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Premature ejaculation. 2. Classification and diagnosis.

A classification of premature ejaculation must distinguish between hyper-orgasmic or hypo-orgasmic, between situational or global; furthermore, it must define whether it occurs during vaginal penetration only or also in masturbation, and must study its latency periods and its relationships to the erectile dysfunction, with which it is often associated. Tests with local anesthetics, biothesiometry and penile vibrotactile stimulation, integrated with a thorough study of the general and psycho-sexual history, provide a good diagnostic classification that makes the therapeutic approach appropriate.

Ejaculation↗

[Influence of Candida albicans on the motility and ultrastructure of human spermatozoa in vitro].

OBJECTIVE: To explore the influence of Candida albicans (Ca) on the motility and ultrastructure of human spermatozoa and its possible mechanism. METHODS: Semen samples obtained from 10 healthy volunteers by masturbation were prepared by the swim-up technique and sperm density to 40 x 10(6)/ml. The samples were then inoculated at 37 degrees C with different concentrations of a uropathogenic strain of Ca isolated from an outpatient, with initial fungi/spermatozoa ratios varying among 1:1 (Group A), 1:10 (Group B), 1:100 (Group C), 1:1000(Group D), and 1:10,000 (Group E). And Group F containing Ham's F-10 only was found as the negative control. Motion parameters were analysed by computer-aided sperm analyzer (CASA) at 0 hour, 1 hour, 2 hours and 4 hours respectively. Modalities of spermatozoa and possible adherence and/or agglutination were observed under the light microscope. Finally, all the samples were studied by transmission electron microscopy. RESULTS: Distinct adhesion of spermatozoa to Ca and agglutination were noticed. In all the motion parameters, progressive motility was affected most and dependent upon incubation time and bacterial concentration. Progressive motility showed a significant difference between Group A and the control (P < 0.01). With the prolongation of incubation time, other parameters were showing more and more differences. Analysis by electron microscopy revealed multiple ultrastructural damages. CONCLUSION: Ca significantly inhibits human sperm motility and decreases sperm viability in vitro. Its mechanism is possibly related to Ca's adhesion to human spermatozoa and the impairment inflicted by Ca to sperm ultrastructure.

Candida albicans↗

The doctor as witness in child abuse cases.

Doctors who have to give evidence in cases of physical or sexual child abuse usually find it a stressful experience. Factors that may help to improve the doctor's ability to cope with the situation are discussed in this article. The importance of good medical notes and a good medical examination is stressed. Hints are given on how to minimise the inevitable delays that precede a court appearance. The hearsay rule means that the history the doctor obtains is not accepted as evidence. The medical procedure, which involves using various facts to build up a complete picture, is contrasted with the legal procedure, which involves testing each separate fact in order to create reasonable doubt that the accused may be guilty. Some common questions put to the doctor are discussed here. They include questions as to whether causes other than abuse, such as masturbation, infection or the use of other instruments, could have damaged the hymen or vagina.

Child↗

Doppler ultrasonography in a young patient with penile Mondor's disease.

OBJECTIVE: Mondor reported the first superficial venous thrombosis on the chest wall in 1939. This condition is usually a benign and self-limited process, requiring only symptomatic treatment. Mondor's disease of the penis is an uncommon condition, which usually involves the superficial dorsal veins, it was first described by Braun-Falco in 1955. Isolated superficial dorsal vein-thrombosis was reported in 1958 by Helm et al. Since then around fifty cases have been reported. Patients experience a cord or string-like induration along the penile superficial dorsal vein, which is often painful and accompanied by localized inflammatory changes. This condition is benign and self-limited in most patients with complete resolution after 6 to 8 weeks of conservative management although sometimes surgery is indicated when it is associated with chronic or severe local pain. MATERIAL AND METHODS: We report on a 23-year sold man with Mondor's disease of the penis following a normal sexual intercourse, who recently underwent microsurgical left varicocelectomy. RESULTS: Treatment consisted in NSAID Aulin (100 mg orally twice a day for 3 weeks) Ciproxin (500 mg orally twice a day for 10 days), Reparil 1 x 3 orally for 25 days and Lansox 30 mg orally 1 per day for 21 days. The patient was advised to abstain from sexual intercourse or masturbation until the thrombosis had completely resolved. In the follow-up visit there was the complete resolution of the disease with no evidence of superficial dorsal vein thrombosis or palpable penile plaque 30 days later. The patient was also able to have sexual intercourse without problems. CONCLUSION: Although penile Mondors' disease is rare, proper clinical diagnosis and consequent reassurance can help the patient to dissipate the anxiety and the following erectile dysfunction. Ultrasound and Doppler Ultrasonography examination was not useful for diagnosis but helped the clinician to show the patient that the disease is a benign condition.

