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This is a situation that occurs when the man cannot “come”. It can be situational or complete. Situational anejaculation occurs when the man comes in certain situations, but not in others, and is usually due to psychological causes. Complete anejaculation occurs when the man has never ejaculated and is therefore anorgasmic, meaning the man has also never had an orgasm, as in men, ejaculation and orgasm usually occur together.{{more}}

So, to summarize, anejaculation may be complete or situational, orgasmic or anorgasmic. The worst and most difficult to treat is the complete; anorgasmic anejaculation, in other words, “no come, no feelings at no time”.

To understand the “no cum” situation, one must remember that an orgasm and “coming” are very complex psychophysical occurrences, and like most complex situations, anything can go wrong at anytime. Like an erection, there are many steps to achieving it. They usually work cohesively and reliably, but when it goes wrong, it can be very hard to remedy. The psychological causes of anejaculation include:

  • Anxieties
  • Stress
  • Relationship distress
  • Religious guilt
  • Education/attitudes about sex
  • Fear of pregnancy or disease
  • Fear of defiling partner with semen

The physical causes include:

  • Surgery to the prostate, bladder or abdomen, which removes the prostate and seminal vesicles or damages the ejaculation nerves, as they pass near to the prostate or bladder.
  • Prostatitis, which is the inflammation of the prostate gland. In acute prostatitis, it is too painful to ejaculate and in chronic prostatitis, the prostatic and ejaculatory ducts are blocked.
  • Conditions affecting the nervous system, such as Parkinson’s disease, Multiple Sclerosis, Diabetes and Spinal cord injuries
  • Partial or complete blocking to the urethra (urine passage).

Medications like those used to treat psychiatric disorders are also a cause of anejaculation. Interestedly, removing the testicles or castration does not cause ejaculation problems.

Treatment of the problems depends on whether the couple wants to achieve a pregnancy or not. If fertility is not an issue, then no treatment is necessary unless the man is not having an orgasm and wants to achieve one. For couples that want to achieve a pregnancy, the psychosexual counseling is paramount, as the vast majority of causes are psychological. This includes treating relationship anxieties, fear of pregnancy and religious guilt. Issues of exposure and guilt are addressed in men who cannot ejaculate with their partner, but who can do it when masturbating alone (situational).

Physical problems like prostatitis and medication induced anejaculation can be easily treated with antibiotics and stopping or changing the medication respectively. The results of treatment for physical causes are good, but physical causes are only a small fraction of the main causes of anejaculation. Patients who have neurological problems like spinal cord injuries, diabetes and multiple sclerosis may be helped to achieve ejaculation, and hence pregnancy, with the aid of vibrators made specifically for the penis, and when this fails, electroejaculation. I mentioned this last week in my previous article. Electroejaculation is the use of electricity (5-10 volts) to stimulate the prostate and seminal vesicles to contract. The procedure is done with the patient anaesthetized, as it is painful! This is not done for pleasure, as some perverted minds may assume. This is a medical procedure, in which a lubricated probe is placed on the prostate and seminal vesicles rectally, and electricity is used to produce an ejaculation. The ejaculate is collected and the sperm used to achieve fertilization. Next week we will look at fertility issues in men.

For comments or question contact:

Dr. Rohan Deshong
Tel: (784) 456-2785
email:[email protected]