Ejaculatory Dysfunction In Men Research Articles

Penile vibratory stimulation in men with spinal cord injury: an educational video demonstration

To demonstrate the different techniques used to perform successful penile vibratory stimulation (PVS) to induce ejaculation in men with spinal cord injuries (SCIs). A video demonstration of the PVS procedure performed in men with SCIs using the FertiCare 2.0 medical vibrator. Major University Medical Center. Men with SCIs. Spinal cord injury is the leading cause of anejaculation in young men. After SCIs, most of these men will need a method of assisted ejaculation to achieve biological fatherhood. In this study, a newly designed and tested vibrator (FertiCare 2.0) was used to induce ejaculation. The initial assessment of each patient included a standard history, physical examination, level of injury determination using the International Standards for Neurological Classification of Spinal Cord Injury as well as assessment of the hip flexor reflex and the bulbocavernosus reflex. Patients with a level of injury at or rostral to T6 were pretreated with 10-40 mg of sublingual nifedipine to manage autonomic dysreflexia. A single vibrator was applied to the dorsum, or frenulum, of the glans penis. Stimulation is delivered in 2-minute increments to a maximum of 10 minutes per visit. Application of two vibrators or abdominal electrical stimulation concurrently with PVS was used in select patients. Ejaculated semen was collected in a sterile cup and examined after liquefaction. Bladder preparation using sperm wash medium was performed in patients suspected of experiencing retrograde ejaculation. Successful ejaculation after performing the PVS procedure in men with SCIs. Penile vibratory stimulation was successful in 86% of men whose level of injury was T10 or rostral. The total motile sperm count in antegrade ejaculates produced using PVS was >5 million (lower limit considered for intrauterine insemination) in 71% of ejaculates. No complications because of PVS were observed in 3,700 trials performed by our group and none in the patients presented in this video. Penile vibratory stimulation is a safe and effective method for the management of ejaculatory dysfunction in men with SCIs. Penile vibratory stimulation can be performed by the male partner after an initial evaluation by a specialized provider, and the ejaculate can be used to perform home insemination.

Understanding and treating ejaculatory dysfunction in men with diabetes mellitus.

Diabetes mellitus is a rapidly rising metabolic disorder with important systemic complications. Global figures have demonstrated the prevalence of diabetes mellitus has almost quadrupled from 108 million in 1980 to 422 million in 2014, with a current prevalence of over 525 million. Of the male sexual dysfunction resulting from diabetes mellitus, significant focus is afforded to erectile dysfunction. Nevertheless, ejaculatory dysfunction constitutes important sexual sequelae in diabetic men, with up to 35%-50% of men with diabetes mellitus suffering from ejaculatory dysfunction. Despite this, aspects of its pathophysiology and treatment are less well understood than erectile dysfunction. The main disorders of ejaculation include premature ejaculation, delayed ejaculation, anejaculation and retrograde ejaculation. Although ejaculatory dysfunction in diabetes mellitus can have complex multifactorial aetiology, understanding its pathophysiological mechanisms has facilitated the development of therapies in the management of ejaculatory dysfunction. Most of our understanding of its pathophysiology is derived from diabetic animal models; however, observational studies in humans have also provided useful information in elucidating important associative factors potentially contributing to ejaculatory dysfunction in diabetic men. These have provided the potential for more tailored treatment regimens in patients depending on the ejaculatory disorder, other co-existing sequelae of diabetes mellitus, specific metabolic factors as well as the need for fertility treatment. However, evidence for treatment of ejaculatory dysfunction, especially delayed ejaculation and retrograde ejaculation, is based on low-level evidence comprising small sample-size series and retrospective or cross-sectional studies. Whilst promising findings from large randomised controlled trials have provided strong evidence for the licensed treatment of premature ejaculation, similar robust studies are needed to accurately elucidate factors predicting ejaculatory dysfunction in diabetes mellitus, as well as for the development of pharmacotherapies for delayed ejaculation and retrograde ejaculation. Similarly, more contemporary robust data are required for fertility outcomes in these patients, including methods of sperm retrieval and assisted reproductive techniques in retrograde ejaculation.

