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Bhattacharya I, Sharma SS, Majumdar SS. Etiology of Male Infertility: an Update. Reprod Sci 2024; 31:942-965. [PMID: 38036863 DOI: 10.1007/s43032-023-01401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
Spermatogenesis is a complex process of germ cell division and differentiation that involves extensive cross-talk between the developing germ cells and the somatic testicular cells. Defective endocrine signaling and/or intrinsic defects within the testes can adversely affect spermatogenic progression, leading to subfertility/infertility. In recent years, male infertility has been recognized as a global public health concern, and research over the last few decades has elucidated the complex etiology of male infertility. Congenital reproductive abnormalities, genetic mutations, and endocrine/metabolic dysfunction have been demonstrated to be involved in infertility/subfertility in males. Furthermore, acquired factors like exposure to environmental toxicants and lifestyle-related disorders such as illicit use of psychoactive drugs have been shown to adversely affect spermatogenesis. Despite the large body of available scientific literature on the etiology of male infertility, a substantial proportion of infertility cases are idiopathic in nature, with no known cause. The inability to treat such idiopathic cases stems from poor knowledge about the complex regulation of spermatogenesis. Emerging scientific evidence indicates that defective functioning of testicular Sertoli cells (Sc) may be an underlying cause of infertility/subfertility in males. Sc plays an indispensable role in regulating spermatogenesis, and impaired functional maturation of Sc has been shown to affect fertility in animal models as well as humans, suggesting abnormal Sc as a potential underlying cause of reproductive insufficiency/failure in such cases of unexplained infertility. This review summarizes the major causes of infertility/subfertility in males, with an emphasis on infertility due to dysregulated Sc function.
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Affiliation(s)
- Indrashis Bhattacharya
- Department of Zoology, Central University of Kerala, Periye Campus, Kasaragod, 671320, Kerala, India.
| | - Souvik Sen Sharma
- National Institute of Animal Biotechnology, Hyderabad, 500 032, Telangana, India
| | - Subeer S Majumdar
- National Institute of Animal Biotechnology, Hyderabad, 500 032, Telangana, India.
- Gujarat Biotechnology University, Gandhinagar, GIFT City, Gandhinagar, 382355, Gujarat, India.
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Gao Q, Chen J, Wang B, Hang Y, Gao S, Yang J, Dai Y. Application of the sexual therapy combined with vacuum negative pressure hydropneumatic/pneumatic bubble massage in primary intravaginal anejaculation. Andrology 2024. [PMID: 38439166 DOI: 10.1111/andr.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/19/2024] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Primary intravaginal anejaculation (PIAJ) is a relatively uncommon male sexual dysfunction characterized by an inability to achieve intravaginal ejaculation during all sexual intercourse. Effective treatment options for this condition are lacking. We aimed to explore the clinical effect of the sexual therapy combined with vacuum negative pressure hydropneumatic/pneumatic bubble massage (VNPHP/PBM) on primary intravaginal anejaculation, and its possible mechanism. METHODS A total of 95 PIAJ patients were randomly divided into three groups, including group A with 32 patients treated with the sexual therapy combined with VNPHP/PBM, group B with 32 patients treated with the sexual therapy and group C with 31 patients treated with VNPHP/PBM. The efficacy of therapeutic regimes, latency of the somatosensory evoked potentials of dorsal nerve (DNSEP), glans penis (GPSEP) and penile shaft sensory threshold (PSST), measures of sexual behavior of patients, as well as the self-rating anxiety scale (SAS) sores of patients and their partners, were compared before and after treatment among three groups. RESULTS The total effective rate of group A (84.38%) was higher than those of groups B and C (53.13% and 41.94%), however, no differences were found between groups B and C. The ratios of patients and their partners with anxiety, frequency of observing erotic films of patients, ratios of patients with special self-masturbation and frequency of masturbation decreased significantly in the three groups after the treatment. The decrease in the ratios of patients and their partners with anxiety, frequency of observing erotic films of patients in groups A and B were higher than those of group C, however, no differences were identified between groups A and B. The decrease in the ratios of patients with special self-masturbation and frequency of masturbation in group A were higher than those of group B, however, no differences were found between groups A and C, B and C. There were no differences in the latency of DNSEP, GPSEP, and PSST among the three groups before and after treatment. CONCLUSION The sexual therapy combined with VNPHP/PBM has good therapeutic effects on PIAJ, which might be achieved by reducing the anxiety level of patients and their partners, improving sexual behavioral patterns, rather than increasing the sensitivity of penis including dorsal nerve and glans penis.
