What medical conditions cause ejaculation without orgasm (anejaculation or dysorgasmia) in men?
Executive summary
Anejaculation (absence of ejaculate) and disorders of orgasm including anorgasmia and dysorgasmia (painful ejaculation) arise from overlapping but distinct medical pathways: pharmacologic effects, neurologic injury or disease, pelvic or genitourinary surgery and iatrogenic changes, endocrinopathies, and psychological causes [1] [2] [3]. The literature and major clinical sources emphasize medication-induced dysfunction, nerve damage from disease or surgery, and pelvic pathology as the most common medical drivers; treatments range from changing medications to targeted medical, surgical or rehabilitative therapies depending on the identified cause [1] [2] [4].
1. Definitions and diagnostic nuance — what the terms mean and where reporting blurs them
Anejaculation is the inability to expel semen despite sexual stimulation, and may occur with or without the subjective experience of orgasm; anorgasmia refers specifically to inability to reach orgasm, while dysorgasmia (also called dysejaculation or painful ejaculation) denotes pain during or after ejaculation — clinical sources stress these overlap but are distinct diagnostic categories and that history-taking is essential to distinguish them [5] [3] [6].
2. Medications: the most common and reversible culprits
A wide range of drugs are repeatedly implicated in delayed ejaculation, anejaculation and anorgasmia — notably serotonergic antidepressants (SSRIs), MAO inhibitors, tricyclics, antipsychotics with alpha-adrenergic blockade, opioids, benzodiazepines, ethanol and alpha‑adrenergic antagonists used for BPH such as tamsulosin — with multiple reviews and clinical papers documenting these classes as frequent causes and often reversible after medication change [1] [6] [7].
3. Neurologic disease, nerve injury and systemic neuropathies
Conditions that damage autonomic or somatic pelvic nerves — spinal cord injury, multiple sclerosis, diabetic neuropathy, or focal pelvic nerve injury — are established causes of ejaculation and orgasm disorders because the ejaculatory reflex requires intact neural pathways; major clinic summaries and specialist overviews list these neurologic etiologies as central drivers of anejaculation and anorgasmia [5] [8] [2].
4. Iatrogenic and post‑surgical causes — prostate, bladder neck and pelvic procedures
Surgical interventions such as radical prostatectomy, bladder neck operations, pelvic radiation and other genitourinary surgeries frequently alter ejaculatory mechanics or nerve integrity and are well‑recognized causes of absent ejaculation, painful ejaculation, or disordered orgasm; clinical reviews recommend preoperative counseling and semen‑preservation discussions for men wishing future fertility [2] [9] [6].
5. Pelvic pathology and painful ejaculation (dysorgasmia)
Prostate inflammation or infection, seminal vesicle stones, benign prostatic hyperplasia, chronic pelvic pain syndromes (UCPPS), and pelvic floor dysfunction are repeatedly associated with pain during or after ejaculation; specialist sources emphasize that dysorgasmia often reflects pelvic pain syndromes rather than active infection and that multimodal management including pelvic floor physical therapy can help [4] [10] [6].
6. Endocrine and psychological contributors, and diagnostic approach
Endocrinopathies such as low testosterone or thyroid dysfunction and psychological factors — performance anxiety, stress, relationship issues or psychogenic causes — are listed across reviews as potential contributors to orgasmic disorders and should be evaluated alongside medications and neurologic disease; authoritative guidelines recommend focused history, medication review, hormonal testing when appropriate, and referral to psychotherapy or sex therapy if no organic cause is evident [3] [11] [8].
7. Practical implications, treatment themes and limits of current reporting
Across the literature, the practical pathway is consistent: identify reversible medication or iatrogenic causes first, evaluate for neurologic and pelvic anatomic contributors, consider hormonal testing and psychosexual assessment, and apply targeted treatments from changing drugs to sympathomimetics, pelvic rehabilitation, sperm retrieval for fertility needs, or specialist interventions — however, the sources vary in depth and none provide exhaustive population‑level incidence for “ejaculation without orgasm” as a unique entity, so precise prevalence and some causal subtleties remain incompletely quantified in the available reporting [12] [2] [11].