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Anejaculation is the inability to ejaculate semen despite stimulation of the penis via intercourse or masturbation. It’s actually a fairly common problem and can be frustrating for a couple trying to have children.
The symptoms presented by anejaculation are not to be confused by those of erectile dysfunction . During anejaculation, a man has a normal libido, gets aroused, has an erection, gets to the orgasm phase but there’s no sperm (which was the male reproductive cells and derived from the Greek word sperma meaning “seed”) that is ejected from the erect penis. After his orgasm, he loses the erection. Because of these conditions, anejaculation is usually self-diagnosed but due to the symptoms, it might be confused for sexual dysfunction or retrograde ejaculation. It’s important to know the differences.
During a retrograde ejaculation, the semen (also known as seminal fluid – it is an organic fluid that may contain sperm and other enzymes that allow the sperm to swim and fertilize an egg) goes backward into the urinary bladder, rather than coming forward. In this case, the post orgasm urine is cloudy. When sent to the lab for examination, the doctor will find sperm in the urine. This is why it’s important to figure out whether it was retrograde ejaculation or anejaculation?
What causes anejaculation? There are two types: anorgasmic anejaculation and orgasmic anejaculation. An anorgasmic anejaculation is when a man never reaches an orgasm either via intercourse or masturbation and therefore can’t ejaculate. There is no physical defect, instead his orgasm is limited by psychological factors like stress therefore, he might need additional stimulation during intercourse to reach an orgasm.
The other type is an orgasmic anejaculation. In this case, a man is fully erect, able to experience an orgasm, but not ejaculate. This could be due to blockage in his tubes or damage to the nerves. This could also be a combination of retrograde ejaculation, which is why it’s important to check the urine post intercourse and/or have an exam by a primary care doctor.
To receive treatment for symptoms of anejaculation, start by talking to your primary care doctor, however the catch is, they will ask for either a urine sample or a sperm sample. How does one give a sperm sample if you can’t ejaculate? In a relaxed environment, the doctor will create something called “coitus interruptus” – this basically the “pull out method” aka pulling out of a vagina before ejaculation and is often done at home so that a sperm sample can be collected in a beaker. If this is not possible, the doctor will attempt to vibrate the penis in an attempt to stimulate it to reach an orgasm and collect a sample for testing. This type of stimulation results in 60% of ejaculations. If vibrator therapy fails, the doctor will then perform electro-ejaculation. This involves the direct stimulation of the nerves in the seminal vesicles and is also a way to test if the nerves are damaged. During this procedure, the doctor can also check for any blockage and if surgery is needed to clear the blockage in the urethra.
Anejaculation can also be physical. If you have had surgery due to an enlarged prostate, have Parkinson’s Disease, Multiple Sclerosis, or diabetes – these can also cause anejaculation. Therefore, it’s important to talk to your doctor and find out what exactly is causing your condition and if there are treatment options available.
The Boston Medical Group Telemedicine is a Men’s Health online network dedicated to research and treatment for Erectile Dysfunction and Premature Ejaculation.
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Advice for Men Who Have Difficulty Ejaculating (and for their partners)

