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At least 19 recordsLinked to original sources
PubMed2005

On-demand SSRI treatment of premature ejaculation: pharmacodynamic limitations for relevant ejaculation delay and consequent solutions.

INTRODUCTION: Recently, the idea has emerged that on-demand use of serotonin reuptake inhibitors (SSRIs), particularly short half-life, should be equally effective in delaying ejaculation as daily SSRI treatment of premature ejaculation. AIM: To provide evidence that SSRI-induced ejaculation delay is mainly dependent on pharmacodynamic properties of the drug and hardly on pharmacokinetic factors, and that combined SSRI administration with specific 5-hydroxytryptamine (5-HT) receptor antagonism leads acutely to stronger ejaculation delay than acute SSRI monoadministration. METHODS: We performed a detailed analysis of serotonin neurotransmission and reviewed animal studies with 5-HT(1A) receptor antagonists. In addition, we critically reviewed existing on-demand SSRI treatments publications and the current debate on a definition of premature ejaculation. MAIN OUTCOME MEASURES: Intravaginal ejaculation latency time (IELT). RESULTS: Acute SSRI administration leads to only a mild or no increase of 5-HT neurotransmission and concomitant stimulation of postsynaptic 5-HT receptors. Existing on-demand SSRI treatment studies suffer from methodological insufficiencies, and the reported high-fold increases of ejaculation time contradict with neuropharmacological insights from serotonin metabolism. Animal studies show that SSRI coadministration with 5-HT(1A) receptor antagonists significantly increases the ejaculation time acutely compared to acute SSRI monoadministration. CONCLUSION: On-demand SSRI treatment has less ejaculation-delaying effects than daily SSRI treatment. SSRIs with a short half-life are likely leading to much less ejaculation delay than current registered SSRIs. Combined use of SSRIs with 5-HT(1A) receptor antagonists increases the likelihood of clinically relevant ejaculation delay after on-demand treatment. On-demand SSRIs with short half-life that insufficiently delay ejaculation in men with IELTs less than 1 minute should be called ejaculation-delaying drugs rather than drugs against premature ejaculation.

Animals↗
PubMed1997

Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: a double-blind, randomized, dose-response study.

OBJECTIVE: To compare the influence of a daily dose of 20 or 40 mg of the serotonergic antidepressant drug paroxetine in delaying ejaculation in patients with primary premature ejaculation. PATIENTS AND METHODS: Thirty-four patients with primary premature ejaculation were randomly assigned to receive 20 mg or 40 mg daily of paroxetine for 7 weeks in a double-blind fixed-dose trial after an initial dose of 20 mg/day in the first week. Patients and their female partners were interviewed separately. In the group receiving 20 mg, one of two capsules consisted of placebo and in the group receiving 40 mg, both capsules contained active drug. RESULTS: The trial was completed by 27 men; both groups showed a statistically significant difference from the baseline values of ejaculation latency (P < 0.001) and a clinically relevant improvement in ejaculation time. The increase in the intravaginal ejaculation latency time was not statistically significant different between the groups. The patient's assessments were confirmed independently by their partners. CONCLUSIONS: The daily use of 20 mg paroxetine may be considered as an adequate treatment for primary premature ejaculation. Increasing the dose may lead to a further increase in ejaculation latency.

Adolescent↗
PubMed1996

Pregnancies achieved with testicular and ejaculated spermatozoa in combination with intracytoplasmic sperm injection in men with totally or initially immotile spermatozoa in the ejaculate.