Ejaculatory dysfunction in men with diabetes mellitus

Diabetes mellitus (DM) is a metabolic disorder that is characterized by elevated blood glucose levels due to absolute or relative insulin deficiency, in the background of β-cell dysfunction, insulin resistance, or both. Such chronic hyperglycemia is linked to long-term damage to blood vessels, nerves, and various organs. Currently, the worldwide burden of DM and its complications is in increase. Male sexual dysfunction is one of the famous complications of DM, including abnormal orgasmic/ejaculatory functions, desire/libido, and erection. Ejaculatory dysfunction encompasses several disorders related to DM and its complications, such as premature ejaculation, anejaculation (AE), delayed ejaculation, retrograde ejaculation (RE), ejaculatory pain, anesthetic ejaculation, decreased ejaculate volume, and decreased force of ejaculation. The problems linked to ejaculatory dysfunction may extend beyond the poor quality of life in diabetics as both AE and RE are alleged to alter the fertility potential of these patients. However, although both diabetes patients and their physicians are increasingly aware of diabetic ejaculatory dysfunction, this awareness still lags behind that of other diabetes complications. Therefore, all these disorders should be looked for thoroughly during the clinical evaluation of diabetic men. Besides, introducing the suitable option and/or maneuvers to treat these disorders should be tailored according to each case. This review aimed to explore the most important findings regarding ejaculatory dysfunction in diabetes from pre-clinical and clinical perspectives.

Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study.

IntroductionPrevalence and bother of ejaculatory dysfunction (EjD) has yet to be evaluated in a men's health referral population.AimTo evaluate the prevalence and associated risk factors of EjD in men presenting to a men's health clinic.MethodsA retrospective review examined patients presenting to an outpatient men's health clinic who completed the Sexual Health Inventory for Men and the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) Short Form. Patient factors including demographics, comorbidities, and medication were examined. Descriptive statistics and multivariable logistic regression were used.Main Outcome MeasuresThe main outcomes of this study are Sexual Health Inventory for Men and MSHQ-EjD scores.ResultsA total of 63 (24%) of patients presenting to the urology clinic were characterized as having EjD based on questionnaire responses. The mean age for men with EjD was 53.8 years, while those without was 42.6 years (P < .001). Of men with EjD, 74.6% were at least moderately bothered (MSHQ-EjD ≥3). Men with EjD were more likely to have erectile dysfunction (77.8%) compared with those without (21%, P < .001) as well as a history of a pelvic cancer (20.6% vs 6%, P = .001). On multivariable regression, erectile dysfunction (odds ratio: 15.04, 95% confidence interval: 6.76–35.92, P < .0001) and alpha inhibitor prescription (odds ratio: 6.82, 95% confidence interval: 1.57–30.16, P = .01) were associated with a higher odds of EjD. ED was found to be a mediator of the relationship between EjD and age, as the age association was lost in the ED population on multivariable regression compared with the non-ED population where it remained significant.ConclusionsEjD is common among patients presenting to a men's health clinic and may present at varying ages, though it is more common in those aged 50 years or older; it is independent of age and race. EjD is associated with erectile dysfunction, pelvic cancer history, and use of alpha inhibitors, presenting a population that could be considered for screening.Kasman AM, Bhambhvani HP, Eisenberg ML. Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study. J Sex Med 2020;8:454–460.

Management of Erectile Dysfunction and Infertility in the Male Spinal Cord Injury Patient.

Men with spinal cord injury (SCI) commonly suffer from erectile dysfunction and ejaculatory dysfunction. The literature regarding the causes and treatment of these two important problems was reviewed. Many of the erectile dysfunction treatments applied to able bodied individuals are also useful in the SCI population, although there are differences in the goals and results of treatment. Ejaculatory dysfunction can be treated with either penile vibratory stimulation or electroejaculation with high success rates. Pregnancies are possible, but poor quality sperm quality in male SCI patients leads to pregnancy rates lower than is observed in the able-bodied population. Although effective treatments are available for erectile and ejaculatory dysfunction in men with SCIs, many challenges remain in optimizing the treatment of these individuals.

