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Anejaculation
Anejaculation
Anejaculation
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Anejaculation is the pathological inability to ejaculate despite an erection[1] in males, with (orgasmic) or without (anorgasmic) orgasm.

Causes

[edit]
The following table shows the frequency of ability to ejaculate by type of spinal cord injury and stimulation method.[2]
Masturbation
or coitus		 Penile
vibratory
stimulation		 AchE
inhibitor
Complete spinal cord injury 12% 47% 55%
Incomplete spinal cord injury 33% 53% 78%
Complete lesion of the
sympathetic centres (T12 to L2) 		None 5%
Complete lesion of the parasympathetic
and somatic centres (S2 – S4) 		None 31%
Complete lesion of all
spinal ejaculation centres (T12 to S5) 		None 0%
Complete lesion strictly
above Onuf's nucleus (S2 – S4) 		98% 98%
Complete lesion of the S2 – S4 segments none none

It can depend on one or more of several causes, including:

Anejaculation, especially the orgasmic variant, is usually indistinguishable from retrograde ejaculation. However, a negative urinalysis measuring no abnormal presence of spermatozoa in the urine will eliminate a retrograde ejaculation diagnosis. Thus, if the affected person has the sensations and involuntary muscle-contractions of an orgasm but no or very low-volume semen, ejaculatory duct obstruction is another possible underlying pathology of anejaculation.[citation needed]

Management

[edit]

Anejaculation in spinal cord injury

[edit]
Further information: Sexuality after spinal cord injury § Ejaculation and male fertility

The first-line method for sperm retrieval in men with spinal cord injury is penile vibratory stimulation (PVS).[2] The penile vibratory stimulator is a plier-like device that is placed around the glans penis to stimulate it by vibration. In case of failure with PVS, spermatozoa are sometimes collected by electroejaculation, or surgically by percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE).[2]

Notes

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Anejaculation

View on Grokipedia
from Grokipedia
Anejaculation is a form of male ejaculatory dysfunction defined as the complete absence of emission during sexual activity, despite adequate and often the presence of orgasmic sensation, leading to personal distress or relational issues. This condition differs from , which involves a marked prolongation before emission, and from , where enters the instead of being expelled forward. It can be classified into subtypes such as lifelong (primary, present since sexual debut) or acquired (secondary, developing later in life), as well as situational (occurring only in specific contexts like intercourse but not ) or total (universal inability to ejaculate consciously). Anejaculation often results in , a major concern for affected individuals. The prevalence of anejaculation is low, estimated at less than 1% in the general population, though it represents a significant portion—up to 77–81%—of cases within broader ejaculatory disorders in certain populations such as clinical settings in . Causes are multifactorial, encompassing both organic and psychogenic etiologies. Organic factors include neurological damage from spinal cord injuries or pelvic surgeries (e.g., radical prostatectomy), metabolic disorders like diabetes mellitus, medication side effects (such as selective serotonin reuptake inhibitors or alpha-blockers), hormonal imbalances (e.g., low testosterone), and anatomical obstructions like issues. Psychogenic causes often stem from psychological stressors, including performance anxiety, relationship conflicts, depression, or maladaptive conditioning from excessive techniques. Diagnosis typically begins with a detailed medical and sexual history to distinguish anejaculation from other dysfunctions, followed by a including genital inspection and digital rectal exam. Laboratory tests may involve post-ejaculation to rule out , serum testosterone levels, blood glucose for screening, and imaging such as transrectal if obstruction is suspected. Treatment approaches are tailored to the underlying cause and goals, particularly preservation. Options include discontinuing offending medications, psychosexual therapy for psychological factors, pharmacotherapy with agents like dopamine agonists (e.g., ) or alpha-1 adrenergics (e.g., ), and assisted techniques such as penile vibratory stimulation or for retrieval in cases.

