The normal male ejaculation process involves many factors, including the complete anatomical structure and neurophysiological reflexes, and any lesion or malfunction in this process can cause ejaculation disorder. The man has normal sexual excitement and penile erection during sexual intercourse, the penis can be inserted into the vagina and can do the pumping piston movement, but never produce a rhythmic ejaculation action, no semen is ejected from the urethra. The excessive prolongation of intercourse caused by ejaculation makes it difficult for the patient to achieve orgasm, or even no orgasm, and often causes male infertility. The incidence of ejaculation varies greatly between domestic and foreign reports, and because the disease has little impact on the patient’s quality of life, relatively few people visit the clinic, and so far there is no authoritative epidemiological survey data, and the domestic and foreign literature reports vary greatly. 20.7%, idiopathic 5.4%, and diabetes mellitus caused 2.1%. In contrast, the domestic literature reports that patients with non-ejaculation are not uncommon in urology, male surgery and infertility specialties, with some reports stating that their prevalence accounts for 28% of male sexual dysfunction and 20% of those with male. This statistical discrepancy may be related to the different criteria for inclusion by the authors and the different proportions of patients concentrated in domestic and foreign specialties. I. Etiology and classification Most of the ejaculation disorders are functional, these people cannot ejaculate during sexual intercourse, most of them have intermittent nocturnal ejaculation, some are awakened when ejaculation occurs, and the fact that sleep triggers ejaculation indicates that the inability to ejaculate during sexual intercourse is psychological, which is the same as normal penile erectile function at night, while erectile dysfunction during waking supports “ED ” is psychogenic in the same way. Functional non-ejaculation often has psychological problems, such as anxiety, worry, etc., which are reflected in the following aspects: (1) misconceptions about sex such as “sexual intercourse is immoral,” “fear of pregnancy during intercourse” (1) misconceptions about sex, such as the belief that “sexual intercourse is immoral”, “fear of pregnancy”, “hostility to the spouse”, etc., harsh parenting from childhood, such as once being reprimanded and scolded by parents for abnormal contact, poor environment for sexual intercourse, anxiety caused by discord between husband and wife, etc., which causes inhibition of the ejaculation center and causes non-ejaculation. (2) Some people masturbate frequently and for a long time, resulting in an increase in the threshold of the ejaculation center, and some people adopt special masturbation methods, resulting in the inability to ejaculate due to the lack of feeling and interest in vaginal intercourse. (3) Penile lesions such as circumcision, penile nodules, short ties or perineal lesions such as chronic prostatitis cause pain in the penis during intercourse and interrupt intercourse, which can also lead to non-ejaculation in the long term. (4) The intensity of sexual stimulation is not strong enough to induce excitement in the ejaculatory center of the spinal cord. Men with short penises, women with loose vaginas, improper position during intercourse, incorrect posture, and even people who do not know how to have intercourse resulting in the penis not being fully inserted into the vagina can lead to non-ejaculation. The factors of organic ejaculation are more complicated, including congenital vas deficiency and accessory gonadal organs, spinal cord injury, retroperitoneal lymph node dissection, pelvic surgery, diabetes mellitus, congenital spina bifida, etc. are all possible causes. Among them, spinal cord injury (SCI) is the most common neurogenic ejaculation, and patients with SCI develop erectile and ejaculatory dysfunction. Patients with upper motor neuron (T9 and above) injury will have reflex erections and can even have short, indeterminate intravaginal intercourse, but will hardly have an ejaculatory reflex; sympathectomy, surgery on the abdominal aorta or around the abdominal aorta, retroperitoneal lymph node dissection, and surgery on the bladder and rectum in the pelvis can damage the sympathetic chain, inferior ventral nerve, postganglionic nerve fibers, and peripheral sympathetic nerves, thus affecting ejaculation and bladder neck closure, and patients may present with non-ejaculation or retrograde ejaculation. Nerve-preserving retroperitoneal lymph node dissection can maintain retrograde ejaculation, and key areas protected include the inferior mesenteric artery, the inferior ventral plexus in front of the abdominal aorta, and the postganglionic sympathetic trunk originating from T10-L2. Diabetes is often complicated by vasculopathy and neuropathy. We are all familiar with diabetes causing erectile dysfunction, but the effect on ejaculatory function is less known. Diabetes-induced changes in ejaculatory function in men manifest as progressive hyperejaculation. The cause is progressive autonomic neuropathy of the sympathetic nerves. The earliest symptoms are a decrease in the amount of ejaculated semen and partial or