Diagnostic d'une anéjaculation

Anejaculation corresponds to absence of ejaculation during orgasm. Most men with anejaculation are aware of their abnormality, but some poorly educated subjects consult for infertility and anejaculation is only suspected on the sperm count. The patient must therefore be questioned about his capacity to ejaculate, for example while sleeping, by masturbation or, less frequently, according to various coital positions. There are various types of anejaculation. Clinical interview is certainly the most important phase of the diagnostic work-up, which is based on analysis of sexual signs and orgasm. It is essential to define the primary or secondary nature of the disorder. After confirming the diagnosis of anejaculation and distinguishing it from retrograde ejaculation and asthenic ejaculation, orgasm without ejaculation and without normal ejaculation outside of coitus must be distinguished from anejaculation without orgasm but with normal ejaculation outside of coitus. The causes of anejaculation may be organic and psychological. The main psychological factors likely to play a role in anejaculation without orgasm can be classified into six categories. However, the presence of one of these factors in a patient with anejaculation does not necessarily imply that it is the cause of the sexual dysfunction; the diagnosis of psychogenic anejaculation is a diagnosis of exclusion after all possible organic causes have been eliminated.     

Managing early ejaculation: what does the future hold?

Recent attention in the field of male sexual dysfunction has focused on erectile dysfunction. However, premature ejaculation (PE) is an extremely common condition that warrants clinical study and exploration of pharmacologic treatments. Until recently, PE was thought to be a behavioral problem for which the best remedy was a learned control technique. However, some drugs currently on the market, including sildenafil and the selective serotonin reuptake inhibitors, appear to have efficacy in the treatment of PE. More research is needed before FDA approval of such agents for this indication, but more and better options for men with PE are anticipated as attention to ejaculatory disorders grows and, hopefully, the associated stigma decreases.     

Définition et épidémiologie des troubles de l'éjaculation

Ejaculatory dysfunction is a male sexual disorder and comprises premature ejaculation, delayed ejaculation, anorgasmia, anejaculation and retrograde ejaculation. The definition of premature ejaculation is based on three essential criteria: brief ejaculatory latency, loss of control and psychological distress for the patient and/or his partner. Comparison of studies on premature ejaculation is difficult due to the absence of physiological data in the general population on ejaculatory latency, the absence of a precise definition of premature ejaculation and the absence of a questionnaire or standardized and valldated methods of evaluation. However, the rare studies performed since 1990 show high prevalences: about 10% of menoften or always experience premature ejaculation. The prevalence of delayed ejaculation and anorgasmia is estimated to be between 5 and 10%. Ejaculatory dysfunctions are therefore significant health problems with consequences on sexuality, fertility and quality of life.     

单纯治疗慢性前列腺炎对其合并早泄的影响

目的:探讨单纯治疗慢性前列腺炎对其合并早泄的影响。方法:选择372例前列腺炎继发早泄的患者进行单纯针对前列腺炎的治疗,评价前列腺炎的治疗效果(包括前列腺炎症状评分(NIH-CPSI)、前列腺液常规等)及早泄的治疗效果(包括患者性生活满意度评分、配偶性生活满意度评分及阴道内射精潜伏期等)。结果:慢性前列腺炎经综合治疗后,患者的NIH-CPSI评分及前列腺液白细胞计数均显著降低(P0.05)。前列腺炎治愈或好转后,大多数患者的早泄情况得到明显改善,患者性生活满意度、配偶性生活满意度均较治疗前显著提高,阴道内射精潜伏期亦较治疗前明显延长,差异均具有统计学意义(P0.05)。结论:单纯治疗慢性前列腺炎继可使大部分患者并发的早泄明显改善,而对少数前列腺炎好转后早泄症状改善不明显者,可联合应用SSRIs等药物治疗。     

Le recueil de sperme chez le blessé médullaire

Infertility is a major issue for men with spinal cord injury (SCI). Male infertility is due to a combination of ejaculatory dysfunction and abnormal sperm quantity and quality. The reported ability to ejaculate during sexual stimulation or masturbation is about 15%. Techniques to remediate ejaculation have vastly improved the fertility potential of men with SCI. Penile vibratory stimulation (PVS) to induce ejaculation is now recommended as first-line treatment due to its safety and relative efficacy. PVS can also be used at home for fertility purposes with success rates of more than 70%. Pharmacological treatments can be associated with PVS to enhance ejaculation. Midodrine, an alpha1-adrenergic agonist, has been recently used with success rates of 66% in SCI patients who failed PVS alone. PVS with midodrine can now be considered as second-line treatment for anejaculation, after PVS and before electroejaculation. It is a safe procedure, but requires cardiovascular monitoring. PVS with midodrine can also be effective in the treatment of retrograde ejaculation by inducing bladder neck closure.     

Diagnostic d'une anéjaculation: à propos de 72 patients

Introduction

Anejaculation is the inability to ejaculate through the urethral meatus despite the presence of adequate erection and sexual stimulation.

Material and Methods

From January 1997 to July 2002, 72 patients (age: 17 to 72 years, mean age: 43 years, 65% under the age of 50) consulted the same urologist because of anejaculation.

Results

Forty seven patients (65%) were unable to achieve orgasm (anorgasmia). Twenty five patients were able to achieve orgasm: retrograde ejaculation (9 cases) or dry ejaculation (7 cases) (depending on the presence or absence spermatozoa in the urine after orgasm), indeterminate anejaculation (7 cases) and sluggish ejaculation (2 cases). Psychological risk factors were detected in 30 patients (42%), neurological risk factors were detected in 34 patients (47%) (especially peripheral neuropathy after pelvic or retroperitoneal surgery or diabetes mellitus) and pharmacological risk factors were detected in 16 patients (22%) (especially selective serotonin reuptake inhibitors). Men with anorgasmia presented psychological risk factors in 57% of cases, neurological risk factors in 36% of cases and pharmacological risk factors in 34% of cases. The percentages of these risk factors in patients with other forms of anejaculation were 12%, 68% and 0%, respectively. Twenty five patients (35%) presented several risk factors with a psychological predominance in 14 of them. No risk factors were detected in 11 patients (5 with retrograde ejaculation and 6 with anorgasmia), but a psychological aetiology appeared likely in 6 patients with anorgasmia, as they were able to achieve orgasm during masturbation. 70% of cases of anorgasmia therefore presented psychological risk factors or aetiologies (primary anorgasmia: 100%, secondary anorgasmia: 63%) versus 12% of patients with other forms of anejaculation.

Conclusion

1. The diagnosis of anejaculation must include the type of anejaculation.
2. The aetiological diagnosis is based on clinical interview.
3. Risk factors and aetiologies are often psychological, but sometimes neurological or pharmacological in patients with anorgasmia, and often neurological in other forms of anejaculation.
4. The term “psychological anejaculation” should be reserved for cases of primary anorgasmia.
5. Anorgasmia requires psychological assessment.

     

Vers une approche physiopathologique des troubles de l’éjaculation

Seminal emission and sperm expulsion are under the control of both the sympathetic and parasympathetic outflows and also of the somatic innervation conveyed by the pudendal nerve. The 2 phases of ejaculation are reflexive with the reflexes handled at the thoraco-lumbar and sacral levels of the spinal cord. Such a spinal organization remains widely unknown. The role of various peripheral neurotransmitters has been evidenced including norepinephrine and acetylcholine and also peptidergic, purinergic i.e. ATP and nitric oxide. Stimulation of the seminal tract afferents play a crucial in the onset of ejaculatory mechanisms. Except for the dorsal nerve of the penis, there is a lack of information concerning these afferents. Several supraspinal centers i.e. hypothalamus, medial amygdala, pons and nucleus paragigantocellularis exert descending and ascending inhibitory and excitatory influences on spinal nuclei controlling emission and expulsion of sperm. Central neurotransmission responsible for this supraspinal control could involve serotonin, oxytocin and norepinephrine. In the light of the available anatomical and neurophysiological data, pathophysiological aspects of ejaculatory disorders are futher discussed. Premature ejaculation could be related to a periheral and central hypersentivity. Most of the other ejaculation abnormalities are likely mainly related to an impairment of the central mechanisms.     

