Ejaculation problems begin in the brain when, after a period of sexual stimulation, it starts sending signals to the thoracic and lumbar area of the spinal cord to trigger the ejaculation process. From this control center, the signals continue on to three structures that play a critical role in ejaculation: the seminal vesicles, which produce most of the seminal fluid; the prostate, which secretes fluid that makes up semen; and the vas deferens, which delivers the sperm.
While a man is sexually aroused but before he ejaculates, the vas deferens and seminal vesicles deposit semen into the urethra. At the same time, a series of other events occur, all of which are focused on one thing: ejaculation. Thus, the bladder neck and urethral sphincter close, which increases pressure inside the urethra within the prostate, and then the urethral sphincter opens while the muscles around the urethra contract. The contractions force semen out through the urethra, and the man ejaculates. Ejaculation problems occur, however, when some portion of this sequence goes wrong.
For ejaculation to occur, all the structures involved need to be operating well and in synch with the others. Therefore, a man who has undergone a radical prostatectomy to remove his prostate cannot ejaculate, but he can still have an orgasm. Similarly, men who undergo radiation therapy may experience some damage to the vas deferens, but again, even though they cannot ejaculate they can still have an orgasm (otherwise known as a “dry orgasm”). More on side effects of prostate treatments
Men who have benign prostatic hyperplasia (BPH) can experience ejaculation problems because the enlarged prostate may hinder the process (Read more on BPH and ED). Similarly, drugs used to treat BPH, such as alpha blockers, can affect it as well. Ejaculation problems can be associated with a prostatectomy, because the surgery may result in a condition called retrograde ejaculation. This means that the semen travels back into the bladder rather than moves through the urethra and out of the body during ejaculation.
A man’s ejaculation problems associated with BPH or after surgery or other treatment procedures are something many physicians fail to tell their patients before the fact, and for older men who are not concerned about fertility, the lack of ejaculation is often not an issue. However, among younger men who may be concerned about fertility or for whom the lack of semen is a psychological blow, it is especially important for them to understand before undergoing a procedure that ejaculation will be affected.
Libido, which is also often called sexual desire or sex drive, starts in the brain and in men is driven by the presence of the hormone testosterone. While it is true that men can have a normal testosterone level and little or no sex drive, it has also been shown that a low testosterone level is associated with low libido. How much testosterone does a man need to have a “normal” or healthy libido? Scientists have not put a definitive number on it, but what they do know is that as men age and their testosterone levels decline, sex drive tends to decline as well.
Because testosterone has a role in libido, men may believe a low hormone level is causing their low sex drive. A simple blood test can identify a man’s testosterone level. To get an accurate reading, the test should be performed in the early morning, and no later than 10 AM, because this is the time the body’s level of the hormone is at its peak.
One of the most common causes of low libido is erectile dysfunction. Generally the cycle goes like this: a man begins experiencing erectile dysfunction, he becomes increasingly distressed and depressed about his inability to achieve an erection, and therefore less inclined to want to pursue any sexual activity. If erectile function does not improve, his sex drive may virtually disappear, including any desire to kiss or engage in physical contact, because he fears it may lead to another failed attempt at an erection.
If a man is not having a problem with erectile dysfunction and his testosterone levels are within normal range, then low libido likely has a psychological component. These may include relationship problems, depression, anxiety, feelings of guilt, history of sexual trauma, or post-traumatic stress disorder. A psychologist, psychiatrist, sex therapist or marriage counselor can be helpful in these situations.