Premature Ejaculation Causes and Treatments

Ejaculation By Command

Everything is explained here in clear, concise and easy-to-understand instructions. The insights, tools and techniques in this program have been rigorously tried, tested and proven effective not only by me, but by thousands of other men who are now enjoying lovemaking that lasts so much longer than before. Here's a Very partial list of what you're going to learn inside this exciting new program: How to overcome mental barriers to sexual endurance develop iron-clad stamina and confidence by using these 9 specific techniques I am going to give you. A primal sexual technique that adds massive control to your arousal. and puts a woman over the edge with sexual excitement. she'll have to have you Right Then And There. and nothing will be able to stop her. 4 powerful breathing strategies that will amplify your staying power and prolong your orgasm for as long as you desire (97% of men screw up their breathing and end up ejaculating too soon) Specific guided love muscle exercises to skyrocket your ejaculatory control and your ability to withstand intense sexual stimulation (The secret is in the step-by-step process, which you'll learn in detail) The Pleasure Acclimatizing technique to train and condition your ejaculation reflexes so that you will Automatically last longer without tipping over in a hurry (this is one of the stamina secrets that Top porn actors use All The Time ) Have you ever blown your load even Before penetration starts. and wondered how the hell that happened? Here's the little-known and closely-guarded Total Immersion technique you can use to Outlast her during sex (it's much easier than you think. when you know the secret) More here...

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Anatomy and neurophysiology of antegrade ejaculation

Normal antegrade ejaculation is the coordinated physiologic process involving sequential phases of seminal emission and bladder neck closure followed by expulsion of semen by rhythmic contraction of the bulbocavernosus and ischiocavernosus muscles. The emission phase is under autonomic sympathetic control with afferent impulses transmitted via the pudendal nerve. Efferent impulses originate in the preganglionic fibers from T10 to L2, synapse in the ganglia of the lumbar sympathetic trunks, and exit via L1 to L4 postganglionic fibers, which decussate along the aorta bilaterally to form the hypogastric plexus. Terminal nerves from the pelvic plexus evoke seminal emission innervating the seminal vesicles, vas deferens, prostate, and bladder neck. From the surgeon's perspective, identification and careful preservation of the lumbar sympathetic trunks, the postganglionic fibers particularly at the L2 to L4 level, and the nerves of the hypogastric plexus are the objectives of the...

Emission And Ejaculation

Emission and ejaculation are the climax of the male sex act both processes result through sympathetic innervation. Impulses originating in the T10-L2 spinal cord levels travel through the lumbar splanchnic nerves and through the hypogastric plexus to the male reproductive organs and glands (Figure 13-2B). Ejaculation. Sympathetic impulses cause rhythmic contraction of smooth muscle within the ductus deferens and urethra. In addition, the pudendal nerves cause contraction of the ischiocavernosus and bulbocavernosus muscles, which compress the bases of the penile erectile tissue. These effects together cause wavelike increases in pressure in the erectile tissue of the penis, the genital ducts, and the urethra, which ejaculate the semen from the urethra to the exterior. Figure 13-2 A. Innervation of the penis. B. Erection and ejaculation. Figure 13-2 A. Innervation of the penis. B. Erection and ejaculation.

Premature Ejaculation

Although various definitions exist, premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners (AUA, 2004). Sexual history, psychological history, and differentiation from ED are essential. Treatment should be tailored to the individual patient. Psychological interventions are options for willing patients. Although no medicines are U.S. Food and Drug Administration (FDA) approved for this problem, exploiting side effects of SSRIs and topical anesthetics is an option.

Female Orgasmic Disorder

The clinical history in secondary inhibited orgasm should focus on the patient's perception of this dysfunction time and circumstances of onset, possible causes, effect on relationship(s), and treatment goals. Physiologic functioning during sexual stimulation, including adequacy of lubrication and ability to sustain states of high arousal, should be explored. Contributing factors such as fatigue, depression, postpartum physical and social changes, preoccupation with other life issues, substance abuse, and other medical illnesses should be considered. Contextual and relationship issues, including lack of tenderness or interest in non-intercourse stimulation by the partner, early ejaculation, problems regarding contraceptive responsibility, lack of privacy, relationship conflicts, and the possibility of abuse, should be discussed. In most cases of orgasmic dysfunction, no specific physical examination or laboratory testing is necessary. As with other sexual dysfunctions, neurologic,...

