Ejaculation Failure Research Articles

Ejaculation: Physiology and Dysfunction

In summary, important events of ejaculation include emission of sperm and the accessory gland fluids into the urethra, simultaneous closure of the bladder neck, and forceful ejaculation of the combined semen through the urethra. Emission and bladder neck closure are primarily alpha-adrenergically mediated thoracolumbar sympathetic reflex events with supraspinal modulation. Ejaculation is a sacralspinal reflex mediated by the pudendal nerve. In stallions, the most common ejaculation disorders are emission and ejaculation failure, and urine contamination of semen. Rare disorders are azoospermia and premature ejaculation. In a large percentage of cases, an ejaculation appears to be a result of musculoskeletal disorders or to be psychogenic in nature rather than attributable to specific ejaculatory dysfunction. Traditional therapeutic approaches for accommodating deficits can extend the breeding life of many stallions. Pharmacologic aids may be useful.

Guidelines for Drug Treatment of Male Infertility

The prerequisite for rational therapy of male fertility disorders is an exact diagnosis. While the possibilities of influencing disturbances of spermiogenesis are limited, male adnexal diseases can be successfully treated in many cases. Drugs for the treatment of fertility disorders must be applied with this in mind, and empiric therapy is often performed in addition to causal treatment which, however, may be quite rationally determined. The therapeutic spectrum in andrology includes antibiotic and antiphlogistic agents, mast cell blockers, zinc, vitamins, and immunosuppressive drugs (corticosteroids). These agents are used for the treatment of inflammatory diseases of the testes and the accessory glands or for suppression of antispermatozoal antibodies. Hormonal disturbances are infrequently encountered by the andrologist, but they can be treated, with proven efficacy, with gonadotrophins, gonadotrophin-releasing hormone (GnRH) or androgens. In certain cases that are not hormonally related, the use of antiestrogens (clomifene, tamoxifen) as stimulating agents may be successful. Furthermore, tissue hormone releasing proteases (kallikrein) can be used both therapeutically (especially in motility disturbances that are not due to structural flagellar defects) and diagnostically (in order to distinguish between inflammatory and noninflammatory testicular damage). Anticholinergics and alpha-sympathomimetics are applied to ameliorate ejaculation or emission failure. In addition to a review of these treatment forms, the development of new concepts, e.g. angiotensin converting enzyme (ACE) inhibitors, is discussed.