Ejaculatory disorder


Q: About a year ago i started having episodes while driving - more than 20-30 minutes on a highway where i would spontaneously ejaculate. I went to my GP and they had me see a urologist. I was checked for prostate, urine test, colonoscopy and they could not determine any issues. They put me on rapaflow as it can inhibit the flow a sperm. This helps but is a painful alternative as when i drive i feel like i have to urinate constantly. I had a second urologist check me out and he suggested that i have some type of ptsd and that it would go away. My GP put me on paxil to handle some of the anxiety. It has done nothing to stop the situation. I stopped taking rapaflow about 2 weeks ago. I notice a constant feeling of having to urinate which is strong while sitting or laying. If i am walking around or active the feeling goes away.

Symptoms:  As mentioned above, constant urge to urinate, non sexual ejaculation - only when in a care

A:   Hello,
Thank you for your medical query at AskTheDoctor.com
I understand your concern.
You have a constant urge to urinate and spontaneous ejaculation, mostly while traveling in the car.
You did not mention whether Rap flow was actually helpful in limiting the ejaculation.
It does seem related to PTSD. And even urinary incontinence you have been experiencing now, causes incontinence.

There are various methods of preventing this constant urge provided the tone at the detrusor muscle and pelvic floor muscles are fine. Kegel exercises, done 2-3 times daily ( where while peeing, you try to hold your fee by contracting a specific abdominal muscle ) can be tried to improve the bladder tone. In such cases of PTSD, it does resolve on its own, but in your case it is taking more time than usual. There are other methods such as biofeedback therapy and electrode therapy which can also prevent this constant urge to urinate.

For both your problems, I want you to discuss with your urologist about the drug " Duloxetine ". This should help in preventing both the incontinence as well as premature ejaculation. Paroxetine ( Paxil ) does not help in certain cases, and in these patients, Duloxetine is the recommended drug.

Hope this was helpful,
Please feel free to ask further follow-up questions. We will be glad to answer your queries.

Comments / Follow Ups

Patient: Thank you - are there any doctors in the Pittsburgh area that you could refer me to?
Doctor: Hello,
I am sorry I won't be able to help you with this, as I am not sure of any doctors in Pittsburgh.
I sincerely apologise for this.
I will advise you to consult a urologist and proceed.

Please let me know if I can help you further,

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