Sex & Relationship Therapist: Stephen Snyder, MD, New York, NY

Address: 115 Central Park West, Suite 15,
New York , NY 10023

When I first started out as a sex therapist thirty years ago, I was taught that difficulty ejaculating was rare, that it was very hard to treat, and that it usually suggested deep-rooted psychological problems.
We now know these are all total myths.
The reality is that difficulty ejaculating is rather common. It’s usually not that hard to treat, once you know how. And no, you don’t have to be neurotic to suffer from this problem.
Don’t bother looking for advice about difficulty ejaculating on the internet, or on Amazon. You won’t find anything useful in either place.
Don’t bother asking your doctor or our therapist either. There’s still a lot of ignorance out there about what causes this condition, and how to treat it.
But at the end of this article, I’m going to show you four rules for overcoming difficulty ejaculating. (Feel free to skip ahead if you like) . And in subsequent articles, we’ll get more technical still about what to do for this common condition.
First, though, some background . . .
Biologically speaking, an orgasm is simply a reflex. That’s true no matter which gender you are.
Your body is full of reflexes: The knee-jerk reflex, the gag reflex, the cough reflex, the sneeze reflex — they all basically work the same way. Sensory inputs get processed by the central nervous system. Then if they’re sufficiently intense, they trigger a muscular reaction.
Your orgasm reflex is a bit different, since psychological stimulation figures into it too. But the principle is the same. All the erotic inputs — physical and psychological — get added together. If arousal reaches a particular level — what we call your “orgasm threshold” — then the reflex happens.
Women’s orgasm thresholds Vary. So do men’s. But most women’s thresholds are somewhat higher. They have to be seriously aroused in order to reach orgasm. Which is of course why vibrators are such big business?
Men tend to have lower orgasm thresholds , so most men can ejaculate even if they’re not very sexually excited. But there are lots of men with high thresholds too.
Like their female counterparts, they can’t get off unless they’re seriously aroused.
Most women and men with high orgasm thresholds eventually figure out on their own how to get aroused enough to climax. But they often have trouble doing it in bed when someone else is present. No matter what gender you are, the fact that you can achieve sufficient arousal for orgasm by yourself — and for yourself — is a very positive sign. It means you know how to cultivate your own arousal. All that’s needed in treatment is to take your knowledge of your own arousal and adapt it to partner sex.
When I say arousal, I’m not just talking about hardness or wetness. I’m talking about a state of mind where you get highly absorbed in the experience, you lose a significant number of IQ points, and you regress to a more child-like state of wonder. What in my office I call “ getting dumb and happy.”
As I discuss in my article, " Sex Tips for Married Lovers ," many couples think that if he’s hard and she’s wet that they’re ready to have intercourse. Big mistake. Hardness in a man, like wetness in a woman, can occur even at fairly low levels of psychological arousal.
Let’s imagine arousal — the real, authentic psychological kind — on a scale from 0 to 100. Most young men only need about a 20 to get hard. But men’s orgasm thresholds vary.
If your innate orgasm threshold happens to be a 30, you’ll probably suffer from premature ejaculation . You’ll most likely expend lots of effort trying to keep your arousal very low , in order not to ejaculate immediately once lovemaking gets started. But let’s say you’re a man whose innate orgasm threshold happens to be an 80. That level of arousal is not always easy to achieve.
So now let’s get to the nuts and bolts. What’s the best way for a man with a high orgasm threshold to get satisfaction in bed?
As a sex therapist, I’ve successfully treated hundreds of men for difficulty ejaculating. Reading an article like this is no substitute for an office consultation. But here are the basics — what I typically recommend for men whom I see in the office:
Remember, genuine arousal is a state of mind . It typically involves losing a bunch of IQ points, or“getting dumb and happy” — as we discussed above. Chances are, you know just how to do that when you’re by yourself, and you don’t have to worry about anyone else’s needs.
But during partner sex, many men spend so much time thinking about whether their partner is aroused that they totally neglect their own arousal. Such men assume the fact that they’re still hard means they’re fully aroused. But that’s just wrong. If you’re a young, healthy man, you can be plenty hard during sex and still be focused on lots of other things and not be that into it.
Sure, if your orgasm threshold is a 30, you could probably still ejaculate under those circumstances. But your orgasm threshold is up around an 80 (i.e. most guys who have difficulty ejaculaing), then just going through the motions isn’t going work.  To get better results, the first thing you need to do is start paying attention to how genuinely aroused you really are.
Most straight couples put a lot of emphasis on penetrative sex. There are of course lots of other ways to make love besides penis-in-vagina intercourse. But most heterosexual couples don’t feel quite right unless intercourse is somewhere on the menu.
Accordingly, the most common clinical situation in sex therapy with men who have difficulty ejaculating is that they can’t ejaculate during intercourse . One important reason men with high orgasm thresholds have difficulty ejaculating during intercourse is that they hurry to penetrate before they’re really ready. Remember, it only takes an arousal level of 20 or so for most young, healthy men to get hard. But if you start intercourse at an arousal level of 20, you’ve got a big climb ahead to get to 80.