The efficacy of intracytoplasmic sperm injection (ICSI) employing testicular and ejaculated spermatozoa was assessed in 24 couples with totally or initially immotile spermatozoa. No criteria were employed in selecting which patients would be treated with testicular or ejaculated spermatozoa. The men were chosen at random. Testicular spermatozoa obtained by testicular sperm extraction were used in 14 and ejaculated spermatozoa were used in 10 of these couples. In all cases. asthenozoospermia was total in their basal semen sample. In 12 male partners, spermatozoa were totally immotile before and after Percoll gradient fractionation (totally immotile). In the remaining 12 men, spermatozoa initially showed a total absence of motility; however, some of the spermatozoa had showed very poor motility (0. 1%) after Percoll gradient fractionation and a 1.5-2.0 h incubation period (initially immotile). Of these 24 total asthenozoospermic males, 14 also had total teratozoospermia. The fertilization and cleavage rates in the testicular and ejaculated sperm groups were 53. 5 and 96.3 and 54.5 and 94.4% respectively. One cycle resulted in complete fertilization failure, and in 23 embryo transfer cycles a total of 10 pregnancies were obtained (41.6%). Eight pregnancies were achieved in the testicular sperm group, while only two pregnancies were obtained in the ejaculated sperm group. Four pregnancies, two from the ejaculated sperm group and two from the testicular sperm group, resulted in clinical abortions in the first trimester. Of the remaining six pregnancies, two have already resulted in healthy births and four pregnancies are now in the second or third trimester in the testicular sperm group. Using testicular spermatozoa in combination with ICSI can be an alternative mode of treatment in cases with totally or initially immotile spermatozoa in the ejaculate. Very low pregnancy rates have been obtained and no ongoing pregnancy has been achieved using ejaculated spermatozoa in these cases.

Adult↗
PubMed2005

Analysis of human ejaculation using color Doppler ultrasonography: a comparison between antegrade and retrograde ejaculation.

OBJECTIVES: To observe the phenomenon of human ejaculation dynamically using color Doppler ultrasonography. METHODS: Human ejaculation was observed using transrectal color Doppler ultrasonography in a healthy man and a patient with retrograde ejaculation. Ejaculation was induced manually with audiovisual sexual stimulation. The ejaculatory phenomenon was analyzed and compared with that of retrograde ejaculation. RESULTS: In the healthy man, the prostatic urethra flattened slightly and the bladder neck contracted just before expulsion. The ejaculatory stream spurted from the seminal vesicles to the bulbous urethra through the ejaculatory duct. In the patient with retrograde ejaculation, the ejaculatory stream from the seminal vesicles and inframontanal and distal prostatic urethras distended into a globular-shaped sac filled with semen. No seminal flow toward the bulbous urethra occurred. The semen remaining in the prostatic urethra began flowing slowly into the bladder. CONCLUSIONS: Differences between antegrade and retrograde ejaculation can be clearly detected by color Doppler ultrasonography, providing a noninvasive method to diagnose ejaculatory disorders.

Adult↗
PubMed1977

Variation in human semen viscoelastic properties with respect to time post ejaculation and frequency of ejaculation.

The present study concerns the rheological characterization of the coagulation-liquefaction process of human semen. Results obtained using a multiple point capillary viscometer reveal marked variations in the elasticity and viscosity of an individual's semen with time immediately following ejaculation and frequency of ejaculation. Similarity among all cases examined for each material property is revealed by relating times post ejaculation to semen liquefaction time, thereby coupling liquefaction time with specific material property values. Further, the final state of liquefied semen is found to be characterized by Newtonian behavior (mean absolute viscosity = 3.37 centipoise). The semen's liquefaction time and ejaculate volume are determined to be functions of the frequency of ejaculation. Steady state ejaculate volume is found to decrease linearly with increasing ejaculation frequency, thereby providing a measure of glandular secretory rate. When collectively considered, these findings provide possible means for monitoring an individual's glandular behavior over an extended period of time and comparing such behavior to established standards.

Ejaculation↗
PubMed2002

Comparison of semen quality obtained by electroejaculation and spontaneous ejaculation in men suffering from ejaculation disorder.

