Anejaculation & Anorgasmia (Fertility Angle)
Failure of Ejaculation and Orgasm - Neurogenic, Psychogenic, and Post-Surgical
Evidence grade 4 of 5, Strong. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- Not applicable (procedure/device-based retrieval)
Reference only. Not medical advice.
What can go wrong
EEJ can cause rectal mucosal injury and, in men with high SCI, autonomic dysreflexia (a hypertensive emergency requiring precautions). PVS is safe but can also trigger dysreflexia in high lesions. Psychogenic anejaculation can be resistant and emotionally distressing. Anorgasmia may reflect medication effects (notably SSRIs) or endocrine and neurologic causes that need addressing.
This is something to take to a clinician. The Atlas can tell you what is known about anejaculation & anorgasmia (fertility angle) in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
Anejaculation is the inability to ejaculate despite adequate erection; anorgasmia is the absence of orgasm. From a fertility standpoint they are pivotal: ejaculatory dysfunction accounts for a large share of male infertility due to sexual dysfunction. Causes include spinal cord injury (the most common neurogenic cause), retroperitoneal lymph node dissection, diabetic autonomic neuropathy, multiple sclerosis, and pelvic surgery; a small fraction is psychogenic/idiopathic. The fertility pathway is a well-defined escalation: penile vibratory stimulation (PVS) first, then electroejaculation (EEJ), then surgical sperm retrieval, feeding into IUI/IVF/ICSI.
When semen never arrives - and how reproduction proceeds anyway.
What people take it for
What it is taken for. Approval, where it exists, covers only some of these.
How it works
Antegrade ejaculation requires coordinated sympathetic (emission - bladder-neck closure and seminal/prostatic contraction) and somatic (expulsion via bulbospongiosus) reflexes integrated at thoracolumbar (T10-L2) and sacral levels. Neurogenic injury above the ejaculatory reflex arc disrupts this; RPLND ablates the sympathetic chain governing emission. PVS drives the reflex arc through afferent penile stimulation and works best when the arc is intact below the lesion; EEJ bypasses higher control by directly stimulating periprostatic nerves via a rectal probe, recovering semen even when reflex components are absent.
The catch: a delivery problem, not a production problem - usually fixable
The reproductive insight is that infertility from anejaculation is often eminently treatable because the testes still make sperm - the problem is delivery, not production. This distinguishes it from azoospermia. The escalation ladder (PVS -> EEJ -> surgical retrieval) recovers usable sperm in the large majority; retrieved sperm are frequently combined with ICSI. The nuance: SCI-related and diabetic ejaculates can have poor sperm motility/viability from stasis, oxidative stress, and heat, so laboratory processing and ICSI matter.
When this is an emergency
History distinguishing anejaculation (no emission) from retrograde ejaculation (dry orgasm with sperm in post-orgasm urine) and from anorgasmia. Post-ejaculatory urinalysis, medication review (SSRIs, alpha-blockers), neurologic and endocrine evaluation, and identification of causes such as SCI, RPLND, diabetes, or MS guide therapy.
What it does to fertility
This entry is fundamentally a fertility topic. Because sperm production is typically intact, structured retrieval (PVS, then EEJ, then surgical extraction) recovers usable sperm in most men, and outcomes with ICSI are generally good despite frequently reduced motility from stasis. It is distinct from the ejaculatory-dysfunction fertility entries by focusing on the retrieval-escalation ladder and its neurophysiologic basis.
What people get wrong
Often saidAnejaculation means a man can't father children
ActuallyUsually he can - the testes still produce sperm, which can be recovered by vibratory stimulation, electroejaculation, or surgical extraction and used with IVF/ICSI.
Often saidIt's always psychological
ActuallyMost cases are neurogenic or post-surgical; purely psychogenic anejaculation is a small minority.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
The people taking it
Men with spinal cord injury, testicular cancer survivors post-RPLND, diabetics with autonomic neuropathy, MS patients, and a smaller psychogenic group; often young men desiring paternity.
What we do not know
- How best to improve poor sperm quality in SCI/diabetic ejaculates before ART?
- What are optimal treatments for refractory psychogenic anejaculation?
At a glance
- Share of sexual-dysfunction infertility
- Ejaculatory failure accounts for a large majority (cited ~72% in one series)
- Most common neurogenic cause
- Spinal cord injury
- PVS success
- ~75% overall; best for lesions above T10
- EEJ
- Almost uniformly successful when PVS fails, including complete SCI
- Psychogenic share
- Small (cited ~0.4-0.5% of anejaculation)
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Anejaculation & Anorgasmia (Fertility Angle). A short entry is not a safe entry.
- Timeline. We have not built the dated record of research and regulatory events.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- What could change. No forward-looking summary yet.
- How it compares. We have not set it against the alternatives.
- Children and teenagers. We have not checked what is known about younger people.
- Where we land. We have not taken a position on this yet.
Sources
The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.
The studies that matter
Sonksen & Ohl, PVS and EEJ in ejaculatory dysfunction2002
Establishes PVS-first, EEJ-second algorithm and success rates by lesion level
Series on EEJ + ART in psychogenic anejaculation refractory to PVS2018
EEJ combined with ART achieves pregnancies in PVS-refractory patients
SMSNA clinical overview of anejaculation/anorgasmiacurrent
Summarizes causes, workup, and treatment ladder