Anejaculation is defined as the inability to ejaculate even with an adequate erection. It is a rare cause of sexual dysfunction and infertility. Cause of anejaculation is usually organic in nature (Multiple sclerosis, Spinal cord Injury, parkinsonism, Diabetes mellitus , drugs and prostate surgery).If there is no cause,  it is considered idiopathic. 
For idiopathic anejaculation, the usual mode of treatment has been psychotherapy and behavioral therapy. 
Penile vibratory stimulation (PVS)  has been successful  for treating patients with organic anejaculation. 
We used our experience of penile vibratory stimulation in SCI patients and were able to achieve ejaculation in these patients of idiopathic anejaculation.

A retrospective analysis of   Infertile men presenting to the outpatient department over a seven  year period(2016-2023)  revealed  eleven patients   with idiopathic Anejaculation. 
None of the patients had an obvious organic cause of Anejaculation. 
Majority of patients had failed treatment with medications and psychotherapy. 
All patients underwent PVS  using a high amplitude FertiCare® vibrator which was applied to the penis for up to 10minutes at a frequency of 100 Hz and an amplitude of 2.5mm .
Patients who failed to have ejaculation in the first sitting were given subsequent trials at weekly interval with two vibrators.
Its is performed in 2-5 minutes intervals , interspersed by 1-2 min rest intervals.The penis was inspected every 2 minutes and the procedure ended if there was edema or abrasion. The procedure with 2 vibrators was similar to that followed with 1 vibrator except the penis was sandwiched between 2 vibrators with 1 placed on the dorsum and 1 placed on the frenulum of the glans penis.

:Ten out of the eleven patients were able to ejaculate successfully with PVS. 
:Five patients had ejaculation in the first sitting , the remaining six required multiple sittings.
:Pregnancy was achieved in 6 patients( by IUI/IVF in five patients and natural pregnancy in one)
 :At subsequent follow up two patients were able to ejaculate intra-vaginally , two patients were able to ejaculate by masturbation and 
 the remaining six still used penile vibrators for ejaculation.

:Anejaculation can be classified as orgasmic (organic) anejaculation, anorgasmic (psychogenic/idiopathic) anejaculation, and situational anejaculation. 
:1.5% of anejaculation cases  have   a psychogenic origin where there is no demonstrable organic aetiology 
:Like other sexual disorders, psychogenic anejaculation can be generalized (with all types of sexual behaviour and all partners) or situational.
:Orthodoxy of religious beliefs can contribute to ejaculatory difficulty. These men may have strong guilt or other such negative associations.
:These patients group may have  significantly lower sensitivity and excitability of glans and the penile shaft.
:Mainstay of treatment is Psycho-therapy and behavioural therapy.
:Penile electro vibration increases the ejaculatory stimulus by stimulating dermal pacinian corpuscle to increase afferent input to the 
 spinal cord, increasing the ejaculatory reflex.

:Idiopathic anejaculation although uncommon is a difficult entity to treat.
 :Most patients ignore this problem till issues of fertility arise. 
:Penile vibratory stimulation is a simple, safe, non-invasive, inexpensive, out patient procedure which can help provide semen for IUI/IVF . 
:It is a useful adjunct to psychotherapy and behavioural therapy to treat this disorder.