Ejaculatory Dysfunctions Other Than Premature Ejaculation

[Michael Scally MD]

Paduch DA, Polzer P, Morgentaler A, et al. Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: A Prospective, Observational Study. The Journal of Sexual Medicine. http://onlinelibrary.wiley.com/doi/10.1111/jsm.13027/abstract

Introduction Ejaculatory dysfunctions other than premature ejaculation are commonly encountered in specialized clinics; however, their characterization in community-dwelling men is lacking.

Aim The aim of this study was to evaluate the prevalence, severity, and associated distress of four ejaculatory dysfunctions: delayed ejaculation (DE), anejaculation (AE), perceived ejaculate volume reduction (PEVR) and/or decreased force of ejaculation (DFE) as a function of demographic and clinical characteristics in men.

Methods Observational analysis of 988 subjects presenting with one or more types of ejaculatory dysfunctions other than premature ejaculation who screened for a randomized clinical trial assessing the efficacy of testosterone replacement on ejaculatory dysfunction. Demographic and clinical characteristics were assessed as potential risk factors using regression analysis.

Main Outcome Measures The main outcome measures used were ejaculatory dysfunction prevalence and scores (3-item Men's Sexual Health Questionnaire Ejaculatory Dysfunction-Short Form [MSHQ-EjD-SF]), and bother (MSHQ-EjD-SF Bother item) and sexual satisfaction/enjoyment (International Index of Erectile Function Questionnaire Q7, Q8) as a function of subject's age, race, body mass index (BMI) and serum testosterone levels (measured by liquid chromatography tandem mass spectrometry).

Results Mean (standard deviation [SD]) age of the participants was 52 years (11). Eighty-eight percent of the men experienced more than one type of ejaculatory dysfunction and 68% considered their symptoms to be bothersome. Prevalence of the ejaculatory dysfunctions was substantial across a range of age, race, BMI, and serum testosterone categories.

Prevalence of PEVR and DFE were positively associated with age (<40 years vs. 60–70 years: PEVR: odds ratio [OR], 3.05; 95% confidence interval [CI], 1.32–7.06; DFE: OR, 2.78; 95% CI, 1.46–5.28) while DFE was associated with BMI (≥30 kg/m2 vs. < 25 kg/m2: OR, 1.80; 95% CI, 1.062–3.05). All ejaculatory dysfunctions were more prevalent in black men.

Conclusion The majority of the participants experienced multiple ejaculatory dysfunctions and found them to be highly bothersome. Ejaculatory dysfunctions were prevalent across a wide range of demographic and clinical characteristics.

 

[Michael Scally MD]

Case 267: A 28-year-old man presented with lifelong anejaculation, which had become an issue because of family planning. The patient had a history of normal erections and experienced the sensation of orgasm without ever ejaculating.

On physical examination, both testes were present in the scrotum, with normal dimensions and a normal epididymis bilaterally. The patient had a slightly tender left testicle, and digital rectal examination findings were normal. The patient underwent further investigation for the possibility of retrograde ejaculation with urine cytology, the results of which were negative.

Genetic testing was performed to exclude Y chromosome microdeletions. Serum-luteinizing and follicle-stimulating hormone levels were normal, with a borderline low level of testosterone (7.6 nmol/L; normal range, 8.0-29.0 nmol/L). All other pertinent laboratory results were noncontributory.

Pelvic MRI was requested to exclude an anatomic cause of anejaculation. MRI was performed in accordance with the standard clinical prostate protocol, with a dynamic contrast material-enhanced study. CT of the upper abdomen was also performed. The patient subsequently underwent cystoscopy, which revealed an intravesicular fluid-filled mass near the left ureteric orifice.

Cz Arniecki M, Barrett T, Thiruchelvam N, Wiseman O. Case 267. Radiology 2019;290:839-42. https://pubs.rsna.org/doi/10.1148/radiol.2019162780

 

[Michael Scally MD]

Anejaculation: Relevance to Sexual Enjoyment

Introduction - Ejaculation and orgasm are important components of sexual response in men. Our understanding of both phenomena is limited. Anejaculation can be a source of substantial distress, even when procreation (ostensibly the only purpose of ejaculation itself) is not a priority.

Aim - To present an opinion on male perceptions of ejaculation disorders (specifically anejaculation) based on a variety of data sources, including peer-reviewed literature.

