Ejaculation is the act of releasing sperm by men, which happens when they reach climax. In plain sight, it is simply a sexual function destined to perpetuate our species through reproduction. But not everything is so simple in humans, and a complex array of psychological factors are involved. Moreover, ejaculation and having sex have been shown beneficial in preventing certain conditions.
But there are many myths and misconceptions about this topic, and people often talk nonsense. That’s why it is essential to find a scientific explanation if you have questions about sex. It is more reliable than people’s opinions and popular culture.
Then, what does the evidence say? Is it harmful to go against the will of nature to reproduce and not release sperm at all? Will there be consequences? What if you have conditions such as retrograde ejaculation or delayed ejaculation?
In this article, we’re covering these topics and showing you what happens and what complications you could expect from not being able or deciding not to release sperm.
Importance of ejaculation
Ejaculation is a physiologic process, and the body rewards it in several ways. Evolution and natural selection have created a system in which anything that perpetuates the species is strongly favored. Ejaculation is a fundamental step to leave a man’s seed in a woman’s womb. As such, it is at the center of reproduction and the survival of the species.
No wonder why natural selection has favored individuals who ejaculate more often, and that’s why a simple act such as ejaculation affects far beyond our genitals. It is crucial for reproduction, but not only that. It lowers a man’s blood pressure. It promotes bonding with your partner through the release of oxytocin. It reduces the sensation of stress and improves sleep. And research even shows that it apparently has a role in immunity and heart disease.
But let us go through each one of these items to highlight the importance of ejaculation:
- Ejaculation and your cardiovascular system: According to studies, ejaculation reduces a man’s blood pressure temporarily. A reduction of cortisol levels probably causes this, but other factors may be involved. Interestingly, men who ejaculate more often also have a lower incidence of cardiovascular disease. The exact reason is unknown, but the association is very noteworthy (1).
- Ejaculation and your sexual partner: Sex is essential in couples, and during ejaculation, a surge of oxytocin is released. This hormone has different functions in the brain, promoting social conduct and bonding with other people. Thus, sexual activity and ejaculation are important to strengthen your relationship with your partner. Besides, we all know how important it is for reproduction, which is sometimes a fundamental goal in couples.
- Ejaculation and your mood and mental health: There’s a strong relationship between mental health and sex. We can indeed reach the mental health benefits of sex without ejaculation, but the organic effects of sexual climax facilitate the process. We will go through this aspect more thoroughly in the section below when discussing the mental health problems associated with delayed ejaculation.
- Ejaculation and your immune system: The immune function activates after ejaculation. The body automatically increases the number of white blood cells. These cells protect us from disease, and there are different types. According to studies, natural killer cells are significantly increased. They are the first line of defense against invader microorganisms. This automatic response is perhaps developed to protect males from sexually-transmitted diseases (3).
- Ejaculation and prostate cancer: Several studies confirm the association between ejaculation and prostate cancer. Frequent ejaculation is a protective factor against prostate cancer. The benefit is only seen in the low-risk disease, but it is noteworthy (4).
All of these extra benefits of ejaculation have the same effect as pleasure. They favor individuals who ejaculate more often to perpetuate their species. But in our day-to-day, it translates into the importance of a healthy sex life for many aspects of our health.
Side effects of not ejaculating
With that in mind, is there anything wrong with not ejaculating?
To cover this topic, it is important to explain two medical conditions that cause this type of ejaculatory problems:
- Delayed ejaculation: It is basically the opposite of premature ejaculation. This is a concerning type of male sexual dysfunction in which patients take very long to ejaculate or do not ejaculate at all. It is also known as inhibited ejaculation or retarded ejaculation. Anejaculation is a more severe type of ejaculatory dysfunction in which patients cannot achieve an orgasm (5).
