Causes of ejaculation problems vary depending on the person and the type of problem.
An ejaculation problem can often have physical and psychological causes. For example, if a man has previously had a health condition that made it difficult to maintain an erection, it may now cause anxiety, leading to premature ejaculation.
Primary premature ejaculation
Primary premature ejaculation (where the male has had premature ejaculation since first becoming sexually active) is often psychological. A number of possible psychological causes are discussed below.
Conditioning
Many doctors believe early sexual experiences can influence future sexual behaviour. For example, if a teenager conditions himself to ejaculate quickly to avoid being caught masturbating it may later be difficult to break the habit.
Traumatic sexual experiences
A traumatic sexual experience at an early age can sometimes lead to life-long sexual anxiety and premature ejaculation. Experiences can range from being caught masturbating to sexual abuse.
Upbringing
Men who have had a strict upbringing, where sexual activity is only considered appropriate in certain circumstances, such as after marriage, may find it difficult to relax during sex, or be unable to let go of the belief that sex is wrong or sinful.
Biological reasons
A number of recent studies suggest biology may play a role in some cases of primary premature ejaculation.
Changes to the normal pattern of nerve signals in some men affected by erectile dysfunction could result in their penis being extra sensitive, meaning it takes much less stimulation to make it ejaculate.
Some men with erectile dysfunction have lower than average levels of a hormone called prolactin in their body. Prolactin is known to have a ‘dampening’ affect on sexual arousal so low levels may lead to a man becoming very aroused in a short space of time and ejaculating quickly.
Secondary premature ejaculation
Secondary premature ejaculation (where premature ejaculation develops in a man who has previously had a history of normal ejaculation) can be caused by both psychological and physical factors.
Common physical causes of acquired premature ejaculation include:
The recommended daily levels of alcohol consumption are three to four units of alcohol for men, and two to three units for women.
A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine, or a pub measure (25ml) of spirits.
Common psychological causes include:
- depression
- stress
- unresolved problems, conflicts, or issues within a sexual and emotional relationship
- anxiety about sexual performance (this is often a contributory factor at the start of a new sexual relationship, or when a man has had previous problems with sexual performance)
Retarded ejaculation
Like premature ejaculation, retarded ejaculation can be caused by psychological and physical factors.
Possible psychological causes of retarded ejaculation are similar to those of premature ejaculation - for example, early sexual trauma, strict upbringing, relationship problems, stress, and depression.
Physical causes of retarded ejaculation include:
- diabetes (usually only type 1 diabetes)
- spinal cord injuries
- multiple sclerosis
- surgery to the bladder or prostate gland
- increasing age
Many medicines are known to cause retarded ejaculations including:
- antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
- medications used to treat high blood pressure (hypertension), such as beta-blockers
- antipsychotics, which are medications that are used to treat episodes of psychosis (a mental condition where it is difficult for a person to distinguish between reality and their imagination)
- muscle relaxants, such as balcofen, which is widely used to treat motor neurone disease and multiple sclerosis
- powerful painkillers, such as naproxen and methadone (which is also widely used to treat people addicted to heroin)
Retrograde ejaculation
Retrograde ejaculation is caused by damage to the nerves or muscles that surround the neck of the bladder (the point where the urethra connects to the bladder).
Usually when you ejaculate, semen is pushed out of your testicles and up through your urethra (the tube that semen and urine passes through). It is prevented from entering your bladder by the muscles around the neck of the bladder, which close tightly at the moment of orgasm.
However, 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.
Prostate gland or bladder surgery is the most common cause of retrograde ejaculation. Other causes are diabetes, multiple sclerosis, and a class of medicines that are known as alpha blockers, which are often used to treat high blood pressure (hypertension).
