Introduction
Anejaculation is when a man cannot release semen during orgasm. Men with this issue still have normal erections. They also have normal sexual desire.
This condition isn’t discussed much. But it affects 2-5% of men who seek help for fertility problems. It can impact both physical health and emotions.
This guide explains anejaculation clearly. We’ll cover what it is, its types, and its causes. We will also discuss how doctors diagnose it and the treatment options available. Our goal is to help you make informed choices about your health and fertility.
What is Anejaculation?
Anejaculation simply means a man cannot ejaculate. This happens even when he is sexually aroused.
Dr. Michael Chen is a specialist in male reproductive health. He explains, “Anejaculation separates the feeling of orgasm from the physical act of ejaculation.” He adds, “Most people think these always happen together. But they can happen separately.”
To understand this, let’s look at normal ejaculation. It has two main steps:
- Emission phase: Sperm moves from the testes through tubes (vas deferens). It mixes with fluids from the prostate and seminal vesicles. This mixture forms semen in the urethra (the tube inside the penis).
- Expulsion phase: Muscles in the pelvis tighten rhythmically. These contractions push semen out through the urethra.
Anejaculation occurs if one or both steps don’t work right. The man might still feel an orgasm. This condition is different from erectile dysfunction (trouble getting an erection). It’s also not the same as retrograde ejaculation (when semen goes into the bladder instead of out).
Types of Anejaculation
Anejaculation can appear in different ways:
Situational Anejaculation
A man with this type can ejaculate sometimes, but not always. Dr. Sarah Williams, a sexual health expert, notes: “Many men with this type can ejaculate during masturbation but not with a partner. Or it might be the other way around.” This often points to mental or emotional causes.
Total Anejaculation
This means a man cannot ejaculate at all, in any situation. This includes sex, masturbation, or even during sleep (wet dreams). This type usually suggests a physical cause is involved.
Primary vs. Secondary Anejaculation
- Primary: A man has never ejaculated in his life.
- Secondary: A man used to ejaculate normally but now cannot. This often happens due to new health issues, medicines, or life changes.
Causes of Anejaculation
Several things can cause anejaculation. These might be psychological issues or nerve problems. Physical issues, medicines, or other health conditions can also play a role.
Psychological Causes
Mental factors often cause anejaculation, especially situational cases. These can include:
- Worry about sexual performance
- Depression
- Relationship troubles
- Past sexual trauma
- Guilt from religious or cultural beliefs
- Stress or anxiety
Dr. James Rodriguez, a psychologist specializing in sexual health, says: “Psychological causes often mean a man can ejaculate in some situations but not others. This suggests the issue is situation-based, not purely physical.”
Neurological Causes
Ejaculation needs good communication between nerves and sex organs. Nerve problems can disrupt this process. Examples include:
- Spinal cord injuries
- Multiple sclerosis
- Nerve damage from diabetes
- Parkinson’s disease
- Strokes
- Nerve damage from pelvic surgery
- Birth defects affecting nerves
“The nervous system is key for the first step of ejaculation,” explains Dr. Lisa Patel, a neurologist. “Damage to these nerve paths can really affect ejaculation. Injury, disease, or surgery can cause this damage.”
Anatomical and Structural Causes
Physical problems in the body can also cause anejaculation:
- Birth defects in reproductive organs
- Blocked tubes (ejaculatory ducts)
- Prostate problems, often after surgery
- Narrowing of the urethra
- Past surgery on the bladder neck, prostate, or urethra
Medication and Substance-Related Causes
Some medicines and substances can interfere with ejaculation:
- Antidepressants (especially SSRIs)
- Antipsychotics
- Some blood pressure medicines
- Heavy alcohol use
- Recreational drugs
- Certain pain relievers
Professor Robert Thompson notes: “Medicine-related anejaculation is quite common. For example, SSRIs affect about 30-60% of men taking them. But not all cases mean a total inability to ejaculate.”
