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PubMed2003

Estradiol in the male rat amygdala facilitates mounting but not ejaculation.

Mating activates estrogen sensitive neurons in several regions of male rat brain, including the medial amygdala (MEA). Infusion of the aromatase inhibitor, Fadrozole, into the MEA reduced mating, presumably by inhibiting conversion of testosterone (T) to estradiol (E(2)). We investigated whether administering E(2) locally into the amygdala (AMG) would maintain sexual behavior in male rats given systemic Fadrozole to eliminate E(2) elsewhere in the brain. Gonadally intact male rats were divided into two matched groups, based on ejaculatory performance in weekly tests with receptive females. All males received 0.29 mg/kg/day sc Fadrozole and bilateral implants to AMG. E(2)-in-AMG males (N=6 experimentals) received implants tipped with a cured mixture of E(2) in Silastic Medical Adhesive, whereas Vehicle-in-AMG males (N=6 controls) received implants tipped with cured adhesive alone (without E(2)). In E(2)-in-AMG males, postoperative mount and intromission frequency did not differ significantly from pretreatment baseline levels, but ejaculation frequency declined significantly (P<.01). Conversely, in Vehicle-in-AMG males, postoperative mounts and intromissions (P<.01) and ejaculations (P<.01) declined significantly. Postoperative mount and intromission frequency of Vehicle-in-AMG males was significantly lower than that of E(2)-in-AMG males (P<.01), but ejaculation frequency did not differ significantly between groups. This suggests that E(2)-sensitive AMG neurons are important for sexual arousal but not ejaculatory performance.

Amygdala↗
PubMed2003

Neurophysiologic evaluation of central-peripheral sensory and motor pudendal pathways in primary premature ejaculation.

OBJECTIVES: Pudendal nerve somatosensory evoked potentials (SEPs), the bulbocavernosus (BC) reflex, and BC perineal motor evoked potentials after transcranial magnetic cortical stimulation were performed in patients with primary premature ejaculation to investigate the somatic sensory and motor function of the genital area. METHODS: Fourteen patients with primary premature ejaculation underwent psychological counseling, urologic physical examination, transrectal ultrasound examination, laboratory testing, and the Stamey test. The spinal and cortical pudendal nerve SEPs were performed by dorsal nerve stimulation at the penile shaft (DN-SEPs) in all patients and at the glans penis (GP-SEPs) in 3 of them. The BC reflex was obtained by stimulating the base of the penis. RESULTS: The mean sensory threshold did not significantly differ between the patients and normal subjects. Cortical DN-SEPs were normal in all patients. The sensory central conduction time, calculated in 6 patients, was normal. The mean cortical DN-SEP amplitude was significantly smaller in patients than in controls. In 3 patients and in 3 controls who underwent both DN-SEP and GP-SEP testing, the glans penis sensory threshold was lower than the dorsal nerve threshold and the cortical GP-SEP latency was longer than the cortical DN-SEP latency. The BC reflex was normal in most patients. The BC motor evoked potentials were normal in all patients, but one. CONCLUSIONS: We did not confirm either a faster conduction along the pudendal sensory pathway or a greater cortical representation of the sensory stimuli from the genital area in our patients. Moreover, we did not confirm hyperexcitability of the BC reflex in them. Our results suggest that the electrophysiologic approach is probably not sufficient to clarify the causes of primary premature ejaculation. A more integrated investigation could allow better results in this field.

Adult↗
PubMed1998

Identification of spermatozoa and round spermatids in the ejaculates of men with spermatogenic failure.