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Affiliation(s)
- Qingqiang Gao
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Jianhuai Chen
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Bin Wang
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Youfeng Hang
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Songzhan Gao
- Department of Andrology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Yang
- Department of Urology, Jiangsu Provincial People's Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, People's Hospital of Xinjiang Kizilsu Kirgiz Autonomous Prefecture, Xinjiang uygur autonomous region, China
| | - Yutian Dai
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
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Kasbe MN, More A, Gajabe G, Jadhav R, Bachate P, Mehakar S, Tyagi P. Fertility Challenges: The Complexities of Retrograde Ejaculation and Cornual Block in Reproductive Health. Cureus 2024; 16:e55523. [PMID: 38576657 PMCID: PMC10993101 DOI: 10.7759/cureus.55523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Infertility, a complicated reproductive health issue that affects both men and women, can have a variety of causes, from anatomical abnormalities to hormone imbalances. This research addresses a couple who have been struggling with infertility for the past four years: a 31-year-old woman with bilateral tubal blockage and her 34-year-old spouse who suffered from primary infertility due to retrograde ejaculation (RE) for the same period. Analyzing the male's semen sample, it was discovered that there were dead sperm and urine, indicating RE. A hysterosalpingography indicated bilateral tubal obstruction in the female partner. Pelvic factors were examined via laparoscopy, which played a crucial role in addressing further issues. The procedure of treatment included testicular sperm aspiration for sperm extraction and intracytoplasmic sperm injection. Hormonal support was involved in the follow-up, and on the 14th day, the β-hCG test came back positive. The intricate procedures of RE and cornual block are discussed, with a focus on how they affect reproductive health.
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Affiliation(s)
- Maitrey N Kasbe
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Akash More
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Gauri Gajabe
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Ritesh Jadhav
- Anatomy, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Praful Bachate
- Interventional Radiology, Datta Meghe Institute of Higher Education & Research, Acharya Vinoba Bhave Rural Hospital, Wardha, IND
| | - Saurabh Mehakar
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Princee Tyagi
- Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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4
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Kaltsas A, Kratiras Z, Zachariou A, Dimitriadis F, Sofikitis N, Chrisofos M. Evaluating the Impact of Benign Prostatic Hyperplasia Surgical Treatments on Sexual Health. Biomedicines 2024; 12:110. [PMID: 38255215 PMCID: PMC10813562 DOI: 10.3390/biomedicines12010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. The methodology encompassed a thorough review of contemporary surgical techniques for BPH, including prostate resection, enucleation, vaporization, and minimally invasive therapies such as UroLift, Rezum, and Aquablation. Additionally, the focus was on patient-centered outcomes, with a special emphasis on sexual health following surgery. Findings reveal that, while surgical interventions effectively alleviate BPH symptoms, they often have significant repercussions in sexual function, including erectile and ejaculatory dysfunction. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. The study highlights the complex interplay between BPH surgery and sexual health, with minimally invasive treatments showing promise in balancing symptom relief and sexual function preservation. In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. This narrative review suggests a paradigm shift towards minimally invasive techniques could optimize patient outcomes, marrying symptom relief with quality-of-life considerations. The need for further research in this domain is evident, particularly in understanding long-term sexual health outcomes following different surgical interventions for BPH.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
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Leisegang K, Opuwari CS, Moichela F, Finelli R. Traditional, Complementary and Alternative Medicines in the Treatment of Ejaculatory Disorders: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1607. [PMID: 37763726 PMCID: PMC10535559 DOI: 10.3390/medicina59091607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Ejaculatory dysfunction (EjD) is a common male sexual disorder that includes premature ejaculation, delayed ejaculation, retrograde ejaculation, and anejaculation. Although psychological and pharmacological treatments are available, traditional, complementary, and alternative medicine (TCAM) is reportedly used. However, the clinical evidence for TCAM in EjD remains unclear. Therefore, this study aims to systematically review human clinical trials investigating the use of TCAM to treat EjD. Materials and Methods: A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted by searching Scopus and PubMed databases. Controlled clinical trials investigating a cohort of male patients diagnosed primarily with EjD and undergoing any TCAM intervention compared to any comparison group were included. Quality of the studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials. Results: Following article screening, 22 articles were included. Of these, 21 investigated TCAM in premature ejaculation, and only 1 investigated TCAM in retrograde ejaculation. Different TCAM categories included studies that investigated lifestyle, exercise and/or physical activities (n = 7); herbal medicine supplements (n = 5); topical herbal applications (n = 4); acupuncture or electroacupuncture (n = 3); vitamin, mineral and/or nutraceutical supplements (n = 1); hyaluronic acid penile injection (n = 1); and music therapy (n = 1). Only 31.8% (n = 7) of the included studies were found to have a low risk of bias. The available studies were widely heterogenous in the TCAM intervention investigated and comparison groups used. However, the included studies generally showed improved outcomes intra-group and when compared to placebo. Conclusions: Different TCAM interventions may have an important role particularly in the management of PE. However, more studies using standardized interventions are needed.
