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PubMed2006

Efficacy of sertraline hydrochloride in treatment of premature ejaculation: a placebo-controlled study using a validated questionnaire.

Selective serotonin reuptake inhibitors (SSRIs) are increasingly used to treat premature ejaculation. We report a large prospective placebo-controlled crossover study of sertraline in premature ejaculation (PE) using Arabic Index of Premature Ejaculation (AIPE). One hundred and forty-seven men suffering from PE were enrolled in a randomized single-blinded crossover study of sertraline hydrochloride and placebo. Patients were randomized into group 1 (n=77) and group 2 (n=70). Both groups received sertraline and placebo interchangeably for 4 weeks. Overall, 127 (81%) of 157 subjects experienced a significant increase in their AIPE total score after sertraline treatment. Sixty-six (66%) of 100 patients available for follow-up experienced relapse of PE within 6 months after sertraline withdrawal. The active drug was generally well tolerated. Our relatively large study, using a validated questionnaire (AIPE), confirmed the useful effect of sertraline on PE.

Adult↗
PubMed1999

Role of ejaculation in the treatment of chronic non-bacterial prostatitis.

BACKGROUND: Chronic non-bacterial prostatitis (NBP) is the most common prostatitis syndrome. Prevention and cure are not possible because the cause of NBP is unknown. However, patients may benefit from supportive measures. The impact of the frequency of ejaculation alone on the course of NBP was evaluated in the present study. METHODS: Thirty-four single male patients who avoided masturbation and extramarital sexual intercourse for personal and/or religious beliefs and who did not respond to a clinical trial of doxycycline hydrochloride therapy (200 mg daily for 4 weeks) directed against mycoplasmas, chlamydiae and ureaplasmas were enrolled in the study. They were encouraged to masturbate regularly at least twice a week and were re-evaluated at the end of a 6 month period, including a complete inquiry regarding their sexual function during this time. Response was assessed by a symptom severity index. RESULTS: Clinical and laboratory re-evaluation could be performed in 28 patients. Of 18 patients who adhered to the recommendations, two (11%) experienced complete relief of symptoms, whereas six (33%) had marked improvement, six had moderate improvement and four (22%) did not benefit. In contrast, three of seven patients who masturbated less frequently reported partial improvement. Three patients who did not ejaculate other than during wet dreams had a worse prognosis. CONCLUSIONS: Young men who are single and suffering from NBP must be informed about their illness in detail and, if they are not doing so, they should be encouraged to ejaculate regularly, for example by masturbation in the absence of a sexual relationship with a partner. We believe that normal sexual activity decreases the incidence of NBP in some cases.

Adolescent↗
PubMed1975

Premature ejaculation: some thoughts about its pathogenesis.

Premature ejaculation has always been assumed to be a male sexual dysfunction whose pathogenesis involved either male physiologic or psychologic considerations. A small series of unselected cases is presented that suggests that premature ejaculation may also result from hidden femal arousal difficulties. The clinical material illustrates that the newer penile stimulation therapies for premature ejaculation are not required for every couple with this complaint.

Adult↗
PubMed1983

The Grafenberg spot and female ejaculation: a review of initial hypotheses.

A controversial set of hypotheses have been proposed as an explanation for nonvulval (i.e., nonclitoral) orgasms in women. First, women have a small sensitive area in the anterior wall of the vagina (the Grafenberg spot) which seems to trigger these "deeper" orgasms. Second, stimulation of this area may be associated with ejaculatory response during orgasm. Investigation of these hypotheses was conducted under laboratory conditions in an effort to assess their validity. Eleven women, six of whom claimed to be "ejaculators," were examined by two gynecologists. Gynecologists found an area similar to other descriptions of the Grafenberg Spot in four of the 11 women. It was not found more in ejaculators than nonejaculators. Examination of the ejaculate of six women failed to detect elevated levels of prostatic acid phosphatase and the substance appeared similar in biochemical properties to urine. A number of alternative explanations for the failure to confirm the hypotheses are offered.

Acid Phosphatase↗
PubMed1989

Premature ejaculation: clinical subgroups and etiology.

Forty-six patients suffering from premature ejaculation (PE) were subdivided into primary premature ejaculators (PPE)--those who suffered from PE since the beginning of their sexual lives--and secondary premature ejaculators (SPE)--those who suffered from PE after years of normal sexual functioning. It is postulated that these two groups can be clinically differentiated by: bulbocavernosus reflex (BCR) latency time; sequential natural history of PPE vs. nonsequential development of SPE; and nondemonstrable organic illness vs. demonstrable organic cause in the great majority of SPE. This classification appears to be helpful in formulating appropriate treatment plans.