OBJECTIVES: As many as 10% of infertile men have azoospermia caused by spermatogenic failure or ductal obstruction. The histologic diagnoses associated with spermatogenic failure--Sertoli cell-only syndrome, maturation arrest, and hypospermatogenesis--do not necessarily represent global changes in the affected testis, as occasional seminiferous tubules may still produce mature germ cells. Intracytoplasmic sperm injection (ICSI) allows individual sperm that have been isolated from testicular tissue to fertilize oocytes. This study assessed whether mature germ cells (either round spermatids or spermatozoa) were present in the ejaculates of patients with spermatogenic failure. METHODS: All semen analyses performed at our tertiary care institution from January 1993 through December 1995 were reviewed to identify azoospermic men with spermatogenic failure. During this period, our laboratory employed Nuclear-Fast Red and picroindigocarmine staining (NF-PICS) of cytospin slides to identify rare spermatozoa and spermatids in otherwise azoospermic ejaculates. RESULTS: Of 3005 analyses reviewed, 20 azoospermic men whose infertility was solely attributable to spermatogenic failure were identified. The histologic diagnoses were germinal cell aplasia (n = 7), complete maturation arrest (n = 6), incomplete maturation arrest (n = 3), and hypospermatogenesis (n = 4). Using the NF-PICS technique, mature germ cells were identified in the ejaculates of 15 men (75%), and 9 men (45%) had fully formed spermatozoa present. CONCLUSIONS: In the clinical management of azoospermic infertile men, the NF-PICS technique may be used to identify men who have some degree of testicular spermatogenesis. This might obviate the need for the purely diagnostic testis biopsy that is performed before therapeutic biopsy for testicular sperm extraction in conjunction with ICSI.

Biopsy↗
PubMed2000

Clinical study of SS-cream in patients with lifelong premature ejaculation.

OBJECTIVES: To investigate the clinical efficacy of SS-cream, the topical agent made from the extracts of nine natural products for the treatment of premature ejaculation, we performed a double-blind, randomized, placebo-controlled Phase III clinical study of patients with lifelong premature ejaculation in three medical centers. METHODS: One hundred six patients (mean age 38.7 +/- 0.61 years) completed this study. The ejaculatory latency measured by stopwatch and sexual satisfaction ratio of both partner and patient were investigated twice in the screening period and once after each treatment (1 placebo 0.20 g and 5 SS-cream 0.20 g for a total of six treatments). Patients were instructed to apply the cream on the glans penis 1 hour before sexual intercourse in a double-blind randomized fashion. Clinical efficacy was compared with the prolongation of ejaculatory latency and improvement of the sexual satisfaction ratio before and after each treatment. RESULTS: In the screening period, the mean ejaculatory latency was assessed at 1.37 +/- 0.12 minutes, and neither the patients nor their partners were satisfied with their sexual lives. After treatment, the mean ejaculatory latency was prolonged to 2.45 +/- 0.29 minutes in the placebo group and 10.92 +/- 0.95 minutes in the SS-cream group. The clinical efficacy of placebo and SS-cream as judged by an ejaculatory latency time prolonged more than 2 minutes was 15.09% and 79.81%, respectively. The improvement of sexual satisfaction to a grade higher than effective was 19.81% and 82.19%, respectively, for placebo and SS-cream. Of 530 trials of SS-cream, 98 (18.49%) resulted in a sense of mild local burning and mild pain. No adverse effect on sexual function or partner and no systemic side effects were observed. CONCLUSIONS: According to these results, SS-cream is effective and safe in the treatment of premature ejaculation, with mild local side effects.

Administration, Topical↗
PubMed1995

Response of the urethral and intracorporeal pressures to cavernosus muscle stimulation: role of the muscles in erection and ejaculation.

OBJECTIVES: The role of the bulbocavernosus (BC) and ischiocavernosus (IC) muscles in erection and ejaculation was studied. METHODS: The response of the urethral and intracorporeal pressure to cavernosus muscle stimulation was evaluated in 18 male volunteers (mean age, 36.6 years). A two-channel microtip catheter was placed in the prostatic and bulbous urethra. Muscle stimulation was done by two needle electrodes inserted into the BC and IC muscles. RESULTS: BC muscle stimulation caused an increase in the pressure of the bulbous urethra (P < 0.001) and corpus spongiosum (P < 0.01) and an insignificant change in the prostatic and pendulous urethral and corpus cavernosal pressures (difference not significant). IC muscle stimulation effected an increase in the corpus cavernosal pressure (P < 0.001) without changing the urethral pressure (difference not significant). CONCLUSIONS: The BC muscle contracts rhythmically at orgasm and this might help to eject the semen from the posterior to the anterior urethra. It is apparent that the muscle has minimal or no role in erection. IC muscle may have a role in erection by increasing the intracavernosal pressure. It seems that it has no role in ejaculation. BC may be considered the "muscle of ejaculation," and IC the "muscle of erection."

