
A premature ejaculation is one that occurs before it is desired. Sometimes it occurs with minimal sexual stimulation early in foreplay. More often, it develops shortly after penetration before mutual gratification is achieved. Either way, it causes shame and embarrassment for the man and frustration and discontent for both partners.
Many men experience premature ejaculation from time to time, but for some it's a recurrent problem. In large surveys, premature ejaculation is the most frequent form of male sexual dysfunction, affecting up to 30% of men. It is most common in young and sexually inexperienced males but can strike at any time of life. Most men with premature ejaculation are perfectly healthy; others have psychological disturbances, medical conditions like diabetes, or urologic problems such as prostatitis . With or without an associated problem, premature ejaculation can be treated. Therapy can use behavioral techniques, medication, or a combination of the two.
Delayed ejaculation
Whereas premature ejaculation is rarely caused by disease, delayed (or absent) ejaculation can result from either psychological or physical problems. Alcohol, medications (including SSRIs and tricyclic antidepressants, and some antihypertensives), and diabetes are among the most frequent causes of delayed or inhibited ejaculation. When drugs are responsible, the problem will usually respond to a change in medication. Some men who need to continue taking an SSRI to treat depression or an anxiety disorder may benefit from Viagra, vardenafil (Levitra), or tadalafil (Cialis). Psychological problems often respond to behavioral techniques or sex therapy.
Ejaculation retrograde
Definition
Retrograde ejaculation refers to the entry of semen into the bladder instead of going out through the urethra during ejaculation.
Causes, incidence, and risk factors
Retrograde ejaculation may be caused by prior prostate or urethral surgery, diabetes , some medications, including some drugs used to treat hypertension (high blood pressure) and some mood-altering drugs.
The condition is relatively uncommon and may occur either partially or completely. The presence of semen in the bladder is harmless. It mixes with the urine and leaves the body with normal urination. Men with diabetes and those who have had genitourinary tract surgery are at increased risk of developing the condition.
Symptoms
- Little or no semen discharged from the urethra in conjunction with the male sexual climax (during ejaculation)
- Possible infertility
- Cloudy urine after sexual climax
Signs and tests
A urinalysis performed on a urine specimen that is obtained shortly after ejaculation will reveal a large amount of sperm in the urine.
Treatment
If retrograde ejaculation is caused by drugs, removal of the specific drug may resolve the condition. Retrograde ejaculation caused by diabetes or following genitourinary tract surgery may be responsive to the use of epinephrine-like drugs (such as pseudoephedrine or imipramine).
Expectations (prognosis)
If retrograde ejaculation is caused by medications, discontinuation of the medication often restores normal ejaculation. If retrograde ejaculation is caused by surgery or diabetes, it is often not correctable.
Complications
The condition may cause infertility.
Calling your health care provider
Call for an appointment with your health care provider if you are having difficulty conceiving a child or you are concerned about retrograde ejaculation.
Prevention
Maintaining good blood sugar control in diabetic men may be helpful in preventing the development of this condition. Avoiding drugs that cause retrograde ejaculation will prevent the condition developing as a result of their use.
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