Retarded or failed ejaculation, (RE) is a relatively common male sexual dysfunction, (MSD) with a prevalence of about 10%. It becomes commoner with advancing age, and can be caused by both psychological and physical factors.
Whereas younger men tend to premature ejaculation, (PE) in response to anxiety during sexual arousal, older men will tend to experience delay or failure; this is of course the more normal pattern in the female sexual response. A particularly common scenario is in a man commencing a new sexual relationship following the loss of his long term sexual partner, perhaps after a period of celibacy. The more important the relationship, the more the problem seems to occur. As with PE the man’s frustration will lead to greater anxiety and worsen the problem.
Any cerebral depressant such as alcohol, antidepressants, pain killers or tranquillisers can delay or abolish the orgasmic response. Nerve damage as a result of diabetes or spinal injury will disrupt the reflex arc and make orgasm or ejaculation impossible.
After prostate surgery or a bladder neck incision will cause retrograde ejaculation, in other words backwards into the bladder. After radical prostatectomy there is usually a complete absence of ejaculate. In all these cases however the sensation of orgasm is still experienced.
Where there is an obvious reversible cause, treatment can simply involve reassurance and cessation or alteration of type or dose of any drug thought to be causing the problem.
In patients without such causes treatment can be difficult and may involve sexual techniques to increase stimulation such as the use of vibrators or stimulation of the anus or prostate gland.
Relaxation techniques can be helpful as they are in PE, as can pubococcygeal muscle exercises.
Some drugs such as pseudephedrine tablets, (eg Sudafed) or the antihistamine agent, cyproheptadine, (eg Periactin) can shorten the time taken to reach orgasm in some men. Other drugs that have been used include buspirone, bupropion, PDE-5 inhibitors, (Viagra, Cialis, or Levitra,) and the herbal treatment gingko biloba.
Correcting low levels of testosterone can increase sexual sensitivity in some men and improve their orgasmic potential.
In summary RE is a surprisingly common form of MSD. It requires a thorough assessment and a holistic approach to treatment.