Adult↗
PubMed2000

Effects of semen plasma from different fractions of individual ejaculates on IVF in pigs.

We applied IVM/IVF techniques to investigate effects of preincubation of sperm with different fractions of semen plasma harvested from fresh ejaculates on in vitro penetration and fertilization of in vitro matured oocytes. Three fractions of semen plasma were separated from the complete ejaculate of three Landrace boars and used to coincubate sperm obtained from the first sperm-rich fraction of the same ejaculates. After 14 to 16 h coincubation at room temperature, sperm were preincubated in capacitation medium and then inseminated into fertilization medium containing porcine oocytes matured in vitro. The semen plasma used for coincubation affected penetration rate (P < 0.001); Sperm coincubated with Fraction 1 semen plasma had a higher penetration rate compared with sperm coincubated with Fraction 2 (P < 0.05), but not with Fraction 3. Boar affected male pronucleus formation rates after insemination (P < 0.05), but no difference among boars was found in monospermy rate, average number of sperm penetrating into each fertilized oocyte, or the average number of sperm attached. No boar by fraction interaction was found for any parameters studied.

Animals↗
PubMed2005

[Use of paroxetine on-demand in premature ejaculation].

INTRODUCTION: It has been described varied definitions of premature ejaculation (PE), which has determined different prevalences and rates of success for the different therapies with selective serotonin re-uptake inhibitors. Our goal was evaluate the effectiveness of paroxetine like treatment of premature ejaculation administered on-demand (4-6 hours previous to intercourse) compared to the scheme of daily dose. PATIENTS AND METHOD: A prospective study type crossover was designed with 14 patients. Grupo A: 7 patient received paroxetine 20 mg/d by three weeks followed by paroxetine 20 mg 4-6 hours before the intercourse by three weeks. Group B: the other 7 patients received the same scheme but replacing by placebo. Later to three weeks of therapy suspension, crossover was made. RESULTS: The intravaginal ejaculatory latency time (IELT) pre-treatment was 0.4 minutes. In the group A the IELT average was of 4.3 minutes in the treatment with daily paroxetine; 5.8 minutes when they received paroxetine on-demanad; 0.9 with daily placebo and 0.6 with placebo on-demand (p < 0.001). For group B the IELT during the daily placebo was 0.8 minutes and with placebo on-demand it was of 1.1. When they received daily paroxetine the IELT was 3.3 minutes and during the phase of paroxetine on-demand it was increased to 6.1 (p<0.001). CONCLUSIONS: The treatment of premature ejaculation with paroxetine in daily dose and scheme on-demand appears similar like effective options.

Adult↗
PubMed2003

Successful pregnancies after using immotile spermatozoa from ejaculate, epididymis and testis.

OBJECTIVE: To assess the efficacy of intracytoplasmic sperm injection (ICSI) in term of pregnancy rate with immotile spermatozoa from ejaculate, epididymis and testis. STUDY DESIGN: A retrospective study was conducted between January 1998 and March 2001. We performed intracytoplasmic sperm injection with immotile spermatozoa, in 160 couples during 172 cycles. RESULTS: The birth rate per cycle was 38.4% in immotile spermatozoa from ejaculate, 35.4% from testis and 38.7% from epididymis. CONCLUSION: This retrospective analysis shows that immotile spermatozoa retrieved from epididymis or testicle gives similar fertilization and pregnancies rates as immotile spermatozoa from ejaculate.

Ejaculation↗
PubMed2003

Premature or rapid ejaculation: heterosexual couples' perceptions of men's ejaculatory behavior.

