Anejaculation and Retrograde Ejaculation

Anejaculation, also known as aspermia, i.e., is the problem associated with transportation of semen as well as the discharge of the ejaculate and this condition is different from another issue called retrograde ejaculation, which relates to the problems in transportation within the urethra. Functional disturbances like premature ejaculation have immense importance in the field of medicine. For a person to have a normal ejaculation, not only is the complete innervation along with sequential contraction of the related organs important, the correct amount of production of the seminal fluid is also equally important. If there is primarily no proper ejaculation in the process of orgasm, it indicates an adverse problem with the discharge as well as inadequate seminal plasma production or it could also indicate the bladder neck being inappropriately closed with retrograde ejaculation.

Anejaculation

Absence of ejaculation due to neurogenic or other obstructive causes can be broadly classified as anejaculation. In some cases it can be a situational condition due to psychological causes like stress or relationship conflicts.

Retrograde Ejaculation

It is a condition wherein the seminal fluid is ejaculated backwards instead of forwards thereby causing the semen to be pushed into the bladder.

Retrograde Ejaculation

Diagnosis

The medical history of the patient needs to be examined in case the loss of ejaculation is secondary. Some usual reasons for retrograde ejaculation are surgeries of bladder neck or prostrate. Disturbances of the autonomic innervation of the bladder neck as well as the ductus deferens, and more importantly ejaculation loss can also be caused due to pelvic surgery, sympathectomies, retroperitoneal lymphadenectomy or an aortofemoral bypass. Some more aspects that need to be eliminated include neurological diseases and causes related to pharmacology, such as alpha blockers. Diabetic polyneuropathy or post infectious blockages of the ejaculatory duct can also have symptoms such as spontaneous ejaculation loss. Disturbances in ejaculation or emission loss can be caused due to any process that hampers with the seminal vesicles or bladder neck and ductus deferens. Deficiency of androgen which can result in decrease in seminal plasma production as well as emission loss, can be ruled out with a tactful diagnosis.

Patients who have a minimal ejaculation or if they do not ejaculate at all need to be examined to understand if the problem is that of retrograde ejaculation or if it is loss of emission. Microscopic investigation of the postcoital postmasturbatory urine as well as transrectal sonography are essential for diagnosis. Anatomic differences in the seminal vesicles like ectasias or aplasias with ductus deferens dilations can be seen through transrectal sonography.  Cystic, congenital or secondary post inflammatory blockages in the ejaculatory duct  are the usual reasons that result in seminal vesicle and the ductus deferens dilation. Transurethral resection is the process which can open the ejaculatory duct cysts that have been detected through sonography. Clarity is very important in cases with any kind of doubts. Inert dyes should be used for this process because the concept of radiological visualization done in contrast media in earlier days, has the secondary blockages risk. Retrograde ejaculation can be confirmed when there is visibility of a higher number of sperms than 15 in every field in the postcoital urine sediment.

Treatment For Anejaculation and Retrograde ejaculation

For the purpose of remedy, treatment related with pharmacology can be given a trial. Patients with anejaculation or retrograde ejaculation can both be given this treatment as there is rare chance that anejaculation may develop into retrograde ejaculation. The treatment process chosen is direct or indirect sympathectomimetic substance such as Gutron® 3–4 × 25–50mg/day or the tricyclic anti depressive imipramin 2 × 25 g/day. The objective of using this treatment process is to achieve an increased adrenergic tone as well as to gain an improved vas deferens and bladder neck contraction. If the medicines are taken regularly for some days, condition is bound to improve.

In some stubbiorn cases of retrograde ejaculation, doctor’s advice men to live with the situation as it itself poses no adverse effects otherwise. However treatment becomes important for men wanting to father children.  In difficult cases –  sperm can be recovered from the postmasturbatory urine and used in assisted fertilization.

Transrectal electrostimulation could cause total loss of emission. A lot of patients are induced with antrograde or retrograde ejaculation due to this. According to literature, the success rate in patients with paraplegic symptoms is 75%, and 90% in patients with lymphadenectomy. One techniques that requires less invasion, no anesthesia and which the patient can apply on oneself is the electrovibrator stimulation.


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