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Affiliation(s)
- Kristian Leisegang
- School of Natural Medicine, University of the Western Cape, Bellville 7535, South Africa;
| | - Chinyerum Sylvia Opuwari
- Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa; (C.S.O.); (F.M.)
| | - Faith Moichela
- Department of Medical Biosciences, University of the Western Cape, Bellville 7535, South Africa; (C.S.O.); (F.M.)
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Pawłowski P, Ziętara KJ, Michalczyk J, Fryze M, Buchacz A, Zaucha-Prażmo A, Zawitkowska J, Torres A, Samardakiewicz M. Fertility Preservation in Children and Adolescents during Oncological Treatment-A Review of Healthcare System Factors and Attitudes of Patients and Their Caregivers. Cancers (Basel) 2023; 15:4393. [PMID: 37686669 PMCID: PMC10487203 DOI: 10.3390/cancers15174393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Oncofertility is any therapeutic intervention to safeguard the fertility of cancer patients. Anti-cancer therapies (chemotherapy, radiation therapy, etc.) entail the risk of reproductive disorders through cytotoxic effects on gamete-building cells, especially those not yet fully developed. This literature review analyzes the available data on securing fertility in pediatric and adolescent populations to identify the methods used and describe aspects related to financing, ethics, and the perspective of patients and their parents. Topics related to oncofertility in this age group are relatively niche, with few peer-reviewed articles available and published studies mostly on adults. Compared to pubertal individuals, a limited number of fertility preservation methods are used for prepubertal patients. Funding for the procedures described varies from country to country, but only a few governments choose to reimburse them. Oncofertility of pediatric and adolescent patients raises many controversies related to the decision, parents' beliefs, having a partner, ethics, as well as the knowledge and experience of healthcare professionals. As the fertility of young cancer patients is at risk, healthcare professionals should make every effort to provide them with an opportunity to fulfill their future reproductive plans and to have a family and offspring. Systemic solutions should form the basis for the development of oncofertility in pediatric and adolescent populations.
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Affiliation(s)
- Piotr Pawłowski
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Karolina Joanna Ziętara
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Justyna Michalczyk
- Student Scientific Association at the Department of Psychology, Faculty of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (P.P.); (J.M.)
| | - Magdalena Fryze
- Department of Psychology, Psychosocial Aspects of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (M.F.); (M.S.)
| | - Anna Buchacz
- Youth Cancer Europe, 400372 Cluj-Napoca, Romania;
| | - Agnieszka Zaucha-Prażmo
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (A.Z.-P.); (J.Z.)
| | - Joanna Zawitkowska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland; (A.Z.-P.); (J.Z.)
| | - Anna Torres
- Department of Pediatric and Adolescent Gynecology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Marzena Samardakiewicz
- Department of Psychology, Psychosocial Aspects of Medicine, Medical University of Lublin, 20-093 Lublin, Poland; (M.F.); (M.S.)