Premature Rapid Ejaculation

Premature ejaculation refers to the occurrence of male ejaculation, usually with orgasm, before desired by the individual, his partner, or both. Premature ejaculation is also referred to as rapid ejaculation or difficulty with ejaculatory control. Evaluation of premature ejaculation is by history. Onset, circumstances, and meaning (personal and relationship) of the dysfunction should be explored, as well as pertinent past sexual experiences. For example, young men whose first sexual experiences were rushed may later have difficulty establishing ejaculatory control in more relaxed contexts. Men having intercourse infrequently are more likely to ejaculate rapidly. The clinician should determine whether a patient can delay his ejaculation while masturbating. In addition, information regarding the patient's level of sexual knowledge and his partner's expectations may be significant. Behavioral techniques, such as the squeeze technique, stop and start, masturbation training, and...

Are there different types of problems with ejaculation What causes them and how are they treated

There are three different types of ejaculatory problems that can occur premature ejaculation, retrograde ejaculation, and anejaculation. What is premature ejaculation and what causes it Premature ejaculation is ejaculation that occurs sooner than desired, either before or shortly after penetration, that causes distress to one or both partners. This condition tends to occur more frequently in younger men. Premature ejaculation is the most common form of sexual dysfunction, occurring in 21 of men ages 18 to 59 years in the United States. The condition may be lifelong (primary) or acquired (secondary). Despite its prevalence, men rarely seek help. Some men with ED may develop secondary premature ejaculation, possibly caused by either the need for intense stimulation to attain and maintain an erection or because of anxiety associated with difficulty in attaining and maintaining an erection. In these patients, treating the erectile dysfunction may lead to resolution of the premature...

Multiple Pattern ejaculations number

Multiple intromissions characterize the copu-latory behaviour of some mammals, such as the laboratory rat, although the number of intromissions a male makes prior to ejaculation is influenced by many factors, including age, and experiential and genetic variations (Larsson 1956). In the rat, the male's intromissions evoke neuroendocrine responses in the female which are important for the secretion of prolactin and for support of the corpus luteum during the ensuing pregnancy (Adler 1978 Freeman 1994). They also serve to dislodge copu-latory plugs deposited by other males during previous ma tings (Wallach and Hart 1983). The role played by sexual selection in the evolution of multiple intromission copulatory patterns is also apparent in some primate species. In various macaques and baboons, red colobus monkeys, and red uaka-ris, males make a series of mounts with intromission and pelvic thrusting prior to ejaculation. All these monkeys have multi-male multi-female mating systems, in...

Urine Formation In A Nephron

The male reproductive system produces sperm - cells that can fuse with eggs from a woman to form offspring. It also makes the male sex hormones needed for sperm production and for sexual development at puberty. The male genitals consist of the penis, the testes, and the scrotum, in which the testes are suspended. Each testis is packed with seminiferous tubules, which make sperm. The sperm are stored in the epididymis, a coiled tube that lies behind each testis. Another tube, the vas deferens, connects each epididymis to an ejaculatory duct, which in turn is connected to the urethra. Three glands - a pair of seminal vesicles and the prostate gland - secrete fluids to transport and nourish the sperm the secretions and sperm form a fluid called semen. During sexual activity, the erectile tissue in the penis fills with blood, making the penis lengthen and stiffen in order to enter the woman's vagina. At orgasm, muscular contractions force semen along each vas deferens, down the urethra,...

