Treatments for Early Ejaculatory Dilemmas
Premature ejaculation is one of the most treatable of male sexual dysfunctions a variety of direct and indirect suggestions have been used in its treatment. Many approaches have focused on anxiety reduction as the primary goal, as performance anxiety is the most common cause of a rapid ejaculatory response. Hypnotically assisted desensitization and rehearsal of appropriate sexual responding are applicable to this anxiety-driven disorder. Creative uses of healthy dissociation and distraction can also assist the male in being able to psychologically distance themselves from overarousal.
Semen, consisting of sperm and the associated fluids, is expelled by a neuromuscular reflex that is divided into two sequential phases emission and ejaculation. Emission moves sperm and associated fluids from the cauda epididymis and vas deferens into the urethra. The latter process involves efferent stimuli originating in the lumbar areas (L1 and L2) of the spinal cord and is mediated by adrenergic sympathetic (hypogastric) nerves that induce contraction of smooth muscles of the epididymis and vas deferens. This action propels sperm through the ejaculatory ducts and into the urethra. Sympathetic discharge also closes the internal urethral sphincter, which prevents retrograde ejaculation into the urinary bladder. Ejaculation is the expulsion of the semen from the penile urethra,- it is initiated after emission. The filling of the urethra with sperm initiates sensory signals via the pu-dendal nerves that travel to the sacrospinal region of the cord. A spinal reflex mechanism that...
Semen may be collected from men who are unable to achieve erection, emission, or ejaculation because of neurological or psychogenic problems by electroejaculation using direct vibratory stimulation of the penis or electrical stimulation of the prostate. Ejaculates from spinal cord injured patients will frequently have high sperm concentrations, decreased motility, and red blood cell contamination. Sperm may also be recovered from the urine of patients whose ejaculation is retrograde into the bladder. It is advisable that these patients be prescribed stomach-acid buffering medications to make the urine pH more hospitable for sperm.
Reflexes coordinated by centers in the lumbar and sacral spinal cord include micturition (emptying the urinary bladder), defecation (emptying the rectum), and sexual response (engorgement of erectile tissue, vaginal lubrication, and ejaculation of semen). Sensory action potentials from receptors in the wall of the bladder or bowel report about degrees of distenion. Sympathetic, parasympathetic, and somatic efferent actions require coordination to produce many of these responses.
As discussed, although other approaches to androgen ablation and androgen inhibition (antiandrogens) have been evaluated in the past, these methods produced only a moderate desired impact and had many side effects, thus limiting their use (14). Typical antiandrogen (e.g., flutamide) side effects include onset of erectile dysfunction, impairment in libido and ejaculation, gastrointestinal distress, nausea, flatulence, gynecomastia, breast pain, diminished energy levels, impairment in spermatogenesis, and decreased muscle mass. In contrast, because mature (postpubertal) patients with 5 a-reductase deficiency did not appear to have impaired sexual function or diminished external mascu-linization, the 5 a-reductase enzyme was a logical target for treating men with clinically significant BPH. The potential blockade of 5a-reductase seemed to provide hope for decreasing prostate growth and minimizing side effects.
Dissociation into sexual involvement rather than away from it can be used to heighten arousal and defeat affective and cognitive distractions. The use of the hypnotic focus and suggestion to encourage amplification of sexual arousal, through intense focusing on sexually pleasurable sensations, heightens sexual involvement, particularly in those disorders that require increased sexual arousal, such as the hypoactive sexual desire disorders, erectile difficulties, dyspareunia (when due to inadequate arousal), female orgasmic disorders and retarded ejaculation.
There have been numerous published studies that have retrospectively surveyed the occupations of men attending infertility clinics and or compared occupations of fertile and infertile groups. There is some consensus in showing, for example, that farmers agricultural workers or lorry drivers, painters, or welders may be overrepresented in infertile men (15,16), but overall, the findings of such studies are inconsistent and have failed to identify common occupational causes of male infertility. Occupation is only one of a range of factors that may cause male infertility, and, therefore, searching for such factors in patients at the infertility clinic may not be the most sensitive approach. However, alternative approaches, such as direct investigation of particular working groups, also have various problems (12). Low participation rates are common and may be biased toward those who have experienced, or suspect, a fertility problem (17). These make interpretation of any findings...
