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CONTACT INFORMATION |
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J. Francois Eid, M.D.
50 East 69th Street
New York, NY 10021 |
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Ph: 212-535-6690 |
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Fax: 212-535-7025 |
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Anejaculation |
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Anejaculation is the inability to ejaculate semen despite stimulation of the penis by intercourse or masturbation. The causes can be psychological or physical and anejaculation can be situational or total.
Situational anejaculation means that a man can ejaculate and attain orgasm in some situations but not in others. Typically, situational ejaculation is stressed induced and occurs selectively. For example, a man who is able to ejaculate at home may not be able to do so in order to provide a specimen in a clinic because he is self conscious and anxious. In some instances, a man may be able to ejaculate and attain orgasm with one partner but not with another. This usually occurs when there is a psychological conflict in a relationship and difficulty with one partner. In total or complete anejaculation the man is never able to ejaculate, either during intercourse or through masturbation. In the absence of spinal cord injury or multiple sclerosis, deep-rooted psychological conflicts may be the cause for this scenario. Such men however, usually have normal nocturnal (night) sleep emissions of semen.
Total anejaculation is further divided into anorgasmic anejaculation and orgasmic anejaculation. In anorgasmic anejaculation the man is never able to reach an orgasm in the waking state (either by masturbation or by intercourse) and does not ejaculate. This failure to reach an orgasm is sometimes attributed to psychological inhibitions, as was previously mentioned. Some may need a high amount of stimulation before they reach orgasm and do not get this stimulation during intercourse or masturbation. Low serum testosterone levels or psychotropic medications may also prevent men from reaching orgasm and ejaculation. Hormonal therapy for the treatment of prostate cancer can also render men anorgasmic. Most men following complete or incomplete spinal cord injury (SCI) will lose their ability to ejaculate and have an orgasm. Approximately 60% of spinal cord injured males will continue to be able to have erections however. In some instances, men taking medications known as serotonin re-uptake inhibitors (Paxil, Zoloft, Lexapro) will experience ejaculation without the sensation of orgasm.
Men with orgasmic anejaculation reach and experience orgasm but they do not ejaculate semen, either because there is failure of emission of semen due to a block in the ejaculatory ducts or damage to ejaculatory nerves. Examples of conditions that cause this situation are diabetes, after trans-urethral (laser) resection of the prostate and following pelvic surgery for prostate, bladder or testicular cancer. Anejaculation must not be confused with retrograde ejaculation (flow of semen back into the bladder due to weakness or surgery of the bladder neck). This occurs in men taking medications such as alpha-blockers (Flomax) that prevent closure of the bladder neck during orgasm. Another situation where retrograde ejaculation may be observed is in men following trans urethral resection (TURP) or laser surgery of the prostate. Anejaculation, however is more likely to occur in this situation, especially if complete trans urethral resection of the prostate occurred including the ejaculatory ducts, which carry semen from the seminal vesicles and testicles. A simple analysis of post orgasmic urine specimen will differentiate between retrograde and anejaculation. The presence of sperm in the urine specimen supports the diagnosis of retrograde ejaculation. Total absence of sperm in urine would indicate complete lack of ejaculation or anejaculation.
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Treatment
Treatment depends on the causes and includes psychosexual counseling, drugs such as ephedrine and imipramine, vibrator therapy and electro ejaculation. If anejaculation is caused by a medication such as Flomax, stopping the medicine will most likely restore normal function. On rare occasions, medications that help to close the bladder neck (ephedrine, imipramine) may convert retrograde ejaculation to antegrade ejaculation.
The vibrator acts by providing a strong stimulus for a long duration to the penis. Vibrator stimulation results in ejaculation in about 60% of men suffering from a neurological (spinal cord) injury. This is a simple and quite effective way of retrieving semen in order to proceed with artificial insemination (inserting sperm directly into the uterus).
Electro ejaculation is a procedure in which an electrical current is applied to the ejaculatory nerve plexus thru the rectum to stimulate ejaculation. Success rates in retrieving sperm for insemination are a nearly 100% for men with anorgasmic anejaculation and in men with no physical defects. If nerves are damaged, vibratory stimulation and electro-ejaculation have an 80% success rate. In some rare instances medicines can help.
No treatment exists to restore ejaculation following open or laser prostate surgery.
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