Targeting the Zona Pellucida

While birth control options for women are limited, those for men are even more so. Other than withdrawal prior to ejaculation, the only choices available for men are condoms and vasectomy. Given the potential permanence of vasectomy, it is not a viable choice for many. Ignoring the facts that some degree of sexism may be attendant to the history of birth control research and that many men and women simply feel that birth control is primarily a woman's responsibility, there are three major physiological reasons for the inequitable emphasis on female rather than male directed approaches. First, since fertilization and conceptus development occur within women, there are a greater number of reproductive events to manipulate to prevent pregnancy. Second, since women have to centers of ''brain control'' of the endocrine events controlling the activities of their ovaries and men have only a single brain center of testic-ular control, it is easier to hormonally interrupt the events...

Inhibition of Sperm Maturation

Rather that directly halting sperm production, this approach would interfere with the maturation of the newly formed sperm in the epididymis where they are housed prior to ejaculation. One reason why disruption of sperm maturation may be preferable to preventing sperm synthesis is that it is easier to deliver products to the epididymis via the bloodstream. There is a natural protective barrier that prevents delivery of potentially injurious products into the testes where sperm production occurs. Also, many products directed at preventing sperm production have had toxic and irreversible effects that caused permanent rather than temporary sterility. Targeting sperm in the epididymis may avoid those problems.

Influence of testosterone on sexual behaviour in men

Ejaculation Besides evidence from nonhuman primates and clinical case reports on effects of castration in human males (Nelson 1995), studies ofhypogonadal men on androgen replacement therapy provide convincing evidence of the essential role of androgens in some aspects of male sexual behaviour (Table 4.1). In patients with induced or spontaneous hypogonadism, pathological withdrawal as well as reintroduction of exogenous androgens affected the frequency of sexual phantasies, sexual arousal and desire, spontanenous erections during sleep and in the morning, ejaculation, sexual activities with and without a partner, and orgasms through coitus or masturbation (Bancroft 1984 1986 Carani etal. 1990a 1992 Davidson etal. 1979 Gooren 1987 Luisi and Franchi 1980 Morales et al. 1997 Salmimies et al. 1982 Schiavi et al. 1988 Skakkebaek etal. 1981).

Nerve Sparing Retroperitoneal Lymphadenectomy

Historically, the major long-term morbidity of RPL was ejaculatory dysfunction and potential infertility resulting from damage to the sympathetic nerves during dissection. Specifically, injuring the lumbar sympathetic trunks, postganglionic sympathetic fibers, and or nerves of the hypogastric plexus risked loss of seminal emission and consequently dry ejaculation. The traditional bilateral lymphadenectomy results demonstrated a 70 to 100 risk of this complication 2 . The movement to include suprahilar dissection was short lived and this approach was abandoned when no added benefit was realized 3 . The original procedures have since been further modified such that the minimal dissection is performed to spare relevant sympathetic nerves without risking an incomplete cancer resection. The initial strategy for minimizing postoperative ejaculatory dysfunction attributable to sympathetic nerve injury was the downscaling of dissection boundaries and development of unilateral resection...

Laparoscopic nervesparing retroperitoneal lymphadenectomy

Small series further supported the feasibility but primarily as a staging procedure using both bilateral and modified unilateral template dissections for Stage I germ-cell tumors 32-38 . The initial results revealed long procedure time and a relatively high complication rate (primarily hemorrhagic complications) that were attributed to inexperience and the recognition of an operative learning curve. In the late 1990s, the group from the University of Innsbruck, Austria, expanded the indications for laparoscopic RPL to include Stage II NSGCT and postchemotherapy masses 39 proposing that with sufficient experience, laparoscopic RPL could be a therapeutic procedure comparable to open surgery. Virtually all laparoscopic RPLs conducted by the Austrian group have used unilateral templates with the goal of preserving antegrade ejaculation 40-44 . Proponents of open surgery have contended that the boundaries of dissection are limited by a laparoscopic approach and that nerve sparing is in...

