Criteria and Causes of Delayed Ejaculation and Anejaculation

Diagnostic Criteria for Delayed Ejaculation and Anejaculation

Delayed ejaculation is characterized by a persistent delay, a marked infrequency, or the complete absence of seminal discharge during sexual activity with a partner.

Anejaculation, on the other hand, represents the most severe clinical manifestation of the disorder, defined by the total inability to ejaculate despite adequate erotic stimulation and a firm erection.

To establish an accurate clinical diagnosis, mental health classifications require that this dysfunctional pattern occur in approximately 75% to 100% of sexual encounters, persist for at least six months, and cause clinically significant distress.

Furthermore, it is essential to verify that the delay or absence of ejaculation is not intentionally sought by the man.

Proper eva luation of the case requires establishing a clear clinical distinction between anejaculation, retrograde ejaculation, and the phenomenon of male anhedonic anorgasmia within the current specialized field of sexology.

Organic and Pharmacological Etiology

In the differential diagnosis process, it is essential to thoroughly investigate medical and iatrogenic causes.

The organic dimension includes both central and peripheral neurological disorders, notably spinal cord injuries, multiple sclerosis, and diabetic neuropathy, all of which disrupt reflex-mediated nerve conduction in the seminal pathway.

Likewise, anatomical obstruction of the ejaculatory ducts, sequelae of pelvic or prostatic surgery, and endocrine imbalances—such as hypogonadism or thyroid disorders—inhibit the reflex. Furthermore, the pharmacological etiology shows an extremely high preva lence.

The medical prescription of psychotropic drugs—especially selective serotonin reuptake inhibitors, tricyclic antidepressants, and neuroleptics—exerts a neurochemical blockade on the spinal ejaculatory center.

Added to this is the negative impact of chronic alcohol consumption, addictive substances, and certain antihypertensive medications, which significantly impair male ejaculatory function during sexual intercourse.

Psychological and Relational Factors

Once physical causes have been ruled out, psychogenic and relational factors underlie the etiology of delayed ejaculation.

Of particular note is performance anxiety combined with the “spectator role”—a dynamic in which the man obsessively monitors his own erotic response, thereby blocking the sympathetic activation required for ejaculation.

A restrictive sexual upbringing, feelings of guilt, traumatic experiences, and the inability to focus on erotic fantasies during intercourse exert a strong influence.

At the systemic level of the couple, covert hostility, an unconscious fear of pregnancy or fatherhood, a loss of physical attraction, and profound deficits in interpersonal communication act as powerful psychological barriers.