Definition of anejaculation
Anejaculation is the absence of expulsion of semen during orgasm. It must be distinguished from other ejaculatory disorders such as retrograde ejaculation (semen redirected towards the bladder), delayed ejaculation, or premature ejaculation.
Anejaculation can be primary (present from the beginning of sexual life) or secondary (appearing after a period of normal sexual functioning). It can be situational (occurring only in certain contexts) or constant.
This disorder, although less well known than erectile dysfunction, can have a significant impact on quality of life, sexuality, and especially on fertility, since the absence of ejaculation prevents natural conception.
Causes of anejaculation
Several causes can be at the origin of anejaculation:
Neurological causes
- Spinal cord injuries: depending on the level and completeness of the injury, ejaculation may be partially or totally impaired.
- Multiple sclerosis and other demyelinating diseases.
- Diabetic neuropathy: prolonged diabetes can damage the nerves controlling ejaculation.
- Surgical sequelae: after pelvic surgery (prostatectomy, retroperitoneal lymph node dissection, abdominoperineal resection).
Pharmacological causes
Many medications can cause anejaculation:
- Antidepressants (in particular serotonin reuptake inhibitors).
- Antipsychotics.
- Alpha-blockers used in benign prostatic hyperplasia.
- Antihypertensives.
Psychogenic causes
Psychological factors can contribute to anejaculation:
- Anxiety and stress.
- Couple conflicts.
- Trauma.
- Educational or religious inhibitions.
Anatomical causes
- Obstruction of the ejaculatory ducts.
- Sequelae of surgery on the bladder neck or the prostate.
Diagnosis of anejaculation
The diagnosis is based on a detailed clinical interview, which specifies:
- The history of the disorder (primary or secondary, situational or constant).
- Medical, surgical, and pharmacological history.
- Personal and couple psychological factors.
- The associated impact on fertility.
The clinical examination assesses the genital organs and looks for associated neurological pathology.
Complementary investigations may include:
- Post-orgasmic urinalysis: looking for spermatozoa in the urine, which signs a retrograde ejaculation.
- Hormonal assessment: testosterone, FSH, LH, prolactin.
- Pelvic ultrasound: looking for an anatomical anomaly.
- Specialized neurological assessment in case of suspicion of a nerve cause.
Treatment of anejaculation
Treatment depends on the identified cause.
Etiological treatment
- Modification of medical treatments when the cause is pharmacological.
- Management of the underlying neurological pathology.
- Sexological or psychological care in case of a psychogenic cause.
Symptomatic treatments
- Medications: certain alpha-stimulant medications can help restore ejaculation.
- Vibratory penile stimulation: a non-invasive technique used in patients with spinal cord injuries.
- Electroejaculation: a technique reserved for certain neurological causes, performed under general anesthesia.
In a fertility context
When the goal is to obtain a pregnancy, several options are possible:
- Recovery of spermatozoa from post-orgasmic urine in case of retrograde ejaculation.
- Surgical recovery of spermatozoa (by epididymal or testicular biopsy).
- Medically assisted procreation (intrauterine insemination, in vitro fertilization, ICSI).
Dr Adam Vardi, urologist and andrologist in Paris, supports patients suffering from anejaculation in the diagnostic and therapeutic process, with particular attention paid to the impact on the couple and on fertility.