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PubMed2003

Topical lidocaine-prilocaine spray for the treatment of premature ejaculation: a proof of concept study.

Premature ejaculation (PE) is the most common sexual dysfunction in men. Since heightened sensitivity of the glans is implicated in PE, it seems reasonable that reducing this sensitivity could have a delaying effect on intravaginal ejaculation latency time (IVELT) without adversely affecting the sensation of ejaculation. We have developed a local anesthetic combination, in a metered-dose aerosol delivery system, that delivers lidocaine and prilocaine in base form without organic solvents. The drug can be easily removed prior to vaginal penetration, circumventing the need for a condom that most patients find undesirable. Herein, we report on a prospective open-label pilot study investigating the safety and efficacy of this novel delivery system for topical local anesthetic to the glans penis aimed at prolonging the IVELT in patients who self-reported having PE. This was an open-label prospective pilot study. The lidocaine-prilocaine (LP) aerosol delivered 7.5 mg lidocaine and 2.5 mg prilocaine, both in base form, per actuation. A total of 14 men who had been referred to urology clinics with the problem of PE were recruited. Consent was obtained from both subjects and their partners. Couples were asked to time their IVELT without treatment on one encounter, and then on five subsequent encounters were asked to apply the spray to the glans penis, leave on for 10-15 min, wipe off carefully before intercourse. The IVELT was timed with a stopwatch and then both partners were asked to rate their individual satisfaction relative to baseline without treatment. They were also asked to document any adverse events or comments. In all, 11 patients completed the study. The average IVELT increased from 1 min:24 s to 11 min:21 s (P=0.008) representing an average eight-fold increase. No subjects experienced a decrease in IVELT. The average satisfaction score for both subjects and partners was 1.0; on a scale where -1 was worse, 0 the same, +1 better and +2 much better. Topical LP spray, applied to the glans penis 15 min before intercourse, prolongs ejaculation time significantly and improves sexual satisfaction in both men with PE and their partners. The glandular numbness, noticed in only two cases, did not adversely affect the quality of the orgasm. Occasionally, a patient reported difficulty maintaining an erection while waiting the required 15 min between application of the spray and the initiation of intercourse.

Administration, Topical↗
PubMedDate not supplied

Evidence for the presence and functioning of the spinal generator for ejaculation in the neonatal male rat.

A spinal pattern generator controls ejaculation in the male rat. In the present study, the hypothesis that the spinal generator for ejaculation was functional at early postnatal stages was evaluated. To this purpose, the expression of the ejaculatory motor pattern and its pharmacological activation in spinally transected neonatal rats from postnatal day 2 to weaning were investigated. Results revealed the presence of the rhythmic ejaculatory motor pattern in neonatal male rats. As in adult sexually experienced animals, the neonatal ejaculatory motor pattern could be elicited after the application of an ejaculation-like-releasing stimulus. The rhythmic genital motor response of neonates exhibited a gradual maturation that was reflected in its motor parameters until showing the features of the adult response at postnatal day 28. Besides, the ejaculatory motor pattern could be induced by the systemic injection of oxytocin in 7-day-old neonates as well as in adult animals. Present findings provide evidence for the presence of the spinal generator for ejaculation early during postnatal development, suggesting that its organisation is innate.

Animals↗
PubMed2006

Does repeated electro-ejaculation improve sperm quality in spinal cord injured men?

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To assess the effect of repeated electro-ejaculation on the sperm quality in spinal cord injured men. SETTING: Regional Spinal Injuries Unit, Southport, UK and Hewitt Center for Reproductive Medicine, Liverpool, UK. METHOD: Retrospective, observational study of men with spinal cord injuries undergoing repeated electro-ejaculation as a part of fertility treatment. RESULT: There was no improvement in the volume, sperm concentration, motility or the total motile count in the successive antegrade and retrograde samples following repeated electro-ejaculations. CONCLUSION: Electro-ejaculation is an invasive procedure and its use should be restricted to obtaining semen sample for carrying out assisted conception procedures only.

