Treatment options for patients with ejaculatory dysfunction

By, Matthew Coward, M.D., Department of Urology, University of North Carolina


Despite much less attention than erectile dysfunction and other male fertility problems, ejaculatory dysfunction can be one of the most frustrating sexual symptoms a patient can experience..

The purpose of ejaculation is to deposit sperm into the vagina for reproduction, and most men with these problems seeking an evaluation are younger patients desiring fertility.  Ejaculatory dysfunction can be characterized as premature, delayed, or absent ejaculation, obstructed, retrograde ejaculation, or anejaculation; this brief review will focus on retrograde and anejaculation.

With retrograde ejaculation, during climax the semen enters the bladder rather than being expelled per urethra.  It is suspected in patients with a very low ejaculate volume or completely dry ejaculate coupled with a normal sensation of climax, occurring after the failure of the bladder neck to close during the ejaculatory reflex.  Retrograde ejaculation may result from diabetes or other neurologic problems, a side effect of certain medications, or previous pelvic surgery.  Retrograde ejaculation should be ruled out as a first step in the workup of ejaculatory dysfunction, as treatment is often successful without invasive procedures.  The evaluation involves examination of the urine after ejaculation.  Antegrade ejaculation can sometimes be induced with medications, but sperm can also be harvested from the urine after ejaculation for insemination or in vitro fertilization. In these situations, medications to change the pH or alkalinize the urine may improve semen quality.

Anejaculation is the lack of a visible ejaculate during a normal climax in the absence of retrograde ejaculation, either from a neurologic condition or is sometimes unknown.  This is different from anorgasmia, which is the lack of climax.  Anejaculation can occur with spinal cord injury, erectile dysfunction, hormone problems, diabetes, or for emotional reasons.  Treatment with medications that stimulate the sympathetic nervous system such as over the counter sudafed or phenylephrine will sometimes increase ejaculate volume or change retrograde ejaculation to antegrade ejaculation.  Treatment options include two different neurostimulatory methods.  Penile vibratory stimulation (PVS) is the recommended first line treatment for anejaculation because it is simple, non-invasive, cost-effective, and successful in a certain percentage of cases.   Penile vibratory stimulation for neurogenic anejaculation due to spinal paralysis is most effective with spinal cord injuries  above T10.  PVS is performed using a commercially available device such as the FertiCare or Viberect.  If PVS is unsuccessful or not desired, electroejaculation is the gold standard treatment of anejaculation because it is almost uniformly successful.  Under general anesthesia, a rectal probe is positioned over the prostate and seminal vesicles to induce pulsatile electrical stimulation to achieve ejaculation.

When treatments with medications or neurostimulatory methods for ejaculatory dysfunction fail, there always remains an option for a surgical sperm extraction.  Using sedation or general anesthesia, sperm can be extracted directly from the testicle or epididymis with a minor outpatient procedure.  Surgically extracted sperm can then be later used for in vitro fertilization.

In summary, ejaculatory dysfunction is a common problem manifested in a variety of different disorders.  Fortunately, with a careful evaluation from a male fertility specialist, treatment of ejaculatory dysfunction is almost always possible to result in pregnancy.  There are medications, assistive devices, and even surgical sperm retrieval, any of which can provide hope for a couple with such a discouraging problem to have a family of their own.


  1. Zak HinesJune 29, 2015

    Good article! Very interesting to see how far our medical and technological efforts have taken us. As a man who would like to have children at some point down the road, I am much less fearful of potential reproductive problems preventing me from having children thanks to this knowledge and technology.

  2. SophiaJune 29, 2015

    Thanks for this informative article! I think it is helpful for men to hear that a discouraging health issue is common and can be treated. It tells men that they are not alone and that their is help available.

  3. Tyrus JacksonJune 29, 2015

    This post was informative. I never knew about Ejaculatory Dysfunction and the issues that go along with it. It is also encouraging to know that their are ways to fix problems associated with ejaculatory dysfunction.

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