Rigi10™ Malleable Penile Prosthesis
Also Known As
Dry Ejaculation, Anejaculation (in some contexts, though anejaculation specifically refers to the inability to ejaculate, which is a cause of aspermia)
Definition
Aspermia is a medical condition characterized by the complete absence of semen during ejaculation. This means that while an individual may experience orgasm, no seminal fluid is expelled from the penis.1˒2 It is important to differentiate aspermia from azoospermia, where semen is ejaculated but contains no sperm.3 Aspermia can be a significant cause of male infertility, as the absence of semen prevents the transport of sperm necessary for natural conception. The condition can arise from various underlying causes, including an inability to transport semen (anejaculation) or the ejaculation of semen in an antegrade direction (retrograde ejaculation), where semen enters the bladder instead of exiting through the urethra.4˒5
Clinical Context
Aspermia is clinically relevant primarily in the context of male infertility, as the absence of ejaculate prevents natural conception.1˒2 It can be caused by a variety of factors. One major cause is retrograde ejaculation, where semen enters the bladder instead of being expelled through the urethra. This can occur due to conditions like diabetes, certain medications (e.g., alpha-blockers for prostate conditions), or as a complication of surgery on the bladder neck or prostate.4˒5 Another significant cause is ejaculatory duct obstruction, which can be congenital or acquired due to infections, inflammation, or cysts.4 Neurological disorders, such as spinal cord injuries or multiple sclerosis, can also lead to anejaculation and subsequently aspermia by disrupting the nerve signals required for ejaculation.4 Hormonal imbalances, particularly androgen deficiency, may result in underdeveloped reproductive glands that do not produce semen.2 Other contributing factors include infections of the urogenital tract (e.g., TORCH infections, brucellosis, tuberculosis), exposure to radiation or chemotherapy, certain medications (e.g., some antihypertensives, progesterone antagonists, anabolic steroids), and psychological factors like stress and anxiety related to sexual performance.4
Diagnosis of aspermia involves a thorough medical history and physical examination. Semen analysis is crucial to confirm the absence of ejaculate.1 Imaging studies, such as transrectal ultrasound (TRUS), may be used to identify obstructions in the ejaculatory ducts.1 Post-ejaculatory urinalysis can detect sperm in the urine, confirming retrograde ejaculation. Hormonal evaluations may also be performed.4
Treatment for aspermia is directed at the underlying cause. If retrograde ejaculation is due to medication, discontinuing or changing the medication may resolve the issue. Medical therapy with sympathomimetics can sometimes help close the bladder neck and restore antegrade ejaculation.5 For ejaculatory duct obstruction, transurethral resection of the ejaculatory ducts (TURED) may be performed to clear the blockage.2˒4 In cases where these treatments are ineffective or not applicable, or if the cause is neurological, assisted reproductive techniques (ART) are often employed. Sperm can be retrieved directly from the testicles (e.g., Testicular Sperm Extraction – TESE) or from the urine (in cases of retrograde ejaculation) for use in procedures like In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI).1˒4 Psychological counseling may be beneficial if stress or anxiety are contributing factors.2
Expected outcomes vary depending on the cause and the treatment pursued. Successful treatment of the underlying cause can restore fertility in some individuals. For those requiring ART, success rates depend on various factors including sperm quality and female partner fertility.4˒5