Introduction
Anejaculation happens when a man can’t ejaculate semen. Some men feel an orgasm but release no semen. Others don’t feel an orgasm or release semen. This differs from retrograde ejaculation, where semen flows back into the bladder instead of out. Though not often talked about, anejaculation affects about 1-2% of men seeking help for fertility. It can impact both sex life and the ability to have children.
This article looks at how ejaculation works, the types and causes of anejaculation, how doctors diagnose it, treatment options, and how it affects men mentally.
The Physiology of Ejaculation
Let’s first understand how normal ejaculation works.
The Ejaculation Process
Ejaculation happens in two main steps:
- Emission phase: Sperm from the testes and fluids from the prostate and seminal vesicles gather in the back of the urethra.
- Expulsion phase: Muscles in the pelvic floor and urethra contract, pushing semen out through the penis.
This process needs the nervous system, hormone system, and sex organs to work together. The sympathetic nervous system controls emission. The somatic nervous system handles expulsion.
Neural Control
Dr. Robert Morgan, neurologist at Johns Hopkins Medicine, explains: “Ejaculation involves a complex interplay between the autonomic and somatic nervous systems. The sympathetic nervous system starts emission, while the pudendal nerve coordinates the rhythmic contractions needed for expulsion.”
Types of Anejaculation
Doctors group anejaculation in several ways:
By Presence of Orgasm
- Orgasmic anejaculation: The man feels an orgasm but no semen comes out
- Anorgasmic anejaculation: The man feels no orgasm and no semen comes out
By Situational Context
- Global anejaculation: Happens in all situations and with all types of stimulation
- Situational anejaculation: Happens only in certain situations (like during sex but not during masturbation)
By Onset
- Primary anejaculation: Present throughout the man’s entire sex life
- Secondary anejaculation: Develops after having normal ejaculation for some time
Causes of Anejaculation
Many things can cause anejaculation. These fall into two main groups: psychological and physical causes.
Psychological Causes
Mental factors can strongly affect ejaculation. These include:
- Anxiety: Worry about sexual performance or general anxiety issues
- Depression: Major depression and related mental health conditions
- Trauma: Past sexual trauma or abuse
- Relationship issues: Problems with sexual partners
- Religious or cultural factors: Strict upbringing about sex
“The mind-body connection in ejaculation is very strong,” notes Dr. Helen Kaplan, sexual health psychologist. “Mental blocks can create actual physical blocks in the ejaculation reflex.”
Physical Causes
Physical causes of anejaculation include:
- Nerve problems:
- Spinal cord injuries
- Multiple sclerosis
- Nerve damage from diabetes
- Stroke affecting certain brain areas
- Parkinson’s disease
- Medication side effects:
- Antidepressants (especially SSRIs)
- Antipsychotics
- Alpha-blockers
- Some blood pressure medicines
- Surgery complications:
- Prostate surgery (radical prostatectomy)
- Bladder neck surgery
- Lymph node removal in the abdomen
- Colorectal surgery
- Birth defects:
- Müllerian duct cysts
- Wolfian duct problems
- Hormone issues:
- Low testosterone
- Thyroid disorders
- High prolactin levels
- Other health conditions:
- Infection or swelling of the prostate or seminal vesicles
- Narrowing of the urethra
- Blocked ejaculatory ducts
A 2022 study in the Journal of Sexual Medicine found that among men with anejaculation, about 60% had physical causes, 25% had psychological causes, and 15% had both types of causes.
Diagnosis of Anejaculation
Diagnosing anejaculation takes a thorough approach to find the root cause.
Medical History
A complete medical history is key, including:
- Sexual history and function
- When and how ejaculation problems began
- Current medications
- Past surgeries
- Ongoing health conditions
- Mental health factors
Physical Examination
The physical exam usually includes:
- Basic nerve function tests
- Checking external sex organs
- Digital rectal exam to check prostate health
- Looking at secondary sex traits
Laboratory Tests
Helpful lab tests may include:
- Hormone panel (testosterone, thyroid, prolactin)
- Testing urine after orgasm to check for retrograde ejaculation
- Semen analysis (if any ejaculate is produced)
- Blood sugar tests to check for diabetes
Specialized Tests
For complex cases, doctors may order:
- Ultrasound through the rectum to look at the prostate and ejaculatory ducts
- MRI of the brain and spinal cord if a nerve problem is suspected
- Tests of bladder and urinary function
- Tests of pelvic floor muscle activity
Treatment Options
Treatment for anejaculation depends on what’s causing it, the man’s goals (having children vs. sexual pleasure), and personal choice.