Adult↗
PubMed2002

Management of premature ejaculation -- a comparison of treatment outcome in patients with and without erectile dysfunction.

This study evaluated the problem of premature ejaculation (PE) in patients treated for erectile dysfunction. The aim was to compare the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the management of primary PE and PE associated with sildenefil treatment. Eighty-seven patients with PE seen over a period of 17 months were recruited into this prospective study. They were categorized into two groups: primary PE (GPI) and PE in sildenefil-treated patients (GPII). All patients recruited into GPII had erectile dysfunction (ED) that was successfully treated with sildenefil citrate for at least a year. Both groups of patients were given sertraline 50 mg 4 h before expected time of sex. The minimum follow-up was 6 months. The ejaculation latency before and after treatment of the two groups were compared. The sexual satisfaction scores of the patients in the two groups were also sought and analysed. Twenty-eight percent of patients with ED who were successfully treated with sildenefil developed PE. Subjects in group GPI were younger and have less comorbid factors than those in group GPII. There was no significant difference in the mean ejaculation latency for both groups (46 vs. 34.6 sec for GPI and GPII, respectively). However, there was highly significant difference in the ejaculation latency between the two groups after treatment with sertraline for 6 months (247.2 vs. 111.6 sec for GPI and GPII, respectively). There was also significant difference in the sexual satisfaction score for group GPI post-treatment, but not for GPII. No significant side-effect of sertraline was reported from patients in both groups. Successful treatment of ED could not assure sexual satisfaction. At least a quarter of sildenefil treated ED patients might develop PE which would continue to frustrate these patients sexually. While selective serotonin re-uptake inhibitors (SSRIs) was effective in the management of primary PE, they were not as effective in patients with sildenefil corrected ED.

Cohort Studies↗
PubMed1999

Recovery of ejaculated spermatozoa for intracytoplasmic sperm injection after anti-inflammatory treatment of an azoospermic patient with genital tract infection: a case report.

In this paper our experiences with anti-inflammatory treatment of an infertile patient with azoospermia and concomitant silent genital infection are reported. The patient was referred to our fertility centre with prediagnosed non-obstructive azoospermia and no spermatozoa were found in the ejaculate on two occasions. The patient showed leukocytospermia and was suspected to be affected by genital infection. Therefore, anti-inflammatory treatment was initiated and 8 weeks later examination of the ejaculate revealed a decreased number of leukocytes and the presence of few but motile spermatozoa. Subsequently, two ICSI cycles were performed with anti-inflammatory therapy in parallel and a sufficient number of spermatozoa could be retrieved for injection. However, in a third cycle without previous treatment, examination of the ejaculate again revealed azoospermia and leukocytospermia. It is concluded that, in cases of azoospermia and chronic genital infection, some patients will benefit from anti-inflammatory treatment prior to and during ICSI treatment. This may allow retrieval of spermatozoa from the ejaculate and thus may avoid the need for a therapeutic testicular biopsy. Using this approach, sufficient spermatozoa in three out of four ICSI cycles could be retrieved and a pregnancy was finally achieved.

Adult↗
PubMed2001

Effective daily treatment with clomipramine in men with premature ejaculation when 25 mg (as required) is ineffective.

