Rigi10™ Malleable Penile Prosthesis
Also Known As
Dry orgasm, aspermia (sometimes used, though aspermia technically refers to complete lack of semen, which can include anejaculation or other causes), ejaculatory failure, orgasmic anejaculation.
Definition
Anejaculation is a medical condition characterized by the inability to ejaculate semen despite the potential for normal orgasm sensation.3 It literally means “no ejaculation.”1 Men with anejaculation can typically produce sperm, but the sperm is not expelled from the body during sexual climax.3 This condition occurs when the prostate and seminal ducts fail to release semen into the urethra.1
Anejaculation can be classified in several ways. It may be congenital (present from birth) or acquired (developing later in life), and can also have psychological underpinnings.1 It is also categorized as situational, where ejaculation is possible in some circumstances but not others, or total, where ejaculation never occurs during intercourse or masturbation.3 Total anejaculation can be further divided into anorgasmic anejaculation (where orgasm is not achieved while awake) and orgasmic anejaculation (where orgasm occurs but without semen expulsion).3 Additionally, anejaculation can be primary, meaning a man has never experienced ejaculation, or secondary, where the inability to ejaculate develops after a period of normal ejaculatory function.3
The primary implication of anejaculation in urology is often related to male infertility, as the absence of ejaculate prevents natural conception. However, men with anejaculation may still be able to have biological children through assisted reproductive technologies.3 The condition itself can arise from various causes, including neurological damage (e.g., spinal cord injuries, multiple sclerosis, diabetes), surgical trauma (especially from pelvic or retroperitoneal surgeries), infections, medications (like certain alpha-blockers or psychotropic drugs), or psychological factors.1 3
Understanding the specific type and cause of anejaculation is crucial for determining appropriate management and treatment strategies, which can range from psychological counseling to medical interventions aimed at sperm retrieval or inducing ejaculation.3
Clinical Context
Anejaculation is clinically relevant primarily in the context of male infertility, as the absence of ejaculate prevents natural conception.3 It is also a concern for men who experience distress due to the inability to ejaculate, impacting sexual satisfaction and psychological well-being.3 Diagnosis typically involves a thorough medical history, including sexual function, and physical examination to identify potential underlying causes.2 It is important to differentiate anejaculation from retrograde ejaculation, where semen enters the bladder instead of being expelled; this is often checked by examining post-orgasmic urine for sperm.2
Patient selection for treatment depends on the cause of anejaculation and the patient’s goals, particularly the desire for fertility.3 For instance, if anejaculation is situational and linked to psychological factors like stress or anxiety, counseling or sex therapy may be the first line of approach.2 If medication is the cause, switching to an alternative drug, under medical supervision, might resolve the issue.1 2
Several procedures are available, especially when fertility is a goal. Penile vibratory stimulation (PVS) is often a first-line treatment, particularly for men with spinal cord injuries. This technique uses a specially designed vibrator to stimulate the penis, triggering ejaculation in a significant percentage of men (around 60%).2 3 If PVS is unsuccessful, electroejaculation (EEJ) may be considered. EEJ involves electrical stimulation of the nerves responsible for ejaculation via a rectal probe, usually performed under general anesthesia.2 3 While EEJ has a high success rate in producing an ejaculate (around 90%), the semen quality can sometimes be poor, and retrograde ejaculation can occur in about a third of cases.2 Sperm retrieved through PVS or EEJ can be used for assisted reproductive techniques such as intrauterine insemination (IUI) or in vitro fertilization (IVF).2 3 In cases where these methods fail or are not suitable, surgical sperm retrieval techniques, such as testicular sperm extraction (TESE) or microsurgical epididymal sperm aspiration (MESA), can be employed to obtain sperm directly from the testes or epididymis for IVF with intracytoplasmic sperm injection (ICSI).2
Expected outcomes vary based on the underlying cause and the treatment modality. For psychogenic anejaculation, therapy can lead to restoration of normal ejaculation.2 For neurogenic causes, PVS and EEJ offer good chances of sperm retrieval for fertility purposes, though restoration of natural coital ejaculation is less common.2 3 Success rates for achieving pregnancy with retrieved sperm depend on various factors, including sperm quality and female partner fertility.2 Drug treatments for anejaculation generally have low success rates compared to PVS and EEJ and are not typically preferred options.2