Disorders Affecting Emission, Ejaculation, & Orgasm

Bilateral sympathectomy at the L2 level has resulted in ejaculatory dysfunction in about 40% of patients. High bilateral retroperitoneal lymphadenectomy causes an even higher percentage of emission failures. Retrograde ejaculation is usually the result of dysfunction of the internal sphincter or the bladder neck, as seen after prostatectomy, with alpha-blocker therapy, and in autonomic neuropathy due to diabetes.

Successful emission and ejaculation without orgasm occur in some patients with spinal cord injury. Phantom orgasm in a paraplegic man also has been described. A history of disease or surgery is helpful in differentiating emission failure from retrograde ejaculation. If microscopic examination confirms the presence of sperm in bladder urine after a dry ejaculation, retrograde ejaculation can be diagnosed. If no sperm is found, emission failure is the cause.