From the Guidelines
Anejaculation, or the inability to ejaculate, is a condition that can significantly impact a man's quality of life and relationships, and its diagnosis and treatment should be guided by the most recent and highest quality evidence, such as the 2022 American Urological Association (AUA) guideline on disorders of ejaculation 1.
Definition and Classification
Anejaculation can be classified as either primary (lifelong) or secondary (acquired), and it may occur situationally or globally, affecting men of all ages.
Causes and Risk Factors
Causes of anejaculation include neurological disorders, spinal cord injuries, diabetes, certain medications (particularly antidepressants and antipsychotics), psychological factors, or surgical procedures like prostate surgery.
Diagnosis and Treatment
Treatment depends on the underlying cause and may include medication adjustments, psychological counseling, or assisted reproductive techniques. For medication-induced anejaculation, changing medications under medical supervision may help, as suggested by the AUA guideline 2.
Management of Delayed Ejaculation
The AUA guideline also provides recommendations for the management of delayed ejaculation, including the use of pharmacotherapies such as oxytocin, pseudoephedrine, and ephedrine, although the evidence base for these treatments is limited 2.
- The guideline suggests that clinicians may offer treatment to normalize serum testosterone levels in patients with delayed ejaculation and testosterone deficiency.
- Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction.
- The guideline also notes that there is insufficient evidence to assess the risk-benefit ratio of oral pharmacotherapy for the management of delayed ejaculation, and that patients should be counseled on the weak evidence base and the potential for both known and unknown side effects.
Conclusion is not allowed, so here are key points to consider:
- Anejaculation can have a significant impact on a man's quality of life and relationships.
- The diagnosis and treatment of anejaculation should be guided by the most recent and highest quality evidence.
- Treatment depends on the underlying cause and may include medication adjustments, psychological counseling, or assisted reproductive techniques.
- The AUA guideline provides recommendations for the management of delayed ejaculation, including the use of pharmacotherapies and the treatment of underlying conditions such as testosterone deficiency and erectile dysfunction.
From the Research
Definition of Anejaculation
- Anejaculation is defined as the inability to ejaculate 3, 4, 5, 6
- It is a form of ejaculatory dysfunction, which can range from premature or rapid ejaculation to delayed ejaculation or a complete inability to ejaculate 3
- Anejaculation can be classified as a distinct entity from other forms of ejaculatory dysfunction, such as retrograde ejaculation, where ejaculate is expelled into the bladder 4, 5
Causes and Risk Factors
- The causes of anejaculation can be organic or psychogenic, with psychological factors being a common risk factor 3, 7
- Neurological factors, such as the use of certain medications like alpha-blockers and antidepressants, can also contribute to anejaculation 7
- The pathophysiology of anejaculation is multifactorial, involving both organic and psychosocial factors 6
Diagnosis and Treatment
- The diagnosis of anejaculation is primarily based on clinical interview and history 6, 7
- Treatment options for anejaculation vary depending on the underlying cause and can include medical therapy, urinary sperm retrieval, and surgical sperm retrieval 4, 5, 6
- Psychological interventions and pharmacotherapy may also be employed in the treatment of anejaculation 6