BACKGROUND: Electroejaculation has become an accepted form of semen procurement in men suffering from anejaculation. However, sperm in these ejaculates often exhibit low motility. The aetiology of asthenozoospermia remains uncertain. It may be related to primary low-grade motility of sperm from anejaculatory men or to detrimental effects of the electroejaculation process itself. The aim of this study was to determine whether the procedure of electroejaculation alters the quality of the semen by comparing the characteristics of the electroejaculates with those of the normal ejaculates of the same patients. METHODS: Nine men suffering from ejaculation disorders underwent 14 procedures of electroejaculation. The sperm concentration and motility of the 14 samples from electroejaculation were compared with 20 collected at a later date after successful ejaculation by the same patients. RESULTS: The mean +/- SD concentration of the electroejaculates was (52.3 +/- 42.1)x10(6)/ml and of the natural samples (67.4 +/- 38.1)x10(6)/ml. No statistical difference was found between the two groups. The mean percentage of sperm showing progressive motility following electroejaculation was 23.1 +/- 18.8% and 36.3 +/- 16.7% after spontaneous ejaculation. No statistical difference was found between the groups (P = 0.082). Likewise, the quality of sperm motility was similar after both methods of procurement. CONCLUSIONS: In our small-sized study group (nine men with ejaculation disorders), the concentration and the motility of sperm obtained by electroejaculation were not significantly different from sperm obtained naturally.

Adult↗
PubMed2006

Etiology of ejaculation and pathophysiology of premature ejaculation.

INTRODUCTION: Ejaculation is comprised of three stages of the male sexual response cycle, namely emission, ejection, and orgasm; however, in comparison with erection, which is a well-understood component of male sexual response, the pathophysiology of ejaculation has yet to be fully delineated. Premature ejaculation (PE), the most common sexual disorder in men, while believed to have a multifactorial etiology, is even less well understood. AIM: This article reviews the physiology of ejaculation, and the multifactorial pathophysiology of PE. METHODS: The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. MAIN OUTCOME MEASURE: Data were obtained by extensive examination of published peer-reviewed literature. RESULTS: Evidence supports that biologic mechanisms associated with neurotransmitters such as norepinephrine, serotonin, oxytocin, Gamma-amino-butyric acid, and nitric oxide (NO) as well as the hormone estrogen play central roles in ejaculation, and subsequently may mediate PE. There is also emerging evidence to show that hyperthyroidism may be a causal factor in PE. Recent data also suggest that psychogenic factors include high level of any experience by some men with PE. CONCLUSIONS: The pathophysiology of both lifelong and acquired PE appears to be both neurobiogenic and psychogenic. While psychogenic factors appear to be contributory to PE, pharmacologic intervention of PE can modify intravaginal ejaculatory latency time (IELT), which suggests that IELT is a biological variable, and is likely biologically dependent upon neurotransmitters and hormones.

Adult↗
PubMed2005

Relevance of an evidence-based ejaculation time cutoff point for neurobiological research of premature ejaculation.

The Diagnostic and Statistical Manual (DSM)-IV definition of premature ejaculation is not based on evidence-based studies. In particular, the absence of a well-defined quantitative measure of the intravaginal ejaculation latency time (IELT) makes the DSM definition inadequate. Therefore, the DSM-IV definition should be replaced by a medical definition that incorporates both quantitative as qualitative parameters of premature ejaculation. An evidence-based medical definition should include a cutoff point of the IELT at the 0.5 and 2.5 percentiles of the IELT distribution in the general male population. Such a definition has recently been proposed on the basis of a stopwatch study of the IELT in 491 men from five different countries. Similarly, a cutoff point of ejaculation frequency in laboratory rats enhances the probability to distinguish genuine rapid-ejaculator rats. Only by the strict application of these cutoff points is the probability enhanced that human and animal neurobiological research can prove whether these sexual endophenotypes differ in brain activation, have particular genetic genotypes (polymorphisms), are strictly under genetic control, or are dependent on environmental conditions and/or genotypic/environmental interactions.

Animals↗
PubMed2005

Citalopram combined with WAY 100635 inhibits ejaculation and ejaculation-related Fos immunoreactivity.

