Anejaculation

Anejaculation is a medical condition characterized by the persistent or intermittent inability to ejaculate despite adequate sexual arousal and stimulation, or by the absence of semen during ejaculation. It is distinct from anorgasmia, which is the inability to reach orgasm, and from retrograde ejaculation, where semen enters the bladder.

Signs and symptoms include normal erection and sexual desire with a failure to ejaculate after stimulation. Semen may be absent from the penis during ejaculation. In retrograde ejaculation, semen is produced but expelled into the bladder, which may be detected as semen in postcoital urine.

Causes are varied and can be grouped into neurological, pharmacological, surgical, hormonal, and psychological factors. Neurological causes include spinal cord injury, multiple sclerosis, or pelvic nerve damage. Medications frequently implicated are antidepressants (notably selective serotonin reuptake inhibitors and other psychotropic drugs), antipsychotics, and certain antihypertensives. Pelvic or prostate surgery, diabetes-related neuropathy, hormonal disorders (low testosterone, thyroid disease), and psychological factors such as stress, anxiety, and depression can contribute. Anejaculation can be primary (present since puberty) or secondary (developed after a period of normal ejaculation).

Diagnosis involves a careful medical and sexual history, physical examination, and targeted testing. Semen analysis after ejaculation helps determine whether semen is present. A post-ejaculatory urine sample can diagnose retrograde ejaculation. Hormonal assays (testosterone, prolactin, thyroid studies) and neurological evaluation may be indicated.

Treatment and management focus on underlying causes and may include adjusting or stopping contributing medications, managing diabetes or hormonal imbalances, and addressing psychological factors. For retrograde ejaculation, alpha-adrenergic agents such as midodrine or other medications have been used; assisted reproduction with sperm retrieval from urine or semen may be considered for fertility. Pelvic floor physical therapy and techniques like penile vibratory stimulation or electrical stimulation can aid some patients, particularly with certain neurological conditions. Counseling and support are important components of care. Prognosis varies with cause and treatment response.