Dry Orgasm or Anejaculation
Dry Orgasm or Anejculation is the inability of a man to ejaculate; simply said with (orgasmic) or without (anorgasmic) an orgasm, there is no semen emission when a man reaches sexual stimulation. Dry orgasm or anejculation may not only be a problem when trying to become pregnant, but it may pose a huge psychological negative effect on a man’s psyche causing emotional distress and self-esteem issue in so far that some men may completely withdrawn from sexual activities. Furthermore, if not understood clearly by couples, dry orgasm or anejculation may be considered as ‘fake orgasm” by the partner causing relationship issues and emotional distress.
Dry Orgasm is usually secondary to many different causes, including:
- Sexual inhibition, where an orgasm and subsequent ejaculation is not achieved
- Pharmacological inhibition, where the use of antidepressant and antipsychotic medication keeps the patient calm and away from orgasm and ejaculation.
- Autonomic nervous system malfunction, where the body’s own nervous system is not allowing a man to achieve appropriate stimulation, orgasm, and ejaculation, or the signals for the muscle contraction are disrupted and an exertion of semen does not occur
- Prostatectomy, where the surgical removal of the prostate may result in nerve and structural damage
- Ejaculatory duct obstruction, where the ejaculate is produced by not excreted due the canals being blocked
- Spinal cord injury, where direct nerve damage or disruption disables the pathway of signaling between the nerves and the muscles preventing ejaculatory response.
When speaking about dry orgasm or anejaculation, we should be aware and distinguish it from retrograde ejaculation. Dry orgasm, especially the orgasmic variant, is usually indistinguishable from retrograde ejaculation. Your doctor can distinguish these to pathologies with a simple urine test where the absence of sperm in the urine will exclude retrograde ejaculation and make anejaculation or dry orgasm the right diagnosis.
After the diagnosis of dry orgasm has been made, your doctor will decide about the proper management based on your personal history, preexisting diseases, use of medication or drugs, and some other factors.
The European Association of Urology has recently published new guidelines for the treatment of anejaculation or dry orgasm summarized in “Guidelines On Disorders Of Ejaculation”, which suggest the following;
Dry Orgasm or Anejaculation Treatments
Drug treatment for dry orgasm due to lymphadenectomy and neuropathy is not very effective. The same applies to psychosexual therapy for anorgasmia. In all these cases and in spinal cord injured men, vibrostimulation is the first-line therapy.
In dry orgasm or anejaculation, penile vibratory stimulation evokes the ejaculation reflex. Vibrostimulation requires an intact lumbosacral spinal cord segment. The more complete the injury above Th10, the better the chance of response. Lack of pinprick or temperature sensation in the saddle area and glans penis, inability to feel testicular squeeze, and intact lower limb and bulbocavernosus reflexes suggest a promising outcome. Negative prognostic factors are injuries below Th10 and flaccid paraplegia. Men with a history of autonomic dysreflexia are premedicated with 10-20 mg nifedipine sublingually. The bladder must be emptied before vibrostimulation. The vibrator is applied around the glans penis and frenulum, with a 1-3 mm peak-to-peak amplitude and a 80-100 Hz frequency. Ejaculation should be expected within 10 minutes and is followed by flushing, abdominal and leg spasm. Once the safety and effectiveness of this procedure are assessed, patients can manage themselves at home. Intra-vaginal insemination via a 10-mL syringe during ovulation can be performed. If semen quality is poor, or ejaculation is retrograde, the couple may enter an in vitro fertilization programme.
If vibrostimulation fails, electroejaculation is the therapy of choice. Electroejaculation is an electric stimulation of the periprostatic nerves via a probe inserted into the rectum, which seems not to be affected by reflex arc integrity. Electroejaculation requires good training because of the associated risks of autonomic hyperreflexia and rectal mucosa burning. Anaesthesia is required except in cases of complete high spinal cord injury. An automatic blood pressure cuff is applied to the patient for continuous readings; his bladder is emptied by a catheter and instilled with Ham’s F10 (or similar medium). Anoscopy is previously performed to check the integrity of the bowel wall. The probe is then placed directly onto the prostate, assuring continuous mucosal contact with the temperature sensor and metal plates. Most stimulation are performed for 5-7 minutes. In 90% of the patients electrostimulation induces ejaculation, which is retrograde in one third of them. Semen quality is often poor, although improving throughout repeated ejaculations, and most couples must resort to in vitro fertilization.
If electroejaculation fails or cannot be performed, sperm retrieval from the seminal ducts may be achieved by
- Sperm aspiration
- Seminal tract washout
- Epididymal obstruction or testicular failure must be suspected in case of failed sperm retrieval. TESE is then performed.
In conclusion, there are many different physical and pharmaceutical possibilities to treat dry orgasm or anejaculation. Make sure you talk to your doctor about this problem and let him help you before it takes control of your personal and psychological well being and your relations.