Other Medical Conditions
Other health issues can contribute to anejaculation:
- Hormone imbalances (like low testosterone)
- Thyroid problems
- Diabetes
- Chronic kidney disease
- Some cancer treatments
- Radiation therapy to the pelvis
Diagnosis of Anejaculation
Diagnosing anejaculation needs a careful approach. Doctors need to find the cause to choose the best treatment. The process usually involves:
Medical and Sexual History
Your doctor will ask detailed questions about your health and sex life. This helps find possible causes. It also shows if the issue is primary or secondary, situational or total. Questions might cover:
- When did the problem start?
- Can you ejaculate in any situation?
- What medicines are you taking?
- Have you had surgery or major illnesses?
- Are you stressed or having relationship issues?
- Do you use alcohol or drugs?
Physical Examination
A physical exam checks for physical causes. The doctor will:
- Test nerves related to ejaculation
- Check genitals for any issues
- Look at signs of male development
- Examine the prostate
Laboratory Tests
Lab tests can provide more clues:
- Hormone levels (testosterone, etc.)
- Blood sugar (for diabetes)
- Thyroid function
- Urine test after orgasm (to check for retrograde ejaculation)
Dr. Emily Watkins, a reproductive specialist, stresses: “Checking hormone levels is vital. Even small hormone changes can affect ejaculation. They might not cause other symptoms.”
Specialized Tests
Sometimes, more specific tests are needed:
- Post-ejaculatory urinalysis: Checks for semen in urine (rules out retrograde ejaculation).
- Transrectal ultrasound: Looks at the prostate and checks for blocked ducts.
- Nerve tests: Assess how well nerves are working.
- Psychological evaluation: Checks for mental health factors.
Treatment Options for Anejaculation
Treatment depends on the cause, the type, and if fertility is a goal. Here are the main options:
Addressing Underlying Causes
If possible, treating the root cause comes first:
- Medicine changes: Your doctor might switch medicines if one is causing the issue.
- Hormone therapy: If hormones are imbalanced.
- Managing health conditions: Treating issues like diabetes or thyroid problems.
- Surgery: To fix blockages or structural problems.
Psychological Approaches
If mental factors are involved:
- Sex therapy: Working with a therapist on mental blocks.
- Cognitive-behavioral therapy (CBT): To help with anxiety or depression.
- Mindfulness: To reduce performance worry and improve sexual focus.
- Couples therapy: If relationship issues are part of the problem.
“Psychological treatments work best when both partners take part,” notes Dr. Rodriguez. “This support really helps improve results, especially in situational cases.”
Vibratory Stimulation
This uses special medical vibrators. They produce strong, fast vibrations on the penis:
- Works well for some men with spinal cord injuries (above T10 level).
- Can be used at home after learning how.
- Success rate is around 60% for suitable patients.
Electroejaculation
This method uses an electrical current. A probe is placed in the rectum to deliver the current:
- Usually done under anesthesia.
- Mainly used if vibratory stimulation doesn’t work.
- Helpful for men with specific spinal cord injuries.
- Needs special equipment and trained medical staff.
Dr. Thomas Wilson, a urologist specializing in fertility, explains: “Electroejaculation bypasses normal nerve signals. It directly stimulates the nerves and muscles for ejaculation. It’s invasive, but it offers hope for men with severe nerve damage.”
Sperm Retrieval Techniques for Fertility
If having children is the main goal, doctors can retrieve sperm directly:
- Testicular sperm extraction (TESE): Surgery removes tiny bits of tissue from the testicle.
- Percutaneous epididymal sperm aspiration (PESA): A needle extracts sperm from the epididymis (a tube near the testicle).
- Microsurgical epididymal sperm aspiration (MESA): A more precise version using microsurgery.
Retrieved sperm can be used with fertility treatments like:
- Intrauterine insemination (IUI): Places sperm directly into the uterus.
