Anejaculation: Causes, TCM Dietary Therapy, and Treatment

There is sexual desire, and the penis can achieve erection and engage in sexual intercourse, but ejaculation does not occur. This condition is known as anejaculation, or “ejaculatory difficulty,” or “ejaculatory wellness.” During sexual intercourse, although the penis remains firm, the patient does not reach orgasm and thus does not ejaculate. However, the patient may often experience nocturnal emissions at other times or can achieve ejaculation through masturbatory stimulation; yet, there are also patients who cannot induce ejaculation by any means.

I. Causes of Anejaculation

1.Organic causes

Congenital malformations of the urogenital organs helps maintain the ejaculation of semen; or spinal cord injuries below the ninth thoracic vertebra, caused by other wellness or trauma, render the reflex arc non-functional, resulting in the inability to ejaculate even with penile erection.

2. Drug-induced causes

Patients with hypertension who take antihypertensive drugs such as guanethidine and reserpine, as well as sedatives, over a long period may also experience effects on the sympathetic nervous system’s regulation of sexual function, which can impede ejaculation and lead to ejaculatory difficulties.

3. Central causes

Due to abnormal brain function, the inhibitory effect on sexual arousal is heightened, particularly the inhibitory effect on the ejaculation center, which can lead to the absence of sexual orgasm and ejaculation in patients. A small number of patients may also experience anejaculation due to visual, auditory, tactile, emotional, or cognitive impairments. Sometimes, dysfunction of the spinal ejaculatory center can also result in ejaculatory wellness and anejaculation.

4. Psychological factors

Having suffered psychological trauma, such as being influenced by feudal superstitious beliefs in childhood and viewing sex as something base and sinful; having hostile and dissatisfied feelings towards one’s wife; or being afraid that ejaculation will harm the body; or having had a bad habit of masturbation and considering masturbation as a serious hazard to one’s own body; or having engaged in long-term masturbation, being accustomed to using intense stimulation to achieve ejaculation, while the stimulation intensity of normal sexual activity cannot reach that of masturbation, etc.

5.Insufficient sexual knowledge

The vast majority of patients with anejaculation are newlyweds who, due to a lack of sexual knowledge, do not know that during sexual intercourse, the penis requires sustained, rapid, and large-amplitude friction within the vagina; or they may adopt incorrect sexual positions; or they may be unaware that ejaculation occurs during sexual intercourse; or they may experience a sensation of needing to urinate during the process of sexual intercourse.

In addition, the speed of ejaculation is related to the length of the interval between two sexual intercourses. The longer the interval between two sexual intercourses, the faster the ejaculation; the shorter the interval, the slower the ejaculation, and even delayed ejaculation or ejaculatory difficulty may occur. If sexual intercourse is too frequent or continuous, it can not only empty the stored semen but also shift the ejaculation center from excitation to inhibition, leading to the inability to ejaculate. Some newlywed couples who have sexual intercourse several times in one night may eventually experience ejaculatory difficulty, which is a common phenomenon.

6. TCM Understanding of the Causes of Anejaculation

In traditional Chinese medicine, anejaculation is referred to as “qiangzhong” (persistent erection), “yangshi bu dao” (persistent penile erection), “yin zong” (unrestrained penis), “jin shan” (scrotal strangury with tendon involvement), etc. The main causes and pathogenesis are as follows: (1) Kidney Yin Deficiency: Excessive sexual activity, overindulgence in lust, or bad habits such as masturbation lead to the depletion of Kidney yin. Yin Deficiency results in yang hyperactivity, which in turn leads to hypersexuality and persistent erection. Yin Deficiency also helps maintain the nourishment of the Heart from the Kidney, disrupting the harmony between the Heart and Kidney and leaving the spermatic gate closed, thus resulting in sexual intercourse without ejaculation. (2) Disharmony of the seven emotions: Emotional imbalance, such as repressed anger damaging the Liver, or dysfunction of the zang-fu organs leading to Liver Qi Stagnation. Over time, this stagnation transforms into fire, with the Liver fire and Heart fire flaring up together, disrupting the regulation of the spermatic gate and causing anejaculation. (3) Kidney yang deficiency: Congenital yang deficiency or inadequate endowment; or excessive depletion leading to a decline in Kidney yang. Insufficient Kidney yang results in the inability to expel semen, thus causing anejaculation. (4) Insufficient nourishment source leading to scanty semen and no ejaculation: Overexertion of the mind and overstrain of the spirit affect the Heart and then the Spleen, leading to Spleen dysfunction and a lack of qi and blood production. Insufficient qi and blood result in scanty semen and no ejaculation.

