Unejaculation, also known as anejaculation, is a medical condition where a man is unable to ejaculate semen during orgasm. Despite experiencing sexual arousal and reaching climax, no semen is expelled from the penis. This condition can be caused by various factors, including nerve damage, certain medications, psychological issues, or underlying health problems. Unejaculation can affect fertility and sexual satisfaction, and treatment often involves addressing the underlying cause.

What is unejaculation?

Unejaculation, also known as anejaculation, is a condition in which a man is unable to ejaculate semen during orgasm, despite normal sexual arousal and the sensation of reaching climax. This can occur due to a variety of reasons, including neurological disorders, spinal cord injuries, certain medications, surgeries, or psychological factors. Unejaculation can affect fertility, as no semen is released to potentially fertilize an egg, and it may also impact sexual satisfaction and emotional well-being. Treatment depends on the underlying cause and may involve medical interventions, therapy, or lifestyle changes.

Types of anejaculation

Anejaculation, or the inability to ejaculate, can be categorized into different types based on its causes and manifestations. Here are the main types:

• Primary Anejaculation: This type refers to a condition where an individual has never been able to ejaculate semen, despite normal sexual arousal. It is often associated with congenital or developmental issues, such as anatomical abnormalities or neurodevelopmental disorders.
• Secondary Anejaculation: This type occurs when a person who previously had normal ejaculation starts experiencing anejaculation. Causes can include: Neurological Issues, Surgical Interventions, Medication Effects and Psychological Factors.
• Retrograde Anejaculation: This is a subtype where semen is not expelled through the penis but instead is redirected into the bladder during orgasm. It can occur due to: Prostate Surgery and Medications.

• Psychogenic Anejaculation: This type is caused by psychological factors such as anxiety, performance pressure, or trauma. Even with normal physical function, psychological barriers prevent ejaculation.
• Functional Anejaculation: This type refers to cases where no physical or psychological cause is identified, and the inability to ejaculate occurs despite normal sexual arousal and function.
• Obstructive Anejaculation: In this case, physical blockages in the ejaculatory ducts or seminal vesicles prevent the passage of semen.

What are the causes of unejaculation?

Unejaculation, or anejaculation, can be caused by various factors, including:

• Neurological Disorders: Damage to the nerves that control ejaculation, often due to conditions like multiple sclerosis, diabetes, or spinal cord injuries, can prevent semen from being expelled during orgasm.
• Medications: Certain medications, particularly those that affect the nervous system, such as antidepressants, antipsychotics, or blood pressure medications, can interfere with the body’s ability to ejaculate.
• Psychological Factors: Anxiety, stress, depression, or other emotional and psychological issues can disrupt the normal ejaculation process.
• Prostate Surgery: Surgical procedures involving the prostate, especially those that involve removal or treatment of prostate cancer, can lead to nerve damage or other changes that affect ejaculation.
• Hormonal Imbalances: Low levels of certain hormones, such as testosterone, can impact sexual function, including the ability to ejaculate.
• Obstructive Conditions: Physical blockages in the ejaculatory ducts or seminal vesicles can prevent semen from being expelled.
• Retrograde Ejaculation: In some cases, semen may travel backward into the bladder instead of exiting through the penis, leading to dry orgasms.
• Spinal Cord Injuries: Injuries to the spinal cord can disrupt the signals that control ejaculation, leading to unejaculation.

Diagnosis

Diagnosing unejaculation (anejaculation) involves a comprehensive evaluation to identify the underlying cause. The diagnostic process typically includes:

• Medical History:
  • Sexual History: Questions about sexual activity, onset of symptoms, and any associated factors, such as psychological stress or relationship issues.
  • Medication Review: A review of current and past medications to identify any that might contribute to the condition.
  • Medical Conditions: Assessment of any underlying health conditions, such as diabetes, multiple sclerosis, or previous surgeries, particularly prostate surgery.
• Physical Examination:
  • A thorough physical exam, focusing on the genital and neurological systems, to check for any abnormalities or signs of nerve damage.
• Laboratory Tests:
  • Hormone Levels: Blood tests to check hormone levels, particularly testosterone, which can influence sexual function.
  • Semen Analysis: Although ejaculation does not occur, analyzing any small amounts of semen (if present) or examining post-orgasmic urine can help determine if retrograde ejaculation is occurring.
• Neurological Evaluation:
  • Tests to assess the function of the nervous system, particularly the nerves controlling ejaculation, to identify any neurological issues.
• Imaging Studies:
  • Ultrasound: To evaluate the prostate, seminal vesicles, and ejaculatory ducts for any physical blockages or abnormalities.
  • MRI or CT Scans: In some cases, advanced imaging may be used to look for spinal cord or other structural issues.
• Psychological Assessment:
  • Evaluation for psychological factors, such as anxiety, depression, or stress, that may contribute to unejaculation.
• Specialized Tests:
  • Vibration or Electrical Stimulation: Sometimes used to stimulate ejaculation in cases where nerve damage is suspected, to see if ejaculation can be induced.

Treatment

The treatment of unejaculation (anejaculation) depends on its underlying cause. Here are some common approaches:

• Medication Adjustments:
  • Review and Modify Prescriptions: If medications are suspected to be the cause, adjusting or changing them under the guidance of a healthcare provider may help. For example, switching from certain antidepressants that affect ejaculation.
  • Hormonal Therapy: If hormonal imbalances are identified, hormone replacement or adjustments may be prescribed.
• Psychological Therapy:
  • Counseling: Therapy with a psychologist or counselor can address psychological factors such as anxiety, depression, or stress that may be affecting sexual function.
  • Sex Therapy: Specialized sex therapy can help with sexual performance issues and improve sexual satisfaction.
• Medical Interventions:
  • Surgical Solutions: In cases where physical obstructions or issues with the prostate or seminal vesicles are present, surgical intervention may be necessary to correct the problem.
  • Neuromodulation: Techniques like nerve stimulation might be used in cases where nerve damage is a factor.
• Lifestyle and Dietary Changes:
  • Diet and Exercise: Adopting a healthy lifestyle can improve overall health and potentially alleviate some symptoms. This includes maintaining a balanced diet and regular physical activity.
  • Avoiding Substance Abuse: Reducing or eliminating alcohol and recreational drug use can also be beneficial.
• Management of Underlying Conditions:
  • Chronic Disease Management: Effectively managing chronic conditions like diabetes or multiple sclerosis can improve symptoms related to unejaculation.
• Sexual Techniques:
  • Vibratory Stimulation: In some cases, vibratory devices may be used to stimulate ejaculation when conventional methods are ineffective.
  • Manual Stimulation Techniques: Techniques involving manual stimulation might be explored to facilitate ejaculation.
• Assisted Reproductive Technologies:
  • Sperm Retrieval: If fertility is a concern, methods like sperm retrieval through techniques such as sperm aspiration or extraction may be considered.

Summary

Unejaculation, or anejaculation, is a condition where a man cannot ejaculate semen during orgasm, despite experiencing sexual arousal and climax. It can result from various causes. Diagnosis involves a thorough medical history, physical examination, and possibly tests like hormone levels or imaging studies. Treatment depends on the underlying cause.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE