Ejaculation is the physiologic process which normally results in the expulsion of sperm from urethral meatus
Anejaculation
Anejaculation is the lack of antegrade and retrograde ejaculation.
Causes of Anejaculation
Diagnosis
Presence of nocturnal emissions is helpful in excluding gross neurological deficits, but it does not indicate that the patient has purely psychogenic anejaculation.
A detailed physical examination with a full neurological exam is critical part of the evaluation.
Treatment for Anejaculation:
Medical Treatment used for anejaculation include
Sympathomimetics
Alpha agoinsts (Midodrin, imipramine, ephedrine,pseudoephedrine ) not very effective in initiating antegrade ejaculation.
Amantadine
Low dose intranasal Buserelin (GnRH analog)
No specific and highly successful medical treatment of anejaculation exists.
Testosterone influences ejaculation at multiple levels and clinical studies are in progress to establish the exact role and therapeutic potential of testosterone in ejaculatory dysfunction.
Penile vibratory stimulation (PVS)
Ejaculation can be induced via penile vibratory stimulation with up to 70% success rate.
It’s an office procedure and can be done without anesthesia
Not successful in patients with spinal cord injury below the ejaculatory reflex arc in the thoracolumbar spinal cord around T10.
Electroejaculation
Electroejaculation has been extensively used in men with spinal cord injury and psychogenic anejaculation.
Electroejaculation is useful /successful in obtaining ejaculate in these etiologies of anejaculation.
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