La fertilité chez le blessé médullaire. Effet du niveau de la lésion médullaire

The majority of spinal cord injured males cannot procreate naturally due to anejaculation as well as abnormal sperm characteristics. Treatment of this impaired fertility must be associated with treatment of neurogenic urinary tract disorders, bowel dysfunction and spasticity. The level of the spinal lesion and the spinal cord injury syndrome influence the possibility of inducing reflex ejaculation by penile vibratory stimulation and sperm quality.     

Prise en charge actuelle de l’ejaculation prematuree

Considered as the most common male sexual problem, premature ejaculation is characterized by the absence of control over the ejaculatory reflex with a correspondingly poor perception of sexual arousal and pleasure. After first considering the nature of the problems underlying premature ejaculation, this article emphasizes the relevance of pathophysiological aspects and considers the main treatments available according to the various contributory factors identifiable during investigation in relation to whether the problem is structural or psychological. Successful treatments is dependent upon modifying and correcting the mental and sensory processes of the premature ejaculator during his sexual activity. When premature ejaculation is an isolated symptom without a concomitant psychological problem, it may be considered a sexual learning disability and has excellent prognosis with sex therapy using behavioural methods (“squeeze technique”, “start-stop technique”). In other cases, the symptom of premature ejaculation is associated with deeper psychological problems and treatment requires a more complex psychodynamic approach, but one which does not exclude behavioural measures when appropriate.     

Le prelevement de sperme deferentiel couple a une Fecondation In Vitro dans les troubles de l’ejaculation

Surgical recovery of spermatozoa from the vas deferens is a simple and reproductible treatment for men with ejaculatory failure. After washing on a Percoll gradient spermatozoa can be used for in vitro fertilization (IVF). Also, when sperm recovery is good, surplus spermatozoa may be frozen. The indications for this treatment include retrograde ejaculation and anejaculation after classic treatments have failed and after failed vasovasostomy. During a one year period five patients were treated in this way (three with retrograde ejaculation and two with anejaculation). The five IVF attemps were performed with aspirates containing 30 to 55 × 106 spermatozoa/ml (mean=42 × 10⁶/ml), 25 to 55% motile spermatozoa (mean=43%). An average of 8.4 ovocytes were inseminated (range=8 to 21) with a fertilization rate of 67% and a success rate of 80% (one term pregnancy, two third trimester pregnancies and one second trimester pregnancy). Surgical sperm aspiration from the vas deferens in cases of ejaculatory failure is a simple, efficacious method by which sufficient mature spermatozoa for an IVF attempt (and/or cryopreservation) can be obtained     

Men's masculinity and attractiveness predict their female partners' reported orgasm frequency and timing

It has been hypothesized that female orgasm evolved to facilitate recruitment of high-quality genes for offspring. Supporting evidence indicates that female orgasm promotes conception, although this may be mediated by the timing of female orgasm in relation to male ejaculation. This hypothesis also predicts that women will achieve orgasm more frequently when copulating with high-quality males, but limited data exist to support this prediction. We therefore explored relationships between the timing and frequency of women's orgasms and putative markers of the genetic quality of their mates, including measures of attractiveness, facial symmetry, dominance, and masculinity. We found that women reported more frequent and earlier-timed orgasms when mated to masculine and dominant men—those with high scores on a principal component characterized by high objectively-measured facial masculinity, observer-rated facial masculinity, partner-rated masculinity, and partner-rated dominance. Women reported more frequent orgasm during or after male ejaculation when mated to attractive men—those with high scores on a principal component characterized by high observer-rated and self-rated attractiveness. Putative measures of men's genetic quality did not predict their mates' orgasms from self-masturbation or from non-coital partnered sexual behavior. Overall, these results appear to support a role for female orgasm in sire choice.     