This study investigated the relationship between men's and their female partner's perceptions of men's ejaculatory behavior as well as the impact of premature or rapid ejaculation on couple functioning. One hundred fifty-two men and their female partners provided information about the man's ejaculatory behavior, their perceptions of whether the man had a problem with premature or rapid ejaculation (RE), their sexual and relationship satisfaction, and their sexual concerns. The men's and women's reports on the man's ejaculatory behavior were only moderately correlated. In general, the women saw RE as less of a problem for the men than their male partners reported for themselves. The women's perceptions of both the men's ejaculatory behavior and his affective responses were uniquely related to her own and her partner's identification of him as having an RE problem. For both the men and the women, having more characteristics of RE was related to lower sexual satisfaction, but was unrelated to relationship satisfaction. RE characteristics were also related to the number of non-RE sexual concerns reported by the men, but not to the number of sexual concerns reported by their female partner. However, men and women who identified the man as having an RE problem rated RE as having only a slightly negative impact on their own or their partners functioning. The results suggest that, for most couples, the timing of ejaculation adversely affects sexual satisfaction but not overall relationship and personal functioning.

Adult↗
PubMed2005

The etiology and management of premature ejaculation.

Premature ejaculation (PE) is a common male sexual disorder. Normative data suggest that men with an intravaginal ejaculatory latency time of less than 1 min have 'definite' premature ejaculation, while men with intravaginal ejaculatory latency times of between 1 and 1.5 min have 'probable' premature ejaculation. Although there is insufficient empirical evidence to identify the etiology of PE, there is correlational evidence to suggest that men with PE have high levels of sexual anxiety and altered sensitivity of central 5-hydroxytryptamine receptors. Pharmacological modulation of the ejaculatory threshold using daily or on-demand selective serotonin reuptake inhibitors offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, leads to improvements in sexual desire and other sexual domains, and is well tolerated.

Algorithms↗
PubMed1980

Severe hypertension in patients with high spinal cord lesions undergoing electro-ejaculation--management with prostaglandin E2.

Intra-arterial blood pressure (BP) and heart rate (HR) were continuously recorded in five patients with spinal cord injuries at different levels who were undergoing electro-ejaculation. In three patients with lesions at C7, C5 and T4 insertion of the electrode and electrical stimulation caused severe hypertension and bradycardia. In a patient with a T7/8 lesion and in another with a T10 lesion there were either moderate or minimal cardiovascular changes. Severe hypertension during electro-ejaculation is a serious problem in patients with high lesions and is probably part of the syndrome of autonomic dysreflexia. In the three patients with high spinal cord lesions the procedures were repeated during an intravenous infusion of Prostaglandin E2. Resting BP was lowered and resting HR raised. The level of BP recorded during electrical stimulation was substantially reduced. This enabled larger stimuli to be used for a longer period and resulted in successful ejaculation in two patients.

Adult↗
PubMed1994

Assisted ejaculation combined with in vitro fertilisation: an effective technique treating male infertility due to spinal cord injury.

Infertility due to spinal cord injury (SCI) in males has been identified for decades as an area of major concern and techniques for assisted ejaculation are available. There has not been an overall consensus regarding which type of assisted procreation is the most appropriate for these couples. We describe here our experience from a programme based on assisted ejaculation combined with in vitro fertilization (IVF). Twelve couples have been treated so far and altogether 22 cycles with ovum pick-up have been completed. Fertilisation of the oocytes was obtained in 18 of these cycles. The overall oocyte fertilisation rate was 49%. Embryo transfer took place in 17 cycles, leading to seven clinical pregnancies. Four of the pregnancies are delivered or are ongoing, whereas three ended in first trimester spontaneous abortion. Thus our initial experience suggests that assisted ejaculation in combination with IVF is an effective option for these couples.

Adult↗
PubMed1999

Ejaculation in testicular cancer patients after post-chemotherapy retroperitoneal lymph node dissection.