Sure, intercourse can be exciting. But if you’re like most men, the most exciting part is right at the moment of penetration. Like most things in life, intercourse just doesn’t deliver the same thrill on the hundredth thrust as it did on the first. So don’t penetrate the minute you get hard. Instead, see if you can get to a 60 or more of arousal before penetration. That way, it won’t be such a big jump to get to 80 before intercourse gets boring.
Having a high orgasm threshold has certain advantages. If you’re a man who has difficulty ejaculating, chances are you can have sex for hours. You can be a perfect gentleman, and make sure your partner lots of orgasms. But after being a perfect gentlemen, most men with this condition have difficulty ejaculating.
To reach orgasm yourself with a partner, you need a different approach — one that maximizes your own arousal.
Let’s say you’ve followed my advice above and waited to get to an arousal level of 60 before penetration. Good. But now that you’re fully hot and bothered, this is not the time to act like a gentleman. Now is the time to be a bit of a beast.
Assuming you have a good, trusting relationship with your partner, chances are they won’t mind if you focus entirely on your own arousal for a bit. If you’re like most men I see who have difficulty ejaculating, your partner will probably be thrilled that you trusted them enough to “really let go.”
Most partners enjoy being treated a bit ruthlessly in bed — assuming you’ve properly relished them first.
If in doubt, check with your partner of course — since people’s tastes do vary. But I’ve treated many men who had difficulty ejaculating where it turned out the main thing they needed was to know it’s okay to be a bit rougher in bed.
If your orgasm threshold is an 80 and you’ve been thrusting away for a half hour or more and you’re nowhere close to being able to come, then for God’s sake please do something else!
The truth is, you can’t always reliably reach an arousal level of 80 with a partner. Some days, for whatever reason, it’s just not going to happen. A modern man with a high orgasm threshold should expect the same consideration most modern women get under the same circumstances.
Most modern couples don’t automatically expect a woman with a high orgasm threshold to climax every time. And if she wants an orgasm, most modern couples find it perfectly acceptable for a woman to give herself one in bed with a partner -- typically with a vibrator .
In my sex therapy office, I encourage couples to give a man who has difficulty ejaculating the same consideration. Don’t assume he has to have an orgasm every time. And if he wants one after you both feel intercourse has gone on long enough, for heaven’s sake let him pull out and give himself one with his own hand. Sure, it’s nice to ejaculate during intercourse. But make sure you have a back-up plan, just in case.
Lots of other factors can be involved when a man has difficulty ejaculating. In sex therapy, it can be important to consider his masturbation habits, his age, his neuro-psychological wiring, and any medications he might be taking.
But the four rules above are a good place to start.
If you’d like more advice on how to nurture your own genuine arousal — and how to enjoy it for life with someone you love — check out my book, Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship (St Martin’s Press, 2018).
Love Worth Making is available online at any of the following retailers, and wherever books are sold.
TeleHealth sex therapy & TeleHealth couples therapy can be the 21st Century version of the "house call." TeleHealth can enhance client privacy, eliminate geographic boundaries, empower clients in relationships, and promote collaboration & creativity.
There are at least 8 ways for men with premature ejaculation to last longer in bed, including both traditional work-arounds and sex therapy techniques. This article discusses how sex therapy plus off-label medication can be particularly effective for PE.
We’ve learned a lot about women’s sexual desire in the last few decades.
Finding a good sex therapist isn’t easy. If you’re suffering from a sexual problem, it’s crucially important that you see someone who understands the difference between a sex therapist and a “regular therapist.”
Trouble Ejaculating and The Orgasmic Double Standard
Men who have trouble ejaculating are a misunderstood bunch.
As a sex therapist, someone who answers sex questions for a living, it’s always a pleasure to get asked questions by Cosmo. Here are some recent ones, along with the answers:

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Sexual dysfunctions. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org/. Accessed Feb. 25, 2018.
Wein AJ, et al., eds. Disorders of male orgasm and ejaculation. In: Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed May 7, 2018.
Ferri FF. Ejaculation and orgasm disorders. In: Ferri's Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Feb. 25, 2018.
Abdel-Hamid IA, et al. Delayed ejaculation: Pathophysiology, diagnosis, and treatment. World Journal of Men's Health. 2018;36:22.
Sadowski DJ et al. A review of pathophysiology and management options for delayed ejaculation. Sexual Medicine Reviews. 2016;4:167.

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Delayed ejaculation — sometimes called impaired ejaculation — is a condition in which it takes an extended period of sexual stimulation for men to reach sexual climax and release semen from the penis (ejaculate). Some men with delayed ejaculation are unable to ejaculate at all.
Delayed ejaculation can be temporary or a
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