44 Prevalence of erectile and ejaculatory dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome

44 Prevalence of erectile and ejaculatory dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome

Seksueel (dis)functioneren en kwaliteit van het seksuele leven na de behandeling van het colorectaal carcinoom: een evaluatie

The aims of this study were (i) to provide a conceptualization of sexual (dys)function and the quality of sexual life, (ii) to describe the most used measurements in the current research on sexual (dys)function and the quality of sexual life in patients with colorectal cancer (CRC), and (iii) to provide a review of the literature. Sexual (dys)function mainly refers to the biological aspects of the sexual response cycle, whereas the quality of sexual life refers to the subjective evaluation of this sexual (dys)function. Current research has mainly focused on measuring sexual (dys)function, such as erectile and ejaculatory dysfunction in men and dyspareunia and vaginal dryness in women. Sexual dysfunction appeared to be present, to some extent, in most patients. The percentage of men that experienced sexual dysfunction postoperatively varied from 5% to 88%. Women who were sexually active preoperative mostly remained sexually active postoperative. The percentage of preoperative sexually active women varied from 27% to 78%. Type of surgery (especially an abdominoperineal resection), (preoperative) radiotherapy, complications after surgery, a lower tumor location, having a stoma, and a higher age influenced sexual dysfunction negatively. Predictors of the quality of sexual life are not yet identified. Existing studies suffered from methodological shortcomings, such as a cross-sectional design, small sample sizes, and the use of non-standardized measurements. In future research, sexuality should be investigated prospectively from a biopsychosocial model, hereby including the quality of sexual life and psychosocial factors associated with or predictive of sexual (dys)function and the quality of sexual life.

The Impact of OAB on Sexual Health in Men and Women: Results from EpiLUTS

Prior research suggests that overactive bladder (OAB) is common and adversely affects sexuality in both men and women. However, more data are needed from population-based studies to evaluate the impact OAB on sexual health. To describe sexual health outcomes in men and women with continent and incontinent OAB (C-OAB, I-OAB) compared to those with no/minimal urinary symptoms (NMS) and to evaluate correlates of decreased sexual activity and enjoyment in men and women, and correlates of erectile dysfunction (ED), ejaculatory dysfunction (EjD), and premature ejaculation (PE) in men. A cross-sectional, population-representative survey was conducted via the Internet in the United Kingdom, Sweden, and United States. OAB was assessed via a questionnaire based on current International Continence Society definitions. Descriptive statistics were used to compare outcomes for those with I-OAB, C-OAB and NMS, and logistic regressions were used to evaluate predictors of sexual functioning. Participants responding to the sexual health portion of the survey were asked questions about sexual activity and satisfaction. Other outcomes included two domains from the Abbreviated Sexual Function Questionnaire, the erectile function domain of the International Index of Erectile Function, and questions assessing EjD and PE. Survey response was 59.2%; 6,326 men and 8,085 women participated in the sexual health portion of the survey. Across outcomes, I-OAB and C-OAB were associated with worse sexual health as compared to those with NMS. Logistic regressions showed that those with I-OAB and C-OAB were significantly (P<0.0001) more likely to report diminished sexual activity and enjoyment of sex. I-OAB and C-OAB were also significant predictors of ED and EjD in men, but not PE. The impact of OAB is evident across domains of sexual health in both men and women. Sexual health should be assessed in men and women presenting with OAB.

Treatment for Ejaculatory Dysfunction in Men With Spinal Cord Injury: An 18-Year Single Center Experience

In what is to our knowledge the largest study of its kind to date we retrospectively reviewed the records of 3,152 semen retrieval procedures in a total of 500 men with spinal cord injury to make recommendations to the medical field on ejaculatory dysfunction treatment in this specialized patient population. We retrospectively studied data from 1991 to 2009 in the Miami Project to Cure Paralysis male fertility research program at our institution. We assessed the semen retrieval success rate and semen quality. Of the 500 men 9% could ejaculate by masturbation. Penile vibratory stimulation was successful in 86% of patients with a T10 or rostral injury level. Electroejaculation was successful in most cases of failed penile vibratory stimulation. Sperm were obtained without surgical sperm retrieval, in 97% of patients completing the treatment algorithm. Total motile sperm counts exceeded 5 million in 63% of cases. Sperm can be easily obtained nonsurgically from most men with spinal cord injury. Sufficient sperm are available for simple insemination procedures. A treatment algorithm based on our experience is presented.

