Anejaculation

Anejaculation means semen doesn’t come out of your penis when you orgasm. It’s a type of sexual dysfunction that can affect how you feel about sexual activity. It can also lead to male infertility. Semen contains sperm, which fertilize eggs for conception and pregnancy. But infertility can occur if you can’t ejaculate the semen that carries sperm.

Some people describe anejaculation (pronounced “an-ih-jak-yuh-LEY-shuhn”) as alarming or even scary. That may be because many expect to see semen after orgasm. They view it as the height of pleasure. Sometimes, anejaculation is a one-time or infrequent event. But if it’s common or happens every time you orgasm, talk to a healthcare provider. You should also talk to a provider if it causes stress or affects your family planning.

More than 12,000 people see a healthcare provider for anejaculation every year. But the actual number of people who experience this may be higher because many don’t seek care.

What are the types?

There are two main types:

• Primary anejaculation: This means you’ve never been able to ejaculate.
• Secondary anejaculation: This is when you lose the ability to ejaculate.

Other types include:

• Orgasmic anejaculation: You can’t ejaculate while having an orgasm. It often occurs due to physical problems like nerve damage.
• Situational anejaculation: You can’t ejaculate in certain situations. For example, you may be able to ejaculate while masturbating, but not during sexual intercourse. Or you may be able to ejaculate at home, but not at a hotel.
• Total anejaculation: You can’t ejaculate while masturbating or having sex. It doesn’t matter where you are or what the situation is.
• Psychogenic anejaculation: Healthcare providers can’t figure out why you can’t ejaculate.

Retrograde ejaculation is a similar condition. It causes semen to flow back into your bladder instead of leaving through the tip of your penis. Orgasms occur, but semen doesn’t come out.

Symptoms of anejaculation

The most obvious anejaculation symptom is the lack of semen during sexual activity. This may happen even if you’re in the mood and it feels good.

Your sexual health is important to your overall quality of life. Not being able to release semen can affect your thoughts, feelings and relationships. It can cause complications such as:

• Anxiety: This causes fear, stress or panic in sexual situations. You may even experience these feelings just by thinking about sex.
• Depression: This causes continuous sadness, low self-confidence, low self-esteem and grief. It may also cause you to lose interest in sex.
• Relationship problems: Anejaculation can make it harder to feel close to your partner(s). One or both of you may feel distant, upset or not good enough.

What is the main cause?

There isn’t one “main” cause of anejaculation. There are many potential causes. These include:

• Certain medications
• Diabetes
• Infections
• Nerve damage from bladder surgery, prostate surgery, lymph node removal (lymphadenectomy), radiation therapy or an injury to your pelvis
• Nervous system disorders, like Parkinson’s disease and multiple sclerosis
• Spinal cord injury

Mental and emotional conditions can also cause situational anejaculation. These include:

• Anxiety and depression
• Fear of pregnancy
• Stress

What drugs cause it?

Medications like antidepressants or alpha-blockers may cause anejaculation.

Talk to a healthcare provider if you have problems releasing semen after starting a new medication. They may recommend adjusting your dosage or trying a different drug.

How doctors diagnose anejaculation

A healthcare provider will:

• Review your medical history
• Ask about your symptoms
• Do a physical exam

If you can orgasm, they may recommend taking a pee test right after. You may have anejaculation if you don’t have any sperm (azoospermia) in your pee sample after you orgasm. If you have sperm in your sample, you may have retrograde ejaculation.

What are the treatment options for anejaculation?

It depends. Anejaculation doesn’t cause any long-term problems. So, some people don’t get treatment. But if you want treatment, the options depend on the cause.

If anxiety and stress are causing situational anejaculation, your healthcare provider may recommend:

• Talk therapy (psychotherapy) or support groups
• Sex therapy
• Anti-anxiety medications (anxiolytics)

Changing medications may also fix anejaculation. Managing conditions like diabetes or an infection may also help.

There isn’t any treatment for certain causes, like nerve damage.

Can a male with anejaculation have biological children?

Anejaculation makes it more difficult to have a biological child. But it’s not impossible. A urologist or reproductive medicine specialist can retrieve sperm from your testicles. They can then use a fertility treatment like IVF or IUI to fertilize eggs with your sperm.

Sperm retrieval methods include:

• Penile vibratory stimulation (PVS): You use a special vibrator on the tip of your penis. Sensory nerves carry the vibrations to your spinal cord, causing you to ejaculate. You may do this at home or a provider’s office. It works for as many as 6 in 10 men.
• Electroejaculation: If PVS doesn’t work, your provider may recommend this treatment. They insert a probe into your rectum to stimulate nerves near your prostate gland. The probe sends mild electrical pulses, which cause you to orgasm and ejaculate. This works for as many as 9 in 10 men. But you may need to go through the procedure a few times to get a good sperm sample.
• Microsurgical testicular sperm extraction (microTESE): A surgeon removes a small amount of tissue from your testicles. Then, they take sperm from the tissue.

When should I see my healthcare provider?

Reach out to your primary care provider (PCP) if you notice anything unexpected when you orgasm, especially if it:

• Affects your ability to enjoy sex or maintain an erection
• Prevents you from having a biological child

If your PCP can’t diagnose the cause, they may refer you to a specialist.

During your appointment, you may wish to ask the following questions:

• What’s causing anejaculation?
• Do I need treatment?
• What treatment do you recommend?
• Are there side effects to your recommended treatment?
• Can I have a biological child?
• Are there any complications I should look out for?
• Can you recommend a sex therapist or support group?

What is the prognosis for anejaculation?

It depends on what’s causing anejaculation. In some cases, it’ll go away with treatment. In others, it’s permanent. Your healthcare provider will give you a better idea of what to expect.

What happens if a man goes a while without ejaculating?

Nothing bad will happen if you go a long time without ejaculating. Your body will naturally absorb the fluids that make up your semen and any sperm you don’t release. It won’t cause any harm.