Anejaculation And Management By Rectal Electroejaculation

Anejaculation refers to an inability to ejaculate due to a defect (or obstruction) in the semen release at the level of seminal ducts or prostate gland. Most frequently reported causes of anejaculation include

• Spinal cord damage or injury
• Pelvic injury or infection
• History of previous pelvic surgeries
• History of chronic medical conditions such as multiple sclerosis, Parkinson’s disease, diabetes, etc.
• Serious damage to vital genital organs due to an advanced malignancy or surgery

Psychological causes of anejaculation include:

• Relationship conflicts
• Chronic anxiety
• Stress disorder

How To Address Anejaculation?

The treatment of anejaculation depends upon its cause. If ejaculatory dysfunction is due to a psychological issue; then person should seek the help of a sex therapist or a psychologist who can treat the primary condition through counseling or medications. If medical or surgical ailments are responsible for anejaculation then adequate medical/ surgical help should be sought.

Anejaculation can also be managed via medications, vibrator therapy and electroejaculation. Although treatment via medications is an easy option but is not generally very successful as compared to other treatment options. Sometimes surgery is also considered if the obstruction is due to certain infections. Various modalities of care can be used to restore testicular function or preserve the sperm count for artificial insemination, depending upon patient age and other factors.

When fertility is the primary interest and none of the above mentioned treatments are effective then in-vitro fertilization (IVF) is usually considered as the treatment of choice. In this method either a sperm is injected or the extracted (preserved) sperms are fertilized with the egg in laboratory, before implantation into the uterus of female partner.

What Is Electroejaculation?

Electroejaculation is a method that involves utilization of electrical stimulations under general anesthesia to obtain viable sperms for artificial insemination. It is considered when vibratory therapy fails to deliver appropriate results.

Study published in the Journal of Urology (2) suggested that there is no difference in the sperm count of the sample obtained from either of the two popular methods (electroejaculation or penile vibratory therapy), but the quality of sperms is generally superior if latter procedure is performed. For example, based on a study conducted on a small sample of 11 men with spinal cord injury, it was observed that motility and viability of sperms is twice as high with penile vibratory therapy then electroejaculation. Also the penile vibratory therapy is far less painful procedure than electroejaculation, which is why the entire study sample preferred penile vibratory therapy over electroejaculation for future collection of semen sample.

How To Perform Electroejaculation?

In this method a probe is introduced into the rectum, adjacent to the prostate gland. Direct electrical stimulations is introduced for about five to seven minutes. These stimulations are increased gradually and as the male ejaculates, these stimulations are stopped. The ejaculated semen is collected and examined for the quality of sperms. These sperms are then used for artificial insemination if found to be of greater quality. If there is insufficient amount of semen then urine is examined for sperms. If sperms are present in urine then semen extraction is performed from the bladder.

In 90% men, electroejaculation is successful in sorting out fertility issues in men who produces sufficient viable sperms but are unable to ejaculate for a variety of reasons or produce low quality sperms in high number. This method has been in use since 1948. It is however believed that electroejaculation may affect the quality of sperms. After numerous ejaculations the sperm quality can be enhanced but this method is considered as a second choice and is preferred when vibratory therapy fails.

What Are Some Complications Of Electroejaculation?

Although, rectal electroejaculation is a highly safe procedure, it is sometimes associated with certain risks; such as:

• Anesthesia related complications such as renal dysfunction, liver damage etc.
• Rectal burns if the electrical probe is extremely hot- the temperature of electrical probe is maintained below 102ºF (39°C).
• Individuals with known history of spinal cord damage/ injury are at risk of developing a spiking increase in the blood pressure due to phenomena of autonomic hyperflexia. In order to reduce the risk of complications, these patients are usually given a dose of an antihypertensive agent before the procedure.

References

1. Ledesma, A., Manes, J., Cesari, A., Alberio, R., & Hozbor, F. (2014). Electroejaculation increases low molecular weight proteins in seminal plasma modifying sperm quality in Corriedale rams. Reproduction in Domestic Animals, 49(2), 324-332.

2. Ohl, D. A., Sonksen, J., Menge, A. C., McCabe, M., & Keller, L. M. (1997). Electroejaculation versus vibratory stimulation in spinal cord injured men: sperm quality and patient preference. The Journal of urology, 157(6), 2147-2149.

3. Seager, S. W. J. (2015). The use of electroejaculation with men incapable of natural ejaculation: 30-year experience. Andrologiâ i Genitalʹnaâ Hirurgiâ, 15(4).

4. Gat, I., Toren, A., Hourvitz, A., Raviv, G., Band, G., Baum, M., ... & Madgar, I. (2014). Sperm preservation by electroejaculation in adolescent cancer patients. Pediatric blood & cancer, 61(2), 286-290.