Anejaculation

Causes

Anejaculation is when a man does not ejaculate during a sexual climax (orgasm). There may be total anejaculation, which occurs during all sexual stimulation, or situational anejaculation, which occurs only under certain conditions.

Men with anejaculation usually have an orgasm that feels normal, but in some men this feeling is reduced. Infertility can also be an issue because there is no ejaculation. However, these men do produce sperm. Using assisted reproductive technologies, sperm can be collected for use in IVF treatments to achieve pregnancy.

The primary causes of anejaculation are:

• Surgery to the prostate, bladder or abdomen that damages the pelvic nerves
• Prostatitis, an inflammation of the prostate gland
• Conditions that affect the nervous system such as Parkinson’s disease, Multiple Sclerosis, Diabetes, and spinal cord injuries
• Partial blockages to the urethra

Diagnosis

A urine sample is taken soon after sexual climax (post ejaculation urine analysis). The analysis checks the urine for sperm. If no sperm is found in the urine, a diagnosis of anejaculation is made. If sperm is found, the diagnosis is retrograde ejaculation. In this condition semen flows into the bladder at the time of orgasm so that little or no fluid is released through the penis.

Treatment

Your local doctor can find the cause of anejaculation and offer treatment. In some cases, your doctor may need to refer you to a specialist or psychosexual counsellor.

Anejaculation due to partial blockages of the urethra can be treated with surgery, but this is uncommon. Infections, such as prostatitis, can be treated.

Otherwise, when fertility is not an issue, no medical treatment is needed. Men who are concerned by not being able to ejaculate may benefit from counselling to discuss their concerns.

Common questions about Anejaculation

Can men with anejaculation still have children?

Men with anejaculation can still have children using assisted reproductive technologies.

Methods include:

• Testicular biopsy: Sperm is collected by a testicular biopsy technique (needle or open biopsy). Sperm found in the biopsy tissue can be used in the assisted reproductive technique called intracytoplasmic sperm injection (ICSI) where a single sperm is injected into the egg by piercing the shell of the egg.
• Vibrator or electrical stimulation: Vibrator or electrical stimulation is used to contract the pelvic muscles and stimulate ejaculation. Sperm can then be collected and used in an in vitro fertilization procedure (IVF).

Are there risks linked with testicular biopsy and electrical or vibrator treatment?

Testicular biopsy has an excellent safety record. Discomfort is common for a few days after the open biopsy procedure and wearing supportive underwear may help. Possible side-effects include bleeding, testicular swelling and infection. These are usually mild and do not last very long.

Electrical stimulation can cause a severe rise in blood pressure and internal bleeding in the brain (cerebral haemorrhage). There is also a small risk of rectal burn and tearing of the rectum.

How can anejaculation affect a man’s life?

Anejaculation can cause distress, especially when the man doesn’t understand what is happening. Discussing his feelings with a doctor or psychosexual therapist may help him come to terms with having an orgasm without ejaculation and accepting that this is normal for him.

For more information about anejaculation, speak with a doctor.