Ejaculation Difficulties: Causes and Solutions

Ejaculatory dysfunction?

Hello Doctor: I have noticed that I have difficulty achieving ejaculation, whether during masturbation or sexual intercourse.
The reason I say it's difficult is that I previously visited a clinic, and the doctor suggested that I try on my own first, but I was able to ejaculate during self-experimentation (although I haven't been able to do so since then).
This situation leaves me unsure of how to address it, as I cannot determine what the problem might be, and the clinic doctor seems reluctant to conduct more complex examinations.
Therefore, I am providing some case details below.
Although the clinic physician believes they are not significantly related, I would appreciate your help in identifying the cause and possible solutions.
Thank you! About a year ago, I underwent a circumcision, and I occasionally experience symptoms of urethral inflammation (pain), but I have not sought specific treatment, and it tends to resolve on its own.
I also have symptoms of frequent urination (especially noticeable before bed).
Urination is often not smooth; sometimes I have to wait a long time or exert pressure in my lower abdomen to urinate.
During sexual activity, I produce a lot of prostatic fluid.
Sometimes, if sexual activity lasts too long, I experience testicular pain (and they become very hard).

Xiao Chen, 20~29 year old female. Ask Date: 2001/09/03

Dr. Liu Jianting reply Urology

Is it really that serious? Moreover, your own "experiment" is going well.
Just let things take their course.
I recommend a book published by Tianxia titled "About Sex."

Reply Date: 2001/09/03

More Info

Ejaculation difficulties can be a complex issue, often stemming from a variety of physical and psychological factors. Based on the symptoms you've described, including difficulty achieving ejaculation during both masturbation and sexual intercourse, as well as urinary issues such as frequency and urgency, there are several potential causes to consider.

1. Physical Factors:
- Post-Surgical Changes: You mentioned having undergone a circumcision about a year ago. Surgical procedures in the genital area can sometimes lead to changes in sensitivity or nerve function, which might affect ejaculation. If there was any nerve damage or if the surgical site has not healed properly, this could contribute to your difficulties.

- Prostate Health: The prostate gland plays a crucial role in ejaculation. If there are issues such as prostatitis (inflammation of the prostate) or benign prostatic hyperplasia (BPH), these can lead to difficulties in ejaculation. The fact that you experience pain in the testicles and have a lot of pre-ejaculatory fluid suggests that there might be some underlying prostate issues.

- Urinary Tract Issues: Your symptoms of frequent urination and difficulty urinating could indicate a urinary tract infection or other urinary issues, which might also impact sexual function. Inflammation or infection in the urinary tract can lead to discomfort and affect ejaculation.

2. Psychological Factors:
- Anxiety and Stress: Psychological factors such as anxiety about sexual performance can significantly impact your ability to ejaculate. If you are feeling pressure to perform or are worried about your symptoms, this can create a cycle of anxiety that makes it even harder to achieve ejaculation.

- Conditioning: If you have had experiences where you were able to ejaculate during masturbation but not during sexual intercourse, this could create a mental block. Your brain may associate sexual activity with difficulty, leading to performance anxiety.

3. Hormonal Factors:
- Hormonal imbalances, particularly involving testosterone, can also affect sexual function. If you suspect that this might be an issue, it could be worth discussing with a healthcare provider.

Recommendations for Management:
1. Consult a Specialist: Since you have already seen a general practitioner, it may be beneficial to consult a urologist or a sexual health specialist. They can perform more specific tests, such as hormone level assessments, prostate examinations, and possibly imaging studies to evaluate any anatomical issues.

2. Address Urinary Symptoms: Since you are experiencing urinary difficulties, it is essential to address these symptoms first. A urologist can help determine if there is an infection or another underlying issue that needs treatment.

3. Psychological Support: If anxiety is a significant factor, consider speaking with a mental health professional who specializes in sexual health. Cognitive-behavioral therapy (CBT) can be particularly effective in addressing performance anxiety and other psychological barriers.

4. Lifestyle Modifications: Maintaining a healthy lifestyle can also support sexual health. Regular exercise, a balanced diet, and adequate hydration can improve overall well-being and potentially alleviate some symptoms.

5. Medication: In some cases, medications may be prescribed to help with ejaculation difficulties or to address any underlying conditions, such as anxiety or prostate issues.

6. Communication with Partners: Open communication with your sexual partner can help alleviate some of the pressure you may be feeling. Discussing your concerns and experiences can foster understanding and support.

In conclusion, ejaculation difficulties can arise from a combination of physical and psychological factors. It is crucial to approach this issue holistically, addressing both the physical symptoms and any underlying psychological concerns. Seeking specialized medical advice will provide you with the best chance of finding a solution tailored to your specific situation.

Similar Q&A

Understanding Ejaculation Issues: Causes and Solutions for Men

I often find that I cannot ejaculate during intercourse with my girlfriend, even though she reaches orgasm multiple times. This has also happened with my previous girlfriend. Could it be due to excessive masturbation in the past? What should I do?

Dr. Xu Weikai reply Urology
Hello, Xiao Xiao: Reasons for difficulty in ejaculation may include: 1. Prolonged erection can lead to difficulty in ejaculation. 2. Insufficient stimulation may result in an inability to ejaculate (the stimulation from masturbation may be more intense). 3. There may be underly...

Understanding and Managing Sexual Desire Issues in Urology

It is common to notice that during daily activities, there may be instances where there is a lack of erection before ejaculation. This can be attributed to various factors, including psychological stress, fatigue, or hormonal imbalances. To address issues related to sexual desire...

Dr. Du Shixi reply Urology
Hello: Your situation is likely not ejaculation, but rather the release of some prostatic fluid. If you do not have a regular partner, then DIY solutions are your only option. Wishing you good health.

Struggling with Ejaculation: Understanding and Overcoming the Issue

As a child, I accidentally experienced ejaculation by applying pressure to my penis and continued to do so without using normal methods until recently when I became intimate with my girlfriend. No matter how long it takes, I am unable to ejaculate normally, and I realize that thi...

Dr. Fu Shizhang reply Urology
It is recommended to reduce the frequency of masturbation and ejaculation.

Struggling with Ejaculation: Tips for Improving Sexual Performance

It sounds like you have been experiencing difficulties with ejaculation and maintaining an erection during sexual activity with your new girlfriend. This can be a common issue, especially if you have a history of frequent masturbation and are now facing a new sexual experience. H...

Dr. Xu Wencang reply Urology
You can observe it a few more times, and if it persists, you should visit the outpatient clinic for examination and treatment.