Anejaculation is the pathological inability to ejaculate despite an erection in males, with (orgasmic) or without (anorgasmic) orgasm.
Causes
The following table shows the frequency of ability to ejaculate by type of spinal cord injury and stimulation method.2| Masturbation or coitus | Penile vibratory stimulation | AchE inhibitor | |
|---|---|---|---|
| Complete spinal cord injury | 12% | 47% | 55% |
| Incomplete spinal cord injury | 33% | 53% | 78% |
| Complete lesion of the sympathetic centres (T12 to L2) | None | 5% | |
| Complete lesion of the parasympathetic and somatic centres (S2 – S4) | None | 31% | |
| Complete lesion of all spinal ejaculation centres (T12 to S5) | None | 0% | |
| Complete lesion strictly above Onuf's nucleus (S2 – S4) | 98% | 98% | |
| Complete lesion of the S2 – S4 segments | none | none |
It can depend on one or more of several causes, including:
- Sexual inhibition
- Pharmacological inhibition. They include mostly antidepressant and antipsychotic medication, and the patients experiencing that tend to quit them3
- Autonomic nervous system malfunction
- Prostatectomy - surgical removal of the prostate.
- Ejaculatory duct obstruction
- Spinal cord injury causes sexual dysfunction including anejaculation. The rate of being able to ejaculate varies with the type of lesion, as detailed in the table at right.
- Old age
- Diabetes mellitus4
Anejaculation, especially the orgasmic variant, is usually indistinguishable from retrograde ejaculation. However, a negative urinalysis measuring no abnormal presence of spermatozoa in the urine will eliminate a retrograde ejaculation diagnosis. Thus, if the affected person has the sensations and involuntary muscle-contractions of an orgasm but no or very low-volume semen, ejaculatory duct obstruction is another possible underlying pathology of anejaculation.
Management
Anejaculation in spinal cord injury
Further information: Sexuality after spinal cord injury § Ejaculation and male fertility
The first-line method for sperm retrieval in men with spinal cord injury is penile vibratory stimulation (PVS).5 The penile vibratory stimulator is a plier-like device that is placed around the glans penis to stimulate it by vibration. In case of failure with PVS, spermatozoa are sometimes collected by electroejaculation, or surgically by percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE).6
Notes
References
Meng, Xianghu; Fan, Longchang; Wang, Tao; Wang, Shaogang; Wang, Zengjun; Liu, Jihong (March 2018). "Electroejaculation combined with assisted reproductive technology in psychogenic anejaculation patients refractory to penile vibratory stimulation". Translational Andrology and Urology. 7 (S1): S17 – S22. doi:10.21037/tau.2018.01.15. PMC 5881218. PMID 29644166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881218 ↩
Chehensse, C.; Bahrami, S.; Denys, P.; Clément, P.; Bernabé, J.; Giuliano, F. (2013). "The spinal control of ejaculation revisited: A systematic review and meta-analysis of anejaculation in spinal cord injured patients". Human Reproduction Update. 19 (5): 507–526. doi:10.1093/humupd/dmt029. PMID 23820516. https://doi.org/10.1093%2Fhumupd%2Fdmt029 ↩
[1] Archived 2008-02-08 at the Wayback Machine (in Italian) and [2] Archived 2014-01-31 at the Wayback Machine (in Italian) http://www.giovannialei.it/patologie/eiaculazione_retrograda.htm ↩
Meng, Xianghu; Fan, Longchang; Wang, Tao; Wang, Shaogang; Wang, Zengjun; Liu, Jihong (March 2018). "Electroejaculation combined with assisted reproductive technology in psychogenic anejaculation patients refractory to penile vibratory stimulation". Translational Andrology and Urology. 7 (S1): S17 – S22. doi:10.21037/tau.2018.01.15. PMC 5881218. PMID 29644166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881218 ↩
Chehensse, C.; Bahrami, S.; Denys, P.; Clément, P.; Bernabé, J.; Giuliano, F. (2013). "The spinal control of ejaculation revisited: A systematic review and meta-analysis of anejaculation in spinal cord injured patients". Human Reproduction Update. 19 (5): 507–526. doi:10.1093/humupd/dmt029. PMID 23820516. https://doi.org/10.1093%2Fhumupd%2Fdmt029 ↩
Chehensse, C.; Bahrami, S.; Denys, P.; Clément, P.; Bernabé, J.; Giuliano, F. (2013). "The spinal control of ejaculation revisited: A systematic review and meta-analysis of anejaculation in spinal cord injured patients". Human Reproduction Update. 19 (5): 507–526. doi:10.1093/humupd/dmt029. PMID 23820516. https://doi.org/10.1093%2Fhumupd%2Fdmt029 ↩