Does Ejaculation Change With Age in Men?

The 2025 EAU Guidelines on Sexual and Reproductive Health provide important insights into how ejaculation changes as men age. Ejaculation is described as “a complex physiological process that comprises emission and expulsion processes and is mediated by interwoven neurological and hormonal pathways”¹. As men age, various aspects of this process can undergo changes that affect sexual function and satisfaction. Interestingly, the guidelines make a clear distinction between different types of ejaculatory disorders and their relationship with aging. According to the National Health and Social Life Survey (NHSLS) cited in the guidelines, “the prevalence of premature ejaculation is not affected by age, unlike erectile dysfunction, which increases with age”². This means that while premature ejaculation remains relatively stable across different age groups, other ejaculatory disorders show clear age-related patterns. Delayed ejaculation (DE), for instance, becomes increasingly prevalent with age. The guidelines indicate that age-related changes in neurological function, hormonal balance, and vascular health contribute to this phenomenon. Older men may experience longer latency to ejaculation, decreased force of ejaculation, and reduced ejaculate volume. These changes are considered part of the normal aging process but can sometimes cause distress or dissatisfaction. The guidelines also highlight that ejaculatory disorders in aging men often coexist with erectile dysfunction (ED)⁵. A significant proportion of men with ED also experience ejaculatory disorders, with high levels of performance anxiety potentially worsening both conditions⁶. This relationship becomes more relevant with age as the prevalence of ED increases in older populations. For men with severe ED who do not respond to other treatments, penile prosthesis implantation may be considered. The guidelines note that “the surgical implantation of a penile prosthesis may be considered in patients who i) are not suitable for different pharmacotherapies or prefer a definitive therapy; and, ii) do not respond to other treatment modalities”⁸. For men concerned about age-related changes in ejaculation, the guidelines recommend a comprehensive approach to assessment and management. This includes careful medical history-taking, physical examination, and appropriate laboratory testing to rule out underlying medical conditions that might exacerbate age-related changes⁹. The guidelines emphasize that many ejaculatory changes with age are physiological rather than pathological, though they may still benefit from medical intervention if they cause significant distress. Treatment options for age-related ejaculatory changes depend on the specific disorder and its impact on quality of life. For men with delayed ejaculation associated with aging, the guidelines suggest that psychological approaches may be beneficial, particularly when there is associated anxiety or relationship factors¹⁰. Pharmacological interventions may be considered in some cases, though the evidence base for their efficacy specifically in age-related ejaculatory disorders is limited¹¹.