II. Syndrome Differentiation and Dietary Therapy

1.Yin Deficiency with essence depletion and unrestrained ministerial fire

The balance of yin and yang in the human body is of utmost importance. Excessive sexual desire and over loss of essence can result in Yin Deficiency and yang hyperactivity. Yang hyperactivity leads to hypersexuality, while Yin Deficiency fails to nourish the Heart fire, causing disharmony between the Heart and Kidneys. The essence gate remains closed, resulting in an inability to ejaculate. Due to the excessive ministerial fire, it is also accompanied by signs of imbalance such as nocturnal emission with dream-disturbed sleep, restlessness, insomnia, irritability, dry mouth, red tongue, and a thin, rapid, and wiry pulse. supports should focus on nourishing yin and marrow and strengthening water to subdue fire. It is advisable to consume Pig’s Trotters Stewed with Scallion.

Formula and Preparation Method: 4 pig’s trotters, 10 grams of Impatiens balsamina L. (garden balsam), 50 grams of green onions. First, clean the pig’s trotters and make incisions with a knife, then place them in a pot; wrap the Impatiens balsamina L. in a cloth and also place it in the pot. Then add green onions and an appropriate amount of salt, add water, first boil it over high heat until it comes to a boil, and then stew it over low heat until it is thoroughly cooked. When serving, remove the Impatiens balsamina L., eat the trotters and drink the soup in portions, or consume it as a side dish with meals.

In the formula, pig’s trotters, also known as pig’s feet, are rich in nutrients and have a delightful aroma. They nourish yin fluid and are suitable for conditions such as Kidney Yin Deficiency, inability to ejaculate, low semen volume, and male infertility. Impatiens seed, the seed of the garden balsam, has an extremely rapid action. The ancients described it as having the property of “penetrating bones and flesh,” and when added, it can significantly enhance the therapeutic effect.

One can also consume steamed turtle meat. Recipe and preparation method: 1 turtle (500 grams), 10 grams of Cordyceps sinensis, 10 red dates, an appropriate amount of cooking wine, refined salt, monosodium glutamate, green onions, ginger slices, garlic, and clear chicken broth. First, cut the slaughtered turtle into 4 pieces, put them into a pot and boil, then take them out, cut open the limbs, remove the leg fat, and wash them clean. Wash the Cordyceps sinensis and soak the red dates in boiling water. Place the turtle in a soup bowl, put Cordyceps sinensis and red dates on top, add cooking wine, salt, monosodium glutamate, green onions, ginger, garlic, and chicken broth, then steam in a steamer for 2 hours. Take it out and remove the green onions and ginger. It can be consumed at will or served as an accompaniment to meals.

In the formula, turtle meat nourishes yin and cools blood. According to Suixi Residential Dietetic Canon, it “nourishes yin of the Liver and Kidney and clears heat from consumptive wellness.” Cordyceps nourishes yin and benefits the Kidney. Jujube replenishes qi, generates body fluids, and nourishes blood. The entire formula focuses on nourishing yin and reducing fire, while also replenishing qi and nourishing blood. It can be used for conditions such as non-ejaculation caused by excessive sexual activity and excessive loss of semen, as well as Yin Deficiency with yang hyperactivity, and also for conditions in men such as low semen volume and infertility.

In addition, one can also choose food therapy recipes that nourish yin and replenish essence for consumption.

2.Liver Qi Stagnation transforming into fire, with excessive Heart fire

Poor marital relationship or lingering attachment to a former lover can lead to depression and emotional imbalance; or hostility towards the spouse, suspicion of the wife’s infidelity, resulting in resentment and anger that injures the Liver; or dysfunction of the visceral organs leading to Liver Qi Stagnation; prolonged stagnation transforms into fire, with wood and fire mutually fanning each other, causing excessive Heart fire and hyperactivity of both the monarch and minister fire, which results in disordered opening and closing of the spermatic gate and inability to ejaculate. Since fire rises upward, heat disturbs the spirit.

Formula and Preparation Method: Flos Mume 6g, Fructus Citri Sarcodactylis 10g, Flos Chrysanthemi 6g, Radix Glycyrrhizae Uraensis (Raw) 3g, Herba Lophatheri 1g. Steep with boiling water, then add an appropriate amount of white sugar or honey and serve as tea.

In the formula, Armeniacae Mume Sinensis Flos (Lü’emei) and Citri Sarcodactylis Fructus (Foshou) soothe the Liver, regulate qi, and helps with occasional depression. Chrysanthemi Flos (Juhua) dispels Liver fire. Lophatheri Herba (Zhuye) and Glycyrrhizae Radix et Rhizoma (Shenggancao) guide the fire downward through the urine by clearing the Heart according to the Daochi Decoction principle. The entire formula works together to purge Liver fire and clear the Heart to open the orifices.

