Absent ejaculation may be due either to retrograde ejaculation or lack of emission (no expulsion of semen through the vas deferens into the posterior urethra.) Retrograde ejaculation is a condition that typically occurs along with conditions such as diabetes or multiple sclerosis. This can also occur after surgeries such as transurethral resection of the prostate or retroperitoneal lymph node dissections for testicular cancer. Success rates as high as 40% have been achieved in clinical studies using either alpha agonist agents such as Sudafed or Phenylpropanolamine or the antidepressant Imipramine to treat retrograde ejaculation associated with diabetes or following retroperitoneal lymph node dissection.
All cases of absent ejaculation and low-volume ejaculation should be evaluated with a postejaculate urine specimen. Some sperm may be found in your urine indicating that you have retrograde ejaculation. If absloutely no sperm is found in the postejaculate urine you may have a physical blockage of the semen flow from the vas deferens as it exits into the urethra via the ejaculatory ducts. If a blockage exists, this would most likely appear on an ultrasound exam as a grossly enlarged vas deferens. This could possibly be relieved by a transurethral resection of the ejaculatory ducts. A physical exam may also show that you have no vas deferens present. It is unlikely that your lack of ejaculation is related to your operation for undescended testicle, but it is a condition that may possibly be remedied by a urologist. Remember that I have not completed a thorough history and physical exam on you, and there is no substitute for a complete exam by a skilled urologist.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).