Anejaculation Treatment in Singapore

Anejaculation is a medical condition characterised by the complete absence of ejaculation, despite normal sexual arousal and orgasm sensations. Unlike retrograde ejaculation where semen flows backward into the bladder, anejaculation involves no semen release at all. This condition can be particularly challenging for men trying to father children naturally.

The condition falls into two main categories: situational anejaculation, which occurs only in specific circumstances, and total anejaculation, where ejaculation never occurs regardless of the situation. Some men may experience orgasm without ejaculation (dry orgasm), while others may have neither orgasm nor ejaculation. The underlying mechanisms involve disruptions in the complex neurological and muscular processes that control ejaculation.

Anejaculation affects approximately 0.5-1% of men, though the actual prevalence may be higher due to underreporting. The condition can result from various causes including neurological disorders, medications, psychological factors, or surgical complications. Early diagnosis and appropriate treatment can significantly improve outcomes for both fertility and sexual satisfaction.

Ideal Candidates

• Men experiencing consistent inability to ejaculate during sexual activity or masturbation
• Individuals with spinal cord injuries affecting ejaculatory function
• Patients who developed anejaculation following pelvic or retroperitoneal surgery
• Men with diabetes-related nerve damage affecting ejaculation
• Couples trying to conceive where male anejaculation is the primary fertility issue
• Individuals experiencing medication-induced anejaculation willing to explore alternatives
• Men with psychogenic anejaculation ready to address underlying factors

Contraindications

• Active urinary tract infections requiring treatment before intervention
• Severe cardiovascular conditions that make certain treatments unsafe
• Uncontrolled hypertension incompatible with some medications
• Psychological conditions requiring stabilisation before treatment
• Certain medication interactions that preclude specific therapies

The suitability for treatment depends on identifying the underlying cause of anejaculation. A thorough evaluation by an experienced urologist is essential to determine the appropriate treatment approach. This assessment includes medical history review, physical examination, and potentially specialised testing to understand the specific factors contributing to the condition.

Medical Therapy

Pharmacological treatment often serves as the first-line approach for anejaculation. Medications work by enhancing sympathetic nervous system activity or addressing underlying conditions. Common medications include sympathomimetics like pseudoephedrine or imipramine, which can stimulate ejaculatory reflexes. For men with psychogenic causes, selective serotonin reuptake inhibitor (SSRI) adjustments or additions of medications like bupropion may help restore function.

Penile Vibratory Stimulation (PVS)

This non-invasive technique uses specialised vibrators applied to the penis to trigger ejaculatory reflexes. PVS works particularly well for men with spinal cord injuries above the T10 level. The device delivers specific frequencies and amplitudes proven to stimulate ejaculation. Success rates vary from 50-80% depending on the underlying cause, with higher success in neurogenic cases.

Electroejaculation (EEJ)

For cases where PVS fails, electroejaculation provides a more intensive option. This procedure involves electrical stimulation of nerves responsible for ejaculation using a rectal probe. Performed under anaesthesia or sedation, EEJ achieves success rates of 70-90% in obtaining sperm. The procedure is particularly effective for spinal cord injury patients and those with retroperitoneal lymph node dissection.

Technology & Equipment Used

Modern treatment utilises specialised equipment including medical-grade penile vibrators with adjustable frequencies (80-100 Hz) and amplitudes (2.5-3.5 mm). Electroejaculation systems feature precise voltage control and safety mechanisms. For sperm retrieval, modern laboratory equipment ensures optimal sample handling and processing for assisted reproduction if needed.

Pre-Treatment Preparation

Before initiating treatment, comprehensive evaluation includes detailed medical history, physical examination, and neurological assessment. Blood tests check hormone levels, particularly testosterone and prolactin. Patients discontinue medications that may interfere with ejaculation when safely possible. For procedures like electroejaculation, bowel preparation may be required. Partners planning conception receive fertility counselling and coordination with reproductive specialists.

Psychological assessment helps identify any contributing emotional factors. Patients receive detailed information about chosen treatments, expected outcomes, and potential alternatives. Written consent documents outline procedures, risks, and success rates. Pre-treatment semen analysis, if obtainable through other methods, establishes baseline parameters.

During the Procedure

For medical therapy, treatment involves taking prescribed medications as directed, typically 1-2 hours before planned sexual activity. Dosing adjustments occur based on response and side effects. Penile vibratory stimulation sessions last 3-10 minutes with breaks to prevent overstimulation. Patients or partners can perform PVS at home after proper training.

Electroejaculation procedures occur in clinical settings. After anaesthesia administration, the rectal probe delivers controlled electrical stimulation. Multiple stimulation cycles may occur to maximise sperm retrieval. Throughout the procedure, vital signs monitoring ensures safety. Immediate sperm collection and processing preserve sample quality for fertility treatments.