Chromosome a molecule of deoxyribonucleic acid (DNA) that contains a string of genes, which consist of coded information essential for all cell functions, including the creation of new life ejaculation the process of expelling semen from the male body endocrine glands glands that produce hormones and secrete them into the blood
The vas deferens passes in a loop next to and under the bladder, the sac that stores urine until it can be removed from the body. Immediately beneath the bladder, the vas deferens is connected by a short tube, the ejaculatory duct, to the urethra. The urethra is the long, fairly straight tube that carries either urine from the bladder or sperm from the reproductive system. A valve located in the urethra below the bladder opens and closes to prevent sperm and urine from mixing, so that only one type of fluid is in the urethra at a time. From their site of production in the testes, sperm pass through the epididymis, the vas deferens, the ejaculatory duct, then finally the urethra to the outside of the body. As sperm are expelled from the body along this route, they are mixed with seminal fluid to produce semen. Seminal fluid is secreted into the tubes by three sets of glands the seminal vesicles, the prostate, and the bulbourethral (Cowper's) glands. The sperm never enter these glands...
Perioperative complications vary according to the surgeon's experience. One study that looked at complication rates according to the surgeon's experience found that the most experienced surgeon's complication rate (2.2 ) was statistically different from that of less experienced surgeons (10.7 ) 79 . Possible gastrointestinal injuries include peritoneal or intestinal tears leading to bowel perforation, peritoneal scarring, and adhesions. Genitourinary complications such as retrograde ejaculation, incontinence, or ureter damage might occur. Peripheral nerve damage, spinal cord injuries, dural tear, epidural hematoma, or herniated nucleus pulposus may occur 80 . Postoperative complications include deep vein thrombosis, pulmonary embolus and infection. Late complications may include pain and leg edema.
Methods based on preventing contact between the germ cells include coitus interruptus (withdrawal before ejaculation), the rhythm method (no intercourse at times of the menstrual cycle, especially when an ovum is present in the oviduct), and barriers. Barrier methods include condoms, diaphragms, and cervical caps. When combined with spermicidal agents, barrier methods approach the high success rate of oral contraceptives. Condoms are the most widely used reversible contraceptives for men. Because they also provide protection against the transmission of venereal diseases and AIDS, their use has increased in recent years. Diaphragms and cervical caps seal off the opening of the cervix. Spermicides are inserted into the vagina. Postcoital douching is not an effective contraceptive because some sperm enter the uterus and oviduct very rapidly.
Neuroeffector of Ejaculation Neuroeffector of Ejaculation Ejaculation 3. Contraction of ducts ductuli efferentes, ductus epididymidis, vasa deferentia, ejaculatory ducts, smooth muscle of testicular capsule. Projectile ejaculation involves Penile Flaccidity, Seminal Emission, and Ejaculation Ejaculation The process of ejaculation involves two steps emission and ejaculation proper. Emission consists of the deposition of secretions from the peri-urethral glands, seminal vesicles, and prostate as well as sperm from the vas deferens into the posterior urethra. This results from the rhythmic contraction of smooth muscle in the walls of these organs. The accumulation of this fluid precedes ejaculation proper by 1 to 2 s and provides the sensation of ejaculatory inevitability. Emission is under sympathetic control from the presacral and hypogastric nerves that originate in the T10-L2 spinal cord levels (33). Ejaculation proper (projectile ejaculation) involves sympathetic controlled closure...
In a male, the Sertoli cells of the seminiferous tubules secrete mullerian inhibition factor (MIF), a polypeptide that causes regression of the mullerian ducts beginning at about day 60. The secretion of testosterone by the Leydig cells of the testes subsequently causes growth and development of the wolf-fian ducts into male accessory sex organs the epididymis, ductus (vas) deferens, seminal vesicles, and ejaculatory duct. for the development and maintenance of the penis, spongy urethra, scrotum, and prostate. Evidence suggests that testosterone itself directly stimulates the wolffian duct derivatives epididymis, ductus deferens, ejaculatory duct, and seminal vesicles.
A semen analysis is done before the cycle to assure that semen quality is not at a nadir for that individual due to recent factors such as stress or a febrile illness. In general, IVF is preferred with reduced semen quality, as gamete intrafallopian transfer (GIFT) has been less successful than with normal sperm, and IVF allows confirmation of whether fertilization occurred. Pyos-permia can reduce sperm function (18). We attempt to clear pyospermia before proceeding to IVF. Frequent ejaculation may augment the action
On each side, as the ductus deferens and seminal vesicle join, they form a single tube on the same side, called the ejaculatory duct. Each ejaculatory duct, left and right, carries the seminal vesicle secretion and spermatozoa through the substance of the prostate gland. Each ejaculatory duct empties into the prostatic urethra.
