Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. It is often quite concerning to patients and their partners, and sometimes frustrates couples' attempts to conceive. This article aims to review the pathophysiology of DE and anejaculation (AE), to explore our current understanding of the diagnosis, and to present the treatment options for this condition. Electronic databases were searched from 1966 to October 2017, including PubMed (MEDLINE) and Embase. We combined “delayed ejaculation,” “retarded ejaculation,” “inhibited ejaculation,” or “anejaculation” as Medical Subject Headings (MeSH) terms or keywords with “epidemiology,” “etiology,” “pathophysiology,” “clinical assessment,” “diagnosis,” or “treatment.” Relevant sexual medicine textbooks were searched as well. The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific. There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men. An approved form of drug therapy does not exist. A number of approaches can be employed for infertile men, including the collection of nocturnal emissions, prostatic massage, prostatic urethra catheterization, penile vibratory stimulation, probe electroejaculation, sperm retrieval by aspiration from either the vas deferens or the epididymis, and testicular sperm extraction.

Adapted Technological Platform for Screening and Identifying Compounds Capable of In vivo Spinal Network-mediated Reflex Ejaculation in Non-anesthetized, Chronic Paraplegic Mice: Evidence of Clonidine-elicited Seminal Emission.

Several drugs have been shown to facilitate locomotor rhythmogenesis and treadmill training after Spinal Cord Injury (SCI). Clonidine, an alpha-adrenoceptor agonist, is of particular interest given its well-known effects on facilitation of reflex-induced spinal stepping in acute or chronic complete low-thoracic spinal cord-transected (Tx) cats. Since locomotion and ejaculation are controlled by neuronal networks located in the same area of the spinal cord (i.e., upper- to mid-lumbar segments), we hypothesized that clonidine may have comparable effects on reflex ejaculation in low-thoracic Tx animals. To achieve that, the main aim was to adapt a technological platform developed initially for in vivo testing of pro-locomotor compounds in order to establish and validate an approach for assessing both behaviourally and quantitatively, drug-induced reflex ejaculation ex copula in an animal model of SCI. At 6 or 7 days post-Tx, male mice received a single injection of clonidine (0.005-2.5 mg/kg, i.p.). At doses ranging between 0.1 and 2.5 mg/kg, clonidine acutely induced, in 88% of cases (35/40 mice), seminal emissions as fluids or plugs (in-urethra) with no erection nor expulsion. Given that clonidine is a partial alpha-2 agonist, the results suggest that alpha-2 adrenoceptor activation is associated with seminal emission in non-copulating and non-stimulated (e.g., manually or electrically) chronic paraplegic mice. To our knowledge, this is the first report of alpha-2-mediated, clonidine-induced seminal emission.

Rectal probe electroejacnlation / 中华泌尿外科杂志

Objective To search a new,safe and effective method to obtain semen using rectal Drobe electroejaculation(RPE).Methods RPE procedures were performed in 8 men with psychological ejaculatory failure,used the electrical stimulate instrument(CGS model,made in Italy).The average age was 26 years.Seminal vesicle was normal by B Uhrasonography or CT examination.Except for 1 case of diabetes,the other 7 cases found no hormones,blood,biochemical and nervous system abnormalities.Three cases had nocturnal emission,but no sexual intercourse ejaculation.Results Adequate sperm was successfully taken out from the 8 patients.Mean seminal fluid volume was 2.3 ml,mean total sperm count was 67×106/ml and mean total motile sperm was 21.3%.Three patients felt abdominal distension during the RPE course.Conclusion RPE is a safe,reliable,non-in-vasive,repeatable method to obtain semen.

Intrauterine Insemination Using Eletroejaculation in Anejaculatory Male / 대한비뇨기과학회지

A total of 41 anejaculatory men participated in the electroejaculation study. Mean patient age was 33.2 years (range 22 to 54 years). Greater than one million motile sperm were obtained in 26 patients(63.4%). We attempted intrauterine insemination on 25 occasions in 14 subjects' spouses. Four of them(28.6%) became pregnant ;two aborted and the other two delivered fullterm healthy babies.

Electroejaculation in the treatment of anejaculatory men / 대한비뇨기과학회지

Rectal probe electroejaculation was attempted in 22 anejaculatory men and sperm were obtained in 86.4%. 8 patients had retrograde only and 11 patients had antegrade and retrograde ejaculations. The semen qualities were relatively poor. Only 11 patients (50.0% ) showed total sperm count more than 10 x 10(5) and total motile sperm count 1 x 10(6). There were blood pressure elevations with headache or sweating in 7 patients during electrostimulation. Among these, 6 patient had lesions above Ts but one had a lower spinal lesion (L1). The other side effects were minimal.

Successful combination therapy with electroejaculation and in vitro fertilization-embryo transfer in the treatment of a patient with neurogenic anejaculation / 대한비뇨기과학회지

Recent case reports of the successful application of electroejaculation techniques for seminal emission and subsequent pregnancies have offered promising fertility alternative for the men with neurogenic anejaculation. The success of his program requires multidisciplinary couple-oriented therapy combining both turologic and gynecologic infertility therapy. However, despite obtaining often normal numbers of spermatozoa. sperm motility rarely exceeds 10-20% in electroejaculation sample. Therefore, realistic potential for pregnancy with intrauterine insemination technique is extremely low. In this report we present the first domestic successful coordination of both electroejaculation and in vitro fertilization-embryo transfer in a neurogenic anejaculation patient with severe oligoasthenospermia.