The purpose of this study was to evaluate fertility after different types of post-chemotherapy retroperitoneal lymph node dissection (RPLND). During 1980-1994, 192 patients with metastatic testicular cancer underwent post-chemotherapy RPLND with a gradual shift from modified bilateral template RPLND to nerve-sparing RPLND. Modified bilateral template RPLND was done in 92% of the patients operated during 1980-1984 as compared to 16% during 1989-1994. Pre- and post-treatment fertility was assessed by microscopic sperm analysis, determination of serum FSH and information on ejaculation and paternity. There was no significant difference of the survival rates between the three treatment periods. Antegrade ejaculation was preserved in 11% of the patients after modified bilateral template RPLND as compared to 89% after the nerve-sparing operation technique. The median ejaculatory volume decreased post-operatively, serum FSH increased and sperm density remained unchanged. Fifty-six patients attempted fatherhood after their treatment, and 27 fathered at least one child after an observation-time of 55 months, nine of them by assisted fertilization. Patients with initially advanced testicular cancer but limited residual retroperitoneal masses after induction chemotherapy can safely undergo limited post-chemotherapy RPLND as a part of multimodality treatment. After nerve-sparing RPLND antegrade ejaculation is preserved in 89% of the patients though the ejaculatory volume decreases after RPLND. Post-treatment fatherhood can be achieved in at least 50% of the patients attempting paternity.

Adolescent↗
PubMed1998

Treatment of premature ejaculation with sertraline hydrochloride.

PURPOSE: To evaluate the efficacy of sertraline hydrochloride in the drug treatment of premature ejaculation (P.E.). MATERIALS AND METHOD: Forty-six normally potent men, aged 22 to 63 years (mean 42 years) with premature ejaculation were treated with oral sertraline in a dose ranging study. All men were either married or in a stable relationship. The mean ejaculatory interval was 1 minute (range 0-5 min). All men were started on Sertraline 25 mg daily and were increased to 50 mg after 3 weeks and 100 mg after a further 3 weeks. None of the men received any formal psychosexual therapy. RESULTS: With a dose of 25 mg, the mean ejaculatory interval increased to 7.6 min (range 0-20 min). With a dose of 50 mg, the mean ejaculatory interval increased to 13.1 min (range 7 min-anejaculation) with 4 men experiencing anejaculation. With a dose of 100 mg, the mean ejaculatory interval increased to 16.4 min (range 7 min-anejaculation), 10 men experiencing anejaculation. With a dose of 25 mg, 1 man described transient dizziness. With a dose of 50 mg, 1 man described some drowsiness and anorexia and 1 man experienced minor dyspepsia. With a dose of 100 mg, 2 men described erectile dysfunction and reduced libido, 2 men described transient drowsiness and anorexia, 2 men experienced minor dyspepsia and 2 men described feelings of anxiety. CONCLUSION: Sertraline appears to be a useful agent in the pharmacological treatment of premature ejaculation.

Adult↗
PubMed1999

Treatment of premature ejaculation with paroxetine hydrochloride.

AIMS OF THIS STUDY: To evaluate the efficacy of chronic and 'on demand' administration of paroxetine hydrochloride in the drug treatment of premature ejaculation (PE). MATERIALS AND METHODS: Ninety-four normally potent men, aged 18-61 y (mean 39 y) with premature ejaculation were treated between January 1996 and March 1997, with oral paroxetine hydrochloride, a selective serotonin re-uptake inhibitor (SSRI). All men were either married or in a stable relationship. Sixty-four out of ninety-four men (Group A) were initially treated with paroxetine hydrochloride 20 mg administered once daily. Those men who responded with improved ejaculatory control within four weeks, were then treated with 'on-demand' paroxetine hydrochloride (20 mg) administered 3-4 h prior to planned intercourse. The remaining 33 out of 94 men (Group B) were initially treated with 'on-demand' paroxetine hydrochloride 20 mg administered 3-4 h prior to planned intercourse. RESULTS: The mean pre-treatment ejaculatory latency time (ELT) of both group A and B was 0.4 min (range 0-1 min) in 205 intercourses at a frequency of 0.4 intercourses per week. In group A after four weeks of daily administration of paroxetine, the mean ELT was 4.5 min (range 1-anejac.) in 761 intercourses at a frequency of 2.4 intercourses per week. Fifty-three out of sixty-one men in group A regarded their ejaculatory control as improved and were then treated with 'on-demand' paroxetine, achieving an ELT of 3.9 min (range 0-10) in 608 intercourses at a frequency of 2.6 intercourses per week. Thirty-six men in this group of 53 regarded that they had maintained improved ejaculatory control with a mean ELT of 5.5 min (range 2-20 min) after a further four weeks of treatment (P < 0.001). The remaining 17 men reported a recurrence of poor ejaculatory control with a mean ELT of 0.7 min (range 0-2 min). In group B with initial 'on-demand' paroxetine after a mean of 4.5 weeks of treatment, the mean ELT was 1.5 min (range 0-5 min) in 298 intercourses at a frequency of 2.2 intercourses per week. Adverse effects were only recorded in men taking daily paroxetine and included anejaculation in 5 out of 61, inhibited orgasm in 3 out of 61 and reduced libido on 3 out of 61. Erectile dysfunction was not reported and 'on demand' paroxetine was not associated with any adverse effects. CONCLUSIONS: Paroxetine hydrochloride appears to be a useful agent in the pharmacological treatment of premature ejaculation when administered on a chronic, an 'on-demand' basis following chronic treatment or initial 'on demand' basis.

