Anejaculation

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Anejaculation is the pathological inability to ejaculate despite an erection [1] in males, with (orgasmic) or without (anorgasmic) orgasm.

Contents

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 injury12%47%55%
Incomplete spinal cord injury33%53%78%
Complete lesion of the
sympathetic centres (T12 to L2)
None5%
Complete lesion of the parasympathetic
and somatic centres (S2 – S4)
None31%
Complete lesion of all
spinal ejaculation centres (T12 to S5)
None0%
Complete lesion strictly
above Onuf's nucleus (S2 – S4)
98%98%
Complete lesion of the S2 – S4 segmentsnonenone

It can depend on one or more of several causes, including:

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.[ citation needed ]

Management

Anejaculation in spinal cord injury

The first-line method for sperm retrieval in men with spinal cord injury is penile vibratory stimulation (PVS). [2] 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). [2]

Notes

  1. 1 2 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.
  2. 1 2 3 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.
  3. Archived 2008-02-08 at the Wayback Machine (in Italian) and Archived 2014-01-31 at the Wayback Machine (in Italian)

Related Research Articles

<span class="mw-page-title-main">Pre-ejaculate</span> Clear fluid emitted from the urethra of the penis during sex

Pre-ejaculate is a clear, colorless, viscous fluid that is emitted from the urethra of the penis during sexual arousal. It is similar in composition to semen but has distinct chemical differences. The presence of sperm in the fluid is variable from low to absent. Pre-ejaculate functions as a lubricant and an acid neutralizer.

A nocturnal emission, informally known as a wet dream, sex dream, nightfall or sleep orgasm, is a spontaneous orgasm during sleep that includes ejaculation for a male, or vaginal wetness or an orgasm for a female. Nocturnal emissions happen after stressful dreams in REM sleep which activate the sympathetic nervous system hence leading to ejaculation. Nocturnal emissions are most common during adolescence and early young adult years, but they may happen any time after puberty. It is possible for men to wake up during a wet dream or simply to sleep through it, but for women, some researchers have added the requirement that she should also awaken during the orgasm and perceive that the orgasm happened before it counts as a wet dream. Vaginal lubrication alone does not mean that the woman has had an orgasm.

<span class="mw-page-title-main">Prostate massage</span> Massage of the prostate gland via the rectum or perineum

Prostate massage is the massage or stimulation of the male prostate gland for medical purposes or sexual stimulation.

Premature ejaculation (PE) occurs when a man expels semen soon after beginning sexual activity, and with minimal penile stimulation. It has also been called early ejaculation, rapid ejaculation, rapid climax, premature climax and (historically) ejaculatio praecox. There is no uniform cut-off defining "premature", but a consensus of experts at the International Society for Sexual Medicine endorsed a definition of around one minute after penetration. The International Classification of Diseases (ICD-10) applies a cut-off of 15 seconds from the beginning of sexual intercourse.

<span class="mw-page-title-main">Retrograde ejaculation</span> Redirection of ejaculated semen into the urinary bladder

Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the release of urine also prevents a reflux of seminal fluids into the male bladder during ejaculation. The semen is forced to exit via the urethra, the path of least resistance. When the bladder sphincter does not function properly, retrograde ejaculation may occur. It can also be induced deliberately by a male as a primitive form of male birth control or as part of certain alternative medicine practices. The retrograde-ejaculated semen, which goes into the bladder, is excreted with the next urination.

<span class="mw-page-title-main">Ejaculatory duct</span> Male anatomical structures

The ejaculatory ducts are paired structures in male reproductive system. Each ejaculatory duct is formed by the union of the vas deferens with the duct of the seminal vesicle. They pass through the prostate, and open into the urethra above the seminal colliculus. During ejaculation, semen passes through the prostate gland, enters the urethra and exits the body via the urinary meatus.

Electroejaculation is a procedure used to obtain semen samples from sexually mature male mammals. The procedure is used for breeding programs and research purposes in various species, as well as in the treatment of ejaculatory dysfunction in human males. This procedure is used frequently with large mammals, particularly bulls and some domestic animals, as well as humans who have certain types of anejaculation. Electroejaculation has also been used for the cryoconservation of animal genetic resources, where semen is stored in low temperatures with the intent of conserving genetic material and future revival.

<span class="mw-page-title-main">Semen collection</span> Process of obtaining semen from male animals

Semen collection refers to the process of obtaining semen from human males or other animals with the use of various methods, for the purposes of artificial insemination, or medical study. Semen can be collected via masturbation, prostate massage, artificial vagina, penile vibratory stimulation (vibroejaculation) and electroejaculation. Semen can be collected from endangered species for cryopreservation of genetic resources.

<span class="mw-page-title-main">Azoospermia</span> Medical condition of a man whose semen contains no sperm

Azoospermia is the medical condition of a man whose semen contains no sperm. It is associated with male infertility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations in Canada.