Existence of an ejaculatory-like reaction in ewes ovariectomized and treated with androgens in adulthood

The complete behavioral repertoire of male sexual activity can be observed during daily androgen treatment (testosterone propionate, 15 mg/day) of normal ewes ovariectomized as adults. This includes the ejaculatory pattern (deep thrust accompanied by a rapid backwards movement of the head) which is followed by a dramatic decrease in the frequency of sexual interactions, similar to the male's postejaculatory reduction of activity. However, the sexual performances of the genetic females remain lower than those of normal males in ejaculation latency, postejaculation latency, and mount/ejaculation ratio.     

Facilitation of Male Sexual Behavior in Syrian Hamsters by the Combined Action of Dihydrotestosterone and Testosterone

Background

Testosterone (T) controls male Syrian hamster sexual behavior, however, neither of T''s primary metabolites, dihydrotestosterone (DHT) and estradiol (E₂), even in highly supraphysiological doses, fully restores sexual behavior in castrated hamsters. DHT and T apparently interact with androgen receptors differentially to control male sexual behavior (MSB), but whether these two hormones act synergistically or antagonistically to control MSB has received scant experimental attention and is addressed in the present study.

Methodology/Principal Findings

Sexually experienced male Syrian hamsters were gonadectomized and monitored 5 weeks later to confirm elimination of the ejaculatory reflex (week 0), at which time they received subcutaneous DHT-filled or empty capsules that remained in situ for the duration of the experiment. Daily injections of a physiological dose of 25 µg T or vehicle commenced two weeks after capsule implantation. MSB was tested 2, 4 and 5 weeks after T treatment began. DHT capsules were no more effective than control treatment for long-term restoration of ejaculation. Combined DHT + T treatment, however, restored the ejaculatory reflex more effectively than T alone, as evidenced by more rapid recovery of ejaculatory behavior, shorter ejaculation latencies, and a greater number of ejaculations in 30 minute tests.

Conclusions/Significance

DHT and T administered together restored sexual behavior to pre-castration levels more rapidly than did T alone, whereas DHT and vehicle were largely ineffective. The additive actions of DHT and T on MSB are discussed in relation to different effects of these androgens on androgen receptors in the male hamster brain mating circuit.     

Ejaculation by male rhesus in the absence of female partners

The number of ejaculatory plugs found beneath the cages of male rhesus over a 14-month period indicated a high incidence of ejaculation in the home cage in the absence of a female partner. Frequency of ejaculation in the home cage was not related to concurrent tests of sexual behavior with receptive females. Moreover, ejaculation in the home cage within 22 hr or less of sex tests did not affect the frequency of ejaculation in tests with stimulus females. Long- and short-term vasectomized males ejaculated as frequently in their home cages as nonvasectomized males. No ejaculatory plugs, of course, were found beneath the cages of males castrated 2 years earlier.     

Prostatic irradiation-induced sexual dysfunction: a review and multidisciplinary guide to management in the radical radiotherapy era (Part I defining the organ at risk for sexual toxicities)

Prostate cancer is the most common malignancy and the second leading cause of cancer-related death in men. Radiotherapy is a curative option that is administered via external beam radiation, brachytherapy, or in combination. Erectile, ejaculatory and orgasm dysfunction(s) is/are known potential and common toxicities associated with prostate radiotherapy. Our multidisciplinary team of physicians and/or scientists have written a three (3) part comprehensive review of the pathogenesis and management radiation-induced sexual dysfunction. Part I reviews pertinent anatomy associated with normal sexual function and then considers the pathogenesis of prostate radiation-induced sexual toxicities. Next, our team considers the associated radiobiological (including the effects of time, dose and fractionation) and physical (treatment planning and defining a novel Organ at Risk (OAR)) components that should be minded in the context of safe radiation treatment planning. The authors identify an OAR (i.e., the prostatic plexus) and provide suggestions on how to minimize injury to said OAR during the radiation treatment planning process.     

