Some men may find it difficult if not impossible to ejaculate. This may be caused by a neurological condition, such as MS or spinal cord injury, or it may have a psychological cause. If you have difficulties ejaculating, and hypnotherapy or psychosexual counselling is not appropriate or has not worked for you, we would recommend PVS as the first line management for this. This very simple non-invasive technique uses vibratory stimulation over the skin at the end of the penis. It may be used in conjunction with Sildenafil (Viagra) or Alprostadil (Caverject) to obtain an ejaculate. This can then be frozen for later use with assisted conception, either IUI or IVF treatment. If this treatment does not work for you, then the next step would be to consider Electroejaculation.