Adult↗

[The analysis of preliminary spermatological parameters in potential donors of semen].

OBJECTIVE: To contribute to the contemporary discussion on the male factor infertility through the evaluation of the basic spermatological parameters in men recruiting for semen donation. DESIGN: A retrospective demographic study. SETTING: Dept. of Obstetrics and Gynaecology, Dept. of Biology, Faculty of Medicine, Palacký University, Olomouc. METHODS: A total of 108 men aged 18 to 35 years came to the preliminary examination for the potential semen donors between January 2000 and April 2004. Spermatological analysis of the fresh ejaculates obtained by masturbation was performed according to WHO guidelines. The following parameters were evaluated: the volume of ejaculate, sperm concentration and total percent motility. RESULTS: Normospermia was found in only 46 men (42.6%). Three males (2.8%) were azoospermic. The most frequent problem was asthenospermia, which was documented in 49 (46.6%) men. CONCLUSION: The analysis of the obtained data may suggest a marked semen quality decline in the Czech male population. In our opinion, further multicentric epidemiological studies concerning fertility potential in Czech male population seem highly needed.

Adolescent↗

Urethral reconstruction using buccal mucosa urethroplasty in the treatment of urethral injury.

A 52-year-old Japanese man was referred to us with a urethral injury caused by masturbation. His penis was swollen and about one and a half times its size due to urine extravasation and infection. Foreign bodies were surgically removed, and debridement and excision of necrotic tissue were performed. After confirming that the infection was under control, we planned the reconstruction of the urethra and penis, following endoscopic urethrotomy for the bulbous urethra stricture. A free graft from the buccal mucosa was harvested, placed over the defect and fixed with interrupted suture as ventral onlay. The patient could achieve satisfactory voiding and no complication was seen during the 18-month follow up. In our experience, buccal mucosa is a useful source of urethral grafting material and excellent results can be expected in case of urethral injury.

Humans↗

[Origin of psychiatric disorders ex sexualibus: explanatory approaches at the beginning of the 19th century].

In the first half of the 19th century there were the first publications, which dealt systematically with the relation between deviations of the sexual system or behaviour and mental disturbances. The knowledge and the theoretical ideas of medicine and of psychiatric diseases at that time and a discussion concerning the consequences of masturbation can be demonstrated in works like "De mentis aberrationibus ex partium sexualium conditione abnormi oriundis" by Hermann Joseph Löwenstein (1823) and "Ueber die Beziehungen des Sexualsystemes zur Psyche überhaupt und zum Cretinismus ins Besondere" by Joseph Häussler (1826). Both publications try to sytemize the issue and prove their hypotheses by numerous casuistics. The autors belong to the so called "Somatis School" in psychiatry at that time.

Adolescent↗

[Penile fracture: report of 4 cases].

OBJECTIVE: To inform practitioners about this rare condition and to emphasize the importance of surgical treatment. MATERIAL AND METHODS: Four patients were treated for penile fracture, by surgery in 3 cases and medically in 1 case. Surgery consisted of a longitudinal elective incision, followed by evacuation of the haematoma and suture of the tunica albuginea. RESULTS: These patients were aged between 19 and 42 years; 3 were single and 1 was married. The mechanisms of fracture were coital injury in 2 cases and masturbation in 2 cases. In the 3 operated patients, all lesions were transverse sections of the tunica albuginea. A good functional result was obtained in operated patients, but could not be evaluated in the medically treated patient. CONCLUSION: The best treatment for penile fracture is surgery after a clinical diagnosis.