Definition and Classification

Definition

Anejaculation is defined as the complete absence of emission during or , despite adequate stimulation and the presence of normal erectile function or , resulting in a phenomenon known as dry . This condition represents a in the ejaculatory process, where may occur subjectively, but no seminal fluid is expelled from the . Anatomically, anejaculation arises from disruptions in the two primary phases of : the emission phase, involving contractions of the , , and to propel into the posterior , or the expulsion phase, characterized by rhythmic contractions of the urethral and muscles to eject outward. Failure in either phase prevents release, distinguishing it from other ejaculatory disorders. It is important to differentiate anejaculation from , in which semen is redirected into the due to incompetence of the bladder neck rather than being absent entirely, and from , which involves a marked prolongation in the time to emission or complete inability to ejaculate. Anejaculation affects approximately 1-4% of men, with higher relevance in fertility contexts where it contributes to by preventing delivery for conception.

Types

Anejaculation is classified into several subtypes based on its onset, , and underlying mechanisms, which aids in differentiating etiologies and guiding management. These classifications include distinctions between total and situational forms, primary and secondary types, as well as subtypes related to the phases of —emission and expulsion. Total anejaculation refers to the complete inability to ejaculate in any situation, including during , , or with stimulation; it is often associated with organic causes such as neurological disorders. In contrast, situational anejaculation occurs only in specific contexts, such as during partnered sexual activity like intercourse, while ejaculation remains possible in others, for example, through ; this form is frequently linked to psychological factors. Anejaculation can also be categorized as primary or secondary based on its temporal onset. Primary anejaculation is lifelong, meaning the individual has never experienced since the onset of , and it is rare, potentially stemming from congenital factors. Secondary anejaculation, which is more common, develops after a period of normal ejaculatory function and is typically acquired due to intervening medical, surgical, or psychological events. Further subclassification focuses on the physiological phases of ejaculation, distinguishing between emission failure and expulsion failure. Emission failure involves the absence of semen deposition into the posterior urethra due to inadequate contractions of the , , or , often resulting from disruptions in sympathetic innervation or seminal fluid production. Expulsion failure, on the other hand, occurs when semen reaches the urethra but cannot be forcefully expelled, typically due to neurological or muscular impairments affecting the or . These phase-specific subtypes often overlap with total anejaculation, particularly when neurological causes predominate.

Signs and Symptoms

Primary Manifestations

Anejaculation is characterized by the complete absence of ejaculation during sexual activity, despite the presence of , penile , and orgasmic sensation. This results in what is often described as a "dry" climax, where the individual experiences the pleasurable sensations of without any fluid expulsion from the . The orgasmic experience itself typically remains intact and subjectively normal, distinguishing anejaculation from , in which is absent or diminished. Individuals may report the usual buildup of tension and release associated with climax, but without the accompanying emission of . Erectile function in anejaculation is often preserved, allowing for adequate and penetration during intercourse, though it can sometimes co-occur with . In most cases, men achieve and maintain erections without difficulty, highlighting that the dysfunction is specific to the ejaculatory process rather than broader sexual response. The onset of anejaculation can vary, presenting either suddenly or gradually, and may be lifelong (primary) or develop later in life (secondary). It can also manifest as total (inability in all contexts), situational (e.g., during intercourse but not ), or specifically during orgasmic events.

Associated Effects

Anejaculation primarily manifests as a significant barrier to natural conception, rendering affected individuals due to the absence of antegrade emission during sexual activity. Without ejaculated containing , fertilization cannot occur through conventional intercourse, necessitating assisted reproductive techniques such as (ICSI) or to retrieve for use in fertility treatments. This often becomes the initial presenting concern in clinical evaluations, particularly among couples seeking parenthood. The psychological ramifications of anejaculation extend beyond the physical, frequently engendering feelings of , anxiety, and diminished due to perceived sexual inadequacy. Individuals may experience heightened stress related to performance during intimacy, which can escalate into depressive symptoms or broader emotional distress, especially when the condition intersects with desires for family-building. Relationship dynamics are also impacted, as partners may encounter mutual strain from unfulfilled reproductive goals and altered sexual experiences, potentially leading to interpersonal tension or reduced emotional closeness. Physically, anejaculation itself poses minimal direct sequelae, though the condition primarily affects reproductive rather than excretory function. Sexual satisfaction is often compromised in anejaculation, as the lack of can render sensations incomplete or less pleasurable, contributing to dissatisfaction with the overall sexual response. This perceived incompleteness may prompt avoidance of sexual activity altogether, further exacerbating relational and personal intimacy challenges. Men's reports frequently link ejaculation quality to fulfillment, highlighting how its absence disrupts the typical progression of sexual pleasure.