Male Sex Act Big Picture

The male sex act begins with sexual stimulation. Somatic sensory nerves relay this information to the central nervous system. Parasympathetic impulses from the S2-S4 levels of the spinal cord cause blood to flow into the erectile tissue of the penis, resulting in penile erection. Sympathetic impulses from the T10-L2 spinal cord levels cause seminal fluids to mix with the sperm in the urethra in a process called emission. Ejaculation is the expulsion of the semen from the penis, which is caused by sympathetic innervation as well.

Bone density in men with disorders of androgen action

A clinical model of androgen effects on bone tissue is represented by the cohort of men undergoing therapeutic orchiectomy for the treatment of prostate cancer or sexual delinquency. In 12 men of the latter group, bone mineral density of the lumbar spine decreased after bilateral orchiectomy (Stepan etal. 1989). Corresponding effects were seen in men treated with surgical or chemical castration for prostate cancer as a consequence, osteoporotic fractures were significantly increased in comparison to controls (14 vs. 1 ) (Daniell 1997 2000). This has been recently confirmed by a study involving 429 men who underwent bilateral orchiectomy for treatment of prostate cancer. Fractures were ascertained from medical records and compared with expected numbers based on local incidence rates this demonstrated a three-fold increase of fractures accounted for by moderate trauma of the hip, spine and distal forearm, locations traditionally linked with osteoporosis (Melton etal. 2003). The...

What is laser therapy of the prostate

The potential advantages of laser therapy include minimal bleeding, avoidance of TUR syndrome, less retrograde ejaculation, the ability to treat patients on blood thinners (such as Warfarin Coumadin and aspirin), and the potential to treat patients on an outpatient basis.

What types of laser therapy are available

The procedure can be repeated in different areas of the prostate. The procedure takes about 30 to 60 minutes to perform. After the procedure is performed an indwelling foley catheter is placed which is usually removed in a few days. It is not uncommon to see some blood in the urine after the procedure, which usually clears in a week. Rarely, erectile dysfunction, retrograde ejaculation, and incontinence can occur.

Coitus Interruptus Withdrawal

The male partner completely removes the penis from the vagina before ejaculation. Withdrawal reduces or eliminates sperm introduction into the vagina and thus the upper reproductive tract. Unless two acts of intercourse are close together, there is little concern for the presence of sperm in preejaculatory secretions (Zeiman et al, 2007). The advantages are affordability and ready availability. The disadvantages are that coitus interruptus relies on the male partner to predict imminent ejaculation and quickly and completely remove the penis from the vagina and introitus. Withdrawal also may limit orgasmic pleasure and spontaneity.

The mammalian oviduct sperm competition and cryptic female choice

It is of the greatest interest, given that hundreds of millions of spermatozoa are deposited in the vagina at ejaculation, that only a few hundreds or thousands of these gametes are recoverable from the oviduct. In Table 4.2, examples are provided of numbers of sperm deposited during copulation, and numbers recovered from the oviducts of various mammals, including Homo sapiens. These numbers do not represent the only spermatozoa to reach the oviducts. Rather they constitute 'snapshot' counts of a small, transient population of sperm which pass through the oviduct, and which are replenished by gametes moving upwards through the uterus and uterotubal junction, to enter the isthmus (Figure 4.4). In the isthmus, spermatozoa typically adhere for a time to the oviductal epithelium before migrating to the upper part of the oviduct (ampulla) where fertilization takes place (Harper 1994 Yanagimachi 1994). This transitory association between spermatozoa and the isthmic epithelium is of great...

Surveillance of testosterone substitution therapy

The presence and frequency of sexual thoughts and fantasies correlate with appropriate testosterone substitution, while loss of libido and sexual desire are a sign of subnormal testosterone values. Spontaneous erections such as those during sleep will not occur if testosterone replacement is inadequate however, erections due to visual erotic stimuli maybe present even with low testosterone levels. The frequency of ejaculations and sexual intercourse correlate with serum testosterone levels in the normal to subnormal range. Therefore, detailed psychological exploration or a diary on sexual activity are useful adjuncts in assessing testosterone substitution. For objective evaluation of psychosexual effects weekly questionnaires on sexual thoughts and fantasies, sexual interest and desire, satisfaction with sexuality, frequency of erections and number of morning erections and ejaculations may be used (Lee et al. 2003). These clinical experiences are substantiated by studies on androgen...