Adolescent↗
PubMed2004

Analysis of retrograde ejaculation using color Doppler ultrasonography before and after transurethral collagen injection.

Transurethral bladder neck collagen injection therapy was performed in a patient with retrograde ejaculation. The phenomenon of retrograde ejaculation and its correction after the therapy were clearly demonstrated by color Doppler ultrasonography. To our knowledge this is the first report showing successful observation of retrograde ejaculation using color Doppler ultrasonography.

Adult↗
PubMedDate not supplied

Role of genital sensory information in the control of the functioning of the spinal generator for ejaculation.

An intrinsic spinal rhythm mediates fictive ejaculation (FE). In this study, the effect of genital sensory stimulation on the functioning of the spinal generator of ejaculation was investigated. To this aim, the effect of (a) stimulation of internal and external genital structures; (b) repeated elicitation of FE and (c) genital stimulation during in progress expression of FE on the rhythmic genital motor pattern of ejaculation (GMPE) was analysed in sexually experienced, spinal male rats. Results showed that the spinal intrinsic ejaculatory rhythm can be modulated by genital inputs, and that repeated stimulation modifies this rhythm, progressively inhibiting its expression. Finally, in progress GMPEs could be reset by overlapping genital stimulation, supporting the notion of the spinal cord mediating the inhibition of FE following repeated genital inflow. Results reveal the nature of the modulatory role that genital afferent information exerts on the expression of FE.

Animals↗
PubMedDate not supplied

alpha-Adrenergic agents modulate the activity of the spinal pattern generator for ejaculation.

Spinal cord transection at a thoracic level activates fictive ejaculation (FE) in the male rat. It has earlier been demonstrated that fictive motor patterns may be activated by pharmacological means and that the noradrenergic system seems to be particularly efficient in triggering locomotor fictive patterns in spinal animals. In the present study, the hypothesis was tested that the spinal noradrenergic system participates in the activation of the spinal generator for ejaculation (SGE). To this aim, the effect of the adrenergic agents, methoxamine, prazosin, clonidine, and yohimbine, upon FE was evaluated in spinal male rats using electromyographic techniques. The results obtained show that ejaculatory rhythmic patterns, accompanied by the expulsion of urethral contents and phasic penile movements, can be elicited by the intravenous (i.v.) injection of methoxamine or yohimbine. These drug-induced motor sequences appear superimposed to the intrinsic ejaculatory spinal rhythm. By contrast, i.v. injection of prazosin or clonidine blocked the expression of the spontaneous ejaculatory rhythmic pattern without inducing any other genital response. These data suggest that an increased noradrenergic tone, either by blockade of presynaptic alpha2-adrenoceptors or by stimulation of postsynaptic alpha1-adrenoceptors, results in the activation of the SGE. Present findings provide the evidence that the SGE might be importantly influenced by the noradrenergic system, which exerts a facilitatory control on the expression of the genital motor pattern of ejaculation.

Adrenergic Agents↗