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Ejaculation. (Ejaculation problems)

Ejaculatory dysfunction includes premature ejaculation, retrograde ejaculation, delayed ejaculation, and anejaculation. Premature ejaculation means that ejaculation occurs too quickly and may occur with light stimulation before, on, or shortly after penetration, or simply before one wishes for it to occur. Retrograde ejaculation is a condition in which the ejaculate passes backward into the bladder; this condition may be associated with decreased ejaculate volume or no ejaculate. Delayed ejaculation is a condition in which it takes too long to ejaculate; it is frequently associated with the use of the newer antidepressants, the SSRIs. Anejaculation is a condition in which no ejaculation occurs at all. Below you can find a list of medications that may affect ejaculation.

What is Premature Ejaculation?

Premature ejaculation is when ejaculation occurs tod quickly, such as before penetration or just after pene-tration. This condition tends to occur more frequently in younger men. Premature ejaculation is the most common form of sexual dysfunction, occurring in 30% to 40% of adult men. The condition may be lifelong or acquired. Despite its prevalence, men rarely seek help for premature ejaculation. There are three criteria for a diagnosis of premature ejaculation:

  1. There must be persistent or recurrent ejaculation with minimal stimulation before, on, or shortly after penetration and before the individual wishes it.
  2. This must cause marked distress or interpersonal difficulty.
  3. The premature ejaculation is not a result of a substance, such as an effect from withdrawal of opioids.

It appears that men with premature ejaculation may have an increased sensitivity and excitability of the glans penis and the dorsal nerve, which supplies sensation to the penis.

What is Retrograde Ejaculation and what causes it?

Retrograde ejaculation occurs when the ejaculate flows backward into the bladder instead of forward and out the tip of the penis. Retrograde ejaculation is very common in men who have underdone a transurethral prostatectomy (TURP), a surgical technique using a specialized instrument that allows the surgeon to remove the prostatic tissue that is bulging into the urethra and blocking the flow of urine through the urethra. A TURP is usually performed to treat benign enlargement of the prostate. Retrograde ejaculation may also occur in men with diabetes mellitus, and sometimes is a side effect of certain medications, including the blood pressure medications phenoxybenzamine (Dibenzyline), phentolamine, prazosin (Minipress), and tamsulosin (Flomax) and the antipsychotic medications thioridazine (Mellaril), chlorpromazine (Thorazine), triflupromazine (Vespein), and mesoridazine (Serentil). In men who have undergone surgery on the bladder neck (bladder oudet), the bladder neck may not close completely, thus allowing the semen to pass backwards into the bladder. Retrograde ejaculation does not cause any harm - one simply urinates out the ejaculate.

What is Anejaculation and what causes it?

Anejaculation is the condition in which there is no flow of ejaculate in either direction. This condition occurs in some men with spinal cord injuries and in some men with cancer of the testis who have undergone surgery to remove affected lymph nodes, a procedure called retroperitoneal lymph node dissection. Anejaculation may also occur if the outflow of the ejaculate is blocked; this may be caused by a small stone in the ejaculatory duct (the structure through which the ejaculate passes into the urethra), or by prior infection and scarring of the male reproductive tract from sexually transmitted diseases, such as gonorrhea, and other diseases that affect the genitourinary tract, including tuberculosis. In such cases, the ejaculatory duct may be opened surgically. Anejaculation occurs after a radical prostatectomy because the seminal vesicals and prostate gland are moved and the vas deferens, the tube that sperm passes through to reach the urethra, is tied off. Conenital disorders and their treatment may also cause aneiaculation; such treatments include imperforate anus a condition in which the rectum does not open to the perineal skin, and thus there is no way for stool to exit the body.

Medications That Affect Ejaculation:

Medications Associated with Impairment of Ejaculation
Amitriptyline (Elavil, Endep)
Baclofen (Lioresal)
Chlordiazepoxide (Librium)
Chlorpromazine (Thorazine)
Chlorprothixene (Taractan)
Clomipramine (Anafranil)
Epsilon aminocaproic acid (Amicar)
Guanethidine sulfate (Ismelin)
Haloperidol (Haldol)
Imipramine hydrochloride (Tofranil)
Methadone (Dolophine)
Naproxen (Naprosyn)
Pargyline (Eutonyl)
Perphenazine (Etrafon)
Phenelzine sulfate (Nardil)
Phenoxybenzamine hydrochloride (Dibenzyline)
Prazosin hydrochloride (Minipress)
Reserpine (Serpasil)
SSRIs - selective serotonin reuptake inhibitors: Fluoxetine, paroxetine, sertraline
Thiazides (hydrochlorothiazide)
Thioridazine (Mellaril)
Trifluoroperazine (Stelazine)

Drugs Used to Promote Seminal Emission
Brompheniramine maleate (Bromfed)
Chlorpheniramine (Chlor-Trimeton)
Ephedrine sulfate
Imipramine hydrochloride
Phenylpropanolamine (Entex, Hycomine, Profen)
Pseudoephedrine hydrochloride (Sudafed)