Apoptosis and Oxidative Stress

Infertile males were reported to have relatively high rates of apoptosis in their testicular biopsies 31 . In addition, the percentage of apoptotic sperm is higher in ejaculated semen samples from infertile men compared with healthy men 32 . Moreover, sperm caspases become more activated in patients with infertility than in healthy donors during cryopreservation 33 . Nevertheless, it has not been confirmed if the apoptotic markers detected in spermatozoa are due to an abortive apop-totic process started before ejaculation or whether they result from apoptosis started in the postejaculation 34, 35 .

Is ED a normal process of aging Is ED preventableIs it curable

It may also take longer to climax. Ejaculation (the release of semen through the penis during orgasm) may not occur, or it may occur with less force. The recovery period after ejaculation increases with age, and many men older than 55 years are not able to have another erection for 12 to 24 hours after ejaculating. These normal changes related to aging should not be confused with sexual dysfunction or ED failure to understand these normal changes and to adapt to them may cause stress and anxiety and may complicate erectile function. In ED, the erections are either inadequate for penetration or do not last long enough for completion of sexual performance. In short, the incidence of ED does increase with age, but it is not an expected process of aging.

What is sexual dysfunction

The term sexual dysfunction broadly encompasses trouble with any component of the sexual response cycle. The sexual response cycle in men consists of sexual desire interest (libido), sexual arousal (erection), orgasm (including emission involuntary discharge of semen from the ejaculatory duct into the urethra and ejaculation), and detumescence (return of the penis to the flaccid, nonerect state). An abnormality in one component of the sexual response cycle may not affect the remainder of the components of the cycle. For example, one may still be able to climax and ejaculate without achieving a rigid erection. Common sexual dysfunctions include problems with libido, ejaculation, and orgasm. Ejaculation Ejaculatory dysfunction includes premature ejaculation, retrograde ejaculation, delayed ejaculation, and anejac-ulation. Premature ejaculation means that ejaculation occurs too quickly and may occur with light stimulation before, on, or shortly after penetration, or simply before one...

Electrical Stimulation

A study of spastic hemiparetic subjects with chronic stroke showed that 15 daily low intensity, high frequency, TENS applications for 1 hour over the proximal common peroneal nerve decreased a clinical measure of spasticity, increased vibratory inhibition of the H-reflex of the soleus muscle, improved voluntary dorsi-flexion force, and reduced the magnitude of the stretch reflex in the affected ankle.220 Enhanced presynaptic inhibition was considered a contributing mechanism. Stimulation of flexor reflex afferents (FRAs) via peroneal and sural nerve stimulation may account for similar positive results in subjects with myelopathies.221,222 Electrostimulation for 5-10 minutes by a rectal probe to elicit ejaculation had the added effect of reducing spasms and tone in 10 of 14 subjects for approximately 9 hours.223

Retroperitoneal lymph node dissection

Historically, bilateral infrahilar RPLND was associated with the loss of antegrade ejaculation because of damage to the paravertebral sympathetic ganglia, postganglionic sympathetic fibers, and or the hypogastric plexus 8 . The incidence of retrograde ejaculation is related to the extent of the retroperitoneal dissection 8,18,19 . In an effort to preserve antegrade ejaculation, a number of side-specific modified templates have been proposed, variably limiting contralateral dissection, particularly below the level of the inferior mesenteric artery (IMA) 8,20,21 . The highest rates of antegrade ejaculation are reported with nerve-sparing techniques in which the sympathetic fibers, hypogastric plexus, and post-ganglionic sympathetic fibers are prospectively identified, dissected, and preserved 8,18,22 .

