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Home › Conditions › Ejaculation problems
HIS FERTILITY · EJACULATION PROBLEMS
Common, treatable, and nothing to be ashamed of.
Ejaculation problems mean semen comes too soon, too late, backwards into the bladder, or not at all. In most men the sperm themselves are fine, and there are several ways to get them to the egg.
- Common
- Sperm are usually healthy
- A urine test finds retrograde ejaculation
- Private conversation
- Testicle — Sperm are made here, usually normally
- Bladder neck — Should close at orgasm
- Retrograde — Semen flows back into the bladder
- Urethra — The normal way out
01What are the types of ejaculation problems?
There are four main types: premature ejaculation, delayed ejaculation, retrograde ejaculation (semen goes into the bladder) and anejaculation (no semen at all).
Premature ejaculation is the most common and happens to many men at some point. Delayed ejaculation means it takes a very long time, or does not happen. In retrograde ejaculation the orgasm feels normal but little or no semen comes out, because the bladder neck does not close. Causes include diabetes, prostate surgery, some medicines, nerve injury, and anxiety.
02Can ejaculation problems stop a pregnancy?
Ejaculation problems can stop a pregnancy only when semen does not reach the vagina; they rarely mean the sperm are poor.
Premature ejaculation after penetration usually does not prevent pregnancy. Ejaculation before penetration, very delayed or absent ejaculation, and retrograde ejaculation do. In most of these men, sperm production in the testicle is normal. The task is getting the sperm out, not fixing them.
03How are ejaculation problems diagnosed?
Diagnosis starts with a private history and a semen analysis, and a urine test after orgasm confirms retrograde ejaculation.
The doctor asks about timing, medicines, diabetes, past surgery and injuries, and examines you. If the semen volume is low or absent, a urine sample passed straight after orgasm is checked for sperm. A blood sugar test looks for diabetes, a common and treatable cause.
Post-ejaculation urine test explained04How are ejaculation problems treated for fertility?
Treatment starts with the cause and the simplest way to collect sperm, and moves to sperm retrieval only if that fails.
A medicine that causes the problem can sometimes be changed, but only with the doctor who prescribed it. Some medicines help the bladder neck close. In retrograde ejaculation, sperm can be recovered from urine after orgasm, once the urine is made less acidic, and used for IUI or ICSI. If there is no ejaculation, vibratory stimulation, electroejaculation (specialist) or TESA or PESA can collect sperm. Premature or delayed ejaculation often improves with sexual health counselling [CONFIRM: in-house or referral].
Honest note
Medicines that close the bladder neck work for some men with retrograde ejaculation, not all, and the evidence for tablets in delayed ejaculation is thin. That is why sperm collection from urine or the testicle is planned early, rather than months of trial and error. (What the evidence says)
05What can you do now?
Tell the doctor exactly what happens, bring a list of every medicine you take, and get a semen analysis.
Do not stop a prescribed medicine on your own. Control of diabetes matters for the nerves that control ejaculation. Pressure to perform on fertile days makes delayed and premature ejaculation worse; regular sex through the month takes that pressure off.
Does this sound like you?
Any of these?
- I finish before we can really start
- I can't finish, however long we try
- I climax but almost nothing comes out
- My urine looks cloudy after sex
- It started after prostate surgery or a new medicine
- I have diabetes and things have changed
Trouble getting or keeping an erection instead? That is a different problem, with its own page.
What we try, in order.
- 1
History, semen analysis and urine test
Find the type and the cause, and check the sperm.
- 2
Treat the cause
Diabetes control, a medicine review with your prescriber, bladder neck medicines, sexual health counselling.
- 3
Collect sperm without surgery
From urine after orgasm, or by vibratory stimulation or electroejaculation. [CONFIRM: which are in-house]
- 4
IUI, or ICSI with retrieved sperm
IUI if enough good sperm are recovered; ICSI with TESA or PESA if not.
His first visit
1
Talk
What happens, since when, your medicines, diabetes and any surgery. In private.
2
Test
Semen analysis, a urine test after orgasm if needed, blood sugar. Her tests too.
3
Plan
The simplest way to get sperm to the egg for the two of you.
4
Treat
Treat the cause, collect sperm, then IUI or ICSI.
Questions men ask
Still unsure? Ask us on WhatsApp — a real person replies.
Can premature ejaculation stop my partner getting pregnant?
Usually no: if ejaculation happens inside the vagina, even quickly, pregnancy can happen. It becomes a fertility problem only when ejaculation happens before penetration, and then IUI with his own sample is a simple answer.
Can a man with retrograde ejaculation have a baby?
Yes, most men with retrograde ejaculation can father a child, because the sperm are usually healthy. They can be recovered from urine after orgasm and used for IUI or ICSI, and some men respond to medicines that close the bladder neck.
What is a post-ejaculation urine test?
A post-ejaculation urine test checks a urine sample passed straight after orgasm for sperm, and it is how retrograde ejaculation is confirmed. Our journal explains how it is done.
Why does nothing come out when I ejaculate?
Orgasm with no semen is most often retrograde ejaculation, where semen goes back into the bladder. It can also be a blockage or a problem with the glands that make semen, which a semen analysis and a urine test tell apart.
What if I cannot ejaculate at all?
Sperm can still be collected when a man cannot ejaculate, by vibratory stimulation, electroejaculation, or TESA or PESA from the testicle. The choice depends on the cause, such as a spinal injury or past surgery.
Can I see a male doctor?
. Whatever you tell us stays between you, your partner if you wish, and your doctor.
In their words, not ours.
Geetha M.
· Google
She prescribes only the very necessary investigations and medications, maintaining high standards and ethics.
Sources (4)
- American Urological Association and Sexual Medicine Society of North America: Disorders of Ejaculation: AUA/SMSNA Guideline (2020)
- European Association of Urology: EAU Guidelines on Sexual and Reproductive Health
- NHS: Ejaculation problems
- World Health Organization: WHO laboratory manual for the examination and processing of human semen, 6th edition (2021)
JOURNAL
The post-ejaculation urine test
What the test is, and how to prepare for it.
TESTSemen analysis
Low volume or no semen is the first clue.
TREATMENTTESA and PESA
Sperm straight from the testicle when nothing else works.
TREATMENTTREATMENT · One sperm per egg, for small numbers of recovered sperm.
One sperm per egg, for small numbers of recovered sperm.
Ask privately. You can come alone.
Write as much or as little as you like. A real person from Dr Vani's team replies on WhatsApp, usually within minutes during clinic hours (Mon to Sat, 9am to 5pm. Sunday closed.).