Application of neurophysiological testing in the clinical evaluation of anejaculation

Anejaculation is primarily diagnosed based on subjective medical history, as objective assessment tools are lacking and its pathophysiological mechanisms remain unclear.

This study aimed to investigate the neurophysiological characteristics of patients with anejaculation in order to evaluate the clinical relevance of electrophysiological testing and to explore the underlying pathophysiological mechanisms.

Between January 2024 and January 2025, 82 participants underwent penile sympathetic skin response (PSSR), dorsal nerve somatosensory evoked potentials (DNSEP), and glans penis somatosensory evoked potentials (GPSEP) testing alongside validated questionnaires assessing ejaculatory function, ejaculation-related distress, anxiety, and depression.

The study compared neuroelectrophysiological parameters (including PSSR, DNSEP, and GPSEP latencies) and psychometric scores (assessing ejaculatory function, ejaculation-related distress, anxiety, and depression) between anejaculatory patients and healthy controls.

Based on the clinical symptom characteristics of patients with anejaculation, participants were stratified into three groups: anejaculatory patients unable to ejaculate during either vaginal intercourse or masturbation (Group A, n = 28), those retaining masturbatory but not vaginal ejaculation capacity (Group B, n = 22), and healthy controls (Group HC, n = 32). Neurophysiological and psychological assessments revealed distinct profiles: Compared to controls, Group A exhibited significantly prolonged latencies in PSSR (P < .05), DNSEP (P < .05), and GPSEP (P < .05), along with significant ejaculatory dysfunction and elevated scores for ejaculation-related distress, anxiety, and depression (P < .05). Group B similarly demonstrated extended PSSR latency (P < .05) and compromised ejaculatory performance with increased distress and depression (P < .05), though their DNSEP and GPSEP latencies and anxiety levels remained comparable to controls. Crucially, while Groups A and B showed equivalent PSSR parameters and comparable distress/depression severity, Group A displayed significantly longer DNSEP and GPSEP latencies (P < .05), worse ejaculatory performance (P < .05), and more pronounced anxiety (P < .05), suggesting a more extensive neurophysiological disorder in complete anejaculation cases.

This study applied electrophysiological testing in patients with anejaculation, supporting its potential value as an objective assessment tool and suggesting that impaired neural conduction may represent a possible underlying cause.

This study is among the few pioneering investigations that have applied electrophysiological testing in patients with anejaculation, demonstrating its clinical application value. However, due to the single-center design and relatively small sample size, the generalizability of the findings is limited, and further exploration of the underlying pathophysiological mechanisms is warranted.

Distinct neuroelectrophysiology abnormalities across anejaculation subtypes indicate different neural involvement patterns, supporting neurophysiological testing as an objective assessment tool and emphasizing the importance of integrated psychological evaluation.