OBJECTIVE: To determine whether men with premature ejaculation who fail to respond to 25 mg clomipramine as needed improve when taking 10-30 mg clomipramine daily. SUBJECTS AND METHODS: Four men with premature ejaculation whose ejaculation latencies increased minimally or not at all when taking 25 mg clomipramine as needed participated in a prospective 12-week study consisting of four treatment phases, beginning with baseline (0 mg) and progressing through increasing daily doses of 10, 20, and 30 mg clomipramine. The subjects maintained daily logs of their sexual activities and estimated their ejaculatory response, sexual arousal and penile rigidity during intercourse. The subjects were contacted 8-15 weeks after the experiment to assess their satisfaction with and continued use of clomipramine. RESULTS: There was a dose-response effect on ejaculatory latency with increasing levels of clomipramine; 30 mg increased the latency from 25 s to 220 s, a clinically significant increase. In addition, 30 mg taken daily was significantly more effective than 25 mg as required. Other variables of sexual response (sexual interest, arousal and penile rigidity) were unaffected. At follow-up all four subjects expressed satisfaction and three continued the dose. CONCLUSION: Men with premature ejaculation who do not respond to clomipramine 'as required' are probably not insensitive to pharmacological treatment, but may simply require higher doses or a different regimen. All four subjects improved when taking daily clomipramine at varying doses. These results suggest that if initial treatment is unsuccessful, 20-30 mg daily clomipramine should be considered.

Adult↗
PubMed1996

Antidepressants in the treatment of premature ejaculation.

The SSRI antidepressants have emerged as effective new treatment for patients with premature ejaculation whether or not these patients suffer from depression. Clomipramine, fluoxetine, paroxetine, and sertraline seem to be a safe treatment option for patients with premature ejaculation, especially in cases of failed psychological treatment, in rejection of psychological treatment, and when partners are unwilling to cooperate in treatment. Further controlled and larger studies that focus on clinically relevant issues such as dose, length of treatment, maintenance of beneficial effects after treatment discontinuation, and the combination of pharmaco- and behavior therapy for premature ejaculation are warranted. Other medications, such as benzodiazepines, may be useful in some cases of premature ejaculation.

1-Naphthylamine↗
PubMedDate not supplied

Successful treatment of retrograde ejaculation with amezinium.

The effect of amezinium, a new type of antihypotensive agent, on retrograde ejaculation was evaluated in 3 patients with retrograde ejaculation. The patients received 10 mg amezinium orally once a day. All patients achieved antegrade ejaculation. Semen analyses revealed 6-50 x 10(6)/mL (mean 28.7 x 10(6)/mL) sperm with a motility of 20-50% (mean 36.7%). The wives of 2 patients became pregnant within 6 months of the initial treatment. None of the patients had any side effects. It would appear that amezinium is a useful treatment for retrograde ejaculation.

Adult↗
PubMedDate not supplied

Successful management of infertility due to retrograde ejaculation using assisted reproductive technologies: a report of two cases.

Although retrograde ejaculation is a relatively uncommon cause of infertility, it is nonetheless the most common cause of ejaculatory dysfunction. Retrograde ejaculation is characterized by either all or part of the seminal fluid going into the bladder. The initial management of patients with ejaculatory dysfunction is medical therapy. In couples who have failed medical therapy, assisted reproductive techniques using sperm harvested from either the urine or the male reproductive tract would be the ultimate option. We report successful management of two couples, both men with advanced age and complete retrograde ejaculation, by intrauterine insemination in one and in vitro fertilization (IVF) using intracytoplasmic sperm injection (ICSI) in the other using sperm harvested from urine. The cases reported herein suggest that male infertility due to retrograde ejaculation may be successfully treated in men significantly older than the usual reproductive age and that traditional methods of hydration and urine alkalinization allow for the successful recovery of fertile sperm for ART. The selection of the method of ART must be individualized to the needs of each couple based upon both male and female factors.

Adult↗
PubMed1998

Repetitive ejaculation before intracytoplasmic sperm injection in patients with absolute immotile spermatozoa.

