Anejaculation

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Anejaculation is the pathological inability to ejaculate in males, with (orgasmic) or without (anorgasmic) orgasm.

Causes[edit]

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

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

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 man 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[edit]

Anejaculation in spinal cord injury[edit]

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 glans penis to stimulate it by vibration. In case of failure with PVS, spermatozoa are sometimes collected by electroejaculation, or surgically by per cutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE).[2]

Notes[edit]

  1. ^ [1] (Italian) and [2] (Italian)
  2. ^ a b c 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.  edit