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Inability to Ejaculate

By Irvin H. Hirsch, MD, Clinical Professor, Department of Urology, Sidney Kimmel Medical College of Thomas Jefferson University

Inability to ejaculate (anejaculation) is usually caused by inability to reach orgasm (anorgasmia). It usually occurs as part of erectile dysfunction.

The cause is usually prostate surgery because

  • The nerves between the spinal cord and the penis may be damaged during pelvic surgery.

  • Removal of the prostate and seminal vesicles during surgery for prostate cancer eliminates the ability to produce semen (these glands are involved in semen production).

Other conditions that damage the nerves of the penis, as well as some mental disorders and some drugs that are used to treat mental disorders, may also affect the ability to ejaculate.

Retrograde ejaculation can sometimes result in absence of visible semen.

Depending on the cause, anejaculation may occur with or without orgasm. A doctor bases the diagnosis of anejaculation on the man's symptoms, results of an examination, and, if orgasm is possible, a urine test. Absence of sperm in a urine sample obtained after an orgasm indicates anejaculation, whereas presence of many sperm indicates retrograde ejaculation.

Treatment depends on the cause and may include stopping any drugs that may be causing the problem, psychotherapy, or helping trigger ejaculation using oral drugs such as pseudoephedrine and/or imipramine. If the goal of therapy is to obtain semen for insemination, the man can use a penile vibrator or his doctor can apply an electric signal to the rectum to activate the nerves responsible for ejaculation (electroejaculation therapy). There is no treatment when anejaculation is due to removal of the prostate and seminal vesicles.

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