Absence of Orgasm

and/or Ejaculation

Most men naturally think of two things when someone mentions ejaculation – orgasm and semen release.  However, there are ejaculatory disorders where orgasm occurs and little or no semen is released, or semen is released and no orgasm occurs.  In addition, it is possible for some men to be unable to ejaculate or experience orgasm at all.  In this section we will discuss various causes for these types of disorders.

ANEJACULATION

(Orgasm with No Semen Ejaculated)

Anejaculation is sometime called “dry orgasm” since orgasm still occurs but no semen will be ejaculated.  For some men, only a very small amount of semen will be ejaculated (couple of drops). 

Medically, anejaculation can occur after surgery on the prostate.  This is especially true if the prostate is removed as orgasm will still occur but the fluid producing prostate is removed. 

 

One cause of anejaculation can be caused by penis rings.  Penis rings can either be used as part of erectile dysfunction penis pumps or they are often touted as enhancing erections in men with no erectile issues.  Penis rings are placed around the base of the penis to trap blood in the erectile columns.  However, they are often very tight and can press so tightly on the urethra that semen is unable to pass the area pressed by the ring.  Orgasm will occur; however, semen can be blocked by the urethra being pinched off by the ring.  This can cause semen to back up into the reproductive glands.  However, semen is usually seen leaking from the urethra of the penis after the ring is removed.  Many medical grade penis rings used with penis pumps will have a small ridge or open space which is designed to go on the underside of the penis over the urethral area to prevent the urethra from being compressed during ejaculation and allowing semen to be ejaculated forward.  Unless used with a prescribed penis pump for erectile dysfunction, penis rings should be avoided because they can also cause penile strangulation

 

Another cause of anejaculation can be complete exhaustion of sexual fluids.  This typically occurs in men who engage in repeated ejaculation over a short period of time.  The majority of the time, this is seen in men who have chronic masturbation addictions.  In this case, semen is typically ejaculated the first and even second or third time during a given day, but then the glands become empty of fluid.  If sexual stimulation occurs again, orgasm may occur and the genitals can go through the motions of ejaculating but without any sexual fluids remaining, no semen is formed and thus not ejaculated.  This practice can be unhealthy to the reproductive glands – taxing them beyond their means.  Occasionally this can occur in married couples as well who engage in intercourse multiple times in a short period of time.

However, the most common cause of anejaculation is a condition called retrograde ejaculation.  If orgasm without ejaculation is not caused by penis rings, exhaustion of sexual fluids or retrograde ejaculation, seeing a healthcare provider may be warranted.

 

 

RETROGRADE EJACULATION 

(Ejaculating Backward into the Bladder)

As the name suggests, retrograde ejaculation is ejaculation that occurs in the wrong direction.  In this disorder, men feel orgasm and can feel semen “settling” during the emission phase of ejaculation.  However, semen is pushed backwards into the bladder rather than forward out of the tip of the penis.  This can be surprising and distressing to men as they experience orgasm, as well as the normal pumping motion of the penis that accompanies ejaculation, but they do not have any semen released. 

Most often retrograde ejaculation is caused by alpha blocking medications that help relax the prostate (the “-osin” drugs – tamsulosin, alfuzosin, silodosin, terazosin, doxazosin).  As the urethra inside the prostate is relaxed, so is the neck of the bladder.  During normal ejaculation, the bladder neck will snap shut during emission to prevent semen from moving into the bladder.  However, if the bladder neck is artificially relaxed due to medication therapy, it often fails to snap shut just prior to ejaculation.  This leaves semen with two possible pathways to exit the ejaculatory duct inside the prostate.  It can move 7 or more inches forward out of the penis or ½ inch backwards into the bladder.  The shorter distance into the bladder often wins when the bladder neck isn’t snapped shut.

