Male ejaculation is a complex process. To ejaculate correctly, a man’s central and peripheral nervous systems must work together. During ejaculation, the bladder neck must close, and sperm must be forced from the vas deferens into the ejaculatory ducts along with fluid from the seminal vesicles.
Rhythmic contractions of the muscles around the urethra in the penis help to move the ejaculate from the ejaculatory ducts through the urethra and out of the body.
Ejaculation Disorder Causes
Men can have ejaculatory problems from any of these things:
- Radical pelvic surgery
- Spinal cord injury
- Spina bifida
- Psychological difficulty with the timing of ejaculation (premature ejaculation)
- After prostate surgery
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Bladder Neck Dysfunction
For patients who have bladder neck dysfunction, a simple test called a post-ejaculatory urinalysis retrograde semen analysis can often diagnose this condition. Bladder neck dysfunction happens when the sperm is propelled adequately into the urethra but then travels back into the bladder.
This test involves providing a semen sample and then a urinalysis after the semen sample. To diagnose bladder neck dysfunction, your doctor will look to see if sperm is in your urine.
This condition can often be treated with oral medication.
Spinal Cord Injury & Male Fertility
For patients with a spinal cord injury, there are three treatment options.*
- The first is vibratory stimulation. This is a procedure where a vibratory device is applied to the base of the penis to induce ejaculation. This is typically performed in clinic with blood pressure monitoring in case the patient develops autonomic dysreflexia (a condition that causes a patient’s blood pressure to rise to a dangerous level because of the stimulation).
- If vibratory stimulation does not work, the second line of treatment is electro ejaculation. This is where the patient is put to sleep with general anesthesia and then a trans-rectal probe is used to stimulate the nerves to induce ejaculation. Both this technique and the vibratory stimulation technique involve multiple ejaculations to obtain high quality sperm.
- A third alternative is more invasive but can be completed with one trip to the operating room. Here, the surgeon performs either testicular sperm extraction (TESE) or microsurgical testicular sperm extraction (microTESE) to obtain sperm.
*Before having any of these procedures, patients should have a male endocrine hormone evaluation to make sure they have enough bioavailable testosterone.