- Retrograde ejaculation: In retrograde ejaculation, men achieve orgasm. The problem is that the ejaculatory fluid is not properly expelled from the urethra. To achieve ejaculation, the penile muscles contract, and the bladder neck is closed. Otherwise, there will be reflux of semen into the bladder. In retrograde ejaculation, the bladder neck is not closed correctly. Instead of being propelled to the outside, semen retention stays in the bladder. In some cases, this results in a low volume of ejaculation. In other cases, patients see no ejaculation at all (6).
But we may not have a medical condition. Not ejaculating can be a decision in at least two settings:
- Edging: Edging is a voluntary modulation of ejaculation to delay the moment of orgasm and prolong the sexual experience. It is simply stopping sexual stimulation when you’re on the edge of an orgasm. When the urge of ejaculating stops, you can resume sexual stimulation. This allows men to last for longer and enjoy sex with their partners (7).
- Abstinence: In this case, it is also a decision, usually involved in a religious practice or associated with taboo or traumatic experiences. Celibacy can be limited to sexual intercourse or any voluntary seminal emission.
With that in mind, let’s evaluate the side effects of each.
Side effects of delayed ejaculation
- A reduction of sexual pleasure and enjoyment of sex: Most people believe that penetrative sex is the only type of pleasurable sex, and it should always end in an orgasm. They think that not having an orgasm is like not having sex at all. Holding these beliefs reduces the capacity to enjoy sex in patients with delayed ejaculation.
- Anxiety triggered by not being able to ejaculate: It is closely related to what’s discussed above. For some people, not being able to ejaculate and not reaching orgasm is like not having sex. They become very anxious about it, and this may contribute to their problem. Sometimes they even question their role as a man for this reason.
- Relationship issues: Sex is essential for couples. These patients are usually anxious about sex and feel frustrated about sex. This affects their partner and their relationship. During intercourse, sexual anxiety about ejaculating can cause erectile dysfunction and other problems.
- Male Infertility: This side effect is more common in anejaculation, which is not being able to ejaculate at all. But delayed ejaculation may also become a problem in couples with fertility treatment. Timing of sex is essential to achieve a good result, and this additional psychological burden may contribute to their symptoms.
Side effects of retrograde ejaculation
- Male Infertility: Even in patients who achieve ejaculation, the volume is severely affected. The sperm count is also much lower than expected. Thus, one of the most common side effects of not ejaculating is infertility.
- A reduction of orgasm pleasure: Not ejecting sperm reduces the intensity and frequency of contractions during orgasm. This significantly reduces the pleasure in orgasm. Some patients may even experience painful ejaculation or discomfort during orgasm.
- Increased risk of bladder infections: In retrograde ejaculation, part of the semen may contact the urethra before reaching the bladder. There are microorganisms in the urethra that will be transported to the bladder and cause an infection.
Side effects of edging
- Epididymal hypertension: This is caused by retained blood in the genitals for a long time. The physical manifestation is a blueish coloration in the testicles and a temporary sensation of heaviness and pain.
Side effects of sexual abstinence
- Sexual anxiety: The experience of abstinence is different from one person to another and is often biased by spiritual fervor. However, in many cases, there is recurrent anxiety and sexual thoughts followed by self-judgment and blame. When sustained for a long time, this pattern of thoughts and emotions causes a psychological burden in some individuals.
Treating medical conditions associated with not releasing sperm can be very challenging. These patients require a multidisciplinary team to help them according to their goals (8,9):
These interventions are particularly important for patients with delayed ejaculation. Sometimes they have a hidden psychological factor that triggers or contributes to the problem. These interventions include:
- Cognitive-behavioral therapy: It is essential to change the way patients view and experience sex. It also includes sex education.
- Masturbatory retraining: It is recommended when a difference is spotted between achieving ejaculations in masturbation and penetrative sex. Adjusting sexual fantasies and expectations to reality may contribute to solving the problem.
- Psychotherapy: There is sometimes a trigger in the past from childhood trauma. Psychotherapy works to detect and treat these alterations.
- Sexual anxiety interventions: In patients with anxiety triggered at the moment of having sexual intercourse. Mindfulness, relaxation, and other techniques work to reduce anxiety and achieve an orgasm.
