Anejaculation Disorder

Anejaculation is the inability to ejaculate semen despite stimulation of the penis by intercourse or masturbation.This is an uncommon,but not rare problem that can cause much distress to the affected man.But this condition is frequently misdiagnosed and often mistreated.However if we take a detailed sexual history of a patient will get a proper diagnosis.

CAUSES;

Anejaculation happens because the prostate gland and seminal ducts can’t release semen. There are a variety of possible causes, including spinal cord injury,Pelvic injury or infection in the pelvis, surgeries in the pelvic area,Parkinson’s disease, diabetes, multiple sclerosis etc…. which affect the nervous system.

Psychological factors such as stress, anxiety,relationship issues ,demanding Sexual activities for infertility issues etc….. can also cause anejaculation disorder.

Types;

1. Anorgasmic Anejaculation 

2.Orgasmic Anejaculation 

1. Anorgasmic Anejaculation: In this type both Ejaculation & Orgasm doesn’t occur during intercourse or masturbation.Most of this type is Psycho-sexual problem.   Two types –  Situational or Total anorgasmic anejaculation.

In situational  Anejaculation, ejaculation will occur in some circumstances but failure in other. situational ejaculation is stressed induced and occurs selectively. For example, a man who is able to ejaculate at home may not be able to do so in order to provide a specimen in a clinic because he is self-conscious and anxious. In some instances, a man may be able to ejaculate and attain orgasm with one partner but not with another. This usually occurs when there is a psychological conflict in a relationship and difficulty with one partner.

In Total anorgasmic anejaculation, ejaculation & orgasm never occur in the conscious state.A man is never able to ejaculate, either during intercourse or through masturbation. In the absence of spinal cord injury or multiple sclerosis, deep-rooted psychological conflicts may be the cause for this scenario. Such men however, usually have normal nocturnal (night) sleep emissions of semen.

2. Orgasmic Anejaculation; In this type a man getting orgasm without ejaculation. This is always due to an organic problem, because there is failure of emission of semen due to a block in the ejaculatory ducts or damage to ejaculatory nerves. Examples of conditions that cause this situation are diabetes, after trans-urethral (laser) resection of the prostate and following pelvic surgery for prostate, bladder or testicular cancer.

Anejaculation must not be confused with retrograde ejaculation (flow of semen back into the bladder due to weakness or surgery of the bladder neck). A simple analysis of post orgasmic urine specimen will differentiate between retrograde and anejaculation. The presence of sperm in the urine specimen supports the diagnosis of retrograde ejaculation. Total absence of sperm in urine would indicate complete lack of ejaculation or anejaculation.

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DIAGNOSIS:

First we should take a detailed Sexual history to differentiate Psychogenic or Organic problem. Two important facts we should notice is

1. Presence of nocturnal emissions

2.Absence of experience of orgasm

MANAGEMENT

1.Psychosexual Counseling & Therapy

2.Pharmacotherapy

3.Vibrator Therapy

4.Electro-Ejaculation Therapy

 

 

 


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