Ejaculatory dysfunction in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia

To assess, using the psychometrically validated Male Sexual Health Questionnaire (MSHQ), the prevalence of ejaculatory dysfunction (EjD) and bother due to EjD in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH), and to assess predictors of EjD in this population. In all, 5999 sexually active men with LUTS completed the International Prostate Symptom Score (IPSS) which rates LUTS severity, and the MSHQ long-form, which evaluates seven EjD symptoms and bother due to EjD. Concomitant intake of medical treatments for BPH and previous BPH-related surgery were collected. The impact of treatments on EjD was compared to a control group (i.e. no previous BPH-related surgery and no medical treatment for BPH). The relationship between EjD, bother due to EjD and selected clinical characteristics was analysed using multiple regression analysis. EjD was highly prevalent and bothersome in men with LUTS, with decreased force of ejaculation (77.9%) and decreased amount of semen (74.4%) being the most commonly reported symptoms. LUTS severity was the strongest predictor of EjD and bother due to EjD. EjD was considered a problem by 35.6%, 51.6% and 64.1% of men with mild, moderate and severe LUTS, respectively (P < 0.001). EjD (except pain/discomfort on ejaculation) and bother due to EjD were also strongly related to age. Men with previous BPH-related surgery and men treated with a 5α-reductase inhibitor plus an α(1)-blocker or tamsulosin alone showed the highest rates of dry ejaculation (67.4%, 57.2% and 52.3%, respectively) compared to controls (31.6%, P < 0.001). Conversely, in men treated with alfuzosin, most EjD symptoms were significantly lower than in controls. Bother due to EjD was also significantly lower with alfuzosin than in controls (34.4% vs 53.1%, P < 0.001) while there was no significant difference for other treatments. EjD is highly prevalent and bothersome in sexually active men with LUTS, and is strongly related to LUTS severity and age. Treatment options for BPH do not have the same effect on EjD. EjD should be considered in the initial evaluation and clinical management of men with LUTS.

Are sexual side effects of prolactin-raising antipsychotics reducible to serum prolactin?

To assess the degree to which sexual side effects (SSE) are associated with prolactin-raising antipsychotics, and to what degree such SSE are reducible to serum prolactin levels. A large sample (n=264) of patients treated for 6 weeks with prolactin-raising and prolactin-sparing antipsychotics was assessed for changes in sexual performance in terms of libido, arousal and orgasm using the Antipsychotics and Sexual Functioning Questionnaire. For men also erection and ejaculation were evaluated. At 6 weeks, prolactin levels were assessed and analyzed in relation to sexual performance. Men and women reported SSE (libido and orgasm) with about the same frequency. Prolactin-raising medication induced significantly more SSE than prolactin-sparing medication (adjusted OR=3.4, 95% CI: 1.8, 6.5) with 43% of emerging SSE attributable to prolactin-raising medication. When adjusted for serum prolactin, the association between prolactin-raising medication and SSE was reduced but remained significant (OR=2.1, 95% CI: 1.0, 4.5); 27% of emerging SSE remained attributable to prolactin-raising medication. For erectile and ejaculatory dysfunction in men, the attributable fraction due to prolactin-raising medication was 32% before, and 11% after adjustment for serum prolactin. Around 40% of emerging SSE in schizophrenia are attributable to the prolactin-raising properties of antipsychotic medication. Of this attributable fraction, around one-third to two-thirds is directly reducible to the effects of serum prolactin.

POD-06.11: Prevalence of ejaculatory dysfunction in men with lower urinary tract symptoms (LUTS) suggestive of BPH receiving medical or surgical treatment

POD-06.11: Prevalence of ejaculatory dysfunction in men with lower urinary tract symptoms (LUTS) suggestive of BPH receiving medical or surgical treatment

1551: Prevalence of Ejaculatory Dysfunction in Men with LUTS Suggestive of BPH Receiving Medical or Surgical Treatment

1551: Prevalence of Ejaculatory Dysfunction in Men with LUTS Suggestive of BPH Receiving Medical or Surgical Treatment

Effects of Acute Treatment With Tamsulosin Versus Alfuzosin on Ejaculatory Function in Normal Volunteers