Xylazine-induced ex copula ejaculation in stallions

This study is a part of ongoing work toward developing pharmacological methods of enhancing and inducing ejaculation in stallions with ejaculatory dysfunction. We evaluated ex copula ejaculatory response to treatment with the alpha-adrenergic agonist xylazine hydrochloride, with and without preliminary sexual stimulation. Twenty-eight mature stallions each reveived, in random order, one xylazine trial (0.3 mg/lb, i.v.) without preliminary sexual stimulation, one xylazine trial with 5 to 10 min of sexual prestimulation, and one control trial (equivalent volume sterile water injection). Trials were conducted in the animal stalls. Ejaculation occurred in 15 of 56 (27%) xylazine trials. No ejaculations occurred in the sterile water control trials. In trials with sexual prestimulation, ejaculation occurred in 39% compared with 14% in trials without prestimulation. This difference was significant (P < 0.05). Xylazine-induced ejaculates were collected into a plastic bag attached to a girth and were similar to those obtained by artificial vagina. Nine of the 15 ejaculations occurred within 2 min of injection.     

Orgasm in female primates

The major genital responses of arousal in women are vasocongestion, resulting in tumescence of the vaginal walls, and vaginal lubrication, facilitating penile intromission and thrusting. During orgasm, several involuntary muscular reactions occur, the most adaptive being in the outer third of the vagina and the uterus. Uterine suction of the ejaculate seems to occur when the reproductive apparatus is functioning at full efficiency. Coitus may result in reflex ovulation. Indices of female nonhuman primate orgasm thus far proposed include rhythmic vaginal and anal contractions, hyperventilation, involuntary muscle tension, arm and leg spasms, grimacing, and uterine contractions. Orgasm in our species may exist as a result of phylogenetic inertia, not as a novel response selected during protohominid or hominid evolution. A theory for the evolutionary nature of orgasm in women states that the orgasmic vaginal contractions stimulate ejaculation. Reasons for the common asynchrony of this adaptive pattern are the usually lowered ejaculatory threshold because of non-species-typical orgasmic frequency in the male, and the frequently delayed female orgasm because of psychological inhibition and/or inadequate control and development of the pubococcygeus.     

早泄的诊疗进展

早泄是男性常见的一种性功能障碍性疾病,属于射精障碍,在男性病中有着相对较高的发病率。早泄严重的影响着患者的生活质量和性生活质量,渐渐的引起患者自信心的缺失,还在一定程度上影响患者的夫妻感情和关系,最终导致患者出现焦虑、紧张、恐慌等症状。这些不良的精神状态最终影响着患者的家庭生活和工作质量等。针对早泄的发病原因,其治疗方法也是多种多样的,治疗效果也不统一,有着很大的差异,新的治疗方法也越来越多。因此对于早泄的治疗有着重要的意义。本文对早泄的治疗进行综述。     

Prise en charge actuelle des ejaculations retardees et des anejaculations psychogenes

The authors have reviewed their management of 220 patients presenting with retarded ejaculation or psychogenic anejaculation between 1973 and 1992. There are three current management approaches: mechanical treatment (vibrator massage); behavioural and cognitive therapy (relaxation, couple therapy) and psychotherapy, indicated when the problem is one of desire. Therapeutic intervention must procede in several stages in the most difficult cases: developing an awareness of subconscious defenses; rehabilitation and relaxation; and untervention at the couple level. This therapeutic strategy has led to a high success rate of 87% of cases, although it requires motivated patients and therapists committed to developing relationships of sexual harmony.