Immediate Post-Treatment

Following medication trials, patients monitor for side effects like increased blood pressure or anxiety. After PVS sessions, temporary penile sensitivity or mild discomfort may occur. Ice application helps reduce any swelling. For electroejaculation, recovery involves monitoring until anaesthesia effects subside. Temporary bowel changes or mild rectal discomfort resolve within 24-48 hours.

Successful ejaculation requires immediate semen processing if used for fertility purposes. Laboratory analysis determines sperm count, motility, and morphology. Results guide decisions about assisted reproductive techniques. Follow-up appointments assess treatment effectiveness and plan ongoing management strategies.

First 24-48 Hours

After medical therapy initiation, patients monitor blood pressure and watch for adverse reactions. Keeping a response diary helps optimise dosing. Following PVS or EEJ procedures, mild discomfort management involves over-the-counter pain relievers. Patients should avoid strenuous activities and maintain good hygiene. Any unusual symptoms warrant immediate medical attention.

Staying well-hydrated supports recovery. For electroejaculation patients, soft stools through dietary modification prevent straining. Partners receive updates about treatment success and fertility sample viability. Emotional support during this period acknowledges the psychological impact of treatment.

First Week

Medical therapy adjustments occur based on initial responses. Side effect management may require dose modifications or timing changes. PVS users practise techniques to optimise success rates. Gradual return to normal activities proceeds as comfort allows. Follow-up consultations assess treatment effectiveness and address concerns.

For fertility purposes, coordinating with reproductive specialists ensures optimal timing of procedures. Lifestyle modifications supporting overall reproductive health include stress reduction, proper nutrition, and avoiding tobacco or excessive alcohol. Regular communication with healthcare providers guides treatment progression.

Long-term Recovery

Ongoing treatment success requires adherence to prescribed regimens. Regular follow-ups every 3-6 months monitor effectiveness and adjust approaches as needed. For couples pursuing pregnancy, integration with assisted reproductive technologies maximises conception chances. Psychological support addresses relationship impacts and emotional wellbeing.

Long-term management may involve combination approaches or treatment modifications based on changing circumstances. Success often improves with experience and technique refinement. Patients maintain treatment logs to identify patterns and optimise outcomes.

Successful treatment restores ejaculatory function, enabling natural conception for many couples. This eliminates or reduces the need for invasive fertility procedures. Men report improved sexual satisfaction and confidence when ejaculation returns. The psychological benefits extend to reduced anxiety, improved self-esteem, and enhanced intimate relationships.

For couples facing infertility, anejaculation treatment provides hope and practical solutions. Even when natural ejaculation cannot be restored, sperm retrieval techniques enable biological fatherhood through assisted reproduction. Treatment success often improves overall quality of life and relationship dynamics.

Many men experience relief simply from understanding their condition and having treatment options. The ability to participate fully in family planning decisions empowers patients. Partners benefit from reduced relationship stress and shared treatment involvement. Long-term success rates justify the investment in comprehensive treatment approaches provided by an experienced urology doctor in Singapore.

Common Side Effects

Medical therapy may cause temporary blood pressure increases, anxiety, or tremors. These effects typically subside with dose adjustment or medication changes. PVS can result in penile irritation or temporary numbness, managed with proper technique and breaks during stimulation. Some men experience mild headaches or dizziness with certain medications.

Electroejaculation may cause temporary autonomic dysreflexia in spinal cord injury patients, requiring careful monitoring. Mild rectal discomfort or temporary bowel changes resolve quickly. Retrograde ejaculation occasionally occurs instead of antegrade ejaculation, requiring urine sperm retrieval.

Rare Complications

Severe medication reactions including hypertensive crisis remain rare but require immediate medical attention. Prolonged PVS use without proper technique may cause tissue damage. Electroejaculation complications like rectal injury or severe autonomic responses occur in less than 1% of procedures when performed by experienced practitioners.

Risk minimisation involves careful patient selection, proper technique, and appropriate monitoring. Experienced urologists anticipate and prevent most complications through established protocols. Regular follow-up ensures early detection and management of any adverse effects.

Treatment costs vary depending on the chosen approach and underlying cause. Initial consultation and diagnostic testing establish baseline expenses. Medical therapy involves ongoing medication costs, while PVS equipment represents a one-time investment for home use. Electroejaculation procedures include facility fees, anaesthesia, and professional charges.

Fertility-related treatments add laboratory processing and storage fees. Multiple treatment sessions may be necessary to achieve desired outcomes. Comprehensive treatment packages often provide better value than individual services. Quality care from experienced specialists justifies investment in proper treatment.

Consultation provides personalised cost estimates based on individual treatment needs. Payment plans may be available for extensive treatment programmes. The long-term benefits of successful treatment often outweigh initial expenses.