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Ejaculatory Dysfunction and Vasodynamics

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Male Infertility

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Abstract

Ejaculation is a complex biological event. It is based on a simple spinal reflex that is modulated by anatomical, cerebral, and learned behavioral events. As a consequence of these varied inputs, disordered ejaculation occurs and is divided into early, delayed, retrograde, and anejaculation. In addition, congenital and acquired causes of abnormal ejaculation include spinal cord injury, diabetes mellitus, congenital absence of the vas deferens, and ejaculatory duct obstruction. Common medications such as antidepressants, alpha-blockers used for enlarged prostates, and finasteride (prostate enlargement and male pattern baldness) can also contribute to disordered ejaculation. Using principles of evidence-based medicine, we review the diagnosis and management of known forms of disordered ejaculation.

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References

  1. Master VA, Turek PJ. Ejaculatory physiology and dysfunction. Urol Clin North Am. 2001;28:363–75.

    Article  CAS  PubMed  Google Scholar 

  2. Yang CC, Bradley WE. Somatic innervation of the human bulbocavernosus muscle. Clin Neurophysiol. 1999;110:412.

    Article  CAS  PubMed  Google Scholar 

  3. Brackett NL, Ohl DA, Sønksen J, Lynne CM. Abnormalities of ejaculation. In: Lipshultz LI, Howards SS, Niederberger CS, editors. Infertility in the male. 4th ed. New York: Cambridge University Press; 2009. p. 454–73.

    Chapter  Google Scholar 

  4. Benson GS. Erection, emission and ejaculation: physiologic mechanisms. In: Lipshultz LI, Howards SS, editors. Infertility in the male. 3rd ed. St. Louis: Mosby; 1997. p. 155.

    Google Scholar 

  5. Eisenberg M, Walsh TJ, Garcia M, et al. Ejaculatory duct manometry in normal men and in patients with ejaculatory duct obstruction. J Urol. 2008;180:255–60.

    Article  PubMed  Google Scholar 

  6. Jarvi K, Zielenski J, Wilschanski M, et al. Cystic fibrosis transmembrane conductance regulator and obstructive azoospermia. Lancet. 1995;345:1578.

    Article  CAS  PubMed  Google Scholar 

  7. Thorpe AC, Cleary R, Coles J, et al. Written consent about sexual function in men undergoing transurethral prostatectomy. Br J Urol. 1994;74:479.

    Article  CAS  PubMed  Google Scholar 

  8. Dunsmuir WD, Emberton M, Neal DE. On behalf of the steering group of the National Prostatectomy Audit. There is significant sexual dissatisfaction following TURP. Br J Urol. 1996;77:161A.

    Article  Google Scholar 

  9. Lue TF, Giuliano F, Montorsi F, et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2004;1:6–23.

    Article  PubMed  Google Scholar 

  10. Purohit RS, Wu DS, Shinohara K, Turek PJ. A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. J Urol. 2004;171:232–5, discussion 235–36

    Article  PubMed  Google Scholar 

  11. Hendry WF, Rickards D, Pryor JP, et al. Seminal megavesicles with adult polycystic kidney disease. Hum Reprod. 1998;13:1567.

    Article  CAS  PubMed  Google Scholar 

  12. Hendry WF, Pryor JP. Mullerian duct (prostatic utricle) cyst: diagnosis and treatment in subfertile males. Br J Urol. 1992;69:79.

    Article  CAS  PubMed  Google Scholar 

  13. Hendry WF. Disorders of ejaculation: congenital, acquired and functional. Br J Urol. 1998;82:331.

    Article  CAS  PubMed  Google Scholar 

  14. Nguyen HT, Etzell J, Turek PJ. Normal human ejaculatory duct anatomy: a study of cadaveric and surgical specimens [see comments]. J Urol. 1996;155:1639.

    Article  CAS  PubMed  Google Scholar 

  15. Turek PJ. Seminal vesicle and ejaculatory duct surgery. In: Graham S, editor. Glenn’s urologic surgery. 6th ed. Philadelphia: Lippincott, Williams & Wilkins; 2006. p. 439–45.