The role of 5-HT (5-hydroxytryptamine, 5-HT)(1A) receptor activation in the sexual side-effects, in particular delayed ejaculation, of selective serotonin reuptake inhibitors (SSRIs) was studied. Male Wistar rats were treated for 15 days with vehicle, the SSRI citalopram (10 mg/kg/day p.o.), the 5-HT(1A) receptor antagonist N-[2-[4-(2-methoxyphenyl)-1-piperazinyl] ethyl]-N-(2-pyridinyl) cyclohexane carboxamide 3HCL (WAY 100635, 0.1 mg/kg/ day s.c.), or both drugs combined. Sexual behavior was assessed weekly. One h after the last sexual behavior test, rat brains were processed for Fos-immunohistochemistry. Acute and chronic citalopram mildly inhibited ejaculation, which was strongly augmented by co-administration of WAY 100635. WAY 100635 alone did not alter sexual behavior. Brain sites associated with ejaculation showed reduced Fos-immunoreactivity in rats treated with both citalopram and WAY 100635. Citalopram reduced Fos-immunoreactivity in the arcuate hypothalamic nucleus, an area that might link serotonergic neurotransmission to ejaculation.

Administration, Oral↗
PubMed1998

Premature ejaculation and serotonergic antidepressants-induced delayed ejaculation: the involvement of the serotonergic system.

Premature ejaculation has generally been considered a psychosexual disorder with psychogenic aetiology. Although still mainly treated by behavioural therapy, in recent years double-blind studies have indicated the beneficial effects of some of the serotonergic antidepressants (SSRIs) in delaying ejaculation. We describe here the neurophysiology and the peripheral neuroanatomy of ejaculation and provide a review of the involvement of serotonin in the central nervous system in relation to serotonergic nuclei and their projections. A hypothesis of the role of 5-HT1A and 5-HT2C receptors in premature ejaculation is postulated.

Animals↗
PubMed2004

Sexual function of premature ejaculation patients assayed with Chinese Index of Premature Ejaculation.

AIM: To assess the psychometric properties of the Chinese Index of Premature Ejaculation (CIPE). METHODS: The sexual function of 167 patients with and 114 normal controls without premature ejaculation (PE) were evaluated with CIPE. All subjects were married and had regular sexual activity. The CIPE has 10 questions, focusing on libido, erectile function, ejaculatory latency, sexual satisfaction and difficulty in delaying ejaculation, self-confidence and depression. Each question was responded to on a 5 point Likert-type scale. The individual question score and the total scale score were analyzed between the two groups. RESULTS: There were no significant differences between the age, duration of marriage and educational level (P> 0.05) of patients with and without PE and normal controls. The mean latency of patients with PE and normal controls were 1.6 +/- 1.2 and 10.2 +/- 9.5 minutes, respectively. Significant differences between patients with (26.7 +/- 4.6) PE and normal controls (41.9 +/- 4.0) were observed on the total score of CIPE (P< 0.01). Using binary logistic regression analysis, PE was significantly related to five questions of the original measure. They are the so-called the CIPE-5 and include: ejaculatory latency, sexual satisfaction of patients and sexual partner, difficulty in delaying ejaculation, anxiety and depression. Receiver Operating Characteristic (ROC) curve analysis of CIPE-5 questionnaire indicated that the sensitivity and specificity of CIPE were 97.60 % and 94.74 %, respectively. Employing the total score of CIPE-5, patients with PE could be divided into three groups: mild (>15 point) 19.8 %, moderate (10-14 point) 62.8 % and severe (< 9 point) 16.7 %. CONCLUSION: The CIPE-5 is a useful method for the evaluation of sexual function of patients with PE and can be used as a clinical endpoint for clinical trials studying the efficacy of pharmacological intervention.

Adult↗
PubMed1988

[Long-term effects of human seminal plasma from whole semen and from different fractions of split ejaculate on motility of human ejaculated spermatozoa].