Victims of Child Maltreatment

Studies show boys, most whom are sexually victimized between the ages of 6 and 10, are just as traumatized by the experience as are girls. By nature of their physiology, older boys might experience erection, ejaculation, and orgasm. It should be understood that these responses are automatic and are not indicative of any reduction in trauma caused by their sexual violation by an adult. The experience of feelings of confusion, guilt, fear, betrayal, shame, and anger are gender neutral in sexual abuse.

Prevalence and incidence of disturbances of sexual functioning

Over a period of one year, 13 of the 34 participants returned to their preinjury level of sexual functioning (Sabhesan & Natarajan, 1989). These 13 subjects then became controls for the remainder of the sample. The remainder demonstrated sexually inappropriate behaviour, total loss of sexual function, and sexual dysfunction. The deviant sexual behaviour included purposeful use of lewd language (9 ), frot-teurism (6 ), exhibitionism (6 ), sadism (6 ), and rape (3 ). Total loss of sexual behaviour was reported in 38 of patients. Approximately 57 of the patients reported decreased interest in sex while two reported increased interest in sex when compared with controls. Premature ejaculation was noted by 7 patients, and a similar number of patients noted postcoital symptoms. Patients with continuing sexual Erectile and ejaculatory problems were uncommon. One female participant's spouse and four male participants reported occasional erectile difficulties after as compared to before the...

The male reproductive tract 1051 Overview

The male reproductive tract consists of the paired testes, epididymides and vasa deferentia and the penis. There are also the accessory structures of the seminal vesicles, prostate and bulbo-urethral glands (Fig. 10.19). As in the female reproductive tract, the development and function of many of these organs is very much under hormonal control. However, the precise timing of erection, emission and ejaculation required to ensure the completion of the primary function of the tract, i.e. insemination of the female, requires accurate neural control, and thus, in contrast to the female, the autonomic innervation of many of these organs is of paramount importance. In the periods between intercourse, the sperm are produced, matured and stored in the epididymis and vas deferens, and the components of the seminal fluid are secreted and stored in the seminal vesicles and prostate. These processes are under hormonal control. For intercourse, erection is produced through a complex neuronal...

What is a transurethral incision of the prostate TUIP

A transurethral incision of the prostate (TUIP) is exactly that an incision rather than a resection of the prostate. Using a special knife-like instrument, a Colling's knife that is placed through the same resectoscope sheath used for TURPs two incisions are made at 5 o'clock and 7 o'clock through the bladder neck and prostate to the verumontanum where the ejaculatory ducts exit. A TUIP is a quicker, easier procedure than a TURP. TUIPs tend to be used in younger men with smaller prostate glands. The incidence of retrograde ejaculation after TURP ranges from 50 to 95 , whereas the incidence is from 0 to 37 with TUIP. In properly selected patients, those with small glands, the rate of symptom relief with TUIP approaches that of TURP.

From the Sushruta Samhita ca 3000 bce

Testicular Atrophy

Two surfaces, dorsal and ventral (urethral), and consists of the root, the shaft, and the head. The shaft is composed of erectile tissue that, when engorged with blood, produces a firm erection necessary for sexual intercourse. The corpora cavernosa also contain smooth muscle that contracts rhythmically during ejaculation.

Identification of an Infection

Biochemical evidence has shown that in males with clinically silent genital tract infections, the prostate and seminal vesicles are the organs predominantly affected and targeted by inflammation 60 . The primary role of the seminal vesicles is to provide high concentrations of fructose to the seminal plasma and is vital to the functional integrity of spermatozoa as it is the major source of glycolytic energy in order to maintain motility 18 . The reference value for normal concentrations of fructose is 13 imol (2.34 mg) or more per ejaculate 18 . Determination of the concentration of the monosaccharide is commonly employed in laboratories for a variety of purposes including the auxiliary diagnosis of retrograde ejaculation, obstructive and nonobstructive azoospermia 61 , and as a marker to assess seminal vesicular function 18, 62 . Changes in seminal vesicles secretory patterns can modify the composition of products of the vesicular fluid and of the ejaculate, affecting sperm function...