Erectile dysfunction, also called impotence, is the male lack of ability to perform intercourse because of failure to initiate or maintain an erection until ejaculation. The disorder may be broadly characterized as psy-chogenic, in which case it is caused by emotional factors, or organic, caused by some physical problem such as an anatomic defect or circulatory problem. More specifically, neurogenic impotence results from a disorder of the nervous system, such as a central nervous system lesion, paralysis, or neurologic damage complicating diabetes. Erectile dysfunction may also be a side effect of drug treatment. A lack of ability to perform intercourse in the man because of failure to initiate or maintain an erection until ejaculation impotence
C.S., a 62-year-old businessman, saw a urologist with complaints of decreased force of urine stream and ejaculation, hesitancy, and sensation of incomplete bladder emptying. He claimed he had taken prostate-health herbal supplements without any real benefit for 2 years before making the appointment. He denied dysuria, hematuria, or flank pain. He has no history of UTI, epididymitis, prostatitis, renal disease, or renal calculi. Rectal examination revealed a 50-g prostate with slight firmness in the right prostatic lobe. Bladder ultrasound showed no intravesical lesions or prostate protrusion into the bladder base. C.S. was diagnosed with benign prostatic hyperplasia with bladder neck obstruction and was scheduled for a TURP.
The limbic system has been described inconsistently over recent decades, but there is a general consensus that it includes cortical and subcortical structures. The amygdala, septal nuclei, fornix, thalamus, hypothalamus, and hippocampus are specifically interesting. These structures influence affect, emotional displays, and male sexual behavior (6,181-187). Cortical signals pass through these limbic structures en route to spinal cord targets, thereby adding an additional level of control to penile erections. Invasive studies in animals have revealed that penile erections may be induced by stimulation of the septal nuclei, mammillary bodies, and other elements ofthe hypothalamus (5,173). Anecdotal reports from human studies using implanted electrodes have indicated that penile erection may occur in response to stimulation of the MFB or septal region. Thalamic loci induce an ejaculatory response that has been shown to occur independently of erection (188). In neurologically intact men,...
Additionally, bilateral anterolateral cordotomies in humans result in the complete loss of erectile function and block orgasm-associated sensations. Because touch and two-point discrimination are not altered by this procedure, it appears likely that the erotic quality of genital stimulation depends on the ascending fibers running with the spinothalamic pathways for pain and temperature. In monkeys, electrical stimulation along the course of the spinothalamic pathways at the level of the brain stem elicits erection and ejaculation (219). The relevant fibers could be traced to the caudal thalamic intralaminar nuclei, which may be the receiving area for erotic genital sensation. Stimulation of these nuclei in humans has been reported to cause erotic feelings and orgasm. Under normal conditions, it seems likely that psychogenic and reflexic stimuli act in a synergistic manner to produce erections. Psychogenic erections in paraplegic men are usually short-lived, only partial, and lack the...
Lates testosterone secretion by the interstitial cells of the testes. Testosterone helps FSH to stimulate sperm maturation. This androgen also stimulates such primary sex characteristics as penis and epi-didymal growth during puberty. The epididymis is a tubular structure that stores sperm in preparation for ejaculation. Testosterone also stimulates secondary sex characters, such as the deepening of the voice and development of muscle mass that manifest during puberty in humans.
No difference in the incidence of serious adverse events between the two groups was observed. In fact, the only adverse effects that were drug-related and for which the incidence was greater than or equal to 1 and greater than placebo were symptoms of sexual dysfunction (impotence, decreased libido, decreased ejaculate volume, ejaculation disorder), breast enlargement tenderness, and rash. Interestingly, two cases of breast cancer were diagnosed in the placebo group neither man had an antecedent history of gynecomastia. No cases of breast cancer were detected in the finasteride group during the study.