One can also consume lotus seed and pig Heart soup. Recipe and preparation method: Take 15 grams of roasted Cassia tora seeds and 15 grams of Impatiens balsamina seeds, decoct them to obtain the juice. Add 1 whole pig Heart (sliced) and 100 grams of lotus seeds (with the cores) into the decoction, cook together to make a soup, and season with a small amount of salt and lard before consumption.

In the formula, Cassiae Semen (Jue Ming Zi) and Nelumbinis Semen (Lian Zi) can clear Liver fire, while Pig Heart nourishes blood and calms the mind, using the Heart to tonify the Heart, and additionally, Impatientis Semen (Ji Xing Zi) is added for rapid effect.

3.Deficiency of Kidney yang

Individuals with inherent yang deficiency or those who have not fully recovered after wellness and engage in unrestrained sexual activity may suffer from insufficient primordial yang in the Kidneys. Although the penis can achieve erection, the lack of qi transformation and impaired sexual function result in the inability to open the spermatic gate and ejaculate. This condition is often accompanied by decreased libido, dizziness, fatigue, lack of energy, a dull complexion, soreness and weakness in the lower back and knees, a sensation of cold below the waist, a pale tongue with a white coating, and a deep, thin or weak pulse. The supports should focus on warming the Kidneys and boosting yang, and one can consume sparrow meat patties.

Formula and Preparation Method: 10 grams of sparrow, 120 grams of lean pork. First, remove the head, feet, feathers, and internal organs of the sparrow. Wash the pork and chop it until it is half minced, then add the sparrow meat and chop together into a paste. Mix with an appropriate amount of soy sauce, sugar, cooking wine, and green onion to form a meat filling. Then, mix flour with water to make a pie crust, wrap the filling to form pies, brush with oil, place in a baking pan, and bake until the surface is golden brown and thoroughly cooked. Can be consumed as desired.

In the formula, sparrow meat can tonify yang and benefit the Kidneys, warm the lumbar region and knees, while pork nourishes yin and moistens dryness to helps maintain excessive warmth. The combination of the two has the marvelous effect of replenishing both yin and yang.

One can also consume stewed fat pigeon with cinnamon. Formula and preparation method: 2 grams of cinnamon, 5 grams of Impatiens balsamina L. (common name: garden balsam), and 1 fat pigeon. First, slaughter the fat pigeon, remove its feathers and internal organs, and wash it clean. Wrap the cinnamon and Impatiens balsamina L. in gauze. Put both into a stewing pot, add an appropriate amount of clean water, cover tightly, and stew over water until cooked. Remove the cinnamon and Impatiens balsamina L., drink the soup and eat the pigeon. Take it every other day, for 10 to 20 consecutive times.

In the formula, cinnamon bark (Cortex Cinnamomi) warms and tonifies Kidney yang, impatient powder (Semen Impatientis) can promote sperm ejaculation, and fat pigeon is considered to have aphrodisiac properties and nourish essence and blood. Therefore, it can be used to supports signs of imbalance such as low libido, sparse sperm, and difficulty in ejaculation.

In addition, any diet therapy prescriptions for warming the Kidney and strengthening yang can be selected.

4.Deficiency of Heart and Spleen, and depletion of Kidney essence

The Spleen is the foundation of acquired constitution and the source of qi and blood production. Spleen deficiency leads to insufficient essence and blood. Therefore, although the penis can achieve erection, ejaculation cannot occur due to the scarcity of essence. Spleen deficiency disrupts the normal transportation and transformation functions, and blood deficiency fails to nourish the Heart. Consequently, patients often present with signs of imbalance such as poor appetite, soreness in the waist, palpitations, insomnia, excessive dreaming, a pale tongue with a thin white coating, and a weak pulse. The supports should focus on invigorating the Spleen and replenishing qi, nourishing the Heart and replenishing essence; Longyan Dazao Decoction can be administered.

Formula and Preparation Method: 10 grams of Impatiens (Impatiens balsamina L., touch-me-not), 25 grams of Longan Aril (Dimocarpus longan Lour., longan pulp), 250 grams of Jujube (Ziziphus jujuba Mill., Chinese date). Place all ingredients in a pot, add an appropriate amount of water, and simmer over low heat. Then, remove the Impatiens and consume the Longan Aril and Jujube. Divide into three servings and finish them all. This can be taken continuously for 5 to 6 doses.