- Couple therapy: It is useful when the relationship with the sexual partner is affected or is a likely trigger of the disease.
There is currently no approved drug for delayed ejaculation, but certain medications can improve the symptoms. Depending on the trigger and the characteristics of the patient, doctors can try different drugs. A recent case report showed that lisdexamfetamine dimesylate 2 hours before masturbation improved a case of neurogenic anejaculation.
In some cases, the condition is triggered by drugs, especially antidepressants (selective serotonin reuptake inhibitors, SSRI). In such cases, changing the antidepressant can solve the problem without significant intervention.
In contrast, medical treatment for retrograde ejaculation has a different aim. What we try to do is increasing the tone of the bladder neck. By doing so, it is more likely that it will close during ejaculation. Doctors can try several drugs depending on the patient, such as pseudoephedrine, ephedrine sulaphate, brompheniramine, or desipramine.
These patients may also require further assistance to have a baby with their partner. There are different approaches to manage delayed ejaculation. For example, we can collect nocturnal emissions in patients who report them. Prostatic massage and catheterization can be used to obtain sperm cells, too.
Penile vibratory stimulation is another treatment, and when nothing works, there is always one possibility left. Percutaneous vasal sperm aspiration is a minimally invasive procedure made to obtain sperm cells directly from the vas deferens in the testis.
Fertility treatment for retrograde ejaculation is usually more straightforward. It is possible to obtain sperm cells from post-ejaculatory urine samples. This is only recommended in assisted reproductive technology settings, and special preparation is done. The urine is made alkaline to prevent the destruction of sperm cells by an acidic environment. The patient’s urine osmolarity and pH should be measured, and everything should be carefully timed with the partner’s ovulation period.
Tips for ejaculation
The best person to help you if you experience one of these medical problems is your doctor. So, we recommend talking to your doctor about this if you’re having problems or feel concerned about it.
But besides their medical therapy and psychological interventions, you can contribute to the treatment. Just be sure to follow these recommendations:
- Avoid alcohol before intercourse. One cup can relieve tension, but excess alcohol is a nervous system depressant and may contribute to the problem.
- Inform your partner about what is happening. It is vital to make your partner feel that it’s nobody’s fault.
- Practice mindfulness, breathing techniques, and other mechanisms to manage stress.
- If your problem does not improve, talk to your doctor.
Seeing a doctor
Sexual abstinence and edging result from a decision, and doctors won’t do anything there. But if you have delayed or retrograde ejaculation, when is an appropriate time to see a doctor? If you experienced this problem once, give yourself more time and do not feel concerned about it. But if this is a recurrent problem, talking to your doctor is a good idea.
Do not hesitate to talk it out if you have one of these problems:
- When the ejaculation disorder affects your relationship with your partner
- When you feel anxiety, stress, and mood problems related to ejaculatory disorders
- If you consume chronic medications that you suspect are contributing to the problem
- If you started experiencing this problem after prostate gland surgery
- If you’re practicing sex to conceive a baby and had unprotected intercourse for one year without success
Everything starts with sexual arousal and intercourse, but not all of us achieve an orgasm. Premature ejaculation is one of the most common sexual problems in males, but there are other forms of abnormal ejaculation, including delayed ejaculation and retrograde ejaculation.
These patients experience sexual desire and enjoy sexual stimulation. They may not have erectile dysfunction problems but do not release sperm. In delayed ejaculation, it takes too long to achieve an orgasm. In retrograde ejaculation, the ejaculate enters the bladder instead of being propelled to the outside.
In some cases, surgery for an enlarged prostate (benign prostatic hyperplasia or prostate cancer) can lead to temporary retrograde ejaculation. But when no trigger is found, it might be difficult to treat the problem. A combination of psychotherapy and medications can be used, and these patients often need special assistance for fertility.
Find out 11 Tips To Improve Male Sexual Health.