- In vitro fertilization (IVF): Fertilizes eggs with sperm in a lab. Often involves injecting sperm directly into eggs (ICSI).
Medications
Certain medicines might help in specific situations:
- Alpha-agonists: Like midodrine or pseudoephedrine.
- Antihistamines: Cyproheptadine may help with SSRI-related issues.
- Cabergoline: Used if high prolactin hormone levels are involved.
“Choosing medication needs careful thought about side effects and health,” warns Professor Thompson. “What helps one person might not help another. Treatment needs to be specific to each person.”
Living with Anejaculation
Besides medical treatments, coping with anejaculation involves other steps:
Emotional and Relationship Impact
Anejaculation can have big emotional effects:
- Lower self-worth
- Strain on relationships
- Anxiety or depression
- Worries about masculinity or fertility
It’s key to talk openly with your partner and doctors. Support groups (online or in-person) can offer comfort and useful tips.
Fertility Considerations
Men wanting to father children should see a fertility specialist. They can explore options like:
- Sperm retrieval with fertility treatments.
- Using donor sperm if biological fatherhood isn’t possible.
- Adoption or other ways to build a family.
According to Dr. Watkins, “Modern fertility treatments give men with anejaculation a much better chance to be biological fathers. Success rates differ, but many couples achieve pregnancy with the right help.”
Long-term Management
Living with anejaculation often means ongoing care:
- Regular check-ups with doctors.
- Changing sexual habits if needed.
- Getting continued mental support if helpful.
- Learning about new treatments as they develop.
When to Seek Medical Help
You should see a doctor if you:
- Have never been able to ejaculate.
- Notice a sudden change in ejaculation.
- Are worried about fertility.
- Find the condition causes distress or relationship problems.
Seeking help early can lead to better treatment and reduce worry.
Frequently Asked Questions
Can anejaculation go away on its own?
Sometimes, if it’s caused by temporary things like stress or certain medicines. But if it’s due to nerve damage, physical issues, or long-term mental factors, it usually needs treatment.
Is anejaculation the same as erectile dysfunction (ED)?
No. ED is trouble getting or keeping an erection. Anejaculation is not being able to ejaculate, even with a normal erection and arousal.
Can men with anejaculation still have an orgasm?
Yes, many can. They feel the pleasure of orgasm even without releasing semen. The feeling (orgasm) and the physical release (ejaculation) are separate, though they usually happen together.
Does anejaculation affect testosterone levels?
Usually, no. But low testosterone can sometimes contribute to ejaculation problems. Doctors often check hormone levels during diagnosis.
If I have anejaculation, can I still father children?
Yes, many men can. Techniques can retrieve sperm for use in fertility treatments. Success depends on the cause, sperm quality, and partner’s fertility. A fertility specialist can give you personalized advice.
Can psychological therapy cure anejaculation if the cause is physical?
Therapy alone likely won’t fix a physical cause. But therapy can help you cope. It’s often part of a full treatment plan. Living with anejaculation can be tough mentally, no matter the cause.
How effective are vibrators for treating anejaculation?
Special medical vibrators have success rates around 60% for the right patients. They work best for certain spinal cord injuries. These are different from regular vibrators; they use specific frequencies shown to work for this condition.
Is retrograde ejaculation the same as anejaculation?
No. In retrograde ejaculation, semen goes backward into the bladder instead of out. In anejaculation, no semen is released at all. They have different causes and treatments, but both can affect fertility.
Conclusion
Anejaculation is a difficult condition, but it can be managed. Many treatments exist, depending on the cause and your situation. Understanding the condition and options helps you make good decisions about your health and fertility. Medical progress continues to improve results, especially for having children.
Talking to specialists in male reproductive health is a crucial first step. With the right diagnosis and personalized care, many men can manage the condition well. They can also find ways to reach their fertility goals. Remember, the emotional side is just as important as the physical side for overall sexual health and happiness.