    Google Scholar 

  16. Jarow JP. Seminal vesicle aspiration in the management of patients with ejaculatory duct obstruction. J Urol. 1994;152:899.

    Article  CAS  PubMed  Google Scholar 

  17. Bird VG, Brackett NL, Lynne CM, et al. Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury. Spinal Cord. 2001;39:514–9.

    Article  CAS  PubMed  Google Scholar 

  18. Brackett NL. Semen retrieval by penile vibratory stimulation in men with spinal cord injury. Hum Reprod Update. 1999;5:216–22.

    Article  CAS  PubMed  Google Scholar 

  19. Brinsden PR, Avery SM, Marcus S, et al. Transrectal electroejaculation combined with in-vitro fertilization: effective treatment of anejaculatory infertility due to spinal cord injury. Hum Reprod. 1997;12:2687.

    Article  CAS  PubMed  Google Scholar 

  20. Momose H, Hirao Y, Yamamoto M, et al. Electroejaculation in patients with spinal cord injury: first report of a large-scale experience from Japan. Int J Urol. 1995;2:326.

    CAS  PubMed  Google Scholar 

  21. Schatte EC, Orejuela FJ, Lipshultz LI, et al. Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection. J Urol. 2000;163:1717.

    Article  CAS  PubMed  Google Scholar 

  22. Ohl DA. Electroejaculation. Urol Clin North Am. 1993;20:181.

    CAS  PubMed  Google Scholar 

  23. Vanderschueren D, Spiessens C, Kiekens C, et al. Successful treatment of idiopathic anejaculation with electroejaculation after microsurgical vas aspiration. Hum Reprod. 1998;13:370.

    Article  CAS  PubMed  Google Scholar 

  24. Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26:1553–79.

    Article  PubMed  Google Scholar 

  25. Dunsmuir WD, Holmes SA. The aetiology and management of erectile, ejaculatory, and fertility problems in men with diabetes mellitus. Diabet Med. 1996;13:700.

    Article  CAS  PubMed  Google Scholar 

  26. Sexton WJ, Jarow JP. Effect of diabetes mellitus upon male reproductive function. Urology. 1997;49:508.

    Article  CAS  PubMed  Google Scholar 

  27. Hojo K, Vernava AMIII, Sugihara K, et al. Preservation of urine voiding and sexual function after rectal cancer surgery. Dis Colon Rectum. 1991;34:532.

    Article  CAS  PubMed  Google Scholar 

  28. Nesbakken A, Nygaard K, Bull-Njaa T, et al. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Brit J Surg. 2000;87:206.

    Article  CAS  PubMed  Google Scholar 

  29. Holman E, Kovacs G, Flasko T, et al. Hand-assisted laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular cancer. J Laparoendosc Adv Surg Tech A. 2007;17:16–20.

    Article  PubMed  Google Scholar 

  30. Neyer M, Peschel R, Akkad T, et al. Long-term results of laparoscopic retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testicular cancer. J Endourol. 2007;21:180–3.

    Article  PubMed  Google Scholar 

  31. Turek PJ, Lowther DN, Carroll PR. Fertility issues and their management in men with testis cancer. Urol Clin North Am. 1998b;25:517.

    Article  CAS  PubMed  Google Scholar 

  32. Styblo K, Bossers GT, Slot GH. Osteotomy for kyphosis in ankylosing spondylitis. Acta Orthop Scand. 1985;56:294.

    Article  CAS  PubMed  Google Scholar 

  33. Berger Y, Blaivas JG, Oliver L. Urinary dysfunction in transverse myelitis. J Urol. 1990;144:103.

    Article  CAS  PubMed  Google Scholar 

  34. Decter RM, Furness PDIII, Nguyen TA, et al. Reproductive understanding, sexual functioning and testosterone levels in men with spina bifida. J Urol. 1997;157:1466.

