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.

Treatment

Elimination of alpha-adrenergic blockers results in cure for some patients with emission failure or retrograde ejaculation. Alpha sympathomimetics such as ephedrine or a combination of chlorpheniramine maleate and phenylpropanolamine hydrochloride (Ornade) have been used successfully in patients with retrograde ejaculation. Electroejaculation via a rectal probe has been applied in patients with spinal cord injury with some success (Perkash et al, 1985; Ohl et al, 1991). Patients who have normal wet dreams but cannot achieve orgasm and ejaculation may benefit from psychosexual counseling. Premature ejaculation can be treated by desensitization, the squeezing technique (_{Masters and Johnson, 1976}), or application of a local anesthetic (_{Berkovitch, Keresteci, and Koren, 1995; Xin et al, 1997}) or a condom to reduce the sensitivity of the glans and frenulum. Selective serotonin reuptake inhibitors (fluoxetine, sertraline, and clomipramine) are also reported to be useful in prolonging the intravaginal ejaculation latency time in patients with premature ejaculation (_{Kim and Seo, 1998}).

References