Cases with absolute immotile sperm syndrome are rare, and include the genetic defect of immotile cilia syndrome with the absence of dynein arms in the flagellum. We attempted to increase the percentage of viable spermatozoa to improve the outcome of intracytoplasmic sperm injection (ICSI). Three couples in whom repeated analysis of the male partners indicated 100% sperm immotility underwent an in-vitro fertilization (IVF) procedure in which ICSI was performed. On their first ICSI cycle the males produced a single ejaculation while in their successive ICSI cycles they were requested to repeatedly ejaculate (two to four times) and only the last ejaculation was used. The eosin-Y test was performed on each used sample. Following their first treatment, one couple had one repeated treatment cycle, another had two and the third couple had three repeated treatment cycles. The mean percentages of viable spermatozoa were 41+/-7.4 and 71+/-6.9% in the first and repeated cycles respectively (P < 0.01; t-test). Of the 39 oocytes injected in the first ICSI cycles only one (3%) was normally fertilized (2PN) compared with 41 (48%) of the 85 oocytes injected in the repeated ICSI cycles. One (3%) embryo in the first and 35 (41%) embryos in the repeated ICSI cycles respectively were obtained (P < 0.001), enabling their replacement into the uterine cavity in all the repeated cycles. One woman (in a repeated cycle) conceived a twin pregnancy and delivered two healthy babies. The use of spermatozoa from repeated ejaculation is recommended in men with absolutely immotile spermatozoa so as to obtain significantly better viability and fertilizing capacity.

Adult↗
PubMed2001

The use of a modified hypo-osmotic swelling test for the selection of viable ejaculated and testicular immotile spermatozoa in ICSI.

A modified hypo-osmotic solution was used to select viable ejaculated and testicular spermatozoa to perform intracytoplasmic sperm injection (ICSI) in 27 treatment cycles from patients with total absence of sperm motility. The treatment cycles consisted of 15 cycles in which ejaculated spermatozoa were used and 12 cycles in which testicular spermatozoa were used. The hypo-osmotic solution consisted of 50% culture medium and 50% deionized water and was shown in previous in-vitro studies to be superior to the original solution used in the classical hypo-osmotic swelling test. Fertilization was achieved in 37.3% of the oocytes injected. Embryos were replaced in 70.4% of the cycles with a mean of 2.0 embryos per cycle. There were no statistically significant differences between the ejaculated sperm group and the testicular sperm group in the fertilization rate (42.7 versus 30.1%) or in the cleavage rate (92.7 versus 77.3%). Four pregnancies resulted, two in the ejaculated sperm group and two in the testicular sperm group, a pregnancy rate of 14.8%. All pregnancies were singletons but one pregnancy in each group had an early miscarriage. There were no statistically significant differences between both groups in the pregnancy rates (13.3 versus 16.7%), in the implantation rates (5.3 versus 11.8%) or in the delivery/ongoing pregnancy rates (6.7 versus 8.3%). It is concluded that the use of this solution to select viable but immotile spermatozoa for ICSI is a simple and practical method and is associated with acceptable fertilization and pregnancy rates.

Adult↗
PubMed2003

Towards a physiological role for cytochrome P450 aromatase in ejaculated human sperm.

BACKGROUND: Advances in the definition of the function and the mechanism of estrogen action in different tissues have come from human and animal models of estrogen insufficiency. Recently we have demonstrated that aromatase is present and biologically active in human ejaculated sperm, suggesting that autonomous estradiol sperm production may influence sperm functions. In the present study we investigate a possible physiological role for enzymatically active P450 aromatase in human ejaculated sperm. METHODS AND RESULTS: To confirm the presence of mRNA coding for P450 aromatase, total RNA isolated from human sperm underwent RT-PCR and then Southern blot analysis. In non-capacitating medium, we observed that only estradiol and aromatizable steroids were able to increase sperm motility/migration; concomitantly they enhanced protein tyrosine phosphorylation and increased p-44/42 extracellular signal-regulated kinase activity. When we tested acrosin activity, it emerged that estradiol and aromatizable androgens were also able to induce the acrosome reaction evaluated by two different cytological staining techniques (triple-stain and fluorescein isothiocyanate-Pisum sativum agglutinin). All these events were enhanced by the 2'-O-dibutyryladenosine-3',5'-cyclic monophosphate and inhibited in the presence of the specific aromatase inhibitor, letrozole. CONCLUSIONS: From this study, it appears that a link exists between the locally produced estradiol (from ejaculated sperm), sperm capacitation and the acrosome reaction. The induction of both events by aromatizable androgens in the absence of exogenous mediators suggests that estrogen biosynthesis in ejaculated sperm is a process that may influence the intrinsic sperm fertilizing capability.