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Flannigan R, Tadayon Najafabadi B, Violette PD, Jarvi K, Patel P, Bach PV, Domes T, Zini A, Grober E, Mak V, Fischer MA, Chan P, Lo K, Chow V, Wu C, Grantmyre J, Patry G. 2023 Canadian Urological Association guideline: Evaluation and management of azoospermia. Can Urol Assoc J 2023; 17:228-240. [PMID: 37581550 PMCID: PMC10426420 DOI: 10.5489/cuaj.8445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | | | - Philippe D. Violette
- Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Premal Patel
- Division of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Phil Vu Bach
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Trustin Domes
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Ethan Grober
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Victor Mak
- Division of Urology, Department of Surgery, Mackenzie Health, Richmond Hill, ON, Canada
| | - Marc Anthony Fischer
- Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Peter Chan
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Kirk Lo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Victor Chow
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Chris Wu
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - John Grantmyre
- Division of Urology, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Genevieve Patry
- Division of Urology, Department of Surgery, Hôtel-Dieu De Lévis, Lévis, QC, Canada
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Masugi-Tokita M, Kubota S, Kobayashi K, Yoshida T, Kageyama S, Sakamoto H, Kawauchi A. Spinal Transection Switches the Effect of Metabotropic Glutamate Receptor Subtype 7 from the Facilitation to Inhibition of Ejaculation. Neuroscience 2023; 509:10-19. [PMID: 36403690 DOI: 10.1016/j.neuroscience.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
Metabotropic glutamate receptor subtype 7 (mGluR7) is a member of the group III mGluRs, which localize to presynaptic active zones of the central nervous system. We previously reported that mGluR7 knockout (KO) mice exhibit ejaculatory disorders, although they have normal sexual motivation. We hypothesized that mGluR7 regulates ejaculation by potentiating the excitability of the neural circuit in the lumbosacral spinal cord, because administration of the mGluR7-selective antagonist into that region inhibits drug-induced ejaculation. In the present study, to elucidate the mechanism of impaired ejaculation in mGluR7 KO mice, we eliminated the influence of the brain by spinal transection (spinalization). Unexpectedly, sexual responses of male mGluR7 KO mice were stronger than those of wild-type mice after spinalization. Histological examination indicated that mGluR7 controls sympathetic neurons as well as parasympathetic neurons. In view of the complexity of its synaptic regulation, mGluR7 might control ejaculation by multi-level and multi-modal mechanisms. Our study provides insight into the mechanism of ejaculation as well as a strategy for future therapies to treat ejaculatory disorders in humans.
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Affiliation(s)
- Miwako Masugi-Tokita
- Department of Urology, Shiga University of Medical Science, Otsu, Japan; World Premier International Research Initiative-Institute for Integrated Cell-Material Sciences (WPI-iCeMS), Kyoto University, Kyoto, Japan; Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan.
| | - Shigehisa Kubota
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Kenichi Kobayashi
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Tetsuya Yoshida
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
| | - Hirotaka Sakamoto
- Ushimado Marine Institute (UMI), Graduate School of Natural Science and Technology, Okayama University, Setouchi, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Otsu, Japan
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Al-Tawalbeh D, Bdeir R, Al-Momani J. The Use of Medicinal Herbs to Treat Male Infertility in Jordan: Evidence-Based Review. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2023. [DOI: 10.51847/42rwhfit62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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10
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Fukuhara S, Shirai M, Ueda N, Takezawa K, Ishikawa K, Hiramatsu I, Uesaka Y, Nozaki T, Iwasa A, Kobayashi K, Nonomura N, Tsujimura A. Therapeutic efficacy and safety of a free-standing motorized ejaculation aid for patients with intravaginal ejaculatory dysfunction. Reprod Med Biol 2023; 22:e12530. [PMID: 37601483 PMCID: PMC10433113 DOI: 10.1002/rmb2.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose There are no approved drugs or devices for the treatment of intravaginal ejaculation disorders, and treatment is often difficult. This study aimed to evaluate the efficacy and safety of the A10 Cyclone SA + PLUS® ejaculation aid (Rends Co., Ltd., Chiba, Japan), which allows the user to adjust the intensity of stimulation, for intravaginal ejaculation disorders. Methods Each participant was instructed to perform practice masturbation with the A10 Cyclone SA + PLUS to simulate vaginal ejaculation. After 8 weeks of training, the participants were asked about their intravaginal ejaculation status. Sexual function was also evaluated before and after the training using several specific questionnaires, including the numerical rating scale for ejaculatory satisfaction. Results Among the 10 participants (41.5 ± 3.21 years) who completed the training and questionnaire evaluation, four (40%) became capable of intravaginal ejaculation. The questionnaire evaluation showed predominant improvement after training in the ejaculation-capable group according to the numerical rating scale, which expresses satisfaction with ejaculation. The participants experienced no significant adverse events. Conclusion As no effective treatment currently exists for intravaginal ejaculation disorders, we conclude that the A10 Cyclone SA + PLUS may be one treatment tool for intravaginal ejaculation disorders with good efficacy and no adverse events.