Urinary Incontinence The Solutions

Holistics Antiandrogen

The true efficacy of Kegel exercises for men apparently has never been formally tested, so recommendations vary widely. Some urologists advise doing them ''at least every hour for five minutes,'' while others suggest much less often. Some urologists say they should only be done standing up, while others urge doing them in any position, ''while watching TV, driving a car, sitting in church, or anywhere at any time.'' Intriguingly, some claim that ''Kegel exercises are also great for improving virility and achieving greater ejaculation and arousal control.'' In 2004 the National Institutes of Health funded a research project that is studying the best way to teach men to do Kegel exercises.4 some desire libido and this urge is instigated by a mix of testosterone and psychological factors. The penis must become erect, which is determined by the arteries, veins, and nerves that supply it. Orgasm is initiated in the brain and involves the ejaculation of sperm and seminal fluid through the...

Adult testosterone levels

Many aspects of sexual behaviour in the normal male are testosterone-dependent. With pathologically low serum testosterone levels a significant decrease in the frequency of sexual fantasies, sexual arousal and desire, spontaneous nocturnal or morning erections, ejaculations, sexual activity with and without a partner has been observed and also successfully treated with androgen replacement. Even among eugonadal men, some evidence for a positive relationship of endogenous testosterone with sexual behaviour has been found. This gave rise to the supposition that abnormally high androgen levels in men might elicit rape or other types of sexual aggression.

Iiiiiiiii 2 4 6 8 10 12 14 16 18 Vaginal length

And copulatory orgasms , the female can influence both the probability of conception in monandrous situations and the outcome of sperm competition in polyandrous situations . . . much of this influence will be cryptic to the male partner(s).' These ideas arose from the notion that female orgasm might produce an 'upsuck' response, drawing sperm through the cervix and into the uterus (Fox, Wolff, and Baker 1970 Singer, 1973). Baker and Bellis conducted experiments with human subjects in order to estimate sperm numbers in 'flowbacks ' the fluid ejected from the vagina after copulation. Their goal was to define the effects of female orgasm upon sperm retention by women. The highest sperm retentions occurred when women experienced orgasm during a window of time extending from 1 min before ejaculation, until 45 min afterwards. Estimates of sperm retention were significantly greater for women who engaged in extra-pair copulations, as compared to estimates involving their usual (long-term)...

Who is a candidate for penile injection

Success rates for intracavernous injection therapy range from 70-94 . This kind of treatment is helpful in ED of all causes. Although injection therapy does not interfere with orgasm or ejaculation, its long-term success requires that the individual be comfortable with the injection process. Besides its overall success rate, another advantage of injection therapy is its quick onset of action, within 5 to 20 minutes of injection.

Initial Evaluation of Sexual Problems

Plateau Phase

The phases illustrated are excitement, plateau, and orgasm. The length of the plateau phase is variable. Women may have a brief plateau followed by orgasm (cycle Q or a long plateau with no orgasm (cycle B). Women may have multiple orgasms before resolution, although many do not (cycle A). For men with premature ejaculation, the plateau phase is brief. After ejaculation, men enter a refractory period lasting minutes to hours during which they are unable to ejaculate. precedes both cycles in this model. The phases illustrated are excitement, plateau, and orgasm. The length of the plateau phase is variable. Women may have a brief plateau followed by orgasm (cycle Q or a long plateau with no orgasm (cycle B). Women may have multiple orgasms before resolution, although many do not (cycle A). For men with premature ejaculation, the plateau phase is brief. After ejaculation, men enter a refractory period lasting minutes to hours during which they are...