In the formula, jujube (Ziziphi Jujubae Fructus) strengthens the Spleen and replenishes qi, longan flesh (Arillus Longan) nourishes the Heart, replenishes essence, and calms the mind, combined with impatient powder (Impatientis Semen) to penetrate bones and open orifices. Therefore, after taking it, the Spleen can be strengthened, blood can be enriched, and essence can be generated, and only when essence is generated can it be discharged.

Patients with relatively severe signs of imbalance can take Weibu Decoction. Formula and preparation method: sea cucumber, edible bird’s nest, lean pork, and eel in equal parts. First, grind the above ingredients into coarse powder, add water and boil, or add one fresh placenta and boil until extremely soft. Take the juice for drinking, and it can be consumed freely.

In the formula, sea cucumber replenishes the Kidney and benefits essence, and can supports scrotal dampness and coldness, and sperm deficiency. Bird’s nest contains collagen, protein, calcium, phosphorus, potassium, etc. It is an excellent tonic that can invigorate yang, replenish qi, and enrich essence and marrow. Eel contains protein and vitamin A. Therefore, this formula is applicable to signs of imbalance such as malnutrition, impotence, inability to ejaculate, thin semen, and sperm deficiency.

In addition, any diet therapy prescriptions that can replenish qi and nourish blood can be selected.

5.Blood stasis obstruction

Over a long period, all the above syndromes can lead to the accumulation of stagnant essence and blood stasis, blocking the spermatic duct, causing pain in the genital area and helps maintain ejaculation. Patients often exhibit signs of imbalance such as being taciturn yet irritable, experiencing chest oppression and discomfort, having a purple tongue or tongue with petechiae, a thin tongue coating, and a deep and astringent pulse. The supports should focus on promoting blood circulation to remove blood stasis while also replenishing Kidney qi. Patients can take Meigui Shanzha Niuxi Wine.

Formula and Preparation Method: 15 grams of Rosa rugosa flower (Meiguihua), 30 grams of Crataegus pinnatifida fruit (Shanzha), 15 grams of Cyathula officinalis root (Chuan Niuxi). Add 500 milliliters of wine and an appropriate amount of rock candy. Soak for one week, shaking once daily. After seven days, take it every night before bedtime.

In the formula, Flos Rosae Rugosae (Meiguihua) promotes blood circulation to remove blood stasis and regulates qi to soothe the Liver; Fructus Crataegi (Shanzha) promotes blood circulation to remove blood stasis; wine unblocks the blood vessels; Radix Achyranthis Bidentatae (Niuxi) enables the blood vessels to be connected from top to bottom. Therefore, the combination of these herbs can achieve the effect of removing blood stasis and unblocking the channels.

Those who cannot consume alcohol may take Peach Kernel Porridge instead. Formula and Preparation Method: Take 10 grams of peach kernels (with peels and tips removed) and decoct them together with 10 grams of cnidium fruit. Strain the decoction to remove the dregs, then add 100 grams of japonica rice to cook into porridge. After the porridge is cooked, add 2 grams of cassia twig powder and 50 grams of brown sugar. Consume it in the morning and afternoon.

In the formula, peach seed (Tao Ren) and brown sugar can activate blood circulation and resolve blood stasis; cassia twig (Gui Xin) can warm and unblock the blood vessels to helps with occasional pain; supplemented by cnidium fruit (She Chuang Zi) to warm the Kidney and strengthen yang, and revitalize the yang pathway. Therefore, taking it can transform the stagnant semen and unblock the seminal pathways.

III. Other Therapies

1.Sensate focus technique

During sexual intercourse, encourage the female partner to intentionally stimulate the penis in a needed manner. The male partner instructs her on the timing, pressure, and types of stimulating activities that can induce sexual arousal. The first step is to have the female partner stimulate the penis manually to induce ejaculation. This involves engaging in sexual activity with the female partner on top. Initially, the female partner stimulates the penis manually to bring the male partner to a high level of sexual arousal. When the male partner feels close to ejaculation, the female partner quickly inserts the penis into the vagina while continuing the stimulation. Often, a single successful ejaculation inside the vagina can permanently alter this dysfunction. In some cases, after repeated attempts, ejaculation inside the vagina still does not occur. In such instances, the female partner should use manual stimulation to make the male partner ejaculate, adopting a position that allows the semen to be ejaculated onto the female partner’s external genitalia. When the male partner sees his semen in contact with the female partner’s genitalia and feels euphoria, it will subsequently become easier to induce ejaculation inside the vagina.

2. External folk and proven recipe: Take 0.3 grams of musk and apply it to the umbilicus to open the orifices.