In-depth Guide to Anejaculation: Functional and Organic Classifications, Diagnostic Criteria, and Physical Therapy System

Normally, men ejaculate upon reaching orgasm, with semen being ejected from the urethra. However, if a man can maintain an erection for a certain period during intercourse but fails to achieve orgasm, ejaculate, or expel semen, and the urine test after intercourse shows no sperm or fructose, this abnormal phenomenon is medically termed "anejaculation" or "ejaculatory inability." Anejaculation can be classified into functional and organic types. Functional anejaculation accounts for approximately 90% of cases. 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 does not 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. Sometimes masturbation can also lead to ejaculation. Most cases end with penile flaccidity after a certain period of intercourse, while some men maintain an erection until exhaustion without ejaculation. The traditional Eastern cultural belief in the preciousness of semen is a significant factor contributing to the relatively high number of anejaculation patients in my country. Men in my country and other Southeast Asian countries often regard semen as the "essence of life" and "vital energy," with the saying "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 patients with ejaculatory dysfunction; "when the semen is full, it overflows." However, patients attempt to "store" their semen by further reducing ejaculation, consciously or unconsciously controlling ejaculation or reducing sexual activity in hopes of longevity, which only exacerbates the problem. Functional ejaculatory dysfunction 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 stress can also lead to ejaculatory dysfunction. Organic ejaculatory dysfunction accounts for about 10% of all cases. The inability to ejaculate under any circumstances, whether awake or asleep, is often caused by various diseases, including neurological factors, metabolic factors (diabetes), endocrine disorders, drug-related factors, and rare congenital factors. It's important to note that frequent sexual activity or decreased ejaculatory ability in individuals over 50 years of age does not fall under the category of "anejaculation." The diagnostic criteria for anejaculation are absence of sexual orgasm, absence of ejaculatory action, and absence of semen discharge. Clinically, it manifests as the "three yeses" and "three noes" during sexual activity: sexual arousal, penile erection, and sufficient intercourse time, but no orgasm, no ejaculatory action, and no semen discharge. For approximately 90% of functional anejaculation cases, prevention is more important than treatment. By vigorously promoting premarital sex education, popularizing sexual knowledge, and eliminating mystique, various undesirable psychogenic sexual dysfunctions among young people can be prevented, and anejaculation can be cured without any medication. Secondly, electric massage can be used. Under the guidance of a doctor, using an electric massager to stimulate sensitive areas such as the glans and frenulum can often induce ejaculation with good results. In addition, circumcision, quitting smoking and alcohol, and improving the living environment can also help with treatment. For patients who are temporarily unable to be cured but are eager to conceive, masturbation or collecting semen during nocturnal emission and injecting it into the vagina can sometimes lead to an unexpected cure as the woman becomes pregnant and the mental stress gradually disappears. Functional ejaculatory dysfunction can be cured by using effective methods of sexual intercourse. When the husband experiences ejaculatory dysfunction, the wife's cooperation, care, and understanding are very important, helping him relax and eliminating the psychological pressure during intercourse. To increase sexual stimulation, the wife can actively use the "sensory concentration method" before intercourse, gently caressing the husband to arouse his sexual excitement. When the husband feels he is about to ejaculate, the wife should quickly adopt the female-superior position for intercourse. If the husband still cannot ejaculate within a short time, the wife should stop intercourse and continue to stimulate the penis with her hand, practicing repeatedly. Generally, this will result in ejaculation inside the vagina.