男性精液常规检查时射精障碍的影响因素

目的 探讨男性手淫法取精液者常规检查时射精障碍的影响因素.方法 对220例手淫法取精者在完成取精后填写一般资料调查问卷、Olson婚姻质量问卷性生活分量表和SCL-90症状自评量表,用t检验x<'2>检验比较其中31例射精障碍者和189例正常射精者的各变量,有统计学意义的变量为自变量,以是否发生射精障碍为应变量,用Logistic回归分析法筛选影响因素.结果 入选回归方程的6个变量为妻子态度、性生活因子分、取精环境、SCL-90评分、年龄、是否有手淫史.结论 妻子不关心理解的态度、取精环境简陋、夫妻性关系不和谐、精神心理压力大、年龄偏人、无手淫史是男性手淫取精时射精障碍的主要影响因素.     

男科门诊精液常规检查时取精失败的原因及解决措施

目的 探讨男性不育患者在男科门诊精液常规检查时手淫取精失败的常见原因及相应的解决措施. 方法 对2003～2010年在我科门诊行精液常规检查时取精失败的120例患者进行回顾性分析. 结果 取精失败常见的影响因素有:不适应取精室环境(65例,占54.17％)、缺乏手淫射精经验(21例,占17.50％)、患有勃起功能障碍(ED)(17例,占14.17％)或原发/继发性不射精(9例,占7.50％)、某些药物的影响(5例,占4.17％)等;进行个体化的辅导、处理或治疗后共有107例(89.17％)患者成功取精. 结论 男科门诊精液常规检查时取精失败的常见原因有:不适应取精室环境、缺乏手淫射精经验、患有ED或原发/继发性不射精,医护人员要对他们进行个体化的有针对性的辅导、处理或治疗.     

射精异常与性功能

随着人们对勃起功能障碍(ED)的了解及治疗进展的不断深入,促使患者及医务人员提高了对其他性相关疾病的认识,特别是射精异常相关疾病。射精异常包括早泄、延迟射精、不射精、无快感、逆向射精、血精、少精及射精痛,本文就目前射精异常的最新进展作一综述。     

射精障碍行卵胞浆内单精子注射治疗的临床结局分析

目的 分析因男性射精障碍采取睾丸穿刺取精术(TESA)联合卵胞浆内单精子注射(ICSI)助孕的临床结局及其可能的影响因素。方法 回顾性分析2009年1月至2021年12月在南京医科大学附属苏州医院因射精障碍接受TESA+ICSI助孕的不孕夫妇的临床资料。根据射精障碍类型分为两组：临时性射精障碍(TEF)组(n=26)和病理性射精障碍(OEF)组(n=24),并以同时期就诊的梗阻性无精子症(OA)男性作为对照组(OA组),比较各组患者男女双方的基本资料、ICSI受精率、优质胚胎率、可移胚胎率、临床妊娠率和活产率的差异。结果 3组患者的基本资料比较中,除TEF组女方及男方年龄显著高于OEF组外(P<0.05),其余指标在组间均无显著性差异(P>0.05)。受精及妊娠结局比较中,与OA组相比,TEF组的受精率、优质胚胎率和可移植胚胎率均无显著性差异(P>0.05),新鲜移植周期胚胎种植率(5.3%vs. 44.9%)、临床妊娠率(9.1%vs. 58.5%)以及累积妊娠率(40.7%vs. 68.6%)均显著降低(P<0.05),冻融周期胚胎种植率、临床妊娠率、早期流...     

低频电脉冲治疗不射精的临床观察

不射精(anejaculation)属于射精障碍的一种类型,占射精障碍的2%[1],近年来随着对射精生理的深入研究,在不射精的治疗学上有着明显进展.我们使用WLZZ-9999伟力多功能男科疾病诊断治疗工作站,通过低频电脉冲治疗本病10例,取得了较好的疗效,现报道如下.     