Adult↗

A rare foreign body into the male penile urethra.

A wide variety of urethral foreign bodies have been described in the literature. In adults, this is commonly caused by the insertion of objects used for masturbation, and is often associated with a mental disorder as in our case described herein. We report a 28-year-old man, hospitalized for self-insertion of a pen into the urethra. The pen was removed successfully by surgery.

Adult↗

[Influence of LY294002 on sperm motility in asthenozoospermia patients in vitro].

OBJECTIVE: To investigate the effects of LY294002, a phosphatidylinositol 3-kinase inhibition, on sperm motility in asthenozoospermia patients in vitro, and further analyze the possible molecular mechanism. METHODS: Sperm aseptically obtained by masturbation and prepared by swim-up technique from 10 patients with asthenozoospermia and 10 healthy fertile men were incubated with different concentrations of LY294002. Measurements of motility were carried out at 10, 30 and 60 min in all specimens by CASA. RESULTS: The sperm in asthenozoospermia patients treated with LY294002 showed a significant increase in sperm progressive motility, the percentage of motile cells, VSL and VAP. CONCLUSION: LY294002 can enhance the motility of sperm in asthenozoospermia patients in vitro.

Asthenozoospermia↗

[Effects of different immunodepressants on the sperm parameters of kidney transplant recipients].

OBJECTIVE: To study the effects of different immunodepressants on the sperm parameters of kidney transplant recipients. METHODS: In 15 healthy fertile men and 37 kidney transplant recipients, ejaculates were aseptically obtained by masturbation. Thirty-seven patients were divided into two groups, 20 patients were treated with Prograf (FK506) combination with mycophenolate mofetil (MMF) and prednisone; 17 patients were treated with cyclosporine (CsA) combination with azathioprine with prednisone. The sperm viability, mobility parameters such as prorsad percentage motility, straight line velocity (VSL), curve line velocity (VCL), velocity of average path (VAP) and morph were estimated with a computer-assisted sperm analyzer (CASA) provided with a multiple-exposure photography system. RESULTS: There were no significant difference in sperm viability rate [(81.7 +/- 5.7)%, (79.4 +/- 6.8)% and (83.8 +/- 6.0)%], VCL [(24.1 +/- 8.6)%, (23.9 +/- 4.4)%, (24.8 +/- 4.2)% ] and VAP [(19.7 +/- 6.6)%, (18.6 +/- 2.9)%, (21.0 +/- 4.0)%] among groups of FK506, CsA and control, respectively (P > 0.05). The rate of anomaly [(67.8 +/- 5.7)%], the prorsad percentage motility [(46.4 +/- 8.1)%] and VSL [(15.4 +/- 4.6)%] in the group of FK506 were respectively significantly lower and higher than those in the group of CsA [(80.1 +/- 5.6%, (33.3 +/- 6.4)%, (10.2 +/- 2.4)%] (P < 0.05). CONCLUSION: The application of FK506 combined with MMF could help recover the mobility and morphology of the sperm in kidney transplantation recipients.

Adolescent↗

[Influence of captopril on human sperm motility parameters in vitro].

OBJECTIVE: To determine the effects of captopril on human sperm motility in vitro. METHODS: Sperm specimens were aseptically obtained by masturbation and prepared by Percoll gradient-centrifugation technique to produce a spermatozoa suspension of high motility from 12 healthy fertile men. The spermatozoa suspension were incubated with captopril at 1:9 ratio of volume at 37 degrees C in vitro, which was administrated at three different concentrations. Measurements were carried out within 5 minutes for all specimens including VAP, VSL, VCL, STR, ALH and progressive motility. RESULTS: Within 5 minutes, three different concentrations of captopril could change the human spermatozoa motility and forward motile sperm percentage, but captopril did not decrease the other motility parameters, including VSL, VCL and VAP etc. The high concentration group could decrease the VCL more than those of the other two groups and it seemed that the velocity parameters of the middle concentration group were higher than those of the other two groups, but there were no significant difference statistically. CONCLUSION: It suggests that captopril can decrease the human spermatozoa motility and forward motile sperm percentage, but it can not directly affect the spermatozoa velocity in vitro.