A number of studies have implied that seminal plasma contains one or more factors that stimulate spermatozoal motility. On the other hand, many authors have shown that continuous, long term exposure to seminal plasma is detrimental to motility and survival of spermatozoa. In this study we examined the long term effects of human seminal plasma not only from whole semen but also from different fractions of split ejaculate on motility of human ejaculated spermatozoa. Washed spermatozoa were incubated in modified BWW medium containing human serum albumin with or without seminal plasma. A considerable percentage of spermatozoa maintained good progressive motility for up to 20 h. when free from seminal plasma. Addition of seminal plasma (20%, v/v) obviously depressed the motility, particularly progressive motility. The most depressive effect occurred in the first (prostatic) fraction of split ejaculate, and the effect of the last (vesicular) fraction was less harmful. These observations suggest that seminal plasma has (a) factor(s) that impair the maintenance of spermatozoal motility which originate possibly from the prostate or epididymis, since both fluids of these accessory organs appear to be secreted mainly into the first portion ejaculate.

Ejaculation↗
PubMed1995

Semen extenders to salvage ejaculate in a retrograde ejaculate environment: a potential use in spinal cord-injured men.

Infertility is a well-recognized complication in spinal cord-injured men. Vibratory stimulation and electroejaculation are being used to overcome the inability to ejaculate, but poor sperm quality remains a significant problem. Retrograde ejaculation is known to occur with both sperm retrieval techniques, and may contribute to the poor semen quality. In addition, the amount of retrograde ejaculate produced is generally of sufficient quantity worthy of salvaging. We investigated the effectiveness of various semen media in maintaining the viability of healthy sperm placed in a retrograde ejaculate environment. Six semen extenders, media used to process spermatozoa for artificial insemination and to maintain viability during cryopreservation, were studied. We found that Ham's F-10 with 3.5gm % bovine serum albumin seems to be an effective medium to maintain sperm viability over a wide range of urine concentrations (up to 60% to 80% urine), and potentially, may be useful by its infusion into the bladder before vibratory or electrostimulation to enhance the recovery of greater numbers of viable sperm from the retrograde environment.

Cell Survival↗
PubMed1994

A simple technique to prevent retrograde ejaculation during assisted ejaculation.

The aim of this study was to develop a technique which would prevent retrograde ejaculation in chronic spinal cord injured (SCI) patients undergoing vibration and electroejaculation procedures. A balloon catheter was used to tamponade the bladder neck in 12 patients who underwent 100 assisted ejaculation procedures. Antegrade ejaculations were collected on all occasions with no incidences of urine contamination and no sperm were seen in post ejaculatory urine. Silicone catheters had minimal effects on sperm motility and viability. All lubricant gels were found to adversely affect sperm quality and were not used.

Adult↗
PubMedDate not supplied

The spinal monoaminergic systems relating to ejaculation. II. Ejaculation and serotonin.

The effects of Ro 4-4602 and L-5-hydroxytryptophan on manually induced ejaculation in dogs and on spinal monoamines in dogs were investigated. From the results obtained in the study it was concluded that the serotonergic system in the spinal cord is an intermediate mechanism which inhibits the occurrence of ejaculation. Both the results in this study and the results in our previous paper seem to indicate that ejaculation occurs with the reconciliation of the spinal dopaminergic and serotonergic system.

Animals↗
PubMedDate not supplied

The spinal monoaminergic systems relating to ejaculation ejaculation and monoamines after spinal cord transection.

The authors investigated the relationship between ejaculation and spinal monoamine levels by transecting the dog spinal cord at the various levels. From the results obtained in this study it was concluded that the lumbar and upper sacral segments of the spinal cord are important for ejaculation, and that the suppression of ejaculation by lower lumbar to upper sacral transection may be induced by increase in serotonin in the 5th lumbar-1st sacral segments.

Animals↗