Dr
Rupin Shah
Dr Rupin Shah is the male infertility specialist
( andrologist) at our clinic. This excellent article
dispels a lot of myths about this common problem, which
is commonly misunderstood and improperly treated.
What is anejaculation?
Anejaculation is the inability to ejaculate semen
despite stimulation of the penis by intercourse or masturbation.
It is a fairly common problem and can be very distressing
to a couple trying for a child.
What causes anejaculation?
Anejaculation may be situational or total.
(a) Situational anejaculation
- in this condition the man is able to ejaculate
in some situations but not in others. Typically, situational
anejaculation is stress-induced and occurs selectively
in the infertility clinic or at the time of ovulation
or egg pick-up during an IVF cycle. Thus, a man who
is able to ejaculate at home may be unable to do so
in the clinic because he is self conscious and anxious.
Similarly, some men become tense when they know they
have to give a semen sample and hence usually fail “on
demand” even though they are able to ejaculate
on other occasions. Another common type of situational
anejaculation when a man can ejaculate during intercourse
but is unable to collect a sample by masturbation because
he is not accustomed to do so.
(b) Total anejaculation –
in this condition the man is never able to ejaculate
semen consciously, either during intercourse or by masturbation,
at home or in the clinic. Total anejaculation is further
divided into anorgasmic anejaculation and orgasmic anejaculation.
Anorgasmic Anejaculation - these
men never reach orgasm in the waking state (either by
masturbation or by intercourse), and hence do not ejaculate.
However, nocturnal emissions are usually present. There
is no physical defect. This failure to reach orgasm
is sometimes due to psychological inhibitions. Alternatively,
some men need a high amount of stimulation before they
reach orgasm and do not get this stimulation during
intercourse or masturbation.
Orgasmic Anejaculation - these
men reach and experience orgasm but they do not ejaculate
semen, either because there is failure of emission of
semen (due to a block in the tubes or damage to the
nerves) or because there is retrograde ejaculation (flow
of semen back into the bladder due to weakness of the
bladder neck).
How is anejaculation treated
?
Situational anejaculation can often be prevented or
treated by simple measures. The semen collection room
in an infertility clinic should be in a quiet, discreet
location and there should not be a queue of men waiting
to use it! If you find the clinic environment is unfavorable
discuss it with the doctor and ask if you can bring
the semen sample from home (if you stay close by) or
from a nearby hotel room.
What to do if you cannot give
a semen sample
Sometimes Viagra helps. Viagra by itself does not facilitate
ejaculation. However, if you are having difficulty getting
an erection, Viagra could help you with that, thus making
it easier to masturbate. If you anticipate having difficulty
giving a semen sample (based on past experience) on
the day of egg pick-up you could request your doctor
to collect and freeze your semen beforehand on a day
when you are relaxed. In fact, some centres routinely
freeze a semen sample from all couples undergoing IVF
since unexpected failure to collect semen, due to the
stress of IVF, is quite common.
If you have difficulty masturbating, but can ejaculate
during intercourse, do not be disturbed. Many men are
unable to masturbate. Discuss this with your doctor
and arrange to collect the semen at home by coitus interruptus.
This means having intercourse till the moment when ejaculation
is about to happen. Withdraw the penis at that moment
and catch the semen in the collection beaker. If that
does not work, you can request your doctor for a non-spermicidal
non-toxic condom made of silastic. You can buy one from
our Online
Store ! This would allow you to have full intercourse
and ejaculate into the condom from which the semen is
then collected. NOTE: Condoms that are routinely available
are coated with a chemical that kills sperm and should
not be used for collecting semen.
Finally, some men with situational anejaculation are
just not able to collect a sample when required. Discuss
this with your doctor beforehand. He will teach you
how to use a vibrator to stimulate the penis and collect
a sample. A couple of practice sessions should be done
before the actual day of collection.
Anorgasmic Anejaculation can be difficult to treat.
If there has been a traumatic sexual episode in the
past that you are aware of, discuss it with your doctor
or ask for a referral to a sexologist or psychologist.
If your doctor feels that you are sexually inhibited
he may suggest a similar referral.
However, in most cases, counseling is not required.
The main treatment for anorgasmic anejaculation is the
use of a vibrator. The
vibrator acts by providing a
strong stimulus, for a long duration, to the penis (use
of the vibrator is described below). Due to the stimulation
the man reaches an orgasm and ejaculates. Vibrator stimulation
results in ejaculation in about 60% of men.
If vibrator therapy fails, electro-ejaculation can
be performed. Electro-ejaculation involves the direct
electrical stimulation of the nerves to the seminal
vesicles and terminal vas. The most commonly used device
is the Seager electro-ejaculator which delivers a sine
wave, alternating current. The procedure is carried
out under general anaesthesia (except in paraplegic
men with no sensations). The electrodes are mounted
on a cylindrical rod which is lubricated and introduced
per rectum with the electrodes facing the prostate gland.
The voltage is turned up to 5 volts, held for a second
and then turned back to 0 volts. For the next stimulus
the voltage is increased to 6 volts. The stimulus is
progressively increased till ejaculation occurs. If
the antegrade ejaculate is scanty, the bladder is catheterized
to check for retrograde ejaculation. Electro-ejaculation
will always succeed in men with anorgasmic anejaculation
since there is no physical defect. However, electro-ejaculation
needs general anesthesia and the semen quality may be
inferior. Hence, it is always a second choice to be
used only if repeated sessions with the vibrator fail.
Orgasmic Anejaculation Since this condition is due
to a physical problem, treatment will depend on the
type of problem.
If the nerves are damaged sometimes medicines can help.
If medicines do not work, vibrator stimulation or electro-ejaculation
will usually be successful in obtaining a sample.
If there is a block due to infection, this can sometimes
be cleared by surgery. If surgery fails, or is not possible,
then pregnancy can be achieved by aspirating sperm from
the epididymis and using these sperm for ICSI (test-tube
baby procedure).
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How to use a vibrator:
The vibrator works by providing a high intensity stimulus
to the penis. This stimulus is strong enough to overcome
any psychological or situational inhibition and trigger
the orgasmic reflex. This is what a vibrator looks like.
You can buy one from our
Online
Store !
The procedure should be carried out in a room with complete
privacy. It is very important to remember that ejaculation
will occur automatically as a result of the vibratory
stimulation – so be relaxed; do not try and force
ejaculation.
Pass urine, take off your clothes and sit on a bed
with your legs apart. The vibrator is placed beneath
the penis. The penis is placed upon the vibrating head
such that the undersurface of the penis (glans and distal
shaft) is stimulated. Once you are comfortable with
the vibratory sensation, press the tip of the penis
(glans) upon the vibrator such that you feel the maximum
amount of stimulation. Keeping the vibrator in place,
close your eyes and fantasize sexually. Stimulation
is continued till ejaculation occurs. This usually occurs
in 10 to 30 minutes but some men with anorgasmic anejaculation,
who have never experienced orgasm, may take up to 2
hours of stimulation before they reach orgasm the first
time! This period shortens during subsequent sessions.
Some men require a second or third session before they
succeed.
In Summary
Failure to ejaculate is a common problem. If
you suffer from this condition do not be disheartened.
A variety of therapies are available to solve the problem.
Some men with be helped by the simple measures described
above for situational anejaculation. Others will be
helped by the use of a vibrator or an electro-ejaculator.
Finally, if nothing else works, sperm can be retrieved
directly from the epididymis or testis and used for
ICSI.
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