What are the potential risks and consequences of ejaculation in adult males, particularly those with a history of prostate issues or sexual dysfunction?

Understanding the Risks and Consequences of Ejaculation

Ejaculation itself is not inherently harmful and carries no significant medical risks for adult males, including those with prostate issues or sexual dysfunction. The evidence overwhelmingly addresses disorders of ejaculation (premature, delayed, or absent ejaculation) rather than risks from normal ejaculatory function itself.

Normal Ejaculatory Function and Prostate Health

• The prostate plays a crucial physiological role in ejaculation by secreting fluid enriched in zinc, citrate, and kallikreins that is essential for sperm activation and the molecular cascade triggered by ejaculatory stimuli 1
• Ejaculation represents a synchronized cascade of events involving multiple glands that fill with fluid during arousal, ultimately enabling sperm to reach an egg for fertilization 1
• Loss of erection after ejaculation is a normal physiological response, not a dysfunction 2

Potential Concerns in Specific Populations

Men with Prostate Disease

• Prostatic diseases (inflammation, hyperplasia, or cancer) can affect spermatozoa functioning and male fertility, but this represents the disease affecting ejaculation rather than ejaculation causing harm 1
• Bacteria-related prostatic inflammation can influence male fertility outcomes 1
• For men with prostate cancer on active surveillance or androgen deprivation therapy, testosterone therapy is contraindicated, which may indirectly affect ejaculatory and orgasmic function 2

Men with Sexual Dysfunction

When erectile dysfunction and ejaculatory disorders coexist, the erectile dysfunction should be treated first, as many men with ED develop secondary premature ejaculation due to anxiety or the need for intense stimulation to maintain erection 2

• Ejaculation and orgasm are distinct from erection and can be impaired independently—20% of diabetic men with erectile dysfunction experience orgasmic dysfunction as a separate issue 3
• Concomitant premature ejaculation may improve when erectile dysfunction is effectively treated 2

Common Ejaculatory Disorders (Not Risks of Normal Ejaculation)

Premature Ejaculation

• Lifelong premature ejaculation is characterized by ejaculation within approximately 2 minutes of penetration since sexual debut, with poor control and associated distress 4
• Acquired premature ejaculation involves either ejaculation under 2-3 minutes or a 50% reduction from prior baseline 4
• Treatment options include SSRIs (paroxetine, sertraline, citalopram, fluoxetine) dosed daily, clomipramine on-demand, or pelvic physical therapy 2

Delayed Ejaculation/Anorgasmia

• Diagnosed in men with latencies beyond 25-30 minutes who report distress 4
• Medications contributing to delayed ejaculation (particularly SSRIs, antipsychotics, and antihypertensives) should be replaced, adjusted, or gradually ceased 3
• Progressively lower serum testosterone correlates with increased symptoms of delayed ejaculation and anorgasmia 3

Important Clinical Distinctions

The diagnosis of ejaculatory dysfunction requires three components: time-based criteria, poor ejaculatory control, and associated distress or bother to the patient and/or partner 4

• Adequate sexual arousal is essential for optimal ejaculatory function through psychosexual mechanisms 3, 5
• Psychological factors including anxiety, depression, history of sexual abuse, decreased emotional intimacy, and relationship conflict are associated with ejaculatory disorders 2, 3
• Patient and partner satisfaction is the primary target outcome for treatment, not arbitrary physiological measures 2, 3

Safety Considerations for Treatment

No FDA-approved treatments exist for many ejaculatory disorders, and all pharmacotherapy is off-label, requiring patients to understand the weak evidence base and potential for known/unknown side effects 3

• Safety should be a primary consideration since ejaculatory disorders are not life-threatening conditions 2
• Some treatments such as neurectomy and penile prosthesis implantation have risks that far outweigh their benefits 2
• Lifestyle modifications (smoking cessation, weight loss, increased physical activity, reduced alcohol consumption) can improve erectile and sexual function 2