Anejaculation: Definition, Classification (Functional, Organic) and Diagnostic Criteria

What is anejaculation?

A normal male ejaculates during orgasm, with semen being ejected from the urethra. If a man can maintain an erection for a certain period of time during intercourse but does not experience orgasm, ejaculation, or semen discharge, and the urine test after intercourse shows no sperm or fructose, this abnormal phenomenon is called "anejaculation."

How is ejaculatory dysfunction classified?

Anejaculation can be classified into two categories based on its nature: functional and organic.

(1) Functional anejaculation

This accounts for approximately 90% of cases of ejaculatory dysfunction. Due to dysfunction of the higher centers in the cerebral cortex and hypothalamus, the spinal ejaculation center is inhibited, and sexual stimulation in the waking state cannot reach the level of excitation required by the ejaculation center. During sleep, the activity of the subcortical centers increases, and sexual dreams can induce ejaculation, manifesting as nocturnal emission during sleep. Sometimes masturbation can also lead to ejaculation. Most cases end with penile flaccidity after a certain period of intercourse, while some maintain an erection until exhaustion without ejaculation. The unique Eastern cultural concept of "the preciousness of semen" is one of the important factors contributing to the high number of ejaculatory dysfunction patients in my country. Men in my country and other Southeast Asian countries often regard semen as "the essence of life" and "vital energy," holding the view that "one drop of semen is worth ten drops of blood," leading many to subconsciously suppress ejaculation. Approximately 75% of patients seek medical attention for "infertility," and 15% for "nocturnal emission." In fact, nocturnal emission is a common compensatory reaction among ejaculatory dysfunction patients; "when semen is full, it overflows." However, patients attempt to "save semen" by further reducing ejaculation, consciously or unconsciously controlling ejaculation or reducing sexual activity in hopes of longevity, which only exacerbates nocturnal emission. Functional anejaculation is characterized by the absence of ejaculation during intercourse, although nocturnal emission may occur. Common causes include lack of sexual knowledge, emotional and psychological factors, female factors, family environment factors, and phimosis. In addition, homosexuality, fear of pregnancy, psychosocial trauma, and premarital anxiety can all contribute to anejaculation.

(2) Organic anejaculation

Organic anejaculation refers to the inability to ejaculate caused by substantial damage to the body's organs. It accounts for approximately 10% of all cases of anejaculation. The inability to ejaculate under any circumstances, whether awake or asleep, is often caused by various diseases, including:

① Neurological factors: diseases and surgeries of the lateral lobe of the brain, damage to the output nerves of the thoracolumbar region, trauma or surgical damage to the sympathetic nerves, pelvic surgery, spinal cord injury, retroperitoneal lymph node dissection, etc.

②Metabolic factors: Diabetes mellitus.

③ Endocrine disorders: hypopituitarism, hypogonadism, hypothyroidism.

④ Drug factors: Various drugs used to treat hypertension and mental illnesses can impair ejaculation ability, such as guanethidine, phenothiazines, reserpine, and nitrazepam.

⑤ Congenital factors are rare, such as absence of unilateral or bilateral vas deferens and seminal vesicles, congenital ejaculatory duct obstruction, etc.

How to diagnose ejaculatory dysfunction

Diagnosing anejaculation is not difficult; the key diagnostic points are absence of sexual orgasm, absence of ejaculatory reflexes, and absence of semen ejaculation. Clinically, the following points should be noted:

(1) Diagnosis is mainly based on medical history. It is necessary to understand the entire process of sexual intercourse, especially the sexual intercourse method, the frequency and amplitude of penile thrusting in the vagina, etc.; and to understand whether sexual arousal is satisfactory during sexual intercourse.

(2) During sexual activity, there is sexual arousal, penile erection, and sufficient time for intercourse, but no orgasm, no ejaculation, and no semen discharge.

(3) There are often subconscious ejaculation actions and orgasms (such as nocturnal emission), often accompanied by nocturnal emission or penile erection that does not retract, which is easily confused with priapism. The difference is that this condition is caused by sexual arousal, while priapism is generally not caused by sexual stimulation; there is no semen ejaculation during intercourse in this condition, while priapism continues to be erect after ejaculation.

It is important to note that the following two situations do not fall under the category of "anejaculation": First, frequent sexual activity can slow down, prolong, or even prevent ejaculation. For example, if newlyweds have multiple sexual encounters in one night and the last encounter results in anejaculation, this is normal. This is because the seminal vesicles have a limited capacity, and semen has a limited quantity. The secretion of the seminal vesicles and prostate gland requires a certain amount of time. If sexual intercourse is too frequent, not only will the stored semen be depleted, but the ejaculation center will also shift from over-excitation to inhibition, leading to anejaculation. Second, men over 50 years of age do not always achieve ejaculation during intercourse. Reduced ejaculatory ability can prolong the duration of intercourse, and this ejaculation is often not a strong ejaculation but a slow, gradual flow, hence the term "weak ejaculation."