Introduction
Ejaculation is the release of semen from the erect penis. It typically occurs when a man reaches sexual climax, that is, orgasm during intercourse and masturbation. The male reproductive system produces semen which contains sperm that fertilizes female eggs for conception and pregnancy. Most men with anejaculation still produce sperm, but infertility can happen as they can not ejaculate the semen that carries sperm. Although it is relatively uncommon, over 12,000 new cases of anejaculation yearly are reported. Nearly 1.5 % have a psychogenic anejaculation with no demonstrable organic cause, and the issue is functional.
What Is Anejaculation?
Anejaculation is the complete absence of ejaculation during sex, despite having normal erections or nocturnal emissions (involuntarily semen ejaculation in sleep). This rare clinical entity may result from various reasons, both psychological and orgasmic. Psychogenic anejaculation is impacted by relationship, psychological, and behavioral factors.
What Are the Types of Anejaculation?
Some men are never able to ejaculate. That is called primary anejaculation. Others cannot ejaculate for varied reasons, which are called secondary anejaculation.
Types of anejaculation include:
1. Situational Anejaculation:
Men can ejaculate in certain situations, like masturbation, but not during sexual intercourse. Or some men can ejaculate only at home and not in other places such as hotels. This can be further described as specific to the partner or type of sexual activity.
2. Total Anejaculation:
Men can not ejaculate while sexual intercourse and masturbating, regardless of the situation or location.
3. Orgasmic Anejaculation:
Men can not ejaculate while having an orgasm. This anejaculation is usually due to physical issues like nerve damage.
What Are the Causes of Anejaculation?
The causes of anejaculation include the followings;
1) Psychological Issues:
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Lack of awareness of one's body.
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Due to fear of loss of control or guilt.
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Insufficient sexual arousal, because of autosexual orientation, is a preference for greater arousal and enjoyment from masturbation than intercourse. This includes idiosyncratic and vigorous masturbation technique, which is held with high frequency and is not easy to duplicate during sexual intercourse.
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Performance anxiety is being excessively focused on pleasing the partner.
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Negative effects, such as resentment or hostility toward the partner.
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Distress is related to the inability to ejaculate.
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Societal and familial pressure to procreate.
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Depression.
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Stress.
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Religious guilt.
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Relationship distress.
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Fear of pregnancy or disease.
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Education or attitudes about sex.
2) Physical Causes:
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Nerve damage from the prostate, bladder, or pelvic surgery and radiation treatment.
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Prostatitis is the inflammation of the prostate gland.
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Parkinson's disease.
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Spinal cord injury.
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Retroperitoneal lymph node dissection.
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Diabetes mellitus.
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Transverse myelitis.
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Multiple sclerosis.
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Multiple sclerosis.
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Spinal cord injuries.
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Partial blocking of the urethra.
3) Pharmacological Causes:
Several drugs may interfere with the ability to ejaculate/orgasm
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Antidepressants.
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Alpha-blockers are used to treat high blood pressure or an enlarged prostate.
What Is the Difference Between Anejaculation and Erectile Dysfunction?
Men with erectile dysfunction are not able to get or keep erections. Some men can not get a hard enough erection for vaginal penetration for sexual intercourse, while others can not hold an erection long enough for orgasm and ejaculation. In contrast, most men with anejaculation do not have any problems regarding erection.
What Are the Symptoms of Anejaculation?
The primary indication of anejaculation is the absence of ejaculatory fluid during orgasm.
When to See the Doctor?
When a man experiences no ejaculatory fluid expelled during orgasm, and there is associated infertility, the affected person should seek treatment.
How Is Anejaculation Diagnosed?
The clinician carefully takes a medical history and performs a physical examination. For example, if men cannot ejaculate, the clinician may prescribe a urine analysis in which a urine sample is taken immediately after the sexual climax if there is a complete absence of sperm (azoospermia) in this urine sample, that indicates anejaculation.
The diagnosis of psychogenic anejaculation is classically based on the unstable nature of the ejaculatory dysfunction. This type of anejaculation is specific to penetrative sex, but they can ejaculate normally during masturbation and have nocturnal emissions. This rules out drug-induced and organic anejaculation, which is consistent with every partner, situation, and circumstance.
How Is Anejaculation Treated?
Anejaculation does not cause any sexual functional problems apart from infertility. As a result, some men do not seek or want treatment. Therefore, the management of anejaculation majorly depends on the underlying cause.
Psychotherapy (talk therapy), sex therapy, and anti-anxiety medications can ease anxiety and stress that cause situational anejaculation. In addition, some men may benefit from changing medications or more efficiently managing conditions like diabetes mellitus. Currently, there is no treatment for anejaculation caused by certain conditions like nerve damage.
1. Situational Anejaculation: The clinician manages it with a combination of techniques that address these factors; such methods include the following;
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Change in masturbatory technique.
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Improvement in marital communication and quality.
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Reduction of anxiety using cognitive behavioral techniques.
2. Psychogenic anejaculation:
- Sex Therapy: The therapist may modify and tailor standard techniques of sex therapy to manage the specific problems of the individual men.
- Vibrator Stimulation: A specially designed vibrator is attached to the tip of the penis. Sensory nerves carry the vibrations to the spinal cord, giving rise to ejaculation. Studies show that six in ten men with anejaculation ejaculates with this penile vibration stimulation. Men can use this device at home.
Is It Possible to Have a Biological Child for Men With Anejaculation?
- Electroejaculation:
Suppose penile vibratory stimulation can not induce ejaculation. In that case, a healthcare provider may advise the electroejaculation method. The clinician inserts a probe into the affected men's rectum to directly stimulate the sensory nerves near the prostate gland. The probe transmits mild electrical pulses that induce orgasm and ejaculation. This procedure is usually performed under general anesthesia. Studies data shows that nine in ten men can ejaculate with this method, though sperm quality may be inadequate at first and may need repetition of the procedure several times to get an adequate sperm sample.
- Sperm Extraction:
A doctor surgically draws a small amount of tissue from testicles and extracts sperm from it during a microscopic testicular sperm extraction procedure. This procedure is done after giving general anesthesia.
Conclusion:
Anejaculation is a clinical condition that is relatively difficult to treat. Moreover, in certain cases of nerve damage and surgical complication, induced anejaculation can not be cured. However, there are few methods by which affected men can be the biological father of a child. In addition, this condition generally does not interfere with a person's sexual activities.
