What are the benefits of semen retention in a male patient of reproductive age with premature ejaculation or erectile dysfunction?

Semen Retention Has No Proven Medical Benefits for Premature Ejaculation or Erectile Dysfunction

There is no evidence-based medical benefit to semen retention for treating premature ejaculation (PE) or erectile dysfunction (ED), and this practice is not recommended in any clinical guidelines. In fact, the established treatments for these conditions involve the opposite approach—regular ejaculation through sexual activity or masturbation is part of standard behavioral therapy protocols.

Evidence-Based Treatment for Premature Ejaculation

The American Urological Association (AUA) and Sexual Medicine Society of North America (SMSNA) provide clear treatment algorithms that make no mention of semen retention as a therapeutic strategy 1:

First-Line Pharmacologic Treatment

• Daily SSRIs are the gold standard, with paroxetine 10-40 mg/day providing the greatest ejaculatory delay (8.8-fold increase in ejaculatory latency time) 2
• Alternative daily SSRIs include sertraline 25-200 mg/day, fluoxetine 5-20 mg/day, or clomipramine 25-50 mg/day 1
• Topical anesthetics (lidocaine/prilocaine cream) applied 20-30 minutes before intercourse effectively delay ejaculation 1

Behavioral Therapy Integration

• Combining behavioral and pharmacological approaches is more effective than either alone (Moderate Recommendation, Evidence Level Grade B) 1
• Behavioral strategies in guidelines focus on techniques like the "stop-start" and "squeeze" methods, which require regular practice with ejaculation, not abstinence 1

Treatment for Concomitant ED

• If ED coexists with PE, treat the ED first—PE often improves when erectile function is restored 1, 2
• PDE5 inhibitors (sildenafil, tadalafil) combined with SSRIs show superior outcomes for men with both conditions 3, 4

Why Semen Retention Is Not Recommended

The medical literature and clinical guidelines consistently emphasize that:

• Patient and partner satisfaction is the primary treatment outcome, not ejaculatory frequency or abstinence 1, 2
• Regular sexual activity with adequate ejaculatory control (achieved through medication and behavioral therapy) is the therapeutic goal 1
• There are no controlled studies demonstrating that semen retention improves ejaculatory latency time, erectile function, or sexual satisfaction 5, 6

Important Clinical Pitfalls

Common Misconceptions to Address

• Some patients believe that "saving" ejaculations will improve sexual performance—this has no scientific basis and may worsen performance anxiety 1
• Prolonged abstinence does not improve sperm quality in men with normal fertility; in fact, regular ejaculation (every 2-3 days) optimizes sperm parameters 1

When Fertility Is a Concern

• For men with testicular atrophy or declining fertility, sperm banking should be performed immediately rather than practicing retention 7
• The American Society for Reproductive Medicine recommends collecting 2-3 ejaculates separated by 2-7 days for optimal cryopreservation 1, 7
• Exogenous testosterone (sometimes sought by men practicing "retention" for perceived virility benefits) will completely suppress spermatogenesis and cause azoospermia 1, 7

Recommended Clinical Algorithm

1. Assess for comorbid ED: If present, initiate PDE5 inhibitor therapy first 1, 2
2. Start daily SSRI therapy: Paroxetine 20 mg/day is first-line for maximal effect 1, 2
3. Add topical anesthetics if needed for situational control 1
4. Integrate behavioral therapy: Teach stop-start or squeeze techniques that require regular sexual practice 1
5. Reassess at 4-8 weeks: Adjust dosing based on ejaculatory latency time and patient satisfaction 1

For Refractory Cases

• Consider alpha-1 adrenoceptor antagonists (alfuzosin, terazosin) as second-line therapy 1, 2
• Combination therapy with PDE5 inhibitors plus SSRIs may enhance efficacy, though side effects (headache, flushing) increase 1, 3, 4

The evidence unequivocally supports active treatment with medications and behavioral techniques involving regular sexual activity, not abstinence or semen retention, for optimizing sexual function and quality of life in men with PE or ED.