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Affiliation(s)
| | - Masato Shirai
- Department of UrologyJuntendo University Urayasu HospitalUrayasuJapan
| | - Norichika Ueda
- Department of UrologyOsaka University Graduate School of MedicineSuitaJapan
| | - Kentaro Takezawa
- Department of UrologyOsaka University Graduate School of MedicineSuitaJapan
| | - Keisuke Ishikawa
- Department of UrologyJuntendo University Urayasu HospitalUrayasuJapan
| | - Ippei Hiramatsu
- Department of UrologyJuntendo University Graduate School of MedicineTokyoJapan
| | - Yuka Uesaka
- Department of UrologyJuntendo University Urayasu HospitalUrayasuJapan
| | - Taiji Nozaki
- Department of UrologyJuntendo University Urayasu HospitalUrayasuJapan
| | | | | | - Norio Nonomura
- Department of UrologyOsaka University Graduate School of MedicineSuitaJapan
| | - Akira Tsujimura
- Department of UrologyJuntendo University Urayasu HospitalUrayasuJapan
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11
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Entwistle PA. Nurse Practitioner–Led Retrograde Ejaculation Management Can Help Optimize Integration of Care. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Anderson D, Laforge J, Ross MM, Vanlangendonck R, Hasoon J, Viswanath O, Kaye AD, Urits I. Male Sexual Dysfunction. Health Psychol Res 2022; 10:37533. [PMID: 35999971 PMCID: PMC9392840 DOI: 10.52965/001c.37533] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Male sexual dysfunction is a series of conditions, most notably including erectile dysfunction (ED), Peyronie's disease (PD), and premature ejaculation (PE), defined by impaired sexual functioning. The prevalence of male sexual dysfunction increases with age and is relatively high with greater than 50% of men aged 40 to 70 describing some degree of erectile dysfunction. Risk factors for male sexual dysfunction include age, diabetes mellitus (DM), cancer, stroke, hypertension, penile trauma, depression, anxiety, and disturbance in central serotonin neurotransmission and 5-HT postsynaptic receptor functioning. Sexual questionnaires including the International Index of Erectile Dysfunction, Sexual Health Inventory for Men, and the Premature Ejaculation Diagnostic Tool are useful in screening for these disorders. Focused history and physical can establish diagnoses. For a condition to be diagnosed as male sexual dysfunction, the patient or their partner must view their sexual functioning as impaired. Treatment of male sexual dysfunction is etiology dependent. For ED, first-line therapy is a phosphodiesterase-5 inhibitor or mental health care for psychogenic ED. More complicated cases may be treated with injections, surgery, or shockwave therapy. PD is either treated with medications for pain management, collagenase clostridium histolyticum injection, corpoplasty, plication, or shockwave therapy. PE may be treated behaviorally or with SSRIs as first line medication.
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Affiliation(s)
| | - John Laforge
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Maggie M Ross
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix; Department of Anesthesiology, Creighton University School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
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Urso D, Leta V, Rukavina K. Management strategies of sexual dysfunctions in Parkinson's disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 162:97-116. [PMID: 35397790 DOI: 10.1016/bs.irn.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual dysfunctions (SD) are frequent and highly disabling nonmotor manifestations of Parkinson's disease (PD) but are also potentially treatable. Neurologists should actively discuss, recognize and treat sexual health issues as an integral part of the management of the disease. In this chapter, we provide recommendations for managing and treating both primary and secondary SD in PD. Many sexual problems can be, at least partially, improved by adjusting the treatment of motor, nonmotor symptoms and comorbidities. Although some treatments of primary SD are evidence-based, many therapeutic options have not been yet systematically studied in patients with PD. The development of new treatments and repurposing of existing remedies in patients with PD remain an unmet need.
