Anejaculation: Symptoms, Types, Causes and Treatment

Anejaculation is a complex male sexual dysfunction characterized by the inability to ejaculate semen during orgasm, despite normal sexual arousal and often preserved erectile function. For many men, this condition can be distressing, impacting self-esteem, relationships, and fertility. In this comprehensive article, we explore the key symptoms, types, underlying causes, and evidence-based treatments for anejaculation, drawing on recent research and clinical practice.

Symptoms of Anejaculation

Anejaculation presents with unique and sometimes subtle symptoms that can be overlooked or mistaken for other sexual issues. Recognizing the primary features is essential for timely diagnosis and management.

Symptom	Description	Impact	Source(s)
Absent Ejaculate	No semen released during orgasm	Infertility, distress	1245
Dry Orgasm	Orgasm sensation without semen emission	Confusion, anxiety	145
Reduced Orgasmic Sensation	Less intense or absent orgasmic feeling	Sexual dissatisfaction	1
Retained Fertility Issues	Inability to deliver sperm for conception	Subfertility	26

Table 1: Key Symptoms

Understanding the Symptoms

Anejaculation is defined by the persistent inability to expel semen during orgasm, regardless of sexual stimulation or arousal. This symptom is distinct from erectile dysfunction; men with anejaculation may still achieve and maintain erections and experience the sensation of orgasm, albeit without ejaculation 124.

Dry Orgasm and Orgasmic Sensation

• Some men experience a "dry orgasm"—a pleasurable climax without semen release. Although orgasmic sensation may persist, it is often less intense or even absent, leading to frustration and diminished sexual satisfaction 1.
• In some cases, the absence of ejaculation is the only sign, especially if the individual is not actively trying to conceive.

Emotional and Psychological Impact

• Men may feel embarrassed, anxious, or concerned about their masculinity and fertility.
• The inability to father children naturally is a frequent reason for seeking medical help 26.

Types of Anejaculation

Not all cases of anejaculation are the same. Understanding the various types helps tailor treatment and set realistic expectations for recovery and fertility.

Type	Key Features	Typical Causes	Source(s)
Complete	No ejaculation under any circumstances	Neurologic, medication	256
Situational	Ejaculation possible in some contexts (e.g., masturbation but not intercourse)	Psychogenic factors	35
Psychogenic	Psychological origin; normal nocturnal emissions	Stress, performance anxiety	35
Organic	Physical or physiological dysfunction	SCI, diabetes, surgery	567
Iatrogenic	Medication-induced (e.g., alpha-blockers)	Prostate meds, antidepressants	14

Table 2: Types of Anejaculation

Complete vs. Situational Anejaculation

• Complete anejaculation means semen is never expelled, regardless of the situation or method of stimulation. This is most often seen in men with significant nerve damage or severe medical illness 256.
• Situational anejaculation refers to cases where ejaculation may occur under specific circumstances (e.g., during sleep or masturbation, but not during intercourse), often linked to psychological or contextual factors 35.

Psychogenic and Organic Subtypes

• Psychogenic anejaculation is rare (0.4–0.5% of cases) and may result from psychological barriers, despite normal physical function. These patients can have erections and nocturnal emissions but fail to ejaculate during sexual activity 35.
• Organic anejaculation is related to physical or physiological dysfunction—most commonly due to nerve injury, chronic diseases like diabetes, or spinal cord injury 567.

Iatrogenic Anejaculation

• Certain medications, particularly those prescribed for prostate enlargement (e.g., silodosin, a selective alpha1A-blocker), are known to cause anejaculation as a side effect by inhibiting seminal emission 14.

Causes of Anejaculation

The causes of anejaculation are multifactorial, encompassing a wide range of physical, psychological, and iatrogenic factors.

Cause Type	Examples	Mechanism/Effect	Source(s)
Neurological	Spinal cord injury, multiple sclerosis, diabetes	Disruption of ejaculatory reflex	567
Surgical	Retroperitoneal lymph node dissection, pelvic surgery	Nerve damage	612
Medication	Alpha-blockers (silodosin), antidepressants	Inhibition of seminal emission	145
Psychological	Anxiety, stress, trauma	Inhibition of ejaculatory reflex	35
Idiopathic	Unknown	No identifiable cause	512

Table 3: Causes of Anejaculation

Neurological and Medical Conditions

• Spinal Cord Injury (SCI): Disruption of the spinal ejaculation generator (SEG) and associated neuropeptides (e.g., gastrin releasing peptide) impairs the ejaculatory reflex, often resulting in complete anejaculation 678.
• Chronic Illnesses: Diabetes mellitus and multiple sclerosis can damage nerves involved in ejaculation, leading to dysfunction 56.