    Article  CAS  PubMed  Google Scholar 

  35. Sønksen J, Ohl DA. Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction. Int J Androl. 2002;25:324–32.

    Article  PubMed  Google Scholar 

  36. Kafetsoulis A, Brackett NL, Ibrahim E, et al. Current trends in the treatment of infertility in men with spinal cord injury. Fertil Steril. 2006;86:781–9.

    Article  PubMed  Google Scholar 

  37. Sønksen J. Assisted ejaculation and semen characteristics in spinal cord injured males. Scand J Urol Nephrol Suppl. 2003;213:1–31.

    Google Scholar 

  38. Kennedy SH, Dickens SE, Eisfeld BS, et al. Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord. 1999;56:201.

    Article  CAS  PubMed  Google Scholar 

  39. Seidman S. Ejaculatory dysfunction and depression: pharmacological and psychobiological interactions. Int J Impot Res. 2006;18(Suppl 1):S33–8.

    Article  PubMed  Google Scholar 

  40. Hellstrom WJ, Sikka SC. Effects of acute treatment with tamsulosin versus alfuzosin on ejaculatory function in normal volunteers. J Urol. 2006;176:1529–33.

    Article  CAS  PubMed  Google Scholar 

  41. Trost L, Saitz TR, Hellstrom WJ. Side effects of 5-alpha reductase inhibitors: a comprehensive review. Sex Med Rev. 2013;1:24–41.

    Article  PubMed  Google Scholar 

  42. Traish AM. The post-finasteride syndrome: clinical manifestation of drug-induced epigenetics due to endocrine disruption. Curr Sex Health Rep. 2018;10:88.

    Article  Google Scholar 

  43. Sharlip ID, Hellstrom WJG, Broderick GA. The ISSM definition of premature ejaculation: a contemporary, evidence-based definition. J Urol Suppl. 2008;179:340.

    Article  Google Scholar 

  44. Read S, King M, Watson J. Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. J Public Health Med. 1997;19:387.

    Article  CAS  PubMed  Google Scholar 

  45. Giuliano F, Hellstrom WFG. The pharmacological treatment of premature ejaculation. BJU Int. 2008;102:668.

    Article  CAS  PubMed  Google Scholar 

  46. Rowland DL, Haensel SM, Blom JH, et al. Penile sensitivity in men with premature ejaculation and erectile dysfunction. J Sex Marital Ther. 1993;19:189.

    Article  CAS  PubMed  Google Scholar 

  47. Biri H, Isen K, Sinik Z, et al. Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study. Int Urol Nephrol. 1998;30:611.

    Article  CAS  PubMed  Google Scholar 

  48. Buvat J, Tesfaye F, Rothman M, Rivas DA, Giuliano F. Dapoxetine for the treatment of premature ejaculation: results from a randomized, double-blind, placebo-controlled phase 3 trial in 22 countries. Eur Urol. 2009;55:957.

    Article  CAS  PubMed  Google Scholar 

  49. Haensel SM, Klem TM, Hop WC, et al. Fluoxetine and premature ejaculation: a double-blind, crossover, placebo-controlled study. J Clin Psychopharmacol. 1998;18:72.

    Article  CAS  PubMed  Google Scholar 

  50. Kara H, Aydin S, Yucel M, et al. The efficacy of fluoxetine in the treatment of premature ejaculation: a double-blind placebo controlled study [see comments]. J Urol. 1996;156:1631.

    Article  CAS  PubMed  Google Scholar 

  51. Kim SC, Seo KK. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. J Urol. 1998;159:425.

    Article  CAS  PubMed  Google Scholar 

  52. McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. J Urol. 1999;161:1826.

    Article  CAS  PubMed  Google Scholar 

  53. Waldinger MD, Hengeveld MW, Zwinderman AH. Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: a double-blind, randomized, dose-response study. Br J Urol. 1997;79:592.

    Article  CAS  PubMed  Google Scholar 

  54. Serefoglu EC, McMahon CG, Waldinger MD, et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the definition of premature ejaculation. Sex Med. 2014;2:41.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Choi JB, Kang SH, Lee DH, Young SK, Jeon J-S, Choi WS, Kim SW. Efficacy and safety of on demand clomipramine for the treatment of premature ejaculation: a multicenter, randomized, double-blind, phase III clinical trial. J Urol. 2018;201:147.