Causes

Neurological and Organic Causes

Neurological and organic causes of anejaculation primarily involve disruptions to the neural pathways, , or structural components essential for the emission and expulsion phases of . These etiologies often result in permanent or significant impairment due to irreversible damage to the sympathetic chain, , or reproductive tract . Common mechanisms include neuropathy affecting thoracolumbar outflow (T10-L2), which coordinates seminal emission, or direct obstruction of ejaculatory ducts. Spinal cord injury (SCI) is a leading neurological cause, where trauma disrupts sympathetic nerves originating from the thoracolumbar region, preventing coordinated contraction of the , , and . In complete lesions, fewer than 5% of individuals retain ejaculatory ability, while incomplete lesions may preserve partial function in about 22% of cases. This interruption often leads to anejaculation without orgasmic sensation, particularly in injuries above T12. Multiple sclerosis (MS) contributes through demyelination of pathways, impairing the ejaculatory , with up to 50% of MS patients experiencing , including anejaculation in approximately 18%. The disease's impact on signaling disrupts both sensory feedback and motor control required for . Parkinson's disease similarly involves neurodegeneration in dopaminergic pathways, leading to delayed or absent by altering autonomic , though specific prevalence data for anejaculation remains limited. Diabetes mellitus induces anejaculation via peripheral and , damaging nerves that innervate the bladder neck and reproductive organs, with 26% of affected men reporting climax inability compared to 15% in non-diabetics. Microvascular complications exacerbate this by reducing blood flow to neural tissues, progressively worsening ejaculatory function over time. Surgical interventions, such as retroperitoneal lymph node dissection (RPLND) for , damage the sympathetic chain, resulting in anejaculation rates of 5-10% even with nerve-sparing techniques. or bladder surgeries similarly sever pelvic nerves or remove accessory glands, causing complete loss of emission in up to 100% of radical cases. These procedures highlight iatrogenic risks to the hypogastric . Infections and inflammation, including and , can lead to ductal obstruction or scarring that blocks expulsion, with 68% of men with prostatic inflammation experiencing ejaculatory issues. Chronic cases may involve neural irritation from persistent inflammation. Congenital anomalies are rare but significant, such as absent , which prevent seminal fluid contribution and cause obstructive anejaculation, often linked to vas deferens . Neural tube defects like mimic SCI effects by altering development, disrupting sympathetic outflow and leading to lifelong ejaculatory impairment. These structural deficits underscore the role of embryological development in ejaculatory integrity. Certain medications commonly prescribed for or other conditions can induce anejaculation as a side effect. Selective serotonin reuptake inhibitors (SSRIs), widely used as antidepressants, interfere with serotonin pathways involved in , leading to delayed or absent in a substantial proportion of users. Antipsychotics, particularly typical agents like , are associated with high rates of , including anejaculation, due to their impact on and other neurotransmitters. Alpha-blockers, employed for or (BPH), represent another key class, as they relax smooth muscles in the reproductive tract, potentially preventing seminal emission. Hormonal imbalances, such as low testosterone or hyperprolactinemia, can indirectly contribute through psychosomatic pathways, where chronic elevates levels or suppresses testosterone, thereby diminishing sexual drive and ejaculatory function. This interplay highlights how stressors may amplify endocrine disruptions, fostering a cycle of ejaculatory impairment.