Surgical and Iatrogenic Causes

• Pelvic and Retroperitoneal Surgery: Procedures such as retroperitoneal lymph node dissection, commonly performed for testicular cancer, may damage sympathetic nerves critical for ejaculation 612.
• Medications: Alpha1-adrenoceptor antagonists, especially silodosin, are strongly associated with inhibition of seminal emission, leading to anejaculation 14. Other drugs, including certain antidepressants, may also contribute 5.

Psychological and Idiopathic Factors

• Psychological Factors: Performance anxiety, stress, and relationship issues can inhibit the ejaculatory reflex even in the presence of normal physiology. Psychogenic anejaculation is rare but recognized 35.
• Idiopathic Cases: Sometimes, no clear cause is identified despite thorough evaluation. These cases are termed idiopathic anejaculation 512.

Treatment of Anejaculation

Managing anejaculation requires a tailored, stepwise approach based on the underlying cause, patient goals (especially regarding fertility), and the presence of comorbidities.

Treatment Option	Indication/Use	Success/Notes	Source(s)
Psychological Therapy	Psychogenic anejaculation	Address stress, anxiety	35
Medication Adjustment	Drug-induced cases	Discontinue/switch meds	145
Penile Vibratory Stimulation (PVS)	Neurological, psychogenic anejaculation	Non-invasive, can restore ejaculation	3810
Electroejaculation (EEJ)	SCI, severe neurologic/anatomic causes	High retrieval rates, used for ART	6891112
Assisted Reproductive Techniques (ART)	Fertility goals	IUI, IVF, ICSI, GIFT, ZIFT	89111213
Surgical Sperm Retrieval	Refractory cases	Vas deferens/epididymal/testicular aspiration	5812

Table 4: Treatment Approaches

Psychological and Behavioral Interventions

• Psychotherapy is the primary treatment for psychogenic anejaculation, focusing on reducing anxiety, addressing relationship issues, and enhancing sexual communication 35.
• Couples counseling can be helpful if relationship dynamics are a contributing factor.

Medication Review and Adjustment

• In cases where medications (like silodosin or antidepressants) are implicated, discontinuing or switching drugs may restore ejaculation 145.
• Always consult a healthcare provider before changing prescribed medications.

Stimulation Techniques: PVS and EEJ

• Penile Vibratory Stimulation (PVS): Non-invasive and effective, especially in psychogenic and some neurologic cases. Some patients regain normal ejaculation after a few sessions 38.
• Electroejaculation (EEJ): Involves electrical stimulation (often via a rectal probe) to induce ejaculation. Highly effective in men with SCI or severe nerve injury. Success rates for semen retrieval range from 60% to 90% 6891011.

Assisted Reproductive Technologies (ART)

• For men desiring biological children, sperm retrieved via PVS or EEJ can be used in intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) 89111213.
• ART success rates vary based on sperm quality, female partner factors, and the technique used. While fertilization rates are similar to conventional cases, pregnancy rates may be lower with electroejaculated sperm 12.

Surgical Sperm Retrieval

• For refractory or complex cases, sperm can be surgically retrieved from the vas deferens, epididymis, or testes for use in ART 5812.

Practical Considerations

• Stepwise Approach: Start with the least invasive options (medication review, PVS), progressing to EEJ or surgical retrieval as needed 81013.
• Fertility Counseling: Early referral to a fertility specialist is recommended for couples struggling to conceive.

Conclusion

Anejaculation is a multifaceted condition affecting sexual satisfaction and fertility. Timely recognition and targeted management can significantly improve outcomes for affected men and their partners.

Key Points Covered:

• Symptoms: Absence of semen during orgasm, dry orgasm, reduced orgasmic sensation, and associated infertility issues.
• Types: Complete, situational, psychogenic, organic, and iatrogenic anejaculation.
• Causes: Neurological injury (SCI, diabetes), surgery, medications (notably alpha-blockers), psychological factors, and idiopathic cases.
• Treatment: Ranges from psychological therapy and medication adjustment to PVS, EEJ, ART, and surgical sperm retrieval, tailored to the underlying cause and fertility goals.

With advances in both diagnosis and treatment, most men with anejaculation can achieve improved sexual satisfaction and, if desired, father biological children. Early evaluation and individualized care remain central to optimal outcomes.