Anejaculation is a sexual health condition defined as the inability to expel semen from the body despite reaching the point of orgasm, resulting in a “dry” orgasm. The man still undergoes the physiological processes leading up to climax, but the final expulsion phase fails. This condition must be distinguished from retrograde ejaculation, where semen flows backward into the bladder. While both result in an absence of visible semen, anejaculation signifies a complete failure of the emission or expulsion mechanism, unlike retrograde ejaculation which involves misdirection of seminal fluid.
Primary Causes of Anejaculation
The causes of anejaculation are broadly categorized as neurological damage, medications, physical obstructions, or psychological factors. Neurological damage is a frequent cause because the sympathetic nervous system controls the muscle contractions necessary for emission and bladder neck closure. Conditions like spinal cord injury (SCI) can disrupt the nerve pathways responsible for the ejaculatory reflex. Neuropathy associated with diabetes mellitus can also progressively impair these peripheral nerves, leading to ejaculatory failure.
Surgical procedures in the pelvic area can inadvertently cause nerve damage or anatomical disruption. Extensive surgeries, such as retroperitoneal lymph node dissection (RPLND) for testicular cancer or procedures involving the bladder neck, can injure the sympathetic nerve fibers necessary for semen emission. Anatomical issues, such as congenital blockages of the ejaculatory ducts, are less common but represent a physical barrier to seminal fluid flow. Damage to the internal sphincter of the bladder, which normally closes during ejaculation, can also contribute to this dysfunction.
Pharmacological agents are a common cause, as many medications interfere with the sympathetic nervous system’s function. Certain psychoactive drugs, including selective serotonin reuptake inhibitors (SSRIs) used to treat depression, are known to inhibit or delay ejaculation. Alpha-blockers, prescribed for hypertension or benign prostatic hyperplasia, can also relax the smooth muscles of the bladder neck and seminal vesicles necessary for emission. The condition often resolves after the patient discontinues or switches the causative medication under medical supervision.
Psychological factors can cause situational anejaculation, where the man can ejaculate during masturbation but not during partnered intercourse. This is often linked to performance anxiety, stress, or conditioned inhibitory responses. Total psychogenic anejaculation, where the man is unable to ejaculate in any situation, is less common. This suggests a deep-seated psychological block or a learned response that overrides the normal physiological process.
Diagnostic Procedures
The evaluation begins with a comprehensive review of the patient’s medical, surgical, and sexual history, including a detailed medication list. The physician will ask about the onset of the condition, whether it is situational or total, and if the patient still experiences the sensation of orgasm. This history helps determine if the cause is likely neurological, anatomical, or psychogenic.
A physical examination, including a focused neurological assessment, is performed to check for signs of peripheral neuropathy or nerve damage. The definitive test to confirm anejaculation and rule out retrograde ejaculation is a post-orgasm urinalysis. The patient provides a urine sample immediately after climaxing.
If the urine sample contains a significant number of sperm, the diagnosis is retrograde ejaculation. The absence of sperm in the post-orgasm urine confirms anejaculation, indicating that semen failed to enter the urethra. Further testing, such as hormone panels or specialized neurological tests, may be performed to pinpoint the underlying cause.
Medical and Behavioral Treatments
Treatment depends on the identified cause, with the first step often involving the cessation or adjustment of any causative medication. If a pharmacological agent is suspected, switching to an alternative drug or temporarily discontinuing the medication can restore normal ejaculatory function. For psychogenic or situational anejaculation, behavioral therapy, sex counseling, and cognitive behavioral techniques can be effective in overcoming learned inhibitions.
When the cause is neurological, particularly from spinal cord injury, physical stimulation techniques are often employed as a first-line intervention. Penile vibratory stimulation (PVS) uses a specialized, high-amplitude vibrator applied to the head of the penis to trigger the ejaculation reflex. PVS is non-invasive and successfully retrieves sperm for many men with upper motor neuron lesions.
If PVS proves ineffective, the specialized procedure of electroejaculation (EEJ) may be used. EEJ involves the insertion of a rectal probe that delivers a controlled electrical current to stimulate the nerves and glands responsible for ejaculation. This procedure is typically performed under anesthesia or deep sedation in a clinic setting and is effective in obtaining a semen sample for men with severe neurological damage.
Reproductive and Fertility Considerations
Anejaculation is a direct cause of male infertility because it prevents the delivery of sperm into the female reproductive tract for natural conception. While the man still produces healthy sperm, the failure of the transport mechanism necessitates intervention if the couple wishes to conceive. The retrieved semen, whether through PVS or EEJ, is often of lower quality, exhibiting reduced motility.
The quality of the retrieved sample dictates the type of assisted reproductive technology (ART) that must be used. Samples with sufficient sperm can sometimes be used for intrauterine insemination (IUI), where the sperm is directly placed into the woman’s uterus. However, the poor motility common in electroejaculates often requires more advanced techniques.
More commonly, the sperm is used for in vitro fertilization (IVF) combined with intracytoplasmic sperm injection (ICSI). ICSI is a technique where a single, viable sperm is injected directly into an egg to achieve fertilization. If PVS and EEJ fail to retrieve a sample, or if the retrieved sperm is non-viable, surgical sperm retrieval techniques are the final option. These procedures, such as testicular sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA), involve obtaining sperm directly from the testicle or epididymis for use with ICSI.