Psychological and Situational Causes

Psychological factors play a significant role in anejaculation, often manifesting as anxiety, depression, or performance-related stress that disrupts the normal and process. These conditions can inhibit the relaxation necessary for , leading to an inability to ejaculate despite adequate stimulation. Past , including experiences of , may contribute by triggering dissociation, avoidance behaviors, or emotional suppression during intimate activities, thereby exacerbating ejaculatory difficulties. Situational triggers frequently involve interpersonal dynamics, such as relationship conflicts or unresolved emotional tensions with a partner, which heighten stress and impair sexual . Specific phobias, like coital anejaculation—where is possible through but not during intercourse—can arise from unconscious conflicts or negative associations with penetrative , often linked to performance anxiety or cultural attitudes. Additionally, psychogenic forms influenced by behavioral patterns, such as infrequent sexual activity, may condition the body to delay or prevent in partnered contexts.

Diagnosis

Clinical Evaluation

The clinical evaluation of anejaculation begins with a comprehensive medical and sexual history to elucidate the and guide further assessment. Clinicians inquire about the onset (lifelong or acquired), frequency of occurrences, and whether the condition is situational (e.g., occurring only during intercourse but not ) or total (absent in all contexts), as this distinction helps differentiate psychological from organic causes. Associated issues, such as , , or altered ic sensation (e.g., dry ), are explored, along with a detailed medication review to identify potential contributors like selective serotonin reuptake inhibitors (SSRIs), antipsychotics, or alpha-blockers. A thorough review of comorbidities, including , injuries, or prior surgeries, is essential to uncover neurological or structural factors. Physical examination follows, focusing on the genitals to detect obstructions or abnormalities in the , , or that might impede ejaculation. Neurological assessment includes evaluation of penile sensation, , and lower extremity reflexes to identify peripheral or involvement. Prostate palpation via digital is performed to assess for enlargement, tenderness, or masses that could affect ejaculatory function. Input from the partner is obtained when possible, particularly regarding goals, as anejaculation often presents in the context of evaluations, and to explore relationship dynamics that may influence sexual performance or psychological factors. To aid in , targeted questions address symptoms suggestive of , such as reduced or fatigue, ensuring endocrine causes are not overlooked during initial assessment.

Diagnostic Tests

Diagnosis of anejaculation typically begins with semen analysis, which reveals zero ejaculate volume, confirming the absence of seminal emission. To differentiate anejaculation from retrograde ejaculation, a post-orgasm urine test is performed after the patient masturbates to climax following bladder emptying; the presence of sperm in the urine indicates retrograde ejaculation, while its absence supports true anejaculation. This test may also be adapted as a post-coital urine check for sperm after intercourse to assess emission in real-world scenarios. Hormone panels are essential to evaluate endocrine etiologies, measuring serum levels of testosterone, , (FSH), and (LH). Low testosterone or elevated can contribute to anejaculation by disrupting the hypothalamic-pituitary-gonadal axis, while abnormal FSH/LH levels may indicate . Imaging studies help identify structural abnormalities, with transrectal ultrasound used to assess the and for obstructions or congenital anomalies that impair emission. (MRI) of the spine is employed when neurological causes, such as spinal cord lesions from injury, are suspected, as these can interrupt ejaculatory pathways. For cases suggesting neuropathy, neurological tests including (EMG) and nerve conduction studies evaluate the integrity of peripheral nerves and muscles involved in , such as the arc. These tests measure electrical activity to detect or conduction delays that may underlie anejaculation.