The frequency of ejaculatory dysfunction in men varies among the alpha-blockers used in the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. We assessed the effect of acute administration of tamsulosin, alfuzosin and placebo on ejaculate volume and sperm concentration in post-ejaculate urine, and addressed the mechanism of action of tamsulosin and alfuzosin on ejaculation. Using a randomized, 3-way crossover design, the effects of 5 days of treatment with 0.8 mg tamsulosin daily, 10 mg alfuzosin daily and placebo on ejaculation in healthy adult men were compared. The primary end points of the study were ejaculate volume and sperm concentration in post-ejaculate urine on each treatment. To aid in clinical interpretation of primary efficacy end points, each primary end point was transformed into a binary outcome, that is subjects with a greater than 20% decrease in ejaculate volume and subjects with a greater than 20% increase in sperm concentration in post-ejaculate urine. In healthy volunteers who completed the study (48), tamsulosin resulted in significantly decreased ejaculate volume (-2.4 +/- 0.17 ml) compared to alfuzosin (+0.3 +/- 0.18 ml, p < 0.0001 vs tamsulosin) or placebo (+0.4 +/- 0.18 ml, p < 0.0001 vs tamsulosin, p = nonsignificant vs alfuzosin). Among completers the incidence of more than 20% decreased ejaculate volume was significantly greater with tamsulosin (89.6%) compared to alfuzosin (20.8%, p < 0.0001 vs tamsulosin) or placebo (12.5%, p < 0.0001 vs tamsulosin, p = nonsignificant vs alfuzosin). While on tamsulosin 35.4% of 48 completers had complete lack of ejaculation (anejaculation) and no subjects experienced anejaculation while on alfuzosin or placebo. On 0.8 mg tamsulosin daily ejaculatory function in subjects was marked by decreased ejaculate volume in almost 90% of subjects and anejaculation in approximately 35% of participants. These ejaculatory disorders with tamsulosin were not attributed to retrograde ejaculation. In contrast, anejaculation was not observed in any subjects in the alfuzosin or placebo groups.

Ejaculatory disorders and lower urinary tract symptoms

A growing body of literature supports the observed association between lower urinary tract symptoms and sexual dysfunction. The causal relationship between these two conditions has not been determined. Ejaculatory function is an important aspect of sexual functioning, and recent studies have shown a high prevalence of this ejaculatory dysfunction in men with lower urinary tract symptoms. Furthermore, the degree of bother associated with ejaculatory dysfunction is quite high, making it an important problem for patients. Thus, health care providers should have a heightened sense of awareness for the presence of ejaculatory dysfunction and appropriate patient counseling should be undertaken before initiation of specific treatments for lower urinary tract symptoms.

Ejaculatory disorders and lower urinary tract symptoms.

A growing body of literature supports the observed association between lower urinary tract symptoms and sexual dysfunction. The causal relationship between these two conditions has not been determined. Ejaculatory function is an important aspect of sexual functioning and recent studies have shown a high prevalence of this ejaculatory dysfunction in men with lower urinary tract symptoms. Furthermore, the degree of bother associated with ejaculatory dysfunction is quite high, making it an important problem for patients. Thus, health care providers should have a heightened sense of awareness for the presence of ejaculatory dysfunction and appropriate patient counseling should be undertaken before initiation of specific treatments for lower urinary tract symptoms.

Sexual Dysfunction in 1,274 European Men Suffering from Lower Urinary Tract Symptoms

We determine the prevalence and bothersomeness of erectile and ejaculatory dysfunction in men with lower urinary tract symptoms suggestive of bladder outlet obstruction in real life practice, and analyze predictors of sexual dysfunction in this population. Sexual function of 1,274 European men with lower urinary tract symptoms was assessed by the DAN-PSSsex questionnaire. The relationship between sexual dysfunction and selected clinical characteristics was analyzed. The proportion of sexually active men decreased from 91% in those 60 years old or younger to 60% in those 70 years old or older. Erectile dysfunction, reduced ejaculation and pain/discomfort on ejaculation were reported by 62%, 63% and 23% of patients, respectively. Erectile dysfunction strongly related with age (40% younger than 60 years, 80% 70 years old or older), lower urinary tract symptom severity (55% mild, 70% severe) and body mass index, hypertension and concomitant treatment with calcium channel antagonists. Reduced ejaculation was significantly related to age (42% younger than 60 years, 82% 70 years old or older), lower urinary tract symptom severity (55% mild, 68% severe) and previous benign prostatic hyperplasia surgery. Pain/discomfort on ejaculation was only related to lower urinary tract symptom severity (7% mild, 31% severe). Erectile dysfunction, reduced ejaculation and pain/discomfort on ejaculation were considered a problem by 96%, 82% and 91% of patients younger than 60 years, respectively. These 3 sexual symptoms were still highly bothersome in patients 70 years old or older. Erectile dysfunction and reduced ejaculation are highly prevalent in men with lower urinary tract symptoms, and are strongly related to increasing age and lower urinary tract symptom severity. Both these aspects of sexual dysfunction are also highly bothersome, even in advanced age. Sexual function should be carefully assessed in the initial evaluation of patients with lower urinary tract symptoms and in deciding on treatment options, as it may have a negative impact on sex life.