Aspermia is the complete lack of semen with ejaculation. It is associated with infertility.

Hypospermia is a condition in which a man has an unusually low ejaculate volume, less than 1.5 mL. It is the opposite of hyperspermia, which is a semen volume of more than 5.5 mL. It should not be confused with oligospermia, which means low sperm count. Normal ejaculate when a man is not drained from prior sex and is suitably aroused is around 1.5–6 mL, although this varies greatly with mood, physical condition, and sexual activity. Of this, around 1% by volume is sperm cells. The U.S.-based National Institutes of Health defines hypospermia as a semen volume lower than 2 mL on at least two semen analyses.

Male infertility refers to a sexually mature male's inability to impregnate a fertile female. In humans it accounts for 40–50% of infertility. It affects approximately 7% of all men. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity. More recently, advance sperm analyses that examine intracellular sperm components are being developed.

Delayed ejaculation (DE) describes a man's inability or persistent difficulty in achieving orgasm, despite typical sexual desire and sexual stimulation. Generally, a man can reach orgasm within a few minutes of active thrusting during sexual intercourse, whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30–45 minutes or more. Delayed ejaculation is closely related to anorgasmia.

<span class="mw-page-title-main">Penile frenulum</span> Band of tissue under the glans penis connecting the foreskin to the vernal mucosa

The frenulum of the penis, often known simply as the frenulum or frenum, is a thin elastic strip of tissue on the underside of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa. In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin during erection. In flaccid state it tightens to narrow the foreskin opening.

<span class="mw-page-title-main">Semen analysis</span> Scientific analysis of semen

A semen analysis, also called seminogram or spermiogram, evaluates certain characteristics of a male's semen and the sperm contained therein. It is done to help evaluate male fertility, whether for those seeking pregnancy or verifying the success of vasectomy. Depending on the measurement method, just a few characteristics may be evaluated or many characteristics may be evaluated. Collection techniques and precise measurement method may influence results.

<span class="mw-page-title-main">Human penis</span> Human male external reproductive organ

In human anatomy, the penis is an external male intromittent organ that additionally serves as the urinary duct. The main parts are the root (radix); the body (corpus); and the epithelium of the penis including the shaft skin and the foreskin (prepuce) covering the glans penis. The body of the penis is made up of three columns of tissue: two corpora cavernosa on the dorsal side and corpus spongiosum between them on the ventral side. The human male urethra passes through the prostate gland, where it is joined by the ejaculatory duct, and then through the penis. The urethra traverses the corpus spongiosum, and its opening, the meatus, lies on the tip of the glans penis. It is a passage both for urination and ejaculation of semen.

<span class="mw-page-title-main">Ejaculation</span> Euphoric stimulative semen discharge of the male reproductive tract

Ejaculation is the discharge of semen from the male reproductive tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. Ejaculation can occur spontaneously during sleep, and is a normal part of human sexual development. In rare cases, ejaculation occurs because of prostatic disease. Anejaculation is the condition of being unable to ejaculate. Ejaculation is usually very pleasurable for men; dysejaculation is an ejaculation that is painful or uncomfortable. Retrograde ejaculation is the condition where semen travels backwards into the bladder rather than out of the urethra.

Ejaculatory duct obstruction (EDO) is a pathological condition which is characterized by the obstruction of one or both ejaculatory ducts. Thus, the efflux of semen is not possible. It can be congenital or acquired. It is a cause of male infertility and/or pelvic pain. Ejaculatory duct obstruction must not be confused with an obstruction of the vas deferens.

Vibroejaculation is a means of inducing ejaculation through vibration. It is used for semen collection, and in humans, the management of anejaculation.

<span class="mw-page-title-main">Sexuality after spinal cord injury</span> Aspect of human sexuality

Although spinal cord injury (SCI) often causes sexual dysfunction, many people with SCI are able to have satisfying sex lives. Physical limitations acquired from SCI affect sexual function and sexuality in broader areas, which in turn has important effects on quality of life. Damage to the spinal cord impairs its ability to transmit messages between the brain and parts of the body below the level of the lesion. This results in lost or reduced sensation and muscle motion, and affects orgasm, erection, ejaculation, and vaginal lubrication. More indirect causes of sexual dysfunction include pain, weakness, and side effects of medications. Psycho-social causes include depression and altered self-image. Many people with SCI have satisfying sex lives, and many experience sexual arousal and orgasm. People with SCI may employ a variety of adaptations to help carry on their sex lives healthily, by focusing on different areas of the body and types of sexual acts. Neural plasticity may account for increases in sensitivity in parts of the body that have not lost sensation, so people often find newly sensitive erotic areas of the skin in erogenous zones or near borders between areas of preserved and lost sensation.