Management and Treatment

Non-Invasive Approaches

Non-invasive approaches to managing anejaculation primarily target situational or psychogenic cases, emphasizing behavioral, psychological, and interventions to alleviate performance anxiety, enhance , and address contributing factors without relying on medications or procedures. These methods are often recommended as first-line options for mild or reversible forms, particularly when linked to stress, relationship dynamics, or habitual patterns, with evidence suggesting improvements in ejaculatory function through and habit changes. Psychotherapy, such as cognitive-behavioral therapy (CBT), focuses on identifying and modifying negative thought patterns, anxiety, or past traumas that inhibit sexual response. In CBT sessions, individuals learn to reframe performance-related fears and develop coping strategies to reduce psychological barriers to , often leading to restored ejaculatory capability in psychogenic cases. For instance, structured CBT protocols have demonstrated efficacy in resolving intercourse-related anejaculation by integrating anxiety reduction with behavioral exercises. Psychodynamic therapy may also be employed for deeper exploration of unconscious conflicts contributing to persistent , though it is typically reserved for treatment-resistant scenarios. Sex therapy employs practical techniques to rebuild sexual confidence and sensory awareness, such as exercises, which involve progressive, non-demanding touch sessions between partners to shift emphasis from ejaculation to pleasurable sensations and intimacy. This approach reduces performance pressure and fosters gradual progression toward genital stimulation and , with reported success in enhancing ejaculatory response for delayed or anejaculation. Complementary methods include scheduled , where individuals practice self-stimulation in a relaxed setting to retrain patterns, and to simulate intimate scenarios without outcome expectations. These interventions, often guided by a certified therapist, prioritize education on sexual and communication to improve overall relational dynamics. Lifestyle modifications play a supportive role by mitigating environmental and habitual factors that exacerbate anejaculation, including stress reduction through or relaxation techniques, regular exercise to boost circulation and hormonal balance, and avoidance of substances like alcohol and that impair . Adjusting habits—such as varying techniques to mimic partnered —can also enhance thresholds, while fostering partner intimacy through non-sexual helps alleviate relational strain. These changes are particularly beneficial for situational anejaculation, with guidelines recommending them alongside to promote sustained improvements in sexual health. Medication adjustment involves supervised discontinuation, dose reduction, or switching of drugs known to induce anejaculation, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or certain antihypertensives, under medical oversight to minimize withdrawal risks. For example, tapering SSRIs has reversed drug-induced ejaculatory delays in many cases, restoring normal function without additional interventions. This approach is essential when pharmacological side effects are the primary culprit, ensuring safe transitions while monitoring for recurrence.

Medical and Assisted Interventions

Medical and assisted interventions for anejaculation primarily target organic causes, such as neurological impairments, by addressing deficiencies in the emission phase of or facilitating retrieval for preservation. Although the American Urological Association/ Society of (AUA/SMSNA) guidelines () note insufficient evidence to recommend specific pharmacotherapies due to limited data, several agents have been used off-label with variable success. Pharmacotherapy often involves sympathomimetic agents that enhance activity to promote seminal vesicle and bladder neck contraction. , an α1-adrenergic , may be considered to stimulate emission in cases of anejaculation associated with autonomic dysfunction, though evidence is limited with success rates around 12-21%. Among alpha-agonists, shows higher efficacy, achieving in up to 65% of cases related to . Similarly, , a with α-adrenergic properties, has been used to restore antegrade by increasing urethral and facilitating expulsion, though with limited success (around 21%) and considered inferior to . For cases with psychogenic components or hyperprolactinemia, , a (0.5 mg twice weekly), has reported improvement in orgasmic function in approximately 67% of men. These medications are typically prescribed for short-term use in mild to moderate cases, following confirmation of organic etiology through clinical evaluation. For patients with spinal cord injury (SCI), penile vibratory stimulation (PVS) serves as a first-line assisted ejaculation technique. This non-invasive method applies a vibrating device to the penile shaft or frenulum to elicit a reflex arc-mediated ejaculation via intact sacral spinal segments. PVS is particularly effective in men with lesions above the T10 level, where lower spinal reflexes remain preserved, allowing for semen collection without anesthesia. In cases refractory to PVS or involving complete disruption, (EEJ) is employed, especially for neurological causes like SCI or . This procedure involves inserting a rectal probe to deliver low-amplitude electrical stimuli to the pelvic nerves and musculature, inducing contraction of the , , and ejaculatory ducts under general . EEJ directly activates autonomic pathways bypassing damaged neural segments, making it suitable for severe anejaculation. When ejaculation cannot be induced, sperm retrieval techniques become essential for fertility goals. Testicular sperm extraction (TESE) surgically obtains spermatozoa directly from testicular tissue, which can then be used in during fertilization (IVF) cycles. Microdissection TESE minimizes tissue trauma while maximizing yield in non-obstructive secondary to anejaculation. For SCI patients, protocols often combine PVS and EEJ to optimize retrieval. Initial attempts with PVS are followed by EEJ if needed, leveraging the complementary mechanisms of vibratory reflex activation and direct electrical stimulation to achieve higher recovery rates in this population. This sequential approach is tailored to the level and completeness of the injury, ensuring comprehensive management of fertility challenges.