性治疗联合小剂量规律服用他达拉非在男性临时射精障碍中的作用

目的探讨性治疗联合小剂量规律服用他达拉非在辅助生殖过程男性临时射精障碍中的临床疗效。方法选取2019年1月至2020年5月本院生殖男科就诊拟行辅助生育, 主诉手淫临时取精困难的患者73例, 门诊给予焦虑与抑郁量表评分(GAD-7+PHQ-9)、国际勃起功能指数评分(IIEF-5)调查患者的心理状态和勃起情况。告知后续治疗方案, 按照患者及家属自主选择的治疗方法将其分为两组, A组为性治疗联合小剂量规律服用他达拉非(43例), B组为小剂量规律服用他达拉非(30例)。统计分析两组治疗1个月后的手淫取精结果。结果 73例患者的IIEF-5评分为22～24分, 均无勃起功能障碍, GAD-7+PHQ-9量表提示, 仅有4例无焦虑, 5例无抑郁表现, 其余患者表现出不同程度的焦虑抑郁症状。取精当日, A组成功取精35例(81.40%), B组成功取精19例(63.33%), A组的取精成功率高于B组, 差异有统计学意义(P<0.05)。结论辅助生殖过程中男性临时取精困难的患者多伴有焦虑、抑郁的心理状态, 相对于单一应用小剂量规律服用他达拉非, 采用性治疗联合小剂量规律服用他达拉非的方法更...     

射精潜伏期的研究进展

早泄虽然是男性人群中常见的性功能障碍类型,但迄今为止,尚没有被广泛接受的统一的早泄定义。越来越多的医生接受了多维早泄的定义,射精潜伏期(IELT)是早泄定义的3个重要维度(射精时间、不能控制或不能延迟射精、消极后果)之一。射精过快是早泄的核心症状之一。IELT是衡量射精快慢的较好客观指标,也是评价早泄的重要工具。本文对一般男性人群、早泄患者或自诉有早泄人群的IELT、估计的IELT与测量的IELT关系以及IELT的影响因素等研究进展进行了综述。     

卵胞浆内单精子注射术结合非手术取精法治疗射精异常性不育2例报告

射精异常主要包括逆行射精和不射精 ,这类患者的原发病治疗通常较困难 ,所引起的不育症治疗更为棘手。最近我院采用非手术取精法结合卵胞浆内单精子注射 (ＩＣＳＩ)治疗射精异常性不育取得成功 ,现报告如下。例 1　患者男性 ,31岁 ,患糖尿病 3年 ,结婚 2年未育 ,性生活时有性高     

自慰器辅助行为治疗对自慰射精困难的疗效初探

目的回顾性分析男科门诊体外受精(in vitro fertilization,IVF)术前主诉通过自慰取精困难的患者,评价自慰器辅助行为治疗的疗效。方法选择2013年8月至2014年5月在上海市第一妇婴保健院生殖中心行IVF治疗的、有射精困难(排除自慰和性生活均不能射精等情况)的患者53例。由患者及家属自主选择治疗方案,倾向优先器械辅助行为治疗的患者31例,占58.49%。根据选择的治疗方法将患者分为两组,治疗组31例,对照组22例。治疗组患者在治疗期间规律射精频率、保持生活习惯,前2周自行采用自慰器,通过视听刺激于家中尝试取精,后2周每周1~2次于手术取精室进行模拟治疗,成功取精后进行1个月维持治疗。在术前选择冷冻保存精子的患者共39例(治疗组20例,对照组19例)。结果治疗组31例患者,在治疗阶段自行通过自慰器成功取精25例(80.65%)。在手术当日,治疗组成功取精19例(61.29%),使用术前冷冻精子10例(32.26%),手术当日睾丸穿刺取精2例(6.45%)。对照组成功取精7例(31.82%),使用术前冷冻精子12例(54.55%),手术当日睾丸穿刺取精3例(13.64%)。两组患者手术当日取精成功率比较差异有显著统计学意义(P0.05)。而在术前冷冻精子的39例患者和未冷冻精子的14例患者手术日取精成功率比较差异无统计学意义(P0.05)。结论自慰器辅助行为治疗对自慰射精困难的患者有一定疗效。但如何取得更好的疗效及明确机制尚待进一步大样本、多中心的深入研究。     

连续射精对正常男性精液分析参数的影响

目的 :探讨连续射精对正常男性精液分析参数的影响。　方法 :8名正常男性逐日手淫取精 ,共 8d。采用世界卫生组织人类精液检验手册方法测定精液体积、pH值、精子密度、总精子数、存活率和活动率 ,进行统计学分析。　结果 :精液体积、总精子数逐日下降 ,从第 5d起至第 8d非常显著低于第 1d(P <0 .0 1)。精子密度亦呈逐渐下降趋势 ,但无显著性差异。精子存活率和精子活动率 (a +b级 )均呈逐渐上升趋势 ,但是仅第 7d显著高于第1d(P <0 .0 5 )。　结论 :人类精液体积、总精子数随射精频度增加而显著降低 ,精子存活率和活动率增加。频繁射精并不影响正常男性精液质量。     

Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction

The purpose of this review is to present the current understanding of penile vibratory stimulation (PVS) and electroejaculation (EEJ) procedures and its clinical use in men with ejaculatory dysfunction. Unfortunately, the record of treating such individuals has been quite poor, but within recent years development and refinement of PVS and EEJ in men with spinal cord injury (SCI) has significantly enhanced the prospects for treatment of ejaculatory dysfunction. The majority of spinal cord injured men are not able to produce antegrade ejaculation by masturbation or sexual stimulation. However, approximately 80% of all spinal cord injured men with an intact ejaculatory reflex arc (above T10) can obtain antegrade ejaculation with PVS. Electroejaculation may be successful in obtaining ejaculate from men with all types of SCI, including men who do not have major components of the ejaculatory reflex arc. Because vibratory stimulation is very simple in use, non-invasive, it does not require anaesthesia and is preferred by the patients when compared with EEJ, PVS is recommended to be the first choice of treatment in spinal cord injured men. Furthermore, EEJ has been successfully used to induce ejaculation in men with multiple sclerosis and diabetic neuropathy. Any other conditions which affect the ejaculatory mechanism of the central and/or peripheral nervous system including surgical nerve injury may be treated successfully with EEJ. Finally, for sperm retrieval and sperm cryopreservation before intensive anticancer therapy in pubertal boys, PVS and EEJ have been successfully performed in patients who failed to obtain ejaculation by masturbation. Nearly all data concerning semen characteristics in men with ejaculatory dysfuntion originate from spinal cord injured men. Semen analyses demonstrate low sperm motility rates in the majority of spinal cord injured men. The data give evidence of a decline in spermatogenesis and motility of ejaculated spermatozoa shortly after (few weeks) an acute SCI. Furthermore, it is suggested that some factors in the seminal plasma and/or disordered storage of spermatozoa in the seminal vesicles are mainly responsible for the impaired semen profiles in men with chronic SCI. Home insemination with semen obtained by penile vibratory and introduced intravaginally in order to achieve successful pregnancies may be an option for some spinal cord injured men and their partners. The majority of men will further enhance their fertility potential when using either penile vibratory or EEJ combined with assisted reproduction techniques such as intrauterine insemination or in-vitro fertilization with or without intracytoplasmic sperm injection.     

Sexual function in spinal cord lesioned men

STUDY DESIGN: Review of literature. OBJECTIVE: To review the physical aspects related to penile erection, ejaculatory dysfunction, semen characteristics, and techniques for enhancement of fertility in spinal cord lesioned (SCL) men. SETTING: Worldwide: individuals with traumatic as well as non-traumatic SCL. RESULTS: Recommendations for management of erectile dysfunction in SCL men: If it is possible to obtain a satisfactory erection but of insufficient duration, then try to use a venous constrictor band to find out if this is sufficient to maintain the erection. Otherwise we recommend Sildenafil. If Sildenafil is not satisfactory then use intracavernous injection with prostaglandin E(1) (some SCL men may prefer cutaneous or intraurethral application). We discourage the implantation of penile prosthesis for the sole purpose of erection. Recommendations for management of ejaculatory dysfunction in SCL men: Penile vibratory stimulation (PVS) to induce ejaculation is recommended as first treatment choice. If PVS fails, SCL men should be referred for electroejaculation (EEJ). Semen characteristics: Impaired semen profiles with low motility rates are seen in the majority of SCL men. Recently reported data gives evidence of a decline in spermatogenesis and motility of ejaculated spermatozoa shortly after (few weeks) an acute SCL. It is suggested that some factors in the seminal plasma and/or disordered storage of spermatozoa in the seminal vesicles are mainly responsible for the impaired semen profiles in men with chronic SCL. Fertility: Home insemination with semen obtained by PVS and introduced intravaginally in order to achieve successful pregnancies may be an option for some SCL men and their partners. The majority of SCL men will further enhance their fertility potential when using either PVS or EEJ combined with assisted reproduction techniques such as intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection.     