Pathophysiology Of Hivinfection In The Reproductive Tract And Potential Mechanisms Of Gonadal Dysfunction
Testicular atrophy is a common finding in autopsy series of patients infected with HIV (8-11). Histological examination of the testes reveals a spectrum of abnormalities, including hypospermatogenesis, spermatogenic arrest, and Sertoli cell-only pheno-types (11). In addition to the loss of germ cells and atrophy, the seminiferous tubules exhibit basement membrane thickening and peritubular fibrosis (8,9). Common abnormalities in semen include leukocytospermia, lower ejaculation volume and total sperm count, and lower percentage of rapidly progressive sperm in comparison to healthy controls (12,13) however, in the majority of HIV-infected patients, these values are within the normal adult male range.
Normal sexual function in males is under the control of both the sympathetic and parasympathetic system erection is mainly mediated by parasympa-thetic fibres, while sympathetic fibres are primarily responsible for deposition of the semen in the posterior urethra and contemporaneous closure of the bladder neck during ejaculation. Damage of this mechanism will result in retrograde ejaculation. Retrograde ejaculation, which is the result of isolated damage of the sympathetic nerves, may be treated with sympathomimetic drugs. If they fail and the patient desires to procreate, sperm can be drawn from the bladder for artificial insemination 157, 158 . In view of this possible complication, some authors suggested that young male patients should cryopreserve sperm before elective proctectomy 159 , while others find this expedient unnecessary and expensive 160 .
Sexual dysfunction, in particular erectile and ejaculatory disturbances, has been reported with varying incidences after TURP, occurring in approx 13 and 75 of patients, respectively, according to recent systematic reviews (2,27). The risk of retrograde ejaculation is substantial because the muscle of the bladder neck internal sphincter is frequently disrupted, allowing entrance of ejaculate into the bladder, thereby interfering with emission. The cavernous nerves run in the neurovascular bundles at approximately the 4 and 8 o'clock positions posterior to the prostate. These nerves are potentially susceptible to injury from the electrocautery current during the resection. Therefore, it has been suggested that maintaining an appropriate depth of resection is important, particularly posteriorly, to prevent this complication. Men with relatively small prostates have in some instances been shown to be at greater risk for perforation of the capsule and thus may be more susceptible to...
One step in the evaluation of fertility is semen analysis. Semen are analyzed on specimens collected after 3 to 5 days of sexual abstinence, as the number of sperm ejaculated remains low for a couple of days after ejaculation. Initial examination includes determination of viscosity, liquefaction, and semen volume. The sperm are then counted and the percentage of sperm showing forward motility is scored. The spermatozoa are evaluated morphologically, with attention to abnormal head configuration and defective tails. Chemical analysis can provide information on the secretory activity of the accessory glands, which is considered abnormal if semen volume is too low or sperm motility is impaired. Fructose and prostaglandin levels are determined to assess the function of the seminal vesicles and levels of zinc, magnesium, and acid phosphatase to evaluate the prostate. Terms used in evaluating fertility include aspermia (no semen), hypospermia and hyperspermia (too small or too large semen...
Frequent ejaculation results in reduced sperm numbers and increased numbers of immotile sperm in the ejaculate. The cauda connects to the vas deferens, which forms a dilated tube, the ampulla, prior to entering the prostate. The ampulla also serves as a storage site for sperm. Cutting and ligation of the vas deferens or vasectomy is an effective method of male contraception. Because sperm are stored in the ampulla, men remain fertile for 4 to 5 weeks after vasectomy.
The volume of semen (ejaculatory fluids and sperm) in fertile men is 2 to 6 mL, and it contains some 20 to 30 million sperm per milliliter, which are deposited in the vagina. The liquid component of the semen, called seminal plasma, coagulates after ejaculation but liquefies within 20 to 30 minutes from the action of proteolytic enzymes secreted by the prostate gland. The coagulum forms a temporary reservoir of sperm, minimizing the expulsion of semen from the vagina. During intercourse, some sperm cells are immediately propelled into the cervical canal. Those remaining in the vagina do not survive long because of the acidic environment (pH 5.7), although some protection is provided by the alkalinity of the seminal plasma. The cervical canal constitutes a more
After their manufacture, sperm cells are stored in a much-coiled tube on the surface of each testis, the epi-didymis (see Figs. 14-1 and 14-2). Here they remain until ejaculation propels them into a series of ducts that lead out of the body. The first of these is the vas (ductus) deferens. This duct ascends through the inguinal canal into the abdominal cavity and travels behind the bladder. A short continuation, the ejaculatory duct, delivers the spermatozoa to the urethra as it passes through the prostate gland below the bladder. Finally, the cells, now mixed with other secretions, travel in the urethra through the penis to be released. The penis is the male organ that transports both urine and semen. It enlarges at the tip to form the glans penis, which is covered by loose skin, the prepuce or foreskin. Surgery to remove the foreskin is circumcision. This may be performed for medical reasons, but is most often performed electively in male infants for reasons of hygiene, cultural...