Adult↗

[Application study of human sperm motility bioassay in IVF laboratory quality control].

OBJECTIVE: To investigate the sensitivity of human sperm survival bioassay to using known concentrations of potential toxin of formalin and to elevate the application value of human sperm motility assay as a quality control method in detecting the components used in IVF program. METHODS: Fresh semen was obtained from healthy males at andrology laboratory by masturbation. Sperm was processed on a gradient column of isolate medium and PBS medium. In experiment 1, the medium with 0.25%, 0.75% concentration of formalin and control medium were added to the Falcon culture tubes containing HTF medium with or without 0.3% bovine albumin serum and with or without light mineral oil. In experiment 2, in 3 types of culture tubes containing HTF medium with or without 0.3% bovine albumin serum and with or without light mineral oil, the sperm was exposed to each culture tube and cultured for 24 and 48 hrs at room temperature, and the motile sperms were counted under the microscope. RESULTS: The average sperm motility index in the HTF medium with 0.25% formalin at 24 hrs was 0.594 +/- 0.331, significantly higher than in the HTF medium with 0.75% formalin (0.450 +/- 0.284) (P < 0.01). In the medium containing 0.25% and 0.75% formalin with 0.3% bovine albumin serum and light mineral oil, the average sperm survival indexes were 0.683 +/- 0.334 and 0.527 +/- 0.345, respectively, higher than without bovine albumin serum and light mineral oil (0.394 +/- 0.311 and 0.424 +/- 0.311). The average sperm index of 7 ml tissue culture tube made in Denmark was 0.677 +/- 0.335, higher than the other two types of culture tubes made in the USA (0.551 +/- 0.317 and 0.596 +/- 0.327) (P < 0.001). When the sperm cultured in the medium with 0.3% bovine albumin serum and light mineral oil, the average sperm survival indexes were 0.821 +/- 0.259 and 0.645 +/- 0.335, respectively, higher than without bovine albumin serum or light mineral oil (0.571 +/- 0.321 and 0.395 +/- 0.245) (P < 0.01). CONCLUSION: The sperm survival bioassay is a sensitivity quality control method to detect the components in the IVF laboratory. The 7 ml tissue culture tube made in Denmark is most suitable for culturing human embryos. Sperm can be protected when cultured in the medium with 0.3% albumin bovine serum and light mineral oil.

Adult↗

[Sexuality of pregnant women].

Over the time when the sexual intercourse has been considered merely one of a number of forms of sexual contact, views on sexuality during pregnancy have undergone considerable transformation. A great many of authors emphasise, that the pregnancy is a stimulus for partners to search for ways to maintain mutual emotional bond, close physical affinity and satisfy sexual needs not necessarily finished with an intercourse. The fact, that one of the two partners is pregnant, imposes some restrictions on sexual life. Not rarely, in particular in the first trimester of pregnancy, a female is little interested in sex. It is due to, inter alia, hormonal changes resulting in nausea, fatigue and increased nervosity. These symptoms contribute to general feebleness and reduction of the level of sexual needs and difficulty to become aroused and sexually ready. In spite of that, a lot of women have the need to keep physical and emotional contact with their partners. For a number of couples, pregnancy becomes a stimulus to search for new ways of pleasing each other in love play, that does not necessarily leads with an intercourse. Most studies concerning sexuality during pregnancy focus on observing sexual activity, physiological changes, mutual relationship of partners, analysis of sexual intercourses and investigation of so-called sexual satisfaction. Examination of sexual satisfaction ruchedes the frequency of sexual contacts, intercourses, foreplay, concurrence of orgasms in the two partners, partners' happiness, sexual satisfaction and mutual heartiness. In some researchers' opinion, sexual satisfaction correlates with the feeling of happiness resulting form being pregnant, pregnant woman's feeling still attractive and experience of orgasm. However, some researchers observe reduced sexual activity during pregnancy, except for the second trimester, when sexual activity is similar to the one outside pregnancy. Pregnant women prefer the following types of sexual activity: non-genital fondling, stimulation of the clitoris, vagina and breasts, oral and anal stimulation and masturbation. Females and their partners are underinformed on sexual life in pregnancy. The research indicates that 68% young mothers were not informed during pregnancy by a gynaecologist or midwife about sexual problems in pregnancy and, in particular, about possibility to derive sexual satisfaction. The research makes it evident, that experiencing sexual satisfaction by pregnant women improves their self-esteem, facilitates mutual relationship between partners and tightens the marital bond.

