“Anejaculation” and “ejaculatory dysfunction” are the terms used to describe the inability of a man to have an ejaculation. This condition typically results from neurologic diseases, traumatic injury, or as a complication of surgery.
The nerves that are responsible for carrying the signal for ejaculation exit the spinal cord and course along the aorta at the back part of the abdomen. These nerves are most commonly injured after spinal trauma resulting in paraplegia or quadriplegia, major bowel or vascular surgery, or surgery for testicular cancer.
Other conditions that can result in ejaculatory failure include diabetes, multiple sclerosis, syringomyelia, psychological disorders and peripheral neuropathies. In the past, men with ejaculatory dysfunction were considered to be suffering from male infertility because they couldn’t ejaculate and impregnate their wives, even though they did produce sperm within their testicles.
Two techniques were developed to help induce ejaculation in a man who is otherwise anejaculatory. Vibratory stimulation (VS) employs a custom-designed mechanical vibrator (store bought vibrators don’t work for many patients) that is applied to the underside of the penis and set to vibrate at a designated frequency and wave amplitude. This vibration travels along the sensory nerves to the spinal cord and may induce a reflex ejaculation. This technique only works in patients with an intact ejaculatory reflex arc and the results are dependent upon the level of spinal cord injury. This is an office procedure that requires no anesthesia or sedation to perform.
The second procedure is called electroejaculation (EEJ). Electroejaculation is performed with a device known as an electroejaculator. Only two electroejaculator machines exist in the Greater Los Angeles/Ventura/Orange County area.
During the procedure, a specially designed electric probe is inserted into the rectum next to the prostate. A current generated by the machine is applied to stimulate the nerves and produce contraction of the pelvic muscles resulting in an ejaculation.
The semen specimen is collected and processed in the andrology laboratory. If the specimen is of very good quality, then it can be used for intrauterine insemination (IUI). If there are few sperm or the sperm have low motility then the specimen can be used with In Vitro Fertilization to establish a pregnancy.
Electroejaculation must be performed under general anesthesia in all patients who have abdominal and perirectal sensation. Anesthesia is not required for men with spinal cord injuries who have high level injuries and are without sensation. Anyone who has a history of autonomic dysreflexia must have his blood pressure and heart rate monitored as electroejaculation may cause a significant increase in blood pressure.
Preparation for Treatment
A complete urologic evaluation is required prior to electroejaculation in order to detect and treat any urinary tract infections.
Men with spinal cord injuries often have a problem with poor sperm production as well as ejaculation after the injury. A diagnostic trial of electroejaculation is attempted to obtain and examine the quality of the semen specimen. Good quality samples are frozen for future use as a backup. A fresh specimen is obtained at the time of the female partner’s ovulation.
Patients are prescribed sodium bicarbonate tablets prior to VS and EEJ to alkalinize the urine and make it more hospitable to sperm since there is often a retrograde component to the electroejaculation and the sperm may need to be retrieved from the bladder via a catheter.
Electroejaculation and vibratory stimulation have enabled many men who suffer from ejaculatory failure to conceive children of their own.
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