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He Medical Clinic

Ejaculatory Disorders: Diagnosis and Treatment in Malaysia

Ejaculatory disorders referes to any problem encountered during ejaculation, be it too fast, too slow, or unable to ejaculate at all. About 33% of males are reported to be experiencing premature ejaculation while about 4% of men are experiencing delay in ejaculation.

The two main types of ejaculatory disorders:

Premature ejaculation (PE)

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Ejaculation is the release of semen from the penis during orgasm. If ejaculation happens sooner than you or your partner anticipates, this is know as Premature Ejaculation. Occasional episodes of PE are not considered alarming. However, if the main symptom of PE is the regular inability to delay ejaculation for more than a minute during intercourse, medical attention is advised. PE can be categorised as “lifelong” or “acquired”. Lifelong (primary) PE means that you have always had this experience while acquired (secondary) PE would mean that you have had longer lasting ejaculations previously, but have now developed PE. While the cause of PE is largely psychological or emotional, PE can also be cased by abnormal levels of certain hormones, such as testosterone, or chemicals produced by nerve cells called neurotransmitters.

Hence, seek medical attention if PE: –
  • Has been persistent enough to cause relationship problems

  • Makes you conscious

  • Keeps you from pursuing intimate relationships

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Delayed Ejaculation

The two types of delayed ejaculations are Primary and Secondary delayed ejaculation.

Similarly to PE, primary delayed ejaculation happens to men who have always had difficulty ejaculating.

Secondary delayed ejaculation, on the other hand, happens to who have previously no issues with intercourse but have newly developed this. The causes to this can be divided into physical and psychological factors.

Physical factors include:

  • Side effects from medications, in particular anti-depressants

  • Alcohol and ilicit drug use

  • Nerve damage or mechanical pelvic injury

  • Hormonal defeciencies such as low testosterone


Psychological factors include:

  • Mood disorders

  • Relationship problems

  • Performance anxiety

  • Existing culture or religious taboos regarding sexual intercourse


Premature Ejaculation

In simple words, premature ejaculation (PE) is when a person ejaculates sooner than he or his partner expects, during sexual intercourse. Although some might feel embarrassed talking about it or seeking help, PE is actually a relatively common and very treatable condition. It is estimated that almost 1 out of every 3 men will experience this problem in some time of their life.
As long as it does not happen persistently, it is not alarming. However, you might be diagnosed with PE if you:-
  • Always or nearly always ejaculate within one minute of penetration
  • Are unable to delay ejaculation during intercourse all or nearly all the time
  • Experience emotional distress, and are frustrated from the outcome of the intercourse.
Many factors come into play when talking about PE- factors that can mainly be divided into psychological and biological factors. The good news is that there are many treatment methods for PE, such as medications, topical anaesthetics, counselling and behavioural techniques that dan delay ejaculation.


The hallmark of PE is the inability to delay ejaculation for more than one minute after penetration. However, the problem might occur in all sexual situations, even during masturbation.
PE can further be classified into:
  • Lifelong (Primary) PE: Lifelong PE that has happened all the time and even since your first sexual encounter.
  • Acquired (Secondary) PE: Acquired PE develops some time throughout your life and persisted.
Many people might feel that they have symptoms of PE, however, the symptoms do not qualify or meet the diagnostic criteria for PE. Instead, they might have natural variable Premature ejaculation, which is a period of rapid ejaculation as well as period of normal ejaculation.


The exact aetiology of PE is still unclear. Once thought to be only psychological, it is now established that PE may involve a series of interaction of psychological and biological/physical factors.
The example of psychological causes are as such:-
  • Early sexual experiences

  • History of sexual abuse

  • Depression

  • Anxiety leading to PE

  • Guilty feelings that cause the tendency to rush through sexual encounters

  • Relationship problems


The example of biological causes are as such:-

  • Abnormal hormone levels

  • Abnormal level of neutrotransmitters (brain stimulatory chemicals)

  • Inflammation or infection of the prostate or urethra

  • Erectile dysfunction



There are multiple treatment options for PE. Bear in mind that it may take time to find the best treatment or combination of treatments that may work for you.