Given the similarity of improvement in indirect parameters, the lower risk profile associated with TUIP has become a major criterion for promotion of TUIP. These factors include the cost related to operative and hospitalization time, patient comfort related to catheterization time, risk of blood transfusion, stricture or bladder neck contracture, impotence, and retrograde ejaculation. The mean intervention time required for TUIP was 14-18 min compared with 32-44 min for the transurethral resection group (30,32,37,39,58).
More than 90 of all men with MS and more than 70 of all women with MS report some change in their sexual life after the onset of the disease. Men most often report impaired genital sensation, decreased sexual drive, inability or difficulty in achieving and maintaining an erection, and delayed ejaculation or decreased force of ejaculation. Women report impaired genital sensation, diminished orgasmic response, and loss of sexual interest they also may be bothered by intense itching, diminished vaginal lubrication, weak vaginal muscles, and a reflex pulling together of the legs (adductor spasms).
Copulation can be dangerous to males. In the domestic honeybee (Apis mellifera), a swarm of drones pursue the unmated queen. In-air copulation occurs as a drone inserts his endophallus into the queen's sting chamber. After ejaculation, a small part of the drone's phallus remains inside the queen and the drone falls to the ground and
Male impotence and infertility is another possible side effect of medical therapy, especially during treatment with sulphasalazine 138-140 . This fact has also been noticed in a survey that compared the quality of life between patients with ulcerative colitis treated medically and patients who had received a restorative proctocolectomy utilising specific questionnaires, it emerged that 26 of patients under medical therapy suffered from impotence and another 16 reported regular failure of ejaculation, while these problems were present in only 8 of those who underwent surgery 141 . However, in most cases discontinuation or changing of the drug is sufficient to return to normality 138,139 .
The prostate is a compound tubuloalveolar gland. It is adjacent to the bladder neck proximally and merges with the membranous urethra to rest on the urogenital diaphragm distally. The intact adult gland resembles a blunted cone, weighing approx 18 to 20 g. The gland measures about 4.4 cm transversely across its base, and it is 3.4 cm in length and 2.6 cm in anteroposterior diameter (1). The urethra enters the prostate near the middle of its base and exits the gland on its anterior surface just before the apical portion. The ejaculatory ducts enter the base on its posterior aspect and run in an oblique fashion, terminating adjacent to the verumontanum. The capsule of the prostate gland is incomplete at the apex and does not represent a true capsule (2). Fibrous septa emanate McNeal observed that the urethra separates the prostate into ventral (fibromuscular) and dorsal (glandular) portions. Approximately midway between the apex and base, the posterior wall of the urethra undergoes an...
Sexual dysfunction and sexually transmitted diseases are common they are not confined to young adults, or to promiscuous individuals. Although such topics are often avoided by patients because of embarrassment, it is particularly important to ask patients about sexual function and activity and if they have any of the disorders known to predispose to sexual dysfunction. These include diabetes mellitus, alcohol abuse, chronic renal failure, marital difficulty or psychological disorder. Similarly, when sexually transmitted diseases are suspected, e.g. IIIV. hepatitis or pelvic inflammatory disease, a careful sexual history should be undertaken. In females, dyspareunia (pain related to sexual intercourse) or failure to achieve an orgasm are common and are frequently caused by. or lead to. psychological difficulties. In males, loss of libido, premature ejaculation and inability to maintain an erection may also be primarily psychological. Questions should be asked objectively with tact and...
Intromissions prior to ejaculation (Dewsbury and Pierce 1989 Dixson 1998), because this could increase the risk of micro-injury (abrasions, cuts) to the genitals and the total contact time for each copulation. Finally aggressive interactions among males that are competing for access to females could lead to the spread of disease (Tutin 2000).
