Male health: Analysis of the causes, classification, diagnosis, and home rehabilitation exercise programs for anejaculation and nocturnal emission

Anejaculation

Anejaculation refers to the absence of semen expelled from the penis and urethra during intercourse. The main causes of anejaculation include functional anejaculation, retrograde ejaculation, and semen production disorders.

1. Functional Anejaculation. These patients often lack sexual knowledge and understanding of the entire sexual process. During intercourse, the nerve endings in the glans penis do not receive sufficient sexual stimulation, failing to excite the spinal ejaculation center, resulting in the inability to ejaculate. However, they may experience nocturnal emissions during sleep.

We have encountered several male infertility patients in our outpatient clinic who had been married for many years without conceiving. Upon careful questioning, we learned that these patients had never ejaculated vaginally during their sexual activity, but they experienced nocturnal emissions. Each time they intercourse, after inserting the penis into the vagina, they remained still until the penis became flaccid, ending the sexual activity without ejaculation. After receiving guidance and being recommended to read relevant sexual knowledge materials, they quickly mastered the techniques of sexual intercourse and soon became pregnant. Some patients experience low frequency of penile thrusting during intercourse, resulting in insufficient stimulation of the glans penis to reach the threshold required for ejaculation. Just like striking a match, a certain amount of force and speed are needed; otherwise, simply rubbing the match against the box won't light it. The reasons for low frequency may include:

① Lack of sexual knowledge, not understanding the relationship between local stimulation intensity and ejaculation.

② The female partner is tense during intercourse, experiencing pain or discomfort at the vaginal opening, which limits the male's thrusting frequency.

③ Inappropriate intercourse positions, leading to male fatigue and affecting the speed and frequency of thrusting.

2. Retrograde ejaculation. Retrograde ejaculation occurs due to impaired closure of the bladder neck. The patient can achieve orgasm and experience the pleasure of ejaculation during intercourse, but no semen is expelled from the urethra. A urinalysis immediately after intercourse will reveal a large number of sperm in the urine, which is an important diagnostic criterion for retrograde ejaculation. The main causes of bladder neck closure dysfunction are local nerve damage or congenital dysfunction of the internal bladder sphincter, such as congenital wide bladder neck, damage to local smooth muscle and sphincter caused by various bladder neck surgeries, spinal cord injury and diabetic neurogenic bladder, traumatic urethral stricture or congenital urethral stricture, and long-term difficulty in urination leading to decreased bladder neck tension. In addition, sometimes taking α-receptor blockers can also cause weakness of local smooth muscle and sphincter contraction, resulting in retrograde ejaculation, such as reserpine, guanethidine, and terbutaline.

3. Sperm production disorders. This is an important cause of ejaculatory dysfunction in some patients. These patients often have endocrine system disorders, primary or secondary gonadal dysfunction, congenital testicular hypoplasia, and bilateral cryptorchidism that has not been treated in time, leading to loss of testicular spermatogenesis. Sometimes, certain oral medications (such as estrogen) can also inhibit testicular spermatogenesis. Without sperm and semen, there is no sperm to ejaculate during intercourse.

Treatment for ejaculatory disorders requires different methods depending on the cause; a one-size-fits-all approach is not appropriate. Therefore, patients should ideally visit a specialized hospital for examination to determine the cause and receive targeted treatment. Never trust quack doctors or so-called "traditional remedies," as this can cause physical and mental distress and financial loss.

Nocturnal Ejaculation

Nocturnal emission refers to ejaculation that occurs without sexual intercourse. This phenomenon often occurs during sleep and is also known as wet dreams. Nocturnal emission is an important marker of male puberty development, marking the gradual transition from adolescence to adulthood and sexual maturity. Approximately 80% of men experience nocturnal emission from puberty until marriage, making it a common physiological phenomenon after male puberty. An adult male ejaculates approximately 3-5 ml of semen each time, of which over 95% is seminal plasma. The main component of seminal plasma is water, while other components are continuously replenished from the body's metabolic pathways through dietary intake. Some observations suggest that in healthy men with a normal diet and sufficient nutrition, seminal plasma is usually replenished within 2-3 days after ejaculation. However, sperm count recovery takes longer. This is because it takes about 80 days for a spermatogonium to develop into a mature sperm after several divisions. Frequent ejaculation may cause a temporary decrease in sperm count, but this usually returns to normal after one spermatogenesis cycle.