Adult↗
PubMed1990

Play therapy with the sexual workhorse: successful treatment with twelve cases of inhibited ejaculation.

This paper explores play as treatment for inhibited ejaculation (IE), based on success with 12 heterosexual and homosexual men. The focus is on men able to ejaculate with their own touch but not with partner touch or penile containment. A definition of IE includes: compulsive need to please partner, response anxiety, nonsexual automatic erections, and the penis's refusal to be commanded interpersonally. Treatment options with individuals and/or couples begin with reframing the symptom as compulsive giving and are not directed at forcing ejaculation. Playing, interfering with erroneous beliefs about sexual arousal, and avoiding helping the workhorse work harder are the trust of this paper.

Creativity↗
PubMed1996

A new treatment for premature ejaculation: the rehabilitation of the pelvic floor.

This study evaluated pelvic floor rehabilitation as a possible treatment for premature ejaculation. In this treatment it is assumed that the pelvic muscles are involved in the control of the ejaculatory reflex. The treatment avails itself of a method already used for fecal and urinary incontinence. Eighteen patients with premature ejaculation were recruited. Fifteen (83%) of them had suffered from this disturbance for at least five years. Most of them had experienced other therapies without success. After 15-20 sessions of pelvic floor rehabilitation, 11 (61%) patients were cured and are able to control the ejaculatory reflex; seven (39%) patients had no improvement. All patients were followed for a minimum of 6 months to a maximum of 14 months. This therapy is easy to perform, has no side effects, and can be included among the therapuetic options for patients with premature ejaculation.

Adult↗
PubMed1997

The association of premature ejaculation and hypogonadotropic hypogonadism.

Twelve patients with premature ejaculation were evaluated and the hypothalamic anterior pituitary-testicular axis studied to determine whether hormonal abnormalities occurred. Plasma testosterone and free testosterone levels were found to be diminished, as were LH and FSH levels. Four of 12 patients with premature ejaculation had increased prolactin levels. The findings of decreased testosterone without the expected increases in gonadotropin in male patients between 24 and 25 years old points to hypothalamic pituitary dysfunction as a factor in the genesis of the hypogonadal state. Further studies are needed to document the association of premature ejaculation and hypogonadotropic hypogonadism, along with other possible clinical correlations that remain to be described.

Adult↗
PubMedDate not supplied

Individual cryopreservation with dimethyl sulfoxide and polyvinylpyrrolidone of ejaculates and pooled semen of three avian species.

Artificial insemination (AI) has been used for avian reproduction due to the discovery of cryoprotectants extending its usefulness both in production of domestic fowl and conservation of wild species. The goal of this study was to assess the effect on domestic and wild fowl pooled semen and individual ejaculate cryopreservation with dimethyl sulfoxide (DMSO) and polyvinylpyrrolidone (PVP). Twenty ejaculates and twenty samples of pooled semen of roosters, pheasants and hawks were frozen in media containing DMSO or PVP. DMSO and PVP cryopreservation are equally effective both for ejaculates and pooled semen. Even PVP is a good alternative since no significant difference was found when compared to DMSO. The fertilizing capacity of fresh and cryopreserved pooled semen was analyzed through AI of hens and female pheasants. Similar fertility rates using DMSO, PVP or frozen-thawed samples demonstrated that reproduction is possible through the use of cryopreserved semen. In the case of female pheasants, the same values were obtained with both cryopreserved and fresh semen.

Animals↗
PubMedDate not supplied

Determination of laboratory specific percent normal sperm morphology value based on prevasectomy ("fertile") ejaculates.

Semen assessments were performed on ejaculates from 25 men with proven fertility requesting vasectomy. Multiple cytological slides were made simultaneously from each ejaculate and analyzed by a single technician. The morphology data obtained were analyzed for repeatability. The mean +/- SD for normal sperm morphology was 30.6+/-7.3, and the within-subject repeatability was < or =1 SD of the mean for 17 of 25 ejaculates. Technician and laboratory specific criteria for the percent normal sperm morphology component of a semen analysis report (that are clinically meaningful) can be developed using the approach described herein.

Ejaculation↗
PubMed2002

Does paradoxical sleep deprivation and cocaine induce penile erection and ejaculation in old rats?

A recent study has established that paradoxical sleep deprivation (PSD) and cocaine administration elicit genital reflexes (penile erection and ejaculation) in young rats. To discover whether the same effects occurred in old animals submitted to PSD, we administered cocaine (15 mg/kg) to young (3-month) and old (22-month) male rats after a 4-day period of PSD or at the equivalent time-point in control animals. We then evaluated erections and ejaculations. Sixty per cent of the old-PSD group displayed erection, although ejaculation was not observed. Genital reflexes were absent in young and old control groups. We found that PSD reduced testosterone and increased progesterone levels in both young and old PSD groups. In conclusion, our results suggest that although genital reflexes usually decrease with age, testosterone levels alone cannot account for these changes. The interaction of PSD and cocaine probably enhances dopamine transmission in the brain and may elicit penile erection in old rats.