Prognosis and Complications

Treatment Outcomes

Treatment outcomes for anejaculation vary significantly depending on the underlying , with higher rates observed in reversible causes such as situational or iatrogenic factors compared to irreversible neurological conditions. According to the American Urological Association (AUA) and Society of (SMSNA) 2020 guidelines on disorders of , management emphasizes etiology-specific approaches, though evidence for outcomes remains limited due to small study sizes and heterogeneity in patient populations, often relying on expert opinion. Early intervention is a key factor influencing , as timely addressing of modifiable causes like side effects or psychological stressors can prevent chronicity and improve reversibility. In cases of situational or psychogenic anejaculation, psychological therapies, including and behavioral interventions, are recommended, particularly when addressing relationship dynamics or performance anxiety, though success rates vary with limited high-quality evidence available. For neurological causes, such as injuries, penile vibratory stimulation (PVS) achieves ejaculation success rates of 60% to 90% in men with lesions at or above T10, with rates as high as 86% reported in systematic reviews. Interventions like , often used when PVS fails, yield overall success rates of 80% to 97% for retrieval across etiologies. Outcomes are generally better for iatrogenic causes (e.g., post-surgical) than neurological ones, where reversibility is lower due to persistent neural damage. Fertility outcomes following sperm retrieval and assisted reproduction techniques are promising, with live birth rates of approximately 40% achieved via (ICSI) using retrieved sperm in cohorts, comparable to those in other cases. The AUA/SMSNA guidelines underscore the importance of multidisciplinary care, including urologists and reproductive specialists, to optimize these outcomes while considering patient-specific factors like age and partner fertility.

Long-Term Impacts

Anejaculation, if untreated, poses significant chronic risks to , particularly for individuals desiring biological children, as it results in the complete absence of emission, preventing natural conception and necessitating lifelong reliance on assisted reproductive technologies such as penile vibratory stimulation, , or testicular sperm extraction combined with (ICSI). In cases where underlying organic causes like neurological damage persist, these interventions may require repeated application over time, increasing emotional and financial burdens without guaranteeing consistent success. The psychological burden of anejaculation often endures beyond initial , manifesting as persistent low , feelings of , and anxiety related to sexual inadequacy, which can exacerbate relational tensions and reduce overall intimacy within partnerships. Even after attempts, individuals may experience ongoing and emotional distress, contributing to a heightened of depression or avoidance of sexual activity, particularly when goals remain unmet. Untreated anejaculation linked to progressive conditions such as diabetes mellitus can lead to worsening health complications, including irreversible that further impairs reproductive and sexual functions, alongside potential developments like calcification or increased susceptibility to urogenital infections. In such scenarios, the failure to address the underlying disease allows for continued hyperglycemia-driven damage to nerves and blood vessels, amplifying systemic risks like cardiovascular issues over the long term. Regarding quality of life, successful non-invasive or medical interventions can enhance sexual satisfaction by restoring some ejaculatory function, yet in total organic cases—such as those involving permanent —residual effects like diminished orgasmic pleasure or incomplete resolution often persist, affecting overall . For instance, in , the long-term prognosis typically involves sustained dependence on assisted techniques for any , with variable improvements in sexual fulfillment.

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