Clinical summary guide

Ejaculatory disorders

10 min

On this page

The GP’s role

How to approach the topic with patients

“Many men experience sexual difficulties. If you have any difficulties, I am happy to discuss them.”


Disorders of ejaculation are uncommon but are important to manage when fertility is an issue.

Early (premature) ejaculation


The Premature Ejaculation Diagnostic Tool (PEDT) can help identify men who have early ejaculation.

Laboratory testing is not routinely necessary for primary early ejaculation but may be useful for identifying comorbid contributors to secondary early ejaculation.


Management should be guided by the underlying cause.

Many men recover longer ejaculation latency following treatment.

Oral pharmacotherapy

Dapoxetine hydrochloride is short-acting on-demand SSRI, and is the only SSRI approved in Australia for treatment of early ejaculation.

Dose: 30 mg taken 1-3 hours before intercourse

Topical pharmacotherapy

Local anaesthetic gels/creams can diminish sensitivity and delay ejaculation. Excess use can be associated with a loss of pleasure, orgasm and erection. Apply 30 minutes prior to intercourse to prevent trans-vaginal absorption. Use a condom if intercourse occurs sooner.

Behavioural techniques

Techniques may be difficult to maintain long-term.

Psychosexual counselling


Delayed ejaculation


Idiosyncratic masturbation, fantasy or pornography use may contribute to delayed ejaculation.

Investigation by a sex therapist may be required to obtain a complete psychological evaluation.


Psychological treatment

Cessation of medications, dose adjustment or substitution should be considered for drugs that disrupt orgasm and ejaculation (e.g., SSRIs, SNRIs, tricyclic antidepressants, opioids).

There is limited evidence for any pharmacological agent in treating delayed ejaculation. Drugs used include α-1-adrenergic agents (e.g., pseudoephedrine, imipramine), dopamine agonists (e.g., apomorphine, cabergoline), and hormones (oxytocin, testosterone).

Penile vibratory stimulation

Anorgasmia (no orgasm) 




Painful ejaculation



Retrograde ejaculation (orgasm with no ejaculation)




Refer to fertility specialist if fertility is an issue.









Refer to a urologist any high risk patient or any with recurrent haemospermia. Specialist investigations may include TRUS, MRI, and cystoscourethroscopy. 

Information sourced from

European Association of Urology. Sexual and Reproductive Health Guidelines

Disorders of Ejaculation: An UAA/SMSNA Guideline

Clinical review

Dr Vincent Chan, Men’s Health Melbourne and Western Health, Victoria; July 2023
Ejaculatory disorders

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