Aging↗
PubMed2003

A technique for preserving retained distal cytoplasmic droplets in situ for immunofluorescence evaluation of ejaculated porcine spermatozoa.

Cytoplasmic droplets (CD) associated with mammalian sperm have traditionally been investigated after isolation from ejaculated sperm cells, or in fixed tissue sections from the epididymides. Many of the current techniques for preparing spermatozoa for immunofluorescence assay (IFA) induce separation of distal cytoplasmic droplets, particularly when membrane permeabilization is required. This article describes a technique capable of maintaining distal cytoplasmic droplets in situ on ejaculated porcine spermatozoa throughout the process of permeabilization and immunostaining. Key steps in this technique include fixation with 0.2%, glutaraldehyde, permeabilization with 0.05% TX-100, and microtube incubations for IFA. Utilizing glutaraldehyde fixation, this technique yielded a mean retention rate of 88% for distal cytoplasmic droplets on ejaculated porcine spermatozoa.

Algorithms↗
PubMed2005

Sexually transmitted infections, prostatitis, ejaculation frequency, and the odds of lower urinary tract symptoms.

Early life sexual factors, including histories of sexually transmitted infections, young-onset prostatitis, and frequency of ejaculation, were investigated in relation to lower urinary tract symptoms (LUTS) in a large case-control study nested within the Health Professionals Follow-up Study. In 1992, study participants were asked to provide information on their histories of sexually transmitted infections, prostatitis, ejaculation frequency, surgery for an enlarged prostate, and LUTS. Information on prostate surgery and LUTS was updated every 2 years. LUTS cases were defined as men who reported surgery for an enlarged prostate or high-moderate to severe LUTS (> or = 15 points on the American Urological Association symptom index) on any study questionnaires (n = 4,608). Controls were men who did not report surgery for an enlarged prostate and who scored 0-7 points on the American Urological Association symptom index on all questionnaires (n = 17,967). History of gonorrhea (adjusted odds ratio = 1.76, 95% confidence interval: 1.43, 2.15) or young-onset prostatitis (adjusted OR = 1.55, 95% confidence interval: 1.22, 1.96) was positively associated with LUTS. No association was observed between ejaculation frequency in early adulthood and LUTS. These results suggest that early genitourinary infections may contribute to later development of LUTS, although confirmation in additional population settings is warranted.

Adult↗
PubMed1998

Results of intracytoplasmic sperm injection with ejaculated, fresh and frozen-thawed epididymal and testicular spermatozoa.

Over the past 5 years, intracytoplasmic sperm injection (ICSI) has been developed to alleviate severe long-standing andrological infertility in couples who could not be helped by standard in-vitro fertilization (IVF), or who could not undergo IVF because too few motile and morphologically normal spermatozoa were present in the ejaculate. ICSI can also be carried out with fresh and frozen-thawed epididymal spermatozoa from patients with obstructive azoospermia and with testicular spermatozoa from most patients with obstructive azoospermia and from some patients with non-obstructive azoospermia. This review reports the results of 5 years of ICSI practice (1991-1995) at the Brussels Free University Centre for Reproductive Medicine, including selection of patients, oocyte and spermatozoa for ICSI, ICSI procedures and its assessment. ICSI was performed in 97% of the 4688 planned treatment cycles. Ejaculated spermatozoa were used in 88% of the cycles, epididymal spermatozoa in 5% of the cycles and testicular spermatozoa in 7% of the cycles. ICSI was performed on 48393 metaphase II oocytes. Of these, 89.5% were morphologically intact, and 70.9% of the intact oocytes were normally fertilized; 64.9% of the two-pronuclear oocytes developed after a further 24 h of in-vitro culture into cleaved embryos, which were transferred or cryopreserved for subsequent use. After transfer of fresh embryos, the percentage of cycles with positive serum human chorionic gonadotrophin was 36.2% per transfer and the percentage of deliveries was 27.0% per transfer. The performance of ICSI with regard to damage, pronuclear status, embryo development and transfer was analysed separately for the four different types of spermatozoa used: fresh ejaculated, epididymal and testicular as well as frozen-thawed epididymal spermatozoa.

Cryopreservation↗
PubMed1999

The outcome of intracytoplasmic sperm injection in patients with retrograde ejaculation.

