ABSTRACT
Painful ejaculation, a previously an underestimated ejaculatory and sexual dysfunction, has gained increased attention being one of the significant sexual dysfunctions associating LUTS of BPH. Other underlying etiopathologic factors are not well studied, To study the underlying etiologic factors responsible for painful ejaculation in a group of patients having this symptom as the main complaint and the efficacy of different treatment modalities. Furthermore we want to test our hypothesis that in suspected cases of genital TB, it is better to search for it in semen rather than in urine. 60 male patients with painful ejaculation were enrolled in this study. Their mean age was 39,4 +/- 8.7 years while the mean duration of their complaint was 15.4 +/- 4.8 months. Patients were subjected to thorough history taking and physical examination including DRE. Patients were extensively investigated by urinalysis, urine culture, Ziehi Neelsen [Z,N.] staining and PCR for acid fast bacilli in both urine and semen ,semen culture, semen culture for TB, TRUS [ +/- biopsy] and/or cystoscopy when indicated in addition to PSA determination in all men above 50 years old. Associated symptoms were premature ejaculation, chronic prostatitis manifestations, ED, cystitis manifestations, infertility, partner dyspareunia or hemospermia in that order of frequency. Significant physical findings included BPH [15], epididymal mass[1], recurrent epididymoorchitis [1] scrotal sinus [1] and prostatic carcinoma [1], UTI was proved by urine culture in 20case with E-coli strains predominantly isolated. Urine PCR for TB was positive in 5 patients [13% sensitivity and 100% specificity] while same test in semen yielded astonishingly high incidence of TB in 40 patients [100% sensitivity and 91% specificity].Semen culture for TB confirmed its presence in 38 out of 40 PCR positive specimens. TRUS findings included calcular prostatitis [7], BPH [15], Prostatic adenocarcinoma [1], pathologic seminal vesicles [15],ejaculatory duct obstruction [3] and prostatic cysts [2]. Treatment of the underlying etiologies produced significant improvement of pain. Alpha blockers improved pain in 93% and 70% of BPH and chronic prostatitis patients respectively. Painful ejaculation may be an important indicator of a serious underlying disease such as prostatic carcinoma. In our locality genitourinary TB is prevalent among this group of patients. We introduce the application of PCR in semen as a highly sensitive and specific test which should be done whenever genitourinary TB is suspected as it showed better sensitivity than same test in urine. Alpha blockers proved effective in relieving painful ejaculation in BPH patients and to less extent in chronic prostatitis patients