Adult↗

[Vulvovaginitis in premenarche girls. A preliminary study].

The study population consisted of 832 premenarcheal girls. Vaginal cultures are performed on 40 premenarcheal girls suffering from vulvovaginitis. All were less than 7 years old. This patients were seen in primary cares. In 23 cases (57.5%) E. coli was isolated, Enterococcus (30%), mixed flora (10%) and G. vaginalis (2.5%). Common clinical characteristics were pruritus (97.5%), vaginal discharge (67.5%). Dysuria and abdominal pain constituted accompanying symptoms. Only in one case masturbation was observed.

Age Factors↗

[Effect of ultrafiltered peritoneal fluid from patients with pelvic endometriosis on the in vitro motility of their spouse's sperm].

Recently, there has been information about the ultrafiltrated peritoneal fluid in patients with endometriosis, containing macromollecules that diminish tubal fimbria action, and the in vitro ovular captation in experimental animals. In order to investigate the presence of these substances in the peritoneal fluid, and to know the possible effect that could have on spermatic motivility in vitro, of their mates; 11 sterile women with diagnosis of pelvic endometriosis, and 11 normal fertile women, were studied. On the other side, the same day of study, the mate of each of these women, produced semen obtained by masturbation, where amount and motility of sperm, in basal conditions, and after, it was capacitated with Ham-F10, were determined. The final results was evaluated as to percentage of spermatozoon with excellent and progressive motility, and percentage of motionless spermatozoo as well as based on average values (mean +/- EE), of each one of them. The statistic analysis of differences was done by t Student that in coupled samples. The results confirm that peritoneal fluid of patient with endometriosis contains macromollecules, and it shows that these substances affect the motility in vitro of mate's spermatozoon, which could explain, partially at least, the origin of sterility in this disease.

Adult↗

Sexual behaviour changes in a cohort of male sexual contacts of men with HIV disease: a three-year overview.

We describe the sexual behaviour reported by 240 seronegative and seropositive homosexual men over a 3-year period. Sexual partners of men with HIV disease were recruited into a prospective study between July 1984 and July 1985 and were monitored every 3 months thereafter. Data on sexual activities were collected through interviewer-administered questionnaires. The cohort experienced a reduction in both the number of sexual partners and the volume of sexual activity. Reductions in the number of partners were early and dramatic. Changes in sexual activities were gradual and consistent in trend. The greatest reduction occurred in high risk activities (receptive and insertive anal intercourse). After 3 years of follow-up, only 10% of the men continue to be exposed to semen through unprotected receptive anal intercourse and 18% through unprotected receptive oral-genital sex. The proportion of men engaging in oral-genital contact and masturbation remained stable over the 3 years. Once informed of their serostatus, both seropositive and seronegative men reduced their high risk behaviour. The decline in rates of STDs and seroconversion confirmed that this cohort had indeed reduced their high risk behaviour.

Cohort Studies↗

[Catamnesis of a group of 84 castrated sexual offenders].

The authors examined 84 castrated sexual delinquents after a 1-15-year interval following castration. 18% of the subjects were capable of occasional sexual intercourse. 21% of the subjects lived in a stable heterosexual partnership. Almost half the men had occasional erections in the morning. More than one third of the group masturbates occasionally. Only three men committed another sexual offence after castration. These offences did not have an aggressive character. From a sub-group of 32 men punished previously on account of non-sexual offences 15, i.e. almost half of them, committed further non-sexual offences. One quarter of the examined subjects had objections to the results of castration. Most frequently because sex was lacking in their life. The authors did not observe serious physical or mental consequences of castration in the examined men. Castration must be considered even nowadays an important part of the therapeutic arsenal in sexual delinquents. It should be performed in those patients who cannot be influenced by other types of treatment.

Adult↗