Acrosin↗
PubMed1994

Retrograde ejaculation.

Retrograde ejaculation is an uncommon cause of male infertility. It should be suspected in any case of azoospermia, and might be congenital, acquired or idiopathic in origin. When pharmacological attempts to restore anterograde ejaculation fail, it is suggested that spermatozoa should be recovered from post-ejaculation urine to be applied in one of the modern techniques of assisted reproduction. The successful recovery of viable spermatozoa from the urine is dependent upon careful regulation of pH and osmolarity of the urine at the time of ejaculation. Careful handling of the retrieved spermatozoa enables isolation of sperm cells with good quality for insemination of ovulated oocytes (in vivo) or retrieved oocytes (in vitro).

Ejaculation↗
PubMed1988

Changes in lectin-binding features of ram sperm surfaces associated with epididymal maturation and ejaculation.

Ram sperm, isolated from the caput, corpus, and cauda epididymidis, plus ejaculated cells were washed free of loosely bound components and tested for their ability to bind fluorescein-conjugated lectins (Con A, SBA, RCA, PNA, ECA and WGA) as assessed by epiluminescent-fluorescence light microscopy and flow cytometry. Detailed preliminary studies established an appropriate lectin-to-sperm ratio and incubation conditions for quantitative comparisons of sperm cell types and permitted a detailed analysis of both the amount of lectin bound as well as its distribution on the various aspects of the cell surface. Con A (mannose positive) bound weakly over the entire surface, with little change associated with maturation in the male tract. SBA (N-acetylgalactosamine positive) bound moderately strongly to caput sperm, with an emphasis on the apical ridge portion of the cell; during epididymal transit this binding was greatly diminished and was regained upon ejaculation. RCA, PNA, and ECA (galactose positive) gave generally equivalent results, where initially strong binding to the entire sperm surface decreased (over all parts of the surface except the anterior head) during epididymal maturation, with no change associated with ejaculation. WGA (sialic acid positive) binding initially was weak, but increased with epididymal transit and ejaculation. In vitro incubations with beta-galactosidase and neuraminidase confirmed the assignments given above. These data, when coupled with previous reports describing the heterogeneous distribution of proteins and lipids and changes in their distribution associated with epididymal maturation, serve to quantitatively describe changes in those aspects of the cell surface that are probably responsible for the acquisition of the capacity of the sperm to bind successfully to the oocyte.

Animals↗
PubMed1993

Boar seminal vesicles secrete arylsulfatases into seminal plasma: evidence that desulfation of seminolipid occurs only after ejaculation.

The presence and composition of arylsulfatases in secretions of various glands of the boar genital tract were studied. Arylsulfatase A was present in seminal plasma but not in extracellular fluids of the testis and epididymis nor in blood serum of boars. On the other hand, arylsulfatase B was present in both seminal plasma and extracellular fluids of the testis but was completely resorbed in the epididymis. The acrosomal arylsulfatase A did not leak out of spermatozoa before ejaculation. We conclude that arylsulfatases A and B present in seminal plasma are secreted by the seminal vesicles, for three reasons: 1) secretions from seminal vesicles contained 2.3-fold higher arylsulfatase activities than did those from seminal plasma, but had an identical composition; 2) cauda epididymal fluids did not contain arylsulfatase; and 3) other accessory glands of the boar genital tract did not secrete arylsulfatase. When intact boar spermatozoa were incubated with arylsulfatase A, complete desulfation of seminolipid was observed. The most important arguments favoring our hypothesis that desulfation of seminolipid does not start before ejaculation are the following: 1) desulfoseminolipid is not detectable in epididymal or freshly ejaculated sperm samples; 2) the acrosomal arylsulfatase A cannot desulfate seminolipid present at the surface of the plasma membrane of intact spermatozoa because of its intracellular localization; 3) extracellular arylsulfatase A is stored in seminal vesicles and thus can interact with spermatozoa during and after ejaculation.

