A study result published in 2015 revealed the prevalence of ejaculatory problems in American men. 988 study subjects’ information was collected for the research. The research data showed that 88% of the study subjects experienced reduced volume while ejaculation, 81% had problems with the reduced force of ejaculation and 62% of men suffered from delayed ejaculation while 37% of men faced anejaculation. Anejaculation occurs when semen fails to be released by the penis. 88% of the study subjects were found to have more than one ejaculatory problem.
Male sexual dysfunction is broadly classified into hypogonadism, erectile dysfunction and ejaculatory problems. In case of ejaculatory disorders, premature ejaculation has been widely studied by many experts. However, other forms of ejaculatory disorders like delayed ejaculation, retrograde ejaculation and anejaculation still needs to be researched more.
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Anejaculation is a type of ejaculatory disorder characterized by the failure to ejaculate semen by the penis when stimulated by masturbation or intercourse. Most of the men with anejaculation can experience orgasm but cannot expel semen which can present infertility issues. Anejaculation is one of the most difficult ejaculatory dysfunction to diagnose as it is often confused with retrograde ejaculation where the semen flows back to the bladder during ejaculation.
Certain men experience anejaculation when the seminal fluid is not released into the urethra due to a dysfunctional prostrate and seminal ducts. Such dysfunction is often seen in men:
- With severe injuries of the spinal cord. As per a study by Chehensse C et al, most of the men with spinal cord injuries fail to ejaculate without medical intervention.
- With neurological disorders like Parkinson’s, multiple sclerosis and other health conditions such as spina bifida, diabetes etc
- With infected pelvic area due to injury and wounds
- Who have been operated for surgical removal of the lymph nodes in groin area as a part of cancer treatment that damages the nerve plexus in the groin area
- Who have had bladder, prostrate or abdominal surgeries that damage the nerves in groin and pelvic area
- With inflamed prostrate glands
- Receiving medications containing alpha-adrenergic blockers
Anejaculation resulting from the above conditions are often secondary in nature. In case of drug induced anejaculation, discontinuing the dosage will address the issue.
Different Types of Anejaculation and Causes
Anejaculation could be primary or secondary in nature. In primary anejaculation the patient would have never experienced ejaculation in his life while in secondary anejaculation patient would have experienced ejaculation but due to various factors he may not be able to ejaculate at some point in his life time (after injuries or surgeries/medication etc). Anejaculation is further classified into situational and total anejaculation.
Situational anejaculation can occur due to psychological stress and anxiety. In situational anejaculation, men can ejaculate in certain situations but they fail to ejaculate in other situation. Usually, it is a temporary condition and can happen to some men when they become anxious or when they face conflicts that are traumatizing.
Sometimes men ejaculate during intercourse but may not ejaculate while masturbating. And in other instances men may ejaculate with one particular partner but not with others. In such situational anejaculation cases, addressing interpersonal conflicts or relationship dynamics plays a major role in treatment of the condition.
One of the clinical case studies on psychogenic anejaculation revealed that situational anejaculation induced by strained relationships, conflicts and underlying psychological factors can be successfully treated by employing a combination of techniques including counseling for improvement in communication with the partner and cognitive behavioral techniques to address underlying psychological issues like low self esteem and anxiety.
In total anejaculation, a man cannot ejaculate in any situation. The patient fails to ejaculate semen out of the penile meatus when stimulated by masturbation or intercourse. Total anejaculation can be either anorgasmic or orgasmic.
In anorgasmic anejaculation, a man cannot attain orgasm while he is awake however, he can ejaculate and experience orgasm in the night while he is asleep. Anorgasmic anejaculation is often linked to underlying psychological disorders.
In orgasmic anejaculation, orgasm is experienced but sans ejaculation of the semen. Orgasmic anejaculation is caused by tubal blockage, damaged nerves or in rare cases due to retrograde ejaculation.
Psychological effects of AE on the Patients
A research led by Enfermia Y Fisioterapia revealed the psychological impact on men with sexual dysfunction (with/without spinal cord injury). The controlled study was conducted on 85 men who had spinal cord injury (with sexual dysfunction) and 80 men suffering from sexual dysfunction without SCI (spinal cord injury).
