You may be experiencing anejaculation and/or retrograde ejaculation. Anejaculation occurs when a man does not release semen from his penis when he orgasms. This could be due to failure of emission, which is when the semen fails to enter the urethra. Alternatively, it could be due to retrograde ejaculation, which is when the neck of the bladder does not fully close during ejaculation, allowing the semen to flow back into the bladder instead of out of the penis.

Is it dangerous?

Fortunately, neither anejaculation nor retrograde ejaculation is a harmful condition. For men with retrograde ejaculation, the semen is released from the body during urination, generally giving the urine a cloudy appearance. Nonetheless, men might be bothered by not ejaculating during orgasm, or their condition may become an issue if they wish to have children.

What causes these conditions?

Anejaculation and retrograde ejaculation have many overlapping potential causes including:

• Bladder removal surgery (cystectomy)
• Prostate removal surgery (simple prostatectomy and radical prostatectomy)
• Other types of surgeries for enlarged prostate (e.g., transurethral resection of the prostate)
• Surgery for testicular cancer that involves removing lymph nodes
• Radiation therapy for prostate cancer
• Spinal cord injuries
• Other conditions such as diabetes, multiple sclerosis, Parkinson’s disease, and spina bifida
• Medications such as alpha-blockers (commonly used to treat enlarged prostate or kidney stones)
• Trauma to the pelvis or groin
• Psychological reasons or relationship issues (e.g., fear of causing pregnancy)

Retrograde ejaculation may also be caused by bladder neck muscles that do not contract normally, and anejaculation may be caused by a blocked sperm duct.

How can these conditions be treated?

As neither condition is harmful, treatment is not strictly necessary unless you are bothered by your symptoms or have fertility concerns. In this case, treatment depends on the cause of your condition.

Some surgeries cause permanent anejaculation due to the changes they create in a person’s anatomy. If you must have this type of surgery and wish to preserve your fertility, you should talk to your health care provider about the possibility of sperm banking before your procedure.

Certain medications may help to keep the bladder neck muscle closed during ejaculation, preventing retrograde ejaculation. Additionally, if your provider believes that the medications you are taking may be interfering with ejaculation, they may recommend switching medications or adjusting your dosage.

Using a vibrator to stimulate the penis may prompt ejaculation in some men, so experimenting with a vibrator can be a worthwhile pursuit. Lastly, counseling or sex therapy can help to resolve issues that may be contributing to ejaculatory problems in some men.  

References:

• Otani T. (2019). Clinical review of ejaculatory dysfunction. Reproductive medicine and biology, 18(4), 331–343. DOI: https://doi.org/10.1002/rmb2.12289
  
  
• Revenig, L., Leung, A., & Hsiao, W. (2014). Ejaculatory physiology and pathophysiology: assessment and treatment in male infertility. Translational andrology and urology, 3(1), 41–49. DOI: https://doi.org/10.3978/j.issn.2223-4683.2014.02.02