Psychotherapy of anejaculation represents the use of counseling and psychological support in treatment of anejaculation (the inability to ejaculate). For men with a psychological cause of the condition, psychotherapy alone may be the first-line and the most effective treatment. For men with an underlying disease as the cause, psychotherapy is often equally important in order to help them cope with the problem.

There are two kinds of anejaculation, one is situational and the second one is total.

  1. Situational anejaculation
    In situational anejaculation, men are able to ejaculate during masturbation, or have nocturnal emissions of semen, but there is a problem with ejaculation during sexual activity. Men can be in able to ejaculation with specific partner or in specific type of sexual activity. This type of anejaculation often has an underlying psychological cause.
  2. Total or complete anejaculation
    Total or complete anejaculation means that the patient does not ejaculate under any circumstances, in contrast to situational anejaculation (see above). This type is further divided into orgasmic and anorgasmic anejaculation. In orgasmic, men are able to achieve orgasm, but ejaculate no semen. It can be caused by blockage of ejaculatory nerves or there can be some obstruction in ejaculatory ducts. On the other hand, in anorgasmic anejaculation, men are not able to have orgasm in any way of sexual arousal, even while they masturbate.

Anejaculation has multiple causes, both physical and psychological. 

  • Physical causes include ejaculatory duct obstruction (Pic. 1), spinal cord injury or, especially in older men, prostate cancer. Anejaculation may also develop as a consequence of the administration of certain drugs. 
  • Psychological causes include discomfort, anxiety, relationship problems or conflicts, dysfunctional psychosexual development, or either conscious or subconscious constraint related to sexual behavior or certain practices.

Treatment of anejaculation depends on the cause. For psychological causes, psychotherapy comprising counseling and psychological support is usually effective. The therapy aims at removing the underlying psychological issue, such as stress, performance anxiety or relationship issues. 

Sex therapy

For the treatment of ejaculatory disorders, including anejaculation, a specific type of psychotherapy, called the sex therapy, may be used. Sex therapy is a specialized form of psychotherapy that focuses on issues regarding human sexuality. Sex therapy can be used to address concerns surrounding sexual arousal, performance, and satisfaction (i.e. reaching an orgasm). Sex therapy has also been found to help people who’ve experienced sexual trauma, have medical conditions that cause sex to be painful, are confused about their gender/sexual identity, and/or whom have sexual addictions. 

Sex therapy focuses on perceptions and feelings, improving communication between partners, increasing sexual skills and self-confidence, and reducing anxiety associated with sexual activity. Short-term improvement with these behavioral approaches was observed; however, there are limited data concerning the efficacy of these methods in the long run. Sex therapy may be either individual, involving only the male patient, or for couples, which can involve both partners in solving the issue.

Sex therapy requires rigorous evaluation that includes a medical and psychological examination. The reason is that sexual dysfunction may have a somatic base (based in the body) or a psychogenic basis (based on the patient’s thoughts, emotions and feelings). Sex therapy is frequently short term, with duration depending on the causes for therapy. Sex therapy can be provided by licensed psychologists or physicians, who have undergone training and become certified. Any licensed mental health counselor can practice sex therapy. Certified sex therapists do not have sexual contact with their clients.

Psychotherapy is usually employed in the treatment of anejaculation in patients without a known organic (physical) cause of the condition. Specifically, cases of anejaculation termed as idiopathic (without an apparent cause) are treated by psychotherapy, as they are most probably caused by psychological issues.

The outcome of psychotherapy (and subsequently, sex therapy) depends on many factors. Whether the therapy is successful in resolving relationship issues, reducing anxiety by so-called cognitive behavioral therapy (psychological intervention aimed at behavioral patterns) and increasing the level of information about sexual intercourse plays a very important role in the outcome. Strict and/or religious upbringing of the patient may cause deep-rooted psychological issues leading to psychogenic anejaculation that may be difficult to treat.

Psychological barrier

Sex therapy sessions are focused on the individual's symptoms (such as the inability to ejaculate during sexual intercourse or under specific circumstances) rather than on underlying psychodynamic conflicts (such as beliefs and upbringing). A therapist's misunderstanding of these conflicts can lead to resistance or serve as a barrier to improving sexual dysfunctions that are directly or indirectly related to sex.

Evidence on the efficacy of psychotherapy in the treatment of ejaculatory disorders, including anejaculation, still needs to be documented in large-scale studies. However, even in cases where psychotherapy fails to restore normal ejaculatory function, anejaculation is nowadays a treatable condition. 

Patients suffering from ejaculation can achieve a pregnancy with the use of assisted reproduction technology (ART), most notably penile vibratory stimulation. Semen collected using penile vibratory stimulation has been reported to have better quality to that collected by the electroejaculation technique. Therefore, penile vibratory stimulation is recommended as the first-line ART method for anejaculation patients.

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Sources

“Anejaculation as an atypical presentation of prostate cancer: a case report” ―by Mufti et al. licensed under CC BY 2.0
“Anejaculation” ―sourced from Fertilitypedia licensed under CC BY-SA 4.0
“Psychotherapy of ejaculatory disorders” ―sourced from Fertilitypedia licensed under CC BY-SA 4.0
“File:Male anatomy.png” ―sourced by Wikipedia Commons licensed under CC BY-SA 3.0
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