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 (lifelong) premature ejaculation
A number of possible causes are discussed below.
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 lifelong sexual anxiety and premature ejaculation. Experiences can range from being caught masturbating to sexual abuse.
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.
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 cause ejaculation.
Studies have recently suggested men with a first-degree relative (father, brother or son) who experiences premature ejaculation are more likely to have the problem themselves. But a definite genetic association has not yet been proved.
Secondary (acquired) premature ejaculation
Acquired 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 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:
- 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)
Like premature ejaculation, delayed ejaculation can be caused by psychological and physical factors.
Possible psychological causes of delayed ejaculation are similar to those of premature ejaculation – for example, early sexual trauma, strict upbringing, relationship problems, stress, and depression.
Physical causes of delayed 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 delayed ejaculation, including:
- antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs)
- medications used to treat high blood pressure (hypertension), such as beta-blockers
- antipsychotics, which are medications used to treat episodes of psychosis
- muscle relaxants, such as balcofen, which is widely used to treat motor neurone disease and multiple sclerosis
- powerful painkillers, such as methadone (which is also widely used to treat people addicted to heroin)
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 pass 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 known as alpha blockers, which are often used to treat high blood pressure (hypertension).