Methods - A non-systematic review of literature on anejaculation and other impairments of ejaculatory and orgasmic response was conducted. Relevant articles were critically analyzed and reported

Main Outcome Measure - An opinion is presented, based on existing data sources, on how and why ejaculation is deemed important to men and their sexual partners.

Results - The peer-reviewed literature on disorders of ejaculation is scant; existing reports oftentimes do not adequately distinguish between orgasm and ejaculation in assessment. Men’s perceptions of ejaculation quality appear to be positively associated with satisfaction with sexual response, particularly regarding orgasm.

Based on very limited data, female sexual partners of men appear to often (but not always) value the orgasmic experience of their partner; only a minority prioritize actual ejaculation. There is evidence that disorders of ejaculation may be particularly troublesome for men who have sex with men.

Clinical Implications - The influence of medical conditions and treatments on ejaculation should be considered in the clinical context. Psychological adaptations and interventions may be of value in some cases.

Strengths & Limitations - Data on the clinical relevance of anejaculation outside the context of concomitant orgasmic dysfunction are sparse. Men’s experience of orgasm is at least partially associated with ejaculation-specific variables; whether this association is mediated by psychological, physical, or a combination of factors remains unclear.

Conclusions - Ejaculation, orgasm, and sexual satisfaction are closely intertwined but distinct phenomena.

Shindel AW. Anejaculation: Relevance to Sexual Enjoyment in Men and Women. J Sex Med 2019;16:1324–1327. https://www.jsm.jsexmed.org/article/S1743-6095(19)31279-2/abstract

 

[Michael Scally MD]

[OA] Two Cases of Psychogenic Anejaculation Patients Got Normal Ejaculation Ability After Penile Vibratory Stimulation or Electroejaculation

Psychogenic anejaculation is a unique problem which accounts for 0.4–0.5% of anejaculation patients. Although patients with this problem may experience erections and nocturnal emissions (NEs), they do not experience ejaculation during either masturbation or coitus. The etiology is presently unknown.

Penile vibratory stimulation (PVS) and electroejaculation (EEJ) have been the main methods of sperm retrieval for psychogenic anejaculation couples undergoing assisted reproduction technology (ART). However, there is no special treatment which can heal psychogenic anejaculation patients.

Here, we report two psychogenic anejaculation patients who recovered normal ejaculation ability after PVS or EEJ procedure.

Cong R, Zhang Q, Wang Y, Meng X, Wang Z, Song N. Two cases of psychogenic anejaculation patients got normal ejaculation ability after penile vibratory stimulation or electroejaculation. Transl Androl Urol. 2019;8(6):758–761. Two cases of psychogenic anejaculation patients got normal ejaculation ability after penile vibratory stimulation or electroejaculation - Cong - Translational Andrology and Urology

 

[Old]

[OA] Two Cases of Psychogenic Anejaculation Patients Got Normal Ejaculation Ability After Penile Vibratory Stimulation or Electroejaculation

Psychogenic anejaculation is a unique problem which accounts for 0.4–0.5% of anejaculation patients. Although patients with this problem may experience erections and nocturnal emissions (NEs), they do not experience ejaculation during either masturbation or coitus. The etiology is presently unknown.

Penile vibratory stimulation (PVS) and electroejaculation (EEJ) have been the main methods of sperm retrieval for psychogenic anejaculation couples undergoing assisted reproduction technology (ART). However, there is no special treatment which can heal psychogenic anejaculation patients.

Here, we report two psychogenic anejaculation patients who recovered normal ejaculation ability after PVS or EEJ procedure.

Cong R, Zhang Q, Wang Y, Meng X, Wang Z, Song N. Two cases of psychogenic anejaculation patients got normal ejaculation ability after penile vibratory stimulation or electroejaculation. Transl Androl Urol. 2019;8(6):758–761. Two cases of psychogenic anejaculation patients got normal ejaculation ability after penile vibratory stimulation or electroejaculation - Cong - Translational Andrology and Urology

It is unclear why these two cases would be diagnosed with a 'psycholgenic' problem (other than the convenience of doing so in the absence of finding a physical problem).

It would appear that the ensuing discussion of Lumbar spinothalamic (LSt) cells implies a 'physical' source. Since these two cases had always had this problem rather than being situational, and the fact that sperm retrieval with one was while unconscious, it would seem to be more a plasticity change (jump starting) of a neurological (physical) issue.