Most men have forward propulsion of semen, or ejaculate, at the moment they experience the sensation of an orgasm (also called climax). Orgasm and ejaculate are often used interchangably, but they are actually distinct processes.
Forward, or antegrade, propulsion of ejaculate requires semen to be pushed into the back of the penis by muscle contractions, the entrance to the bladder (also called the bladder neck) to close, and then muscle contractions push the semen forward towards the end of the penis. Some neurologic conditions including diabetes interfere with muscle contraction, however, and semen is not pushed into the penis, or not pushed forward once it gets there. If the bladder neck has been altered by surgery, or fails to close tightly due to neurologic conditions (again including diabetes), then semen that’s been deposited in the back of the penis may get squeezed retrograde (backwards) towards the bladder, instead of being squeezed in an antegrade direction.
Men with the condition described above typically have regular pleasurable sensations of orgasm, but don’t actually ejaculate (at least not in the expected forward direction). The term premature ejaculation might better be called premature orgasm in these men. The distress related to reaching orgasm too soon is similar to that experienced with PE, and the treatment options are also the same.
This information is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.