Ejaculatory problems

Ejaculation is a natural event that is a reflex in a man occurring as a consequence of sexual stimulation.  The reflex results in a series of anatomic changes and muscular contractions that release seminal fluid into the urine passage and propel it out through the urethra (urine passage.)  However, this natural reflex can be disrupted for neurologic problems, such as spinal cord injury or surgery that has been done near nerves in the back of the abdomen (for example, lymph node dissection done as part of treatment for advanced testicular cancer.)  Another group of men have difficulty reaching a climax during sexual activity, which is often referred to as psychogenic anejaculation (failure to achieve climax and ejaculation without a physical problem/abnormality.)  Sexual counseling can help in such situations, but other men still do not respond to this intervention.

Treatments for ejaculatory dysfunction can include penile vibratory stimulation or electroejaculation.  Penile vibratory stimulation can be effective for some men with psychogenic anejaculation or spinal cord injury, but is routinely unhelpful when nerves have been injured during retroperitoneal surgery.  In this intervention, a vibrator is applied to the undersurface of the penis, referred to as the ventral far end of the penis near the urine passage.

Electroejaculation (EEJ) is a procedure done by applying increasing amounts of electrical stimulation to the area of the prostate and seminal vesicles, applied using a probe placed into the rectum, allowing electrical stimulation directly to these structures that force seminal fluid into the urethra, which can be collected after its release from the penis or by catheterization of the bladder, collecting any semen that may have backed up from the urine passage into the bladder.   Sperm obtained from EEJ can be used for intrauterine insemination, where sperm are processed and placed directly into the uterus to facilitate conception.  Alternatively, sperm can be used with IVF/ICSI that results in a much higher chance of pregnancy per treatment attempt, particularly important when a procedure under anesthesia is needed for EEJ.

Risks of EEJ are low; contemporary machines used for this procedure monitor probe temperature to prevent overheating and potential injury to the rectum, making the risk of this procedure very low, beyond that of anesthesia.