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Affiliation(s)
- Daniele Urso
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom; Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
| | - Valentina Leta
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Katarina Rukavina
- King's College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; Parkinson's Foundation Centre of Excellence, King's College Hospital, Denmark Hill, London, United Kingdom
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Erbay G, Ceyhun G. Is heart rate variability a risk factor for premature ejaculation? Int J Clin Pract 2021; 75:e14699. [PMID: 34343389 DOI: 10.1111/ijcp.14699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/02/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The purpose of this study is to assess the parameters of heart rate variability, which is an indicator of the change in autonomic nervous system (ANS) activity, in individuals with premature ejaculation (PE). MATERIAL AND METHODS This study was performed by comparing 40 patients with PE (mean age, 31.2 ± 4.1 years) and 40 healthy individuals (mean age, 30.4 ± 4.8 years) without PE from May 2018 to December 2019. HRV parameters were compared between men with PE and healthy controls in 24-hour heart rhythm Holter examination. RESULTS In the time domain analysis, which is a subgroup of HRV, square root of differences between consecutive normal NN intervals (RMSSD), which is an indicator of parasympathetic activity, was lower in patients with PE compared with controls (P = .025). Moreover, within the frequency domain analysis, high frequency (HF), another indicator of parasympathetic activity, was lower in patients compared with controls (P = .032). Finally, the LF/HF ratio, reflecting sympathetic/parasympathetic activity ratio, was significantly higher in patients compared with controls (P = .008). Furthermore, the multivariate logistic regression analysis showed that LF/HF ratio is independently associated with PE (P = .005). The ROC curve analysis showed that the optimal cut-off value of LF/HF above 2.7 predicted PE at a sensitivity of 77.5% and specificity of 82.5% (positive predictive value: 81.5% and negative predictive value: 78.5%). CONCLUSION Different HRV parameters were exhibited in the comparison of patients with PE and normal controls. It suggests that the change in HRV parameters will be an indicator of imbalance in ANS and this imbalance may cause PE. Therefore, HRV analysis can be a diagnostic tool to assess altered ANS activity in patients with PE and may be considered as a rapid screening tool.
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Affiliation(s)
- Güven Erbay
- Urology Clinic, Karamanoglu Mehmetbey University Faculty of Medicine, Karaman, Turkey
| | - Gökhan Ceyhun
- Department of Cardiology, Ataturk University Faculty of Medicine, Erzurum, Turkey
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Witherspoon L, Flannigan R. Male factor infertility: Initial workup and diagnosis in primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:248-254. [PMID: 33853910 DOI: 10.46747/cfp.6704248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To present a case-based discussion on the workup of male factor infertility and review currently available treatments. SOURCES OF INFORMATION This discussion is based on the current Canadian Urological Association and American Urological Association guidelines, with reference to landmark papers as appropriate from 2010 onward. All articles were retrieved through PubMed. MAIN MESSAGE Approximately 15% of Canadian couples experience infertility, making it a commonly encountered condition in the primary care setting. Among couples suffering from infertility, male factors can be identified as the sole cause in 30% of cases and as a contributing issue in 20% of cases. Although many of the treatments described aim to improve a couple's chances of naturally conceiving a child via intercourse, many patients ultimately require medical or surgical intervention to achieve pregnancy. This can be a long, protracted course for patients, with important roles for primary care providers and fertility specialists alike. CONCLUSION Male fertility assessment and treatment has historically been left in the hands of fertility specialists, creating a bottleneck for patients to receive fertility care. However, with increased understanding of the underlying causes of male factor infertility, the workup and initial management can occur in the primary care setting, helping to streamline care.