The study subjects were put into two groups of those with SCI and without SCI. The first group with SCI had 75.2% reported cases of anejaculation and out of which 16.47% of participants had signs of depression while 35.3% of men in the group had anxiety disorder. All of the research participants showed high quality of living (QOL) scores but felt their sexual life was not satisfactory.
Unlike premature ejaculation, anejaculation is difficult to diagnose. For instance, in case of low semen volume, men often feel that they are not ejaculating at all as they do not notice the small amount of seminal fluid that has been ejaculated. Such cases cannot be treated for AE (anejaculation). In case of primary anejaculation, it will be extremely difficult for men to explain their ejaculatory problems as they would have never experienced ejaculation.
Situational AE can be treated with combination techniques to address behavioral and psychological issues and in such cases the success rate is often high. Diagnosis and treatment also depends on the relevance of AE for fertility or psychological stress.
Post-ejaculation urine analysis is conducted to see if there is sperm in the urine sample. When the urine sample contains sperm, the patient will be treated for RE (retrograde ejaculation). But when the post-ejaculation urine sample does not contain sperm the patient will receive treatment for AE.
- Anejaculation of psychogenic nature is treated with combination techniques of customized counseling and cognitive behavioral therapy.
- Doctors may suggest surgery to remove the urethral blockage that is preventing the ejaculation of the semen
- AE due to inflamed prostrate will be treated by an antibiotic dose
- In some cases AE can be treated pharmacologically by prescription drugs such as midodrine. However, the success rate of treating AE through prescription drugs is low.
Infertility and AE
Anejaculation can cause distress and anxiety in men but the presence of ejaculatory disorder becomes troublesome for men who desire to father a child. Thankfully, majority of the men suffering from AE can certainly father a child with some medical help.
- In case of primary ejaculation, especially to address infertility issues the seminal fluid is collected for artificial insemination by various methods such as testicular biopsy and vibrator stimulation and electrical stimulation.
- For men with situational AE, there is also an option to freeze the semen for In Vitro fertilization (IVF).
- AE of psychogenic nature or AE (anorgasmic) due to traumatic sexual past can be addressed by sex therapy and counseling.
To facilitate artificial insemination, the sperm is collected from the biopsy tissue and then injected through a sperm injection (intracytoplasmic) into the egg.
Vibrator stimulation is one of the most preferred methods to induce ejaculation. Ejaculation of the semen is induced by a strong stimulus given for a longer period and the ejaculated semen is collected for artificial insemination. Vibration stimulation can be easily conducted at home or in the clinic and the success rate is almost 60%. However, for those with an injured spine or men who are not neurologically intact vibrator stimulation is not an option.
Electroejaculation (EEJ/Electrical stimulation)
A study reveals the effectiveness of electroejaculation for men with AE of psychogenic nature as it can be successfully treated with EEJ. The EEJ is a simple procedure that is performed in the clinical settings. A general or spinal anesthesia is required to conduct EEJ. In EEJ, the ejaculation is stimulated by using an electric probe placed in the rectum. When a person fails to ejaculate through vibrator stimulation, electroejaculation is advised to retrieve seminal fluid for artificial insemination.
At times, depending on the situation of the patients, a combination of the above therapies can be used. The Electroejaculation along with sperm injection has shown to yield success in patients with SCI.
Anejaculation is one of the most difficult ejaculatory disorders to diagnose as it is often confused with RE (retrograde ejaculation) or low seminal output is misinterpreted as AE. For managing AE, a proper diagnosis is equally important as much as the treatment.
Men who cannot ejaculate need not despair. AE can be reversed in many cases by various techniques and drugs. Although anejaculation is caused by different factors, but doctors have several solutions to the condition. When AE cannot be reversed, medical intervention in the form of vibrator stimulation or Electroejaculation is necessary to retrieve seminal fluid for artificial insemination and the success rate for such methods is high. In most of the men with anejaculation, counseling and sex therapy has shown positive results.