Male infertility in spinal cord trauma

Every year there are 10 thousand new cases of patients victimized by spinal cord trauma (SCT) in the United States and it is estimated that there are 7 thousand new cases in Brazil. Eighty percent of patients are fertile males. Infertility in this patient group is due to 3 main factors resulting from spinal cord lesions: erectile dysfunction, ejaculatory disorder and low sperm counts. Erectile dysfunction has been successfully treated with oral and injectable medications, use of vacuum devices and penile prosthesis implants. The technological improvement in penile vibratory stimulation devices (PVS) and rectal probe electro-ejaculation (RPE) has made such procedures safer and accessible to patients with ejaculatory dysfunction. Despite the normal number of spermatozoa found in semen of spinal cord-injured patients, their motility is abnormal. This change does not seem to be related to changes in scrotal thermal regulation, frequency of ejaculation or duration of spinal cord damage but to factors related to the seminal plasma. Despite the poor seminal quality, increasingly more men with SCT have become fathers through techniques ranging from simple homologous insemination to sophisticated assisted reproduction techniques such as intracytoplasmic sperm injection (ICSI).     

Application of 2 vibrators salvages ejaculatory failures to 1 vibrator during penile vibratory stimulation in men with spinal cord injuries

PURPOSE: Penile vibratory stimulation is the treatment of first choice for anejaculation in men with spinal cord injury. Nonresponders to penile vibratory stimulation are usually referred for electroejaculation or surgical sperm retrieval. Compared to penile vibratory stimulation these methods are invasive and usually yield lower total motile sperm, potentially limiting options for assisted reproductive technologies. To avoid these less than ideal options a simple method to salvage penile vibratory stimulation failures would be of benefit to spinal cord injured patients. We investigated the recovery rate when 2 vibrators were used to salvage ejaculatory failures to 1 vibrator in men with spinal cord injury. MATERIALS AND METHODS: A retrospective chart review was performed in 297 spinal cord injured men who underwent a total of 965 trials of penile vibratory stimulation at our center between 1991 and 2006. Only trials with high amplitude vibrators were examined. All men underwent 2 or more penile vibratory stimulation trials using 1 vibrator applied to the dorsum or frenulum of the glans penis. Men failing to ejaculate with 1 vibrator received 1 or more trials in which the glans penis was then sandwiched between 2 vibrators. RESULTS: Of all men 49% and 57% of those whose level of injury was T10 or above responded to penile vibratory stimulation with 1 vibrator. Of failures with 1 vibrator 22% responded to penile vibratory stimulation with 2 vibrators. CONCLUSIONS: Application of 2 vibrators salvaged ejaculatory failures to 1 vibrator during penile vibratory stimulation procedures in men with spinal cord injury. This simple penile vibratory stimulation sandwich method is recommended before referring patients for electroejaculation or surgical sperm retrieval.     

Erectile function and male reproduction in men with spinal cord injury: a review

Spinal cord injury (SCI) in men results in defects in erectile function, ejaculatory process and male reproductive potential. There are alterations in the capacity of men with SCI to achieve reflexogenic, psychogenic and nocturnal erections. The sexual function in different stages after SCI and the types of erections depend mainly on the completeness of the injury and the level of neurological damage. Furthermore, most of the SCI men demonstrate defects concerning the entrance of semen into the posterior urethra and the expulsion of the semen through the penile urethra and the urethral orifice. In addition, SCI men develop defects in the secretory function of the Leydig cells, Sertoli cells and the male accessory genital glands. The overall result is a decreased quality of the semen is recovered either with penile vibratory stimulation (PVS) or with electroejaculation. Nowadays the therapeutic andrological approach of SCI men focuses on achievement of erectile function, recovery of spermatozoa and assisted reproductive technology. The first line of therapy recommended for infertility in SCI men is collection of semen via PVS with concomitant evaluation of total motile sperm yields for assisted conception which may include intravaginal insemination, intrauterine insemination, or in vitro fertilisation/intracytoplasmic sperm injection. Patients failing PVS may be referred for electroejaculation or surgical sperm retrieval.     

Male sexual dysfunction and infertility associated with neurological disorders

Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury. Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.     

AN ANALYSIS OF 653 TRIALS OF PENILE VIBRATORY STIMULATION IN MEN WITH SPINAL CORD INJURY

Purpose

We evaluated ejaculatory response and semen quality in 653 trials of penile vibratory stimulation in 211 men with spinal cord injury, and compared results with low versus high amplitude vibratory stimulation.