Retrograde ejaculation is not dangerous, and semen simply mixes with urine and is urinated out of the bladder the next time a man goes to the bathroom.  After experiencing orgasm, a man may notice that the first stream of urine seems cloudy.  Oftentimes, there is no reason to treat retrograde ejaculation unless it causes severe distress or is a leading cause of infertility (sperm aren’t ejaculated into the female reproductive tract).  Oftentimes treatment is as simply as removing the medication that causes the retrograde ejaculation.  In some cases, an alternative medication that doesn’t cause retrograde ejaculation may be selected.

However, a type of retrograde ejaculation that is not due to medication side effects can be problematic.  In men with pelvic tension disorder, the tightness of the pelvic muscles may prevent semen from passing through the urethra and out of the penis.  In these cases, the bladder neck is often snapped shut leaving the semen nowhere to go.  This can cause semen to back up into the reproductive glands and perhaps a small amount to make it out of the penis or into the bladder.  This can cause a man to feel more sexually congested after ejaculation than before.  Treating the pelvic tension disorder often resolves this type of retrograde ejaculation.  In addition, men with pelvic tension may have to pay specific attention to the pelvic floor just prior to and during ejaculation, ensuring that they try to relax all of the pelvic muscles as much as possible to allow semen to ejaculate forward.  For some men, this may require sexual positions where they are lying on their sides or back rather than straddling positions on top, in order to allow the muscles of the pelvis to stay as relaxed as possible.

Another cause of retrograde ejaculation can occur in men who had epispadias.  These men often not only had a structural abnormality with the urethra, but also structural abnormalities near the bladder with the urethra that can cause retrograde ejaculation. 

A final cause of retrograde ejaculation can be men who have had spinal cord injuries where the coordination of muscles can cause semen to move backward rather than forward.  Oftentimes, alternative sperm delivery treatments are options in these men who are unable to father children due to their retrograde ejaculation.

 

ANORGASMIA

(Ejaculation of Semen without Orgasm)

Anorgasmia (also called orgasmic anhedonia or ejaculatory anhedonia) is a rare condition where ejaculation of semen occurs normally but there is no orgasm or associated pleasure (anhedonia means “lack of pleasure”). 

This can occur due to some medications like serotonin drugs or medications that decrease dopamine.  It can also occur due to psychological issues such as depression and addiction.  However, hormonal issues with low testosterone, high prolactin levels, or even imbalances in thyroid hormone can disrupt pleasure men should feel during orgasm.  Correction of the underlying cause of anhedonia can often help orgasm occur in coordination with ejaculation again.  In some cases orgasm doesn’t occur during ejaculation but it may occur separately.  For example, a man may experience orgasm long before he ejaculates semen.  Seeking medical advice is often critical to getting the appropriate treatment for anhedonia.

COMPLETE ANEJACULATION & ANORGASMIA

This is a combination of anejaculation and anorgasmia – it is the complete failure of orgasm and ejaculation to occur at all.  Some often consider this a form of delayed ejaculation where the delay is so long that the man stops sexual stimulation.  Most often, the cause is due to either a medication or a medical problem such as erectile dysfunction or a spinal cord injury.  Previously we discussed serotinergic drugs causing delayed ejaculation.  If the inhibition of sexual function is great enough, then ejaculation is not just delayed, it’s inhibited from occurring at all.  As a review, serotonin is released in high levels during normal ejaculation – this is the reason men lose an erection and cannot turn around and immediately ejaculate again.  So men are chemically in a state of post-ejaculation, unable to ejaculate again. 

Erectile dysfunction can also be a problem with anejaculation.  Typically, the penis become sensitive to sexual stimulation when it is erect (otherwise sexual stimulation would occur when the penis simply moves around the underwear in its flaccid or limp state).  However, treatment of the erectile dysfunction typically restores sexual sensations and ejaculatory functions. 

Finally, some men who have had spinal cord injuries have damaged some of the nerve networks that are involved in ejaculation.  However, not all men with spinal cord injuries have anejaculation.  Depending on how low in the spine the injury was often dictates if a man with a spinal cord injury will have difficulties with ejaculation.  In some cases, treatments are available.