Treating Psychological Causes
For anejaculation caused by mental factors:
- Talk therapy: Cognitive-behavioral therapy (CBT) can help with anxiety, depression, or trauma
- Sex therapy: Special therapy focused on sexual function
- Relaxation methods: Mindfulness, progressive muscle relaxation
- Sensate focus exercises: Structured touching exercises to reduce performance anxiety
“In my practice, I’ve found that combining CBT with sensate focus exercises works well for psychologically-caused anejaculation,” states Dr. Michael Perelman, sex therapist at Weill Cornell Medical College.
Treating Physical Causes
Treatment options for physically-caused anejaculation include:
- Changing medications: Switching or stopping drugs known to affect ejaculation
- Medication treatments:
- Alpha-agonists like midodrine or pseudoephedrine
- Antihistamines like cyproheptadine
- Dopamine boosters for high prolactin levels
- Surgery:
- Fixing blocked ejaculatory ducts
- Repairing narrowed urethra
Sperm Retrieval for Fertility
For men wanting to father children, doctors can use several methods to get sperm:
- Penile vibratory stimulation (PVS): Using a special vibrator to trigger ejaculation
- Electroejaculation (EEJ): Using mild electrical current to cause ejaculation (works well for men with spinal cord injuries)
- Surgical sperm retrieval: Including taking sperm directly from the testicle (TESE) or from the epididymis (MESA)
Dr. Paul Turek, reproductive urologist, explains: “Success rates for assisted reproduction have improved greatly. With modern sperm retrieval methods combined with direct sperm injection (ICSI), many men with anejaculation can still father biological children.”
Effectiveness of Treatments
According to a 2023 review in European Urology:
- Talk therapy helps 60-70% of men with psychological anejaculation
- Medication treatments work in 30-60% of cases
- Penile vibration works in 50-60% of nerve-related cases
- Electrical stimulation succeeds in over 90% of suitable candidates
- Surgical sperm retrieval gets sperm in up to 95% of cases
Living with Anejaculation
Psychological Impact
Anejaculation can affect men mentally:
- Lower self-esteem and concerns about masculinity
- Strain on relationships
- Worry about sexual performance
- Depression
- Feelings of failure, especially about fertility
A 2021 study in the Journal of Sex Research found that men with anejaculation reported more sexual unhappiness and relationship stress than men with other sexual problems.
Coping Strategies
Helpful coping strategies include:
- Open talks with partners
- Learning about the condition
- Focusing on sexual pleasure beyond ejaculation
- Joining support groups
- Professional counseling
Partner Perspectives
Partners may also struggle with:
- Confusion about their role
- Concerns about relationship satisfaction
- Questions about having children
“Partners benefit from being included in treatment talks,” notes sex therapist Dr. Emily Nagoski. “Understanding the condition helps reduce blame and strengthen the couple’s bond.”
Future Directions in Treatment
Research into anejaculation treatments continues to grow:
- Nerve stimulation: Experimental techniques like sacral nerve stimulation
- Stem cell therapies: To repair damaged nerve pathways
- Advanced drug approaches: Targeting specific nerve pathways involved in ejaculation
- Improved fertility techniques: Better sperm retrieval and fertilization methods
Expert Perspective
According to Dr. Thomas Walsh, Professor of Urology at the University of Washington: “Anejaculation remains undertreated partly because many men hesitate to discuss ejaculation problems with doctors. Greater awareness will help more men get proper care for this treatable condition.”
Frequently Asked Questions
Is anejaculation the same as erectile dysfunction?
No. Erectile dysfunction means trouble getting or keeping an erection. Anejaculation means inability to ejaculate, even with a normal erection.
Can men with anejaculation still enjoy sex?
Yes, many men with anejaculation can still feel sexual pleasure and even orgasm (in orgasmic anejaculation), though it may feel different from ejaculatory orgasms.
Does anejaculation affect testosterone levels?
Anejaculation itself doesn’t usually affect testosterone. However, low testosterone can sometimes contribute to ejaculation problems.
Can lifestyle changes help with anejaculation?
Lifestyle changes may help in some cases, especially stress reduction, drinking less alcohol, and improving overall health. The effectiveness depends on what’s causing the problem.
Is anejaculation permanent?
It depends on the cause. Temporary anejaculation can happen due to certain medications or psychological factors and may resolve with proper treatment. Cases from permanent nerve damage or certain surgeries may not be reversible.
How common is anejaculation?
Anejaculation affects about 1-2% of men seeking fertility treatment and is less common in the general population.
Conclusion
Anejaculation, though often overlooked, is a significant condition affecting both sexual pleasure and fertility. With proper diagnosis, most men can find out what’s causing their anejaculation and get appropriate treatment. Whether the goal is restoring ejaculation or using assisted reproduction for fertility, several effective options exist.
The mental impact of anejaculation is important, and good care should address both physical and emotional aspects. With ongoing research and greater awareness, treatment options will likely improve, offering hope to affected men.