The association between ejaculatory dysfunction and lumbosacral disorders: a systematic review of an underrecognized clinical link.

INTRODUCTION

Lumbosacral disorders commonly cause neurological symptoms such as low back pain and radiculopathy, their contribution to ejaculatory dysfunction (EjD) remains underrecognized.

OBJECTIVES

To summarize neuroanatomical and neurophysiological mechanisms linking the lumbosacral spine to ejaculation, synthesize clinical evidence of EjD in lumbosacral disorders, identify diagnostic challenges, and discuss implications for clinical evaluation and multidisciplinary management.

METHODS

A comprehensive literature search was performed in PubMed, Web of Science, Embase, and Scopus from inception to December 31, 2025, using keywords covering lumbosacral pathologies and ejaculation. Eligible studies reported original clinical data on males with confirmed lumbosacral disorders and documented ejaculatory outcomes. Observational studies and case reports were included; reviews, guidelines, conference abstracts, and non-human studies were excluded.

RESULT: Twenty-four studies met the inclusion criteria. EjD was associated with lumbar disc herniation, cauda equina syndrome, lumbar spinal stenosis, Tarlov cysts, spina bifida, ankylosing spondylitis, and pudendal nerve entrapment. EjD phenotypes included premature ejaculation, delayed ejaculation, anejaculation, retrograde ejaculation, weak ejaculation, and anorgasmia. Lumbosacral lesions may impair ejaculation by disrupting afferent, sympathetic (T10-L2), or somatic pudendal pathways (S2-S4). Ejaculatory function often improved after treating the underlying spinal disorder. However, evidence was limited by small sample sizes, heterogeneous outcomes, and low-level study designs.

CONCLUSION

Lumbosacral disorders represent a potentially underrecognized cause of EjD. While a clear causal link between specific pathologies and EjD phenotypes remains unproven, neuroanatomical plausibility and clinical observations support a meaningful association in selected patients. Increased clinical awareness and multidisciplinary evaluation can improve diagnosis and management, especially in patients with concurrent lumbosacral or neurological symptoms. Future prospective studies with standardized tools are needed to clarify mechanisms and identify subgroups likely to benefit from targeted interventions.This study was registered in PROSPERO: CRD420261372301.