Roehrborn reported the following order of magnitude of symptomatic improvement attributed to therapies for LUTS transurethral resection, open prostatectomy, transurethral incision, balloon dilation, a-blocker therapy, placebo, and finasteride (68). Long-term outcome data from randomized trials revealed no statistically significant difference in total, irritative, or obstructive symptom improvement at all follow-up intervals for either the TURP or TUIP group (59). Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly better with TUIP (59). The cost associated with TUIP may be reduced because of decreased operative time, decreased hospital stay, and the ability to perform the surgery using local anesthesia (69). Further, sexual function, including erectile function and ejaculation, are better preserved after TUIP. Finally, long-term success rates are probably less than with TURP or open...
Diaries were kept throughout the study period, recording sexual acts (intercourse masturbation), occurrence of ejaculation, and subjective quality of the sexual act (1 unpleasant to 4 very satisfactory). The men also made weekly ratings of frequency of sexual thoughts and the extent to which those thoughts were associated with sexual excitement and mood (Lorr and McNair Mood Check List), giving scales for anxiety tension, depression, anger, vigor and fatigue. At monthly interviews, the investigator rated the patient's enjoyment of sexual contact and his erectile and ejaculatory difficulties. Blood was also collected monthly for endocrine assessment (testosterone, 5 a-dihydrotestosterone, estradiol, sex hormone-binding globulin SHBG , FSH, LH, and prolactin).
Continued sexual stimulation will eventually result in an ejaculation, with semen being forced out of the body by contractions of muscles in the fluid-producing glands and along the tube system. Ejaculation is coordinated by nerves that arise in the spinal cord. The normal volume of fluid ejaculated varies from species to species. In man, it is usually two to six milliliters it may be up to one hundred milliliters in pigs. The ejaculate of most animals contains many millions of sperm per milliliter of fluid.
Preservation of sexual function after transurethral surgery for LUTS includes both antegrade ejaculation and erectile function. Retrograde ejaculation after TURP is reported in 62-100 of men but in only 035 of men after TUIP (8-10,30,47,57,59,60). The successful preservation of antegrade ejaculation after transurethral surgery is most likely related to the quantity of residual tissue. Studies have noted that preservation of antegrade ejaculation is more likely in those men treated with a single incision than in those treated by the two-incision technique (46,61). The risk of erectile dysfunction after TUIP is estimated at 3.9-24.4 . Other investigators have reported a 100 potency preservation rate when TUIP was performed with the holmium yttrium-aluminum-garnet laser (45).
Globozoospermia) High titers of antisperm antibodies Repeated fertilization failure after conventional IVF Autoconserved frozen sperm from cancer patients in remission Ejaculatory disorders (e.g., electroejaculation, retrograde ejaculation) Epididymal spermatozoa Obstruction of both ejaculatory ducts
The approximate volume of semen for each ejaculation is 1.5 to 5.0 milliliters. The bulk of this fluid (45 to 80 ) is produced by the seminal vesicles, and 15 to 30 is contributed by the prostate. There are usually between 60 and 150 million sperm per milliliter of ejaculate. Normal human semen values are summarized in table 20.5. A sperm concentration below about 20 million per milliliter is termed oligospermia (oligo few) and is associated with decreased fertility. A total sperm count below about 50 million per ejaculation is clinically significant in male infertility. Oligospermia may be caused by a variety of factors, including heat from a sauna or hot tub, various pharmaceutical drugs, lead and arsenic poisoning, and such illicit drugs as marijuana, cocaine, and anabolic steroids. It may be temporary or permanent. In addition to low sperm counts as a cause of in 1 hour after ejaculation 3 hours after ejaculation
Semen is the thick, whitish fluid in which spermatozoa are transported. It contains, in addition to sperm cells, secretions from three types of accessory glands. The first of these, the paired seminal vesicles, release their secretions into the ejaculatory duct. The second, the prostate gland, secretes into the first part of the urethra beneath the bladder. As men age, enlargement of the prostate gland may compress the urethra and cause urinary problems. The two bulbourethral (Cowper) glands secrete into the urethra just below the prostate gland. Together these glands produce a slightly alkaline mixture that nourishes and transports the sperm cells and also protects them by neutralizing the acidity of the female vaginal tract.
Postoperative voiding dysfunction are more common after TUMT, and bleeding, retrograde ejaculation, and urethral strictures are more common after TURP. After TURP, patients are catheterized for an average of 2-4 d, whereas many patients undergoing TUMT have prolonged catheterization because of prostatic edema. There is an increased risk of urinary tract infection after TUMT because of the longer duration of catheterization and the remaining in situ necrotic tissue. Retrograde ejaculation has been reported to occur in48-90 of patients after TURP compared with 0-29 after TUMT (27).