Animals↗
PubMed2000

Evidence that anoreceptive intercourse with ejaculate exposure is associated with rapid CD4 cell loss.

OBJECTIVE: To determine whether ejaculate exposure through anoreceptive intercourse is associated with rapid CD4 cell loss. DESIGN: Self-reported behavioral, demographic data and blood samples were gathered longitudinally at ten semiannual visits from individuals participating in the Multicenter AIDS Cohort Study (MACS). PATIENTS/PARTICIPANTS: A group of 937 HIV-seropositive men who were continuously followed for four to ten semiannual visits. OUTCOME MEASURES: A loss of 10% or more in CD4 cells between the first two of any three consecutive semiannual visits that was followed by a 10% or greater loss between the second and third visits. RESULTS: A period of rapid CD4 cell loss over three semiannual visits occurred in 389 of the 937 (42%) HIV-seropositive men studied. Men who reported one or more anoreceptive intercourse partners with whom they were exposed to ejaculate (RAI-E) during the 12 months immediately preceding their visits were more than twice as likely to show this rapid CD4 cell loss compared with men with no such partners. CONCLUSIONS: The association between RAI-E partnerships and rapid CD4 cell loss suggests factors associated with ejaculate exposure (e.g., sexually transmitted diseases) may hasten the clinical progression of HIV disease. It is suggested that infectious diseases, which are known to be associated with ejaculate exposure, may be the causal factor underlying the association between RAI-E partnerships and rapid CD4 cell loss in these men, although the presence of these diseases was not ascertained in these data. HIV-infected individuals should be cautioned against unprotected anoreceptive intercourse.

CD4 Lymphocyte Count↗
PubMed1997

The treatment of comorbid premature ejaculation and panic disorder with fluoxetine.

Premature ejaculation is a common sexual disturbance among men. Both open-label and double-blind studies have demonstrated the effectiveness of serotonergic medications for this disorder. These studies support the hypothesis that the serotonergic system has an important role in the modulation of sexual response, especially attainment of orgasm. Serotonergic dysfunction also has been linked to the pathogenesis of panic disorder. Several studies have demonstrated the efficacy of serotonergic drugs in this disorder. The purpose of the present study was to examine the efficacy of fluoxetine, a serotonin selective reuptake inhibitor for the treatment of comorbid premature ejaculation and panic disorder, in 10 men in an open-label design. The patients were given 20 mg of fluoxetine for 8 weeks of the study. Parameters pertaining to sexual function and measures of anxiety were examined. Improvement of premature ejaculation was noted as of week 2 of the study, whereas measures of panic and sexual satisfaction became statistically significant only as of week 4. Further studies with larger samples and longer periods of follow-up are needed in order to determine the usefulness of fluoxetine for the treatment of comorbid premature ejaculation and panic disorder.

Adult↗
PubMed1996

The effects of ejaculation on serum prostate specific antigen.

PURPOSE: We evaluated the correlation of prostate specific antigen (PSA) and ejaculation in patients with symptomatic benign prostatic hyperplasia and an active sexual life. MATERIALS AND METHODS: In a study of 40 patients 50 to 60 years old (mean age 55) with prostatic symptoms serum PSA was evaluated before as well as 1 and 7 days after ejaculation. Due to clinical significance of PSA in diagnosis and monitoring of prostate cancer, we included men at risk age and with an active sex life. RESULTS: The results were compared to those of a control group of 10 asymptomatic (without coitus) men 50 to 60 years old (mean age 55 years). There were no statistically significant differences in PSA levels before and after ejaculation or between the groups. These results suggested that there was no physiological relationship between ejaculation and PSA level. CONCLUSIONS: Based on our data we conclude that sexual activity does not preclude the use of PSA to screen men for prostatic cancer.

Ejaculation↗