The most common problems of sexual dysfunction in men are ejaculation disorders, which include premature ejaculation, retrograde ejaculation, partial retrograde ejaculation, and post-spinal injury ejaculation. These and other sexual dysfunctions in men can result from physical causes such as diabetes, heart and vascular disease, hormonal imbalances, side effects from certain drugs, drug or alcohol abuse, and surgery, or psychological causes such as work-related stress and anxiety, concerns about sexual performance, marital or relationship problems, and sexual trauma.

Premature Ejaculation

Premature ejaculation is the occurrence of ejaculation before a man wishes it to happen or too quickly to satisfy his sexual partner. A common condition, premature ejaculation is rarely the result of a physical problem. It can occur before penetration or just after penetration, and may leave the couple feeling sexually unfulfilled. Treatments for premature ejaculation include behavioral methods, exercise methods, condom use, and drug treatments.

Commonly Prescribed (On-Label) Drugs: Bumetanide

Off-Label Prescription Drugs Breakthrough Options: Clomipramine, Fluoxetine, Paroxetine, Zoloft

Retrograde Ejaculation

Retrograde ejaculation occurs when the semen enters the bladder instead of emerging from the penis during an orgasm. During retrograde ejaculation, a tiny muscle (a sphincter) at the opening of the bladder does not work properly, and semen travels backward into the bladder. Causes of retrograde ejaculation include injury to the bladder neck muscle or bladder neck nerves during surgery, nerve damage from diabetes or other illnesses, or side effects from certain medications. Retrograde ejaculation can impair fertility, but otherwise is not harmful.

Commonly Prescribed (On-Label) Drugs: Bethanidine

Off-Label Prescription Drug Breakthrough Option: Imipramine

Partial Retrograde Ejaculation

Retrograde ejaculation refers to the entry of semen into the bladder instead of it exiting through the urethra during ejaculation. Partial retrograde ejaculation may be caused by prior prostate or urethral surgery, illness such as diabetes, or certain drugs like high blood pressure drugs. Although this disorder is relatively uncommon, it may result in infertility in some men.

Commonly Prescribed (On-Label) Drugs: None

Off-Label Prescription Drug Breakthrough Option: Midodrine

Post–Spinal Injury Ejaculation

The inability to ejaculate as a result of damage to the spinal cord affects approximately 90% of men with spinal cord injuries, and is referred to as post–spinal injury ejaculation. Another problem that may affect men with spinal cord injuries is retrograde ejaculation, or the entry of semen into the bladder instead of exiting through the urethra during ejaculation. Additionally, the motility of sperm in men with spinal cord injuries is considerably lower than for men without injury to the spine.

Commonly Prescribed (On-Label) Drugs: None

Off-Label Prescription Drug Breakthrough Option: Midodrine

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