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Affiliation(s)
- Luke Witherspoon
- Sexual and Reproductive Medicine Fellow in the Department of Urologic Sciences at the University of British Columbia in Vancouver
| | - Ryan Flannigan
- Assistant Professor in the Department of Urologic Sciences at the University of British Columbia and Adjunct Assistant Professor in the Department of Urology at Weill Cornell Medicine in New York, NY
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Mostafa T, Abdel-Hamid IA. Ejaculatory dysfunction in men with diabetes mellitus. World J Diabetes 2021; 12:954-974. [PMID: 34326948 PMCID: PMC8311479 DOI: 10.4239/wjd.v12.i7.954] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/06/2021] [Accepted: 06/15/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Taymour Mostafa
- Department of Andrology & Sexology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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Aoun F, Mjaess G, Lilly E, Khalil N, Tayeh GA, Sarkis J, Mansour R, Alkassis M, Chebel R, Absil F, Bollens R. Is pudendal nerve entrapment a potential cause for weak ejaculation? Int J Impot Res 2021; 34:520-523. [PMID: 33972715 DOI: 10.1038/s41443-021-00443-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 11/09/2022]
Abstract
Ejaculatory dysfunction is one of the most common complaints of patients with sexual disorders. While it encompasses several ejaculatory disorders, weak ejaculation is seldom described in the literature. Since the pudendal nerve is the main nerve of ejaculation, we aim to hypothesize that pudendal nerve entrapment could be a cause of weak ejaculation, and that pudendal nerve release could contribute to the improvement of the ejaculatory stream. We presented two cases suffering from a weak ejaculatory stream and sensation of incomplete semen emptying, accompanied with clinical features of pudendal nerve entrapment. Both cases improved after pudendal nerve block and then laparoscopic transperitoneal pudendal release, with a sustained amelioration of the ejaculatory stream after 3 weeks of surgery. Pudendal canal entrapment is therefore a potentially curable cause for weak ejaculation.
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Affiliation(s)
- Fouad Aoun
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon. .,Department of Urology, Institut Jules Bordet, Brussels, Belgium.
| | - Georges Mjaess
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Eddy Lilly
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Nour Khalil
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | | | - Julien Sarkis
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Raymond Mansour
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Marwan Alkassis
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Roy Chebel
- Department of Urology, Hotel-Dieu de France, Beirut, Lebanon
| | - Fabienne Absil
- Department of Gynecology, EpiCura Hospital, Ath, Belgium
| | - Renaud Bollens
- Department of Urology, Wallonie Picarde Hospital, Tournai, Belgium
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Akgül M, Yazıcı C, Şipal T, Arda E. The clinical significance of abnormal ejaculation by silodosin. Is it important? Andrologia 2021; 53:e14086. [PMID: 33951747 DOI: 10.1111/and.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/25/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022] Open
Abstract
We aimed to evaluate the effect of the abnormal ejaculation (AEj) on patients using silodosin in terms of drug cessation. We also analysed the possible factors that may affect the decisions of patients with AEj to proceed or change their medication. The patients (n = 118) treated with silodosin 8 mg daily were prospectively analysed. In order to evaluate the erectile function, ejaculatory function, depression and sexual satisfaction; IIEF, MSHQ-EjD, Beck's depression and Golombok-Rust questionnaires were given to patients respectively. Patients were re-evaluated at the 3rd month of their treatment. The rate of AEj was 52.5%. Nearly 42% of the patients with AEj desired to stop their medication whereas it was 7.1% at patients without AEj (p < .001). The pre-treatment International Prostate Symptom Score (IPSS) and the decrease in IPSS score were significantly lower in patients who demand to stop their treatment (p < .05). AEj was significantly higher in patients who wanted to stop their medication (p < .001). Even if they had an AEj, patients who were happy with the clinical efficacy of silodosin did not want to change their drug. In addition to this, pre-treatment ejaculatory status was an important indicator for patients to decide drug cessation due to AEj side effect of silodosin.