Behavioural Therapy

There is increasing data suggesting that behavioural therapy itself is potentially more effective than medication to manage premature ejaculation. Behavioural therapy are a set of psychological/behavioural exercises or strategies that may be taught by the doctors to delay ejaculation. Examples of such techniques are the “squeeze-pause” technique, “distraction” technique, etc.

Pelvic floor exercises

The pelvic floor muscles are muscles that help control ejaculations located the lower pelvic region.

To identify and feel your pelvic floor muscles, concentrate on stopping urination in midstream or use the muscles that keep you from passing gas. Once you understand where the muscles are, you can practice exercises known as “Kegel Exercise”. You may do them standing, sitting, or lying down.


To do Kegel maneuvers:

1. Tighten your pelvic floor muscles to a count of three.

2. Relax for a count of three

3. Do this several times in a row throughout a day and work your way up to three sets of 10 repititions a day.


Decreased sensitivity

Decreasing the sensitivity of your penis during intercourse may also help.

For example, you may wear a condom during intercourse may help. In addition to that, topical anaesthetic numbing agents can help reduce the sensory stimulation and delay ejaculation.

Uncircumcised individuals may also consider circumcision as the foreskin is a house to many sensory fibres that contribute to sensory stimulation during intercourse.

Oral Medications

Many different classes of medication can help delay orgasm. These medications might be prescribed for either on-demand or daily use, and might be prescribed alone or in combination with other treatments. One must consult a physician prior to use of any of the oral medication. The commonly used medications are such as:-

  • Antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRI) (eg, dapoxetine, paroxetine, sertraline, citalopram)

  • Phosphodiesterase type 5 (PDE5) inhibitors (eg, sildenafil, tadalafil etc.)

  • Other agents (eg, tramadol).


No recommended surgical therapy currently exists.

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Delayed Ejaculation

What is Delayed Ejaculation (DE)?

There is a spectrum of delayed ejaculation (DE) disorders ranging from increased latency (time from penetration to ejaculation) to absent ejaculation, retrograde ejaculation, and anorgasmia. While there is no firm criteria for the diagnosis of DE, men with latencies more than 25-30 minutes are considered having DE.

DE can be tempororay or a lifelong problem. Similarly to Premature ejaculation (PE), DE is also divided into lifelong vs acquired DE. With lifelong DE, the problem is present from the time of sexual maturity. Acquired DE is preceeded by a period of normal sexual functioning.

What contributes to DE?

DE can result from medications, certain chronic health conditions, and surgeries. It can even be cause by substance abuse or a mental issue, such as anxiety or depression. In many cases, it is a combination of many factors, leading to DE.

Psychological causes of DE:-

  • Depression, anxiety or other mental health conditions

  • Relationship problems due to poor communication or other concerns

  • Performance anxiety

  • Poor body image

  • Cultural belief

  • Differences between reality of sex with a partner and sexual fantasies


Medication/Substance causes of DE:-

  • Antidepressants

  • Certain high blood pressure medications

  • Certain diuretics

  • Some antipsychotic medications

  • Some anti-seizure medications

  • Alcohol – excessive alcohol consumption

Physical/ Mechanical causes of DE include:
  • Certain birth defects that affect the male reproductive system

  • Prior pelvic injury

  • Urinary tract infections

  • Prostate Surgery

  • Neurological pathologies, such as diabetic neuropathy, stroke or spinal cord damage

  • Hormone-related conditions, such as low thyroid hormone or low testosterone levels

  • Retrograde ejaculation, a condition in which the semen flows backward into the bladder than outside the penis

The treatment of DE depends on the underlying cause, but it might include taking some medications such as Amantadine (A parkinson’s medication), Buspirone (anti-anxiety medication) or cyproheptadine (allergy medication). These drugs aren’t specifically used for DE, and are primarily used to treat other conditions. Till date, there aren’t any drugs that are specifically for DE.

Psychotherapy, or psychological counselling, on the other hand, is another beneficial treatment, particularly if there is an underlying mental health issue. This might involve seeing a psychologist or sex therapist – a mental health counsellor who specializes in talk therapy for sexual problems.