    Article  Google Scholar 

  56. Safarinejad MR, Hosseini SY. Safety and efficacy of tramadol in the treatment of premature ejaculation: a double-blind, placebo-controlled, fixed-dose, randomized study. J Clin Psychopharmacol. 2006;26:27.

    Article  CAS  PubMed  Google Scholar 

  57. Berkovitch M, Keresteci AG, Koren G. Efficacy of prilocaine-lidocaine cream in the treatment of premature ejaculation [see comments]. J Urol. 1995;154:1360.

    Article  CAS  PubMed  Google Scholar 

  58. Andersen KH. A new method of analgesia for relief of circumcision pain. Anaesthesia. 1989;44:118.

    Article  CAS  PubMed  Google Scholar 

  59. Choi HK, Jung GW, Moon KH, et al. Clinical study of SS-cream in patients with lifelong premature ejaculation. Urology. 2000;55:257.

    Article  CAS  PubMed  Google Scholar 

  60. Gajjala SR, Khalidi A. Premature ejaculation: a review. Indian J Sex Transm Dis AIDS. 2014;35:92.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Annon J. The behavioral treatment of sexual problems, vol. 1. Honolulu: Enabling Systems; 1974.

    Google Scholar 

  62. Sank L. Traumatic masturbatory syndrome. J Sex Marital Ther. 1998;24:37.

    Article  CAS  PubMed  Google Scholar 

  63. Turek PJ, Magana JO, Lipshultz LI. Semen parameters before and after transurethral surgery for ejaculatory duct obstruction. J Urol. 1996;155:1291.

    Article  CAS  PubMed  Google Scholar 

  64. Turek PJ, Aslam K, Younes AK, et al. Observations on seminal vesicle dynamics in an in vivo rat model. J Urol. 1998a;159:1731.

    Article  CAS  PubMed  Google Scholar 

  65. Sandler B. Idiopathic retrograde ejaculation. Fertil Steril. 1979;32:474.

    Article  CAS  PubMed  Google Scholar 

  66. Van der Linden PJQ, Nan PM, te Velde ER, et al. Retrograde ejaculation: Successful treatment with artificial insemination. Obstet Gynecol. 1992;79:126.

    PubMed  Google Scholar 

  67. Kim SW, Paick JS. Short-term analysis of the effects of as needed use of sertraline at 5 PM for the treatment of premature ejaculation. Urology. 1999;54:544.

    Article  CAS  PubMed  Google Scholar 

  68. Hovav Y, Dan-Goor M, Yaffe H, et al. Nocturnal sperm emission in men with psychogenic anejaculation. Fertil Steril. 1999;72:364.

    Article  CAS  PubMed  Google Scholar 

  69. Geboes K, Steeno O, De Moor P. Primary anejaculation: diagnosis and therapy. Fertil Steril. 1975;26:1018.

    Article  CAS  PubMed  Google Scholar 

  70. Denil J, Kupker W, Al-Hasani S, et al. Successful combination of transrectal electroejaculation and intracytoplasmic sperm injection in the treatment of anejaculation. Hum Reprod. 1996;11:1247.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The author would like to acknowledge the contributions of Melody Lowman MA of San Francisco, California, to this chapter. As a psychotherapist with 50 years of experience, her knowledge and experience in reproductive psychology has been invaluable.

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  1. The Turek Clinics, San Francisco, CA, USA

    Paul J. Turek

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  1. PUR Clinic, University of Central Florida (UCF), Clermont, FL, USA

    Sijo J. Parekattil

  2. ANDROFERT and State University of Campinas (UNICAMP), Campinas, Brazil

    Sandro C. Esteves

  3. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Ashok Agarwal

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Turek, P.J. (2020). Ejaculatory Dysfunction and Vasodynamics. In: Parekattil, S., Esteves, S., Agarwal, A. (eds) Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-030-32300-4_33

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  • DOI: https://doi.org/10.1007/978-3-030-32300-4_33

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