complete retrograde ejaculation until no ejaculation occurs. The control of diabetic blood glucose is directly related to the risk of complications. Congenital spinal anomalies such as spina bifida are also capable of impairing ejaculatory function, and occasionally people may present with lifelong non-ejaculation; these individuals are usually identified by abnormal development of the lower spinal cord. Other neuropathies that affect spinal cord function or sympathetic efferent function causing ejaculatory dysfunction include multiple sclerosis and transverse inertial myelitis. Drug-induced ejaculation will also be seen frequently, the most common being 5 hydroxychrome receptor recycling inhibitors and tricyclic antidepressants used to treat premature ejaculation, the most common problem with the application of these drugs is the absence of orgasm, which leads to non-ejaculation, another class of drugs are a-blockers such as tamsulosin and alfuzosin, although most cases of ejaculation dysfunction caused by these drugs are retrograde ejaculation, but non-ejaculation disorders can also occur. The degree to which the drug affects ejaculatory function is related to the dose of the drug and the length of time it is used. II. Clinical evaluation of ejaculation Most patients with ejaculation present for infertility, so the actual number of patients with ejaculation may be much greater than the number of patients seen. It is important to take a careful history and physical examination. Many patients confuse erectile dysfunction with ejaculation and are not clear about the nature of the dysfunction, which requires the physician to help the patient identify the problem through patient questioning. The medical history includes the duration of non-ejaculation, previous ejaculation, any sudden events during sexual intercourse, history of surgery, history of medication, etc. Detailed information on whether the patient has masturbated, any wrong thoughts or bad stimuli that affect sexual intercourse. A systematic review may then reveal previously undiagnosed underlying diseases. A careful physical examination determines the presence of external genital deformities such as hypospadias, prepuce, penile curvature, and whether the penis is short. If there are abnormal results, further examination is needed to determine the cause of the abnormal results. If the prolactin level is abnormally elevated with non-ejaculation, attention should be paid to the presence of pituitary tumors and a cranial CT examination is needed. Urine microscopy after sexual intercourse reveals sperm and large amounts of fructose as the cause of retrograde ejaculation. Ultrasound examination can be used to find out whether there is a deficiency of the prostate and seminal vesicle glands, and cystoscopy can reveal the condition of the seminal vesicles. Third, the treatment options for non-ejaculation The treatment of non-ejaculation must first identify the cause. The majority of patients with functional ejaculation can be cured by educating them about the basic process of sexual intercourse and ejaculation and abandoning their previous bad habits and wrong ideas. In contrast, for organic ejaculation, appropriate treatment methods need to be used according to the different underlying diseases. In patients without spinal cord injury (SCI), a-receptor agonists are used as the first choice because this is the only chance to provide natural conception. However, the success rate of a-receptor agonists to induce cis-ejaculation is disappointing, with some finding only a 12% success rate through meta-analysis, and the most commonly used drugs are promethazine, ephedrine and pseudoephedrine. Recently, milodrin was found to be significantly better than the above-mentioned conventional drugs in the treatment of ejaculation, so it has been included as the drug of choice for patients with non-spinal cord injury ejaculation, and although the overall reversal rate was satisfactory (61%), the rate of paracolic ejaculation remained low (18%). In non-spinal cord injury incontinence where retrograde or paracentral ejaculation cannot be obtained by pharmacological treatment, prostate massage, penile electrovocal stimulation (EVS), rectal electrical stimulation to induce ejaculation (EE), or even surgical methods to obtain sperm for artificial insemination or in vitro fertilization are options. Prostate massage is doubly popular because it is simple, has few side effects, and is inexpensive, but its reversal rate is less than ideal and further clinical studies are needed. For patients with spinal cord injury-induced ejaculation, the parasympathomimetic neostigmine and toxic lentil base have been used, and the effects of both drugs are comparable, because the side effects of neostigmine are large and rarely used, toxic lentil base also has potential side effects, the use of close monitoring, and even the use of some drugs in advance, so patients with spinal cord injury-induced ejaculation generally do not make drug therapy as the first choice, and penile vibration stimulation therapy The quality of semen obtained by penile vibrostimulation is better than that obtained by rectal electrical stimulation induced ejaculation therapy, so EVS is the first choice for patients with spinal cord injury incontinence.