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Affiliation(s)
- Murat Akgül
- Department of Urology, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Cenk Yazıcı
- Department of Urology, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Timuçin Şipal
- Clinic of Urology, Tekirdağ Çerkezköy State Hospital, Tekirdağ, Turkey
| | - Ersan Arda
- Department of Urology, Faculty of Medicine, Trakya University, Edirne, Turkey
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Kaseki H, Kaseki S, Shimizu M, Hayashi A, Suganuma N. Indication of intravaginal insemination for infertility treatment in couples with sexual dysfunction. Reprod Med Biol 2021; 20:241-245. [PMID: 33850458 PMCID: PMC8022094 DOI: 10.1002/rmb2.12376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To analyze the usefulness of intravaginal insemination (IVI) for the infertility treatment in couples with sexual dysfunction before applying assisted reproductive technology (ART). METHODS Among 208 couples who presented sexual dysfunction, 144 couples underwent IVI procedures. The profiles of pregnant and non-pregnant patients were compared. RESULTS Of 144 patients, 58 women conceived successfully (40.3% pregnancy rate). Between the pregnant and non-pregnant cases, the husband's age and infertility period were significantly higher (P = .0104) and longer (P = .0027) in the unsuccessful cases than the successful ones. The husbands who could not impregnate had a significantly higher ratio of sperm abnormalities (P = .0048). Among the 57 successful cases who underwent IVI treatment, 38 (66.7%) patients became pregnant within 3 times of the procedure, while 48 (84.2%) patients conceived within 6 times. CONCLUSION The authors can propose the following inclusion IVI criteria for couples with sexual dysfunction: (a) younger husband (36 years old or less) which may be most important, (b) infertility duration of 3 years or less, (c) normal sperm condition, and (d) IVI trial for 3 times (maximum of 6 times). Since IVI appears to be a simple, noninvasive, and inexpensive way for couples with sexual dysfunction, it can be attempted before ART application.
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Affiliation(s)
| | - Satoshi Kaseki
- Kaseki Ladies ClinicIchinomiyaAichiJapan
- Department of Obstetrics and GynecologyKariya Toyota General HospitalKariyaAichiJapan
| | | | - Ayako Hayashi
- Depatment of NursingAichi Medical UniversityNagakuteAichiJapan
| | - Nobuhiko Suganuma
- Kaseki Ladies ClinicIchinomiyaAichiJapan
- Department of NursingNagoya University of Arts and SciencesNagoyaAichiJapan
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Spontaneous Ejaculation: A Focused Review for the Clinicians. Sex Med Rev 2020; 9:406-422. [PMID: 33262094 DOI: 10.1016/j.sxmr.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/25/2020] [Accepted: 11/01/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The process of ejaculation has important meanings not only for its association with orgasm but also for the timing to ejaculate in the context of sexual activity. Spontaneous (involuntary) ejaculation (SE) without any sexual stimulation is a distressing symptom. Our understanding of SE is limited. Unfortunately, many physicians are not aware of these cases. OBJECTIVES The objective of this study is to describe the etiopathogenesis, clinical features, diagnosis, and treatment options for SE. METHODS We searched the literature for publications on "SE," "spontaneous emission" or "involuntary ejaculation," and factors influencing SE in the PUBMED/MEDLINE, Scopus, Cochrane Library, EMBASE, PsycINFO, ProQuest, Academic Search Complete database, Google Scholar, and CINAHL databases from inception to August 2020. RESULTS The literature search yielded 36 relevant publications reporting on 43 patients with SE. Attempts to explain the cause of pathologic SE have included 4 etiological groups (spinal cord lesions, psychological causes, rabies, and drug-induced). The underlying mechanisms responsible for induction of SE may include increased adrenergic activity, overactivity in dopaminergic system, decreased serotonergic activity, damage of descending inhibitory pathway, or penile hyperexcitability. SE may occur in the absence of an identifiable trigger or may be triggered by non-sexual circumstances (micturition, defecation, glans touch, anxiety, panic attack, or school examinations). Treatment options include psychoanalytic treatment, paroxetine, citalopram, sertraline, silodosin, and anxiolytics. In drug-induced SE, dose reduction and drug withdrawal with or without switching to another drug may relief SE. CONCLUSIONS SE is one of the least reported ejaculatory dysfunction. The key feature shared in common by these men is SE without any sexual thoughts or fantasies, may be triggered by non-sexual contexts, rarely associated with orgasm or erection. Treatment by psychoanalytic treatment and pharmacotherapy may be helpful. Further research might explore the definite underlying mechanisms. Abdel-Hamid IA, Ali OI. Spontaneous Ejaculation: A Focused Review for the Clinicians. Sex Med Rev 2021;9:406-422.
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