Inability to ejaculate (anejaculation) is usually caused by inability to reach orgasm (anorgasmia). It usually occurs as part of erectile dysfunction. (See also Overview of Sexual Function and Dysfunction in Men. See Premature Ejaculation and Retrograde Ejaculation.)
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 conditions and some medications that are used to treat them, may also affect the ability to ejaculate.
Retrograde ejaculation can sometimes result in the 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 of anejaculation depends on the cause and may include stopping any medications that may be causing the problem, engaging in psychotherapy, or helping trigger ejaculation using oral medications 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. In infertile patients who cannot produce semen, sperm can be directly extracted from the testicles and used for assisted reproduction, such asin vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
