Ejaculatory Failure

“Anejaculation” and “ejaculatory dysfunction” are the terms used to describe the inability of a man to have an ejaculation. This condition typically results from neurologic diseases, traumatic injury, or as a complication of surgery.

The causes can be psychological or physical and anejaculation can be situational or total. Situational anejaculation means that a man can ejaculate and attain orgasm in some situations but not in others. Typically, 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 or complete anejaculation the 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.

Total anejaculation is further divided into anorgasmic anejaculation and orgasmic anejaculation. In anorgasmic anejaculation the man is never able to reach an orgasm in the waking state (either by masturbation or by intercourse) and does not ejaculate. This failure to reach an orgasm is sometimes attributed to psychological inhibitions, as was previously mentioned. Some may need a high amount of stimulation before they reach orgasm and do not get this stimulation during intercourse or masturbation.

Inside the Ejaculate

The normal ejaculate has a volume of at least 1.5-2 mL. It includes fluid from the prostate (10% of volume), the vas deferens (sperm, 10%), the seminal vesicles (80%) and a small amount from Cowper’s glands. The first part of the ejaculate contains the most sperm and the highest amounts of prostatic enzymes, zinc and citrate, suggesting that is it compose of mainly fluid from the vas deferens and prostate. Fructose levels are highest in the latter half of the ejaculate, which is largely from the seminal vesicles. The normal pH of the ejaculate is 7.2-8.0. A low pH on a semen analysis suggests that there might be an obstruction in the system. Similarly, a lack of fructose in the semen implies seminal vesicle blockage. So, a semen analysis can be very valuable aid to use to evaluate ejaculatory disorders.

Ejaculatory Disorder Evaluation

The most informative part of the evaluation of ejaculatory disorders is a detailed patient history. It is important to understand whether normal ejaculation was ever present, which can suggest whether the problem is congenital or acquired. The physical examination includes an assessment of the testicles and genitalia to make sure all necessary components are present, including the vas deferens.

As part of the evaluation, the patient should try to produce a semen sample for analysis. If there is no ejaculate, a post-ejaculate urine sample should be obtained and examined for the presence of sperm. If sperm are present in the bladder urine after ejaculation, this indicates retrograde ejaculation. Blood tests including FSH and testosterone are also assessed, as a low testosterone level may cause low semen volume. Other tests may include imaging with transrectal ultrasound (TRUS) to define structural abnormalities in the prostate or seminal vesicles.