Why does nocturnal emission occur? During puberty, the reproductive system gradually matures. Accessory organs such as the testes, seminal vesicles, and prostate constantly produce semen. When the amount of semen stored in the epididymis reaches a certain level, it can be involuntarily ejaculated under appropriate sexual stimulation. Sleeping on your back with a heavy blanket, tight underwear, or smegma buildup due to phimosis can all trigger nocturnal emissions. Some say nocturnal emission is a form of excretion without sexual intercourse, but it's essentially a matter of "overflowing when full." Therefore, there's no need to worry or fear about nocturnal emissions.

The frequency and amount of nocturnal emissions can vary greatly. Some healthy men may never experience nocturnal emissions in their lives, while others may experience them frequently. How often is considered normal for nocturnal emissions? Due to significant individual differences, it's difficult to establish a precise standard. Some say once a week is ideal, while others consider once every two weeks normal. Generally, the frequency is considered best calculated monthly, typically around 4-8 times per month, but the distribution is uneven, sometimes more, sometimes less. The amount of semen in each nocturnal emission is related to the interval between emissions; shorter intervals result in less semen, and longer intervals in more semen. Some male teenagers misunderstand nocturnal emission as a normal physiological phenomenon, believing it to be a pathological condition that severely depletes their "vital energy," and that excessive loss of semen is harmful to the body.

Each instance of nocturnal emission leads to significant anxiety and psychological stress, which, over time, can result in serious psychogenic illnesses such as neurasthenia and psychogenic sexual dysfunction. These illnesses are not caused by the nocturnal emission itself, but by an abnormal psychological state. Therefore, it is important to have a correct understanding of nocturnal emission and not carry a heavy mental burden.

Some cases of nocturnal emission are caused by pathological reasons, such as leukemia or certain diseases of the genitals (phimosis, redundant foreskin, urethritis, prostatitis, etc.). Therefore, patients experiencing excessively frequent nocturnal emissions in a short period should consult a specialist to determine the cause and receive targeted treatment. They should never believe in quack doctors or blindly use medication; self-training methods can be used to treat nocturnal emission.

Furthermore, some men mistakenly believe that the small amount of viscous fluid that flows from the urethra during sexual arousal, penile erection, or defecation is nocturnal emission. This is not nocturnal emission; it is a viscous fluid secreted by the urethral glands and prostate gland. A small amount of this secretion normally remains in the urethra, and when the urethra is compressed by the erect penis or rectal contents, it flows out from the urethral opening. This is a normal physiological process and should not be mistaken for nocturnal emission, which is a serious pathological condition.

Introduced by Dr. He Shoukang and Dr. Li Meidi of the Shanghai Municipal Traditional Chinese Medicine Clinic, Mr. Chen Yingfu, President of the Beijing Taoist Association, teaches a simple and easy-to-follow exercise method that, if consistently practiced, can effectively treat nocturnal emission and premature ejaculation. The method is as follows:

Use a hard bed with one end higher than the other, a difference of about 6-7 inches. Place a slightly thick mattress (or blanket) on the bed, ensuring warmth and comfort. The patient sits on the bed, facing the lower end. Stand with your legs straight, toes pointing upwards. Keep your upper body upright, palms resting on your knees. Then, repeat the following three movements in sequence:

Lightly clench your fists, slowly retract your arms, extending your elbows as far behind you as possible, forearms close to your sides.

Release your fists, palms facing upwards, and lift them straight up from the sides of your head, as if lifting a heavy object, extending your arms as straight as possible, backs of your hands facing down, eyes looking up at the backs of your hands.

Gradually lower your head, bend at the waist, and extend your arms forward and downwards, so that your fingertips reach towards your toes.

Then return to the original position, hands still resting on your knees. These three movements combined count as one repetition. Begin by doing 10 repetitions each time, twice a day. Do the first repetition upon waking in the morning, and the second before going to bed. Starting the second day, increase by one repetition each time, until after two months, you can increase to 60-70 repetitions each time. For those with poor physical strength, lower the requirements and do fewer repetitions. Don't force yourself or feel too tired. Gradually aim for at least 30 repetitions per session. The movements should be slow, gentle, and natural; avoid excessive force.

During the exercise, pay attention to the following:

① When bending forward: When reaching your hands towards your toes, keep your legs straight, not bent. Initially, your fingers and toes may not touch, but this is okay; just keep trying.

② When bending forward: When reaching your hands towards your toes, you will feel a slight soreness in your lower back and legs, a tightening sensation in your scrotum (testicles) and anus, and friction between your perineum and the bed. This is key to achieving results.

③ Exercise requires determination, patience, and perseverance. Don't give up due to difficulty (in reality, it's not difficult; it just requires determination and patience). After finishing, rest in bed for 10-20 minutes; if you can sit quietly, you can sit for 20-30 minutes for even faster results.