Does Ejaculation Change With Age in Men?

The 2025 EAU Guidelines on Sexual and Reproductive Health include some information on how age relates to ejaculation problems. 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 suggest that age does not affect all ejaculatory disorders in the same way. 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 list aging, through degeneration of the nerves that carry sensation from the penis, as one possible cause of delayed or absent ejaculation. 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 note that a significant proportion of men with erectile dysfunction (ED) have premature ejaculation as well⁵, and that high levels of performance anxiety related to ED may worsen premature ejaculation⁶. 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 with delayed ejaculation, the guidelines advise a full medical and sexual history and a detailed physical examination. This includes careful medical history-taking, physical examination, and appropriate laboratory testing to rule out underlying medical conditions that might exacerbate age-related changes⁹. Some changes in ejaculation are common as men get older, and medical help is available if they cause 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, the guidelines describe psychological approaches such as anxiety reduction and sex therapy, although evidence for them is limited¹⁰. Pharmacological interventions may be considered in some cases, though the evidence base for their efficacy specifically in age-related ejaculatory disorders is limited¹¹.