Miscellaneous Topics - Anejaculation

What is anejaculation?

Anejaculation is defined as the inability to ejaculate semen; the word itself means “no ejaculation.” With this condition, a man can produce sperm but cannot expel them during normal ejaculation even though anejaculation often is accompanied with normal orgasmic sensation.

Anejaculation can be divided into several categories:

• Situational anejaculation: Situational anejaculation is when a man can ejaculate in some situations but not in others. Frequently, this type of anejaculation is caused by stress in situations such as being in the fertility clinic where some men become tense when they know they have to give a semen sample “on demand.” Additionally,  if a man can ejaculate during intercourse but cannot ejaculate through masturbation (or vice versa) then this is considered situational.
• Total anejaculation: Total anejaculation is when a man is never able to ejaculate semen either during intercourse or by masturbation, at home or in the clinic. Total anejaculation also can be divided into:
  • Anorgasmic anejaculation - a man who can never achieve an orgasm while awake, but can reach orgasm, and ejaculation, while asleep at night. In these cases, psychological factors rather than physical ones are likely causing the condition
  • Orgasmic anejaculation - a man can reach and achieve orgasm, but cannot ejaculate semen. This failure to release semen can be due to a block in the tubes or damage to the nerves, or possibly due to retrograde ejaculation where semen is going into the bladder rather than leaving the penis through its tip

Anejaculation can also be classified as primary or secondary.  Primary anejaculation is when ejaculation has never been experienced in a man's entire lifetime and secondary anejaculation is when a man is unable to ejaculate after he has been experiencing normal sexual functioning.

What causes anejaculation?

Anejaculation occurs when the prostate and seminal ducts fail to release semen into the urethra.  This problem can be due to several causes:

• Spinal cord injuries
• Conditions that affect the nervous system (such as Parkinson's disease, multiple sclerosis, diabetes, spinal bifida, etc.)
• Traumatic injury or infection to the pelvis/groin area
• Surgical treatment for testicular cancer or other cancers requiring the removal of lymph nodes located in the groin
• Surgeries that may cause damage to the pelvic area (such as prostate, bladder or abdominal surgery that can damage or traumatize nerves)

Sometimes hormonal and psychological factors can play a role (e.g. anxiety, marital problems, fear of causing pregnancy). It has been found that situational anejaculation can be due to psychological factors such as stress.

Can men who have anejaculation still have children?

Yes, men with anejaculation can still have children. Since men with anejaculation still produce sperm even though they cannot ejaculate semen, medical procedures can induce ejaculation or retrieve sperm in other ways, following which artificial insemination can help the couple conceive.  

How is anejaculation treated?

There are several treatment options for men with anejaculation; the main goal of which is to retrieve sperm for artificial insemination.

Situational anejaculation can often be prevented or treated by simple methods that make the man feel more comfortable (such as the clinic being quiet with no waiting lines, or the man collecting a semen sample at home). If situational anejaculation is due to psychological causes it can often be treated by simple measures such as psychological or sexual counseling. You should talk to your doctor about what is right for you.

When the cause of anejaculation is due to a physical problem then you will have to consult with your doctor to find out exactly what is happening and what action can be taken. Treatment can be as easy as changing to a different type of medication after consultation with your doctor. You may want to reduce or stop drinking or taking other non-prescription drugs.

For other physical causes of anejaculation, treatment is the use of a vibrator (called penile vibratory stimulation). With this treatment, vibrations travel along the sensory nerves to the spinal cord to cause ejaculation. A specially designed vibrator applies vibrations to the tip of the penis and the immediate surrounding area. Vibrator stimulation results in ejaculation in about 60% of men. In men with spinal cord injuries, depending on the level of injury, this technique may not work.

If vibrator therapy fails, electroejaculation can be performed. This involves the direct electrical stimulation of the nerves and is carried out under general anesthesia.

Drug treatment for anejaculation has shown low success rates compared to vibrator stimulation and electroejaculation stimulation and therefore is not a preferred treatment option.

If there is a block due to infection, this can sometimes be cleared by surgery and sexual function can be regained.

If the above measures are not successful and fertility is the main concern, it is possible for a trained physician to extract sperm from the testicles and in vitro fertilization (IVF) (egg-sperm fertilization in a test tube and then inserted into uterus of mother) or single sperm injection can be attempted.

What is electroejaculation?

Electroejaculation is the use of electrical stimulation to cause ejaculation. This method stimulates ejaculatory nerves by inserting a lubricated probe, called an electroejaculator, into the rectum and applying electrical stimulations. General anesthesia is usually required, except in some cases of complete spinal cord injury.

The probe is placed into the rectum next to the prostate and stimulations are preformed for five to seven minutes, during which the stimulus is progressively increased until the man ejaculates. The semen specimen is then collected, processed and analyzed for sperm quality.  If sperm quality is high enough, then the sperm can be used for artificial insemination.

Although about 90% of men successfully ejaculate with electroejaculation, retrograde ejaculation occurs in about a third. If insufficient amounts of semen are obtained, urine is checked for the presence of sperm. If present, the semen is then extracted from the bladder for artificial insemination.

The major downfall with electroejaculation is that semen quality is often poor, although semen quality often improves after repeated ejaculations. Therefore electroejaculation is usually the second choice treatment only after repeated sessions of vibratory stimulation fail. When electroejaculation also fails, or if the quality of the sperm obtained from this procedure is too poor, many couples resort to in vitro