The optimal candidate for TUNA is a patient with mild-to-moderate obstructive voiding symptoms attributable to BPH, who has no evidence of neurologic bladder dysfunction and no significant obstruction caused by median lobe hypertrophy. Cystoscopy is useful preopera-tively to rule out urethral stricture disease and bladder neck contracture and to evaluate for median lobe hypertrophy. Transrectal ultrasound is necessary for volume estimation of the prostate and to plan the needle placement. The transverse diameter of the gland should be measured at the base, at midgland, and at the apex to accurately map out the desired necrotic lesions within the gland (13). TUNA is most successful in patients with predominant lateral lobe enlargement and an estimated gland size of 60 g (14). For those patients with either large glands ( 100 g) or isolated median lobe hypertrophy, TUNA has not had equal success (14). Traditionally, the median lobe and bladder neck have been avoided during TUNA because...
The appeal of minimally invasive therapies for the treatment of BPH is the ability to achieve efficacy similar to that of TURP but with significantly lower morbidity. Mortality has not been described in patients undergoing TUNA. The most common complications experienced by these patients are urinary retention, hematuria, and irritative voiding symptoms. In most cases, patients are able to void spontaneously shortly after treatment, but urinary retention has been described in 13.3-41.6 of patients (27,31-33). Most commonly, retention is transient and resolves within 1 wk. Hematuria, although common within the first days after treatment, has never been reported to require a blood transfusion. Rosario et al. reported no increased incidence of bleeding complications, even in patients receiving warfarin at the time of TUNA (34). The presumed ability of TUNA to spare the prostatic urethra from thermal injury accounts for the incidence of irritative voiding symptoms, dysuria, frequency, and...
The normal male sexual response has three phases desire, lubrication-swelling (excitement, plateau phases), and orgasm. The first response to sexual stimulation is erection, which is accompanied by increases in muscle tension, heart rate, blood pressure, and respiration. This then plateaus with advanced lubrication and swelling and is followed by a series of contractions by which the sympathetic nervous system allows for ejaculation (emission). Finally, the body returns to its resting state during the resolution stage. The penis has soft, spongy tissue that easily expands when it is filled with blood. The tip of the penis, the bulb, is very sensitive to stimulation and sends messages to the various centers if it is appropriately stimulated. These centers allow the parasympathetic system to be stimulated, causing blood to be trapped within the spongy tissue of the penis to produce an erection. Ejaculation, the expulsion of liquid (semen) from the penis, is handled by the sympathetic...
Open prostatectomy can have an adverse impact on sexual performance. The review conducted by McConnell and associates revealed postoperative erectile dysfunction in 32 , 16 , and 18 in patients undergoing perineal, retropubic, and suprapubic prostatectomy, respectively (21). In theory, leaving an intact and nonviolated prostatic capsule should mitigate against the development of either incontinence or erectile dysfunction. It has been assumed that preexisting erectile dysfunction may be more pervasive than previously suggested. However, the study conducted by Ertekin et al. documented postoperative erectile dysfunction in more than half of patients who claimed preoperative potency and subsequently underwent suprapubic prostatectomy (25). In that study, however, there was no clear connection between surgical technique and development of erectile dysfunction. As anticipated, the incidence of retrograde ejaculation is very high, occurring in about 77 of all cases, a rate similar to that...
Males of mammals, some reptiles, and many arthropods also have intromittent organs that deposit sperm directly into the female reproductive tract. In these copulations, by either female behavior or male manipulation, the opening of the female reproductive tract must be exposed. In many organisms, the male mounts a squatting or otherwise stationary female. Male snakes and lizards (Squamata) have two intromittent organs called hemipenes. Males and females line up side by side and the male uses the hemipenis closer to the female to inseminate her. Many arthropods often go through intricate body contortions to bring the male's penis in proper position for mating. This may be the common rear-mounting pattern, but can also be face-to-face or tail-to-tail. In many animal species, insertion of the penis is followed by one or more thrusting movements that lead to ejaculation.
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5 Secrets to Lasting Longer In The Bedroom
How to increase your staying power to extend your pleasure-and hers. There are many techniques, exercises and even devices, aids, and drugs to help you last longer in the bedroom. However, in most cases, the main reason most guys don't last long is due to what's going on in their minds, not their bodies.