What causes a lack of semen during orgasm in elderly men and how is it treated?

Causes and Treatment of Lack of Semen During Orgasm in Elderly Men

In elderly men, lack of semen during orgasm (also known as dry orgasm) is primarily age-related and can be managed through behavioral interventions, medication adjustments, and in some cases pharmacotherapy to enhance arousal and ejaculatory function.

Causes of Lack of Semen in Elderly Men

• Age is one of the most significant factors in ejaculatory dysfunction, with physiological changes in ejaculatory function occurring naturally as men age 1
• Decreased testosterone levels associated with aging can contribute to ejaculatory dysfunction and reduced semen volume 1
• Delayed ejaculation (DE) or absence of ejaculation despite adequate stimulation becomes increasingly common with age 1
• Medications, particularly antidepressants, antipsychotics, and certain antihypertensives, can significantly contribute to ejaculatory dysfunction in elderly men 1
• Comorbid erectile dysfunction, which is common in older men, can exacerbate ejaculatory problems 1
• Neurological conditions more prevalent in older men can affect the complex neural pathways involved in ejaculation 2

Evaluation Approach

• A thorough assessment of medication history is essential, as many commonly prescribed medications in elderly populations can cause ejaculatory dysfunction 1
• Morning testosterone testing is recommended for men with ejaculatory dysfunction, as low testosterone levels correlate with ejaculatory problems 1
• Basic serum studies including electrolytes, lipids, and glycosylated hemoglobin may help identify medical conditions contributing to ejaculatory dysfunction 1
• Physical examination should assess for neurological conditions that may affect ejaculatory function 2
• Assessment of erectile function is important as ED and ejaculatory disorders often coexist 1

Treatment Options

First-Line Approaches

• Modification of sexual positions or practices to increase arousal should be the initial approach for elderly men with lack of semen during orgasm 1
• Behavioral interventions including alternative sexual practices and incorporation of sexual enhancement devices can help trigger orgasmic response 1
• Open communication about sexual needs and desires between partners can facilitate treatment and improve satisfaction 1
• Adjustment, replacement, or staged cessation of medications that may contribute to ejaculatory dysfunction 1

Pharmacological Options

• Testosterone replacement therapy may be considered for men with confirmed testosterone deficiency and ejaculatory dysfunction 1
• Several medications have shown potential efficacy for delayed ejaculation, though evidence is limited 1:
  • Pseudoephedrine (60-120 mg, 120-150 minutes prior to sexual activity) 1
  • Ephedrine (15-60 mg, 1 hour prior to sexual activity) 1
  • Midodrine (5-40 mg, 30-120 minutes prior to sexual activity) 1
  • Bethanecol (20 mg daily) 1
  • Yohimbine (5.4 mg three times daily) 1
  • Cabergoline (0.25-2 mg twice weekly) 1
  • Imipramine (25-75 mg daily) 1

Important Considerations

• Sex remains important to elderly men, with studies showing that even among 70-80-year-olds, intact sexual desire, erection, and orgasm are common and considered important to preserve 3
• Patients should be counseled on the weak evidence base for pharmacological treatments and potential side effects 1
• When ejaculatory dysfunction is accompanied by erectile dysfunction, treating the ED according to established guidelines may help improve overall sexual function 1
• Physical activity has been shown to improve sexual function in middle-aged and older men and should be recommended as part of a comprehensive approach 4
• Psychological factors can contribute significantly to ejaculatory dysfunction, and referral to a mental health professional with expertise in sexual health should be considered 1

Treatment Algorithm

1. Evaluate and adjust medications that may contribute to ejaculatory dysfunction 1
2. Assess testosterone levels and consider replacement if deficient 1
3. Recommend behavioral interventions to enhance arousal 1
4. If erectile dysfunction is present, treat according to established guidelines 1
5. Consider pharmacotherapy options if other approaches are insufficient 1
6. Refer to a mental health professional with expertise in sexual health if psychological factors are significant 1