Materials and Methods

Low and/or high amplitude penile vibratory stimulation was performed 1 to 27 times in each patient, and antegrade and retrograde specimens of those who ejaculated were analyzed.

Results

Significantly more patients ejaculated using high (54.5%) versus low (39.9%) amplitude stimulation. Using either amplitude the ejaculatory success rate was highest in men with injuries at C3 to C7, followed by T1 to T5, T6 to T10 and T11 to L3. While high amplitude stimulation increased the ejaculatory success rate in each group, the highest rate occurred in men with injuries at C3 to C7 (65.6%). Ejaculation was reliable, since most men who ejaculated did so during 100% of the trials and within 2 minutes of stimulation onset. Symptoms of autonomic dysreflexia were safely managed with nifedipine. All patients who ejaculated produced antegrade specimens. With the exception of ejaculate volume, which was significantly higher with high versus low amplitude stimulation, semen parameters were similar using both vibrator amplitudes.

Conclusions

Ejaculatory success is better while semen quality is similar using high versus low amplitude penile vibratory stimulation in men with spinal cord injury. This method may be considered first line treatment for anejaculation in men with spinal cord injury. This method may be relative effectiveness, and relatively low investment of time and money.     

Anesthetic block of the dorsal penile nerve inhibits vibratory-induced ejaculation in men with spinal cord injuries

OBJECTIUES: We investigated which nerve pathways are necessary to achieve ejaculation using penile vibratory stimulation (PVS) in men with spinal cord injury (SCI). METHODS: Eight men with SCI were selected based on the presence of a bulbocavernosus reflex (BCR) and consistent antegrade ejaculation with PVS. Level of injury was cervical (4), upper thoracic (4), and lower thoracic (1). Mean age was 30.4 years (range 22 to 38). Usual responses to PVS included autonomic dysreflexia (4), erection (4), and consistent somatic responses such as abdominal contractions (8). Local anesthesia of the dorsal penile nerves (penile block) was achieved using 1% plain lidocaine injection. Effective penile block was confirmed by loss of the BCR. Two PVS ejaculation trials were performed: one trial during the penile block and one trial when the penile block had worn off. In 4 subjects, the bladder contents were analyzed for retrograde ejaculation. RESULTS: With the penile block, ejaculation was inhibited in 100% of the subjects. None of the bladder washings demonstrated sperm, indicating absence of retrograde ejaculation. None of the subjects exhibited their usual erectile response, somatic responses, or signs of autonomic dysreflexia. After the penile block wore off, PVS induced ejaculation in all subjects. If subjects usually had erection, somatic responses, or signs of autonomic dysreflexia, these also returned. CONCLUSIONS: Our data suggest that ejaculatory response to PVS in SCI men requires the presence of intact dorsal penile nerves.     

Midodrine in patients with spinal cord injury and anejaculation: A double-blind randomized placebo-controlled pilot study

Objective

The objective of this study is to evaluate the efficacy of midodrine in the treatment of anejaculation in men with spinal cord injury (SCI).

Study design

Prospective, double-blind, randomized, placebo-controlled pilot study.

Method

Men with anejaculation associated with SCI (level of injury above T10) of more than 1 year in duration were approached. Those with no ejaculatory response to one penile vibratory stimulation (PVS) trial were assigned in a double-blind manner to one of the two following interventions once a week for a maximum of 3 weeks or until ejaculation occurred: oral administration of flexible midodrine (7.5–22.5 mg max) followed by PVS (group M), or oral administration of flexible sham-midodrine (placebo) followed by PVS (group P). Sociodemographic data, medical characteristics, and plasma desglymidodrine concentration were collected for all participants.

Outcome measure

Ejaculation success rate in each group.

Results

Among the 78 men approached, 23 participants (level of SCI: C4–T9) were randomized. Three participants abandoned the study and 20 completed the study; 10 were assigned to group M, 10 to group P. Ejaculation was reached for one participant of group M and for two participants of group P. Autonomic dysreflexia associated to PVS occurred in three patients.

Conclusion

In this small sample study, treatment of anejaculation after SCI with midodrine and PVS did not result in a better rate of antegrade ejaculation in 10 men than in 10 men treated with a placebo and PVS.