The objective of this retrospective clinical study was to assess the benefit of assisted fertilization in cases of anejaculatory infertility due to retrograde ejaculation. We report the outcome of intracytoplasmic sperm injection (ICSI) treatment. In 16 couples in which the men suffered from retrograde ejaculation. We performed 35 cycles of ICSI with spermatozoa retrieved from post-ejaculatory urine. The patients had been instructed to alkalinize the urine by ingesting sodium bicarbonate before the procedure. The fertilization rate averaged 51.2%. Seven clinical pregnancies were achieved. Three spontaneous first trimester abortions occurred, but three live offspring were delivered and one pregnancy is ongoing. In conclusion, the use of ICSI may be feasible for patients with retrograde ejaculation who are resistant to medical treatment and whose sperm quality is so low or unpredictable that intrauterine insemination or conventional methods of in-vitro fertilization are not possible.

Adult↗
PubMed2001

Blastocyst transfer following intracytoplasmic injection of ejaculated, epididymal or testicular spermatozoa.

Recent studies indicate a strong paternal influence on embryo development and progression of the embryo to the blastocyst stage. The aim of this study was to compare, during extended culture, the in-vitro development of embryos resulting from intracytoplasmic sperm injection (ICSI) of ejaculated spermatozoa (group 1, n = 347), epididymal (group 2, n = 22) or testicular (group 3, n = 18) spermatozoa from obstructive azoospermic and testicular spermatozoa from non-obstructive azoospermic (group 4, n = 31) subjects. Fertilization and blastocyst formation rates were significantly lower in group 4 (P < 0.05). The incidence of expanded and hatching blastocysts was significantly lower in group 4 (P < 0.05). Overall in 93.2% ejaculate ICSI cycles, blastocysts were transferred on day 5. This was significantly higher than the 62% day 5 transfers in the non-obstructive azoospermic group (P < 0.05). Implantation rate per embryo was significantly higher in the ejaculate ICSI group compared with the other groups (P < 0.05). Clinical pregnancy per transfer was similar between groups; however, significantly fewer multiple pregnancies were encountered in the non-obstructive azoospermic group (P < 0.01). In conclusion, the source of the spermatozoa, most likely to be indicative of the severity of spermatogenic disorder, affects the rate of blastocyst formation and blastocyst implantation. Spermatozoa from non-obstructive azoospermic subjects, when utilized for ICSI, result in embryos that progress to the blastocyst stage at a lower and slower rate and implant less efficiently.

Adult↗
PubMedDate not supplied

Treatment of retrograde ejaculation and anejaculation.

Treatment of retrograde ejaculation and anejaculation The various options for the treatment of retrograde ejaculation (RE) and anejaculation (AE) are discussed systematically in this review. A total of 88 studies dealing with patients with RE emphasize medical treatment for reversal of RE and retrieval of spermatozoa from urine. In 136 studies concerning patients with AE, the main emphasis is on medical treatment, electroejaculation (EE) and electrovibration stimulation (EVS) for the reversal of AE. Sperm quality in patients with RE and AE is often impaired. However, with the help of assisted reproduction techniques (ART) available today, both ejaculation disorders can be considered as treatable diseases. The major problem when analysing the studies was the uneven methodological quality of the original articles and the difficulties presented by different drugs and dosages, equipment and techniques, along with different criteria for success. In conclusion, controlled clinical trials comparing different treatment options appear urgently warranted.

Ejaculation↗
PubMed1997

RNA in the ejaculate spermatozoon: a window into molecular events in spermatogenesis and a record of the unusual requirements of haploid gene expression and post-meiotic equilibration.

Several reports demonstrating the presence of messenger RNAs for sperm-specific nucleoproteins, the protamines PRM-1, PRM-2, and the transition protein TP-1 as well as beta-actin, c-MYC, HLA1, and beta 1 integrin have challenged the accepted view of the transcriptional dormance of terminally differentiated spermatozoa. Whatever nuclear activity the ejaculate spermatozoon may possess, these data suggest that spermatozoa are a repository of information regarding meiotic and post-meiotic gene expression in the human and are likely to contain transcripts for many homologues of genes identified from animal models, which play an essential role in spermiogenesis. The use of ejaculate spermatozoa as a wholly non-invasive biopsy of the spermatid should now be evaluated. At the same time, spermatozoal RNAs require further analysis and characterization. One explanation for their persistence in ejaculate spermatozoa is that they serve to equilibrate imbalances in spermatozoal phenotypes brought about by melotic recombination and segregation. Transcript exchange is likely considering the presence of inter-cellular cytoplasmic bridges between haploid spermatids, which also offers a route for the translocation and expansion of non-mendelian trials linked to retrotransposon activity.

Animals↗