Joel Sheinfeld MDab Pramod Sogani Md Facsab

Retroperitoneal lymph node dissection (RPLND) remains a critical component in the management of germ-cell tumor (GCT) in both the primary and post-chemotherapy setting and when properly performed, is a therapeutic procedure and not limited to diagnosis and staging 3,4 . Unfortunately, some patients will relapse in the retroperitoneum after RPLND and require reoperative retroperitoneal surgery. Emerging data on patients suffering late relapse and or requiring reoperative retroperitoneal surgery clearly indicate that the liberal use of effective cisplatin-based chemotherapy will not compensate for inadequate initial surgery 3,5,6 . Therefore, surgical margins and templates should not be compromised in an attempt to preserve ejaculation. Complete surgical resection of metastatic retroperitoneal disease has been shown to be a significant and independent variable in relapse-free survival for patients with both low-stage and advanced nonseminomatous germ-cell tumor (NSGCT) 3,7 .

Inferior Hypogastric Plexus

Hypogastric

The inferior hypogastric plexus is formed by the union of nerves from the superior hypogastric plexus, sacral splanchnic nerves, and pelvic splanchnic nerves (Figure 12-4A). The inferior hypogastric plexus is located diffusely around the lateral walls of the rectum, bladder, and vagina. The plexus contains ganglia in which both sympathetic and parasympathetic pre-ganglionic fibers synapse. Therefore, the inferior hypogastric plexus consists of preganglionic and postganglionic sympathetic and parasympathetic fibers, as well as visceral sensory fibers. The inferior hypogastric plexus gives rise to many other smaller plexuses that provide innervation to organs involved with urination, defecation, erection, ejaculation, and orgasm.

Surgical complications

Ejaculatory dysfunction Ejaculatory dysfunction and infertility following RPLND One of the most troubling long-term morbidities following RPLND is the loss of antegrade ejaculation secondary to intraoperative damage to crucial autonomic nerve fibers. Sympathetic fibers from the thoracolumbar outflow tract decussating around the aortic bifurcation are responsible for seminal emission into the posterior urethra. Ejaculation depends on both autonomic and somatic sacral and lumbar nerves that tighten the bladder neck, relax the external sphincter, and contract the bulbourethral and perineal muscles. Damage to these structures may result in loss of seminal emission or retrograde ejaculation. This loss of antegrade ejaculation is particularly morbid for this young patient population with its associated potential infertility and patients are counseled to consider sperm banking before RPLND. As our understanding of the neuroanatomy associated with ejaculatory dysfunction has evolved,...

Copulatory Pelvic Thrusting In Apes

Although prolonged intercourse may be facilitated by learning and encouraged by cultural preferences, the fundamental human pattern is mostly likely to have been relatively brief, involving a single intromission with pelvic thrusting to achieve ejaculation. Frequencies of copulation are also greatest in those primate species in which females mate with multiple partners during the fertile period. Although data on ejaculatory frequencies in monkeys and apes are limited, they are sufficient to show that males in multi-male multi-female groups copulate much more frequently than those which have polygynous monogamous mating systems. Large-scale surveys of human sexual behaviour conducted in North America, Europe and China confirm that for the majority of couples, frequencies of intercourse are commensurate with those that occur in polygynous or monogamous primates. Moreover, experimental studies that require men to ejaculate at artificially high daily frequencies clearly show...

Relationship between infertility and testicular cancer

Postorchiectomy surveillance is a viable treatment option for men who have stage I testis tumors for patients who are willing to adhere to a strict follow-up regimen. Surveillance protocols allow patients to avoid post-RPLND ejaculatory disturbances and gonadotoxic therapies but approximately 20 of men relapse and ultimately require additional treatment. Men who relapse on surveillance protocols and require gonadotoxic treatments may be at greater risk for infertility than men initially treated with nerve-sparing RPLND 34 . in the pelvis. The ampullary vas deferens seminal vesicles, periurethral glands, internal sphincter, bulbourethral, and periurethral musculature receive innervation from these nerves. The surgical disruption of these nerves during RPLND or pelvic node dissection can result in retrograde ejaculation or anejaculation depending on the severity of the nerve injury. The presence or extent of retroperitoneal disease often dictates the type of lymph node dissection...

Rapid sperm transport the vas deferens and sperm competition

Gambar Vas Deferens

Given that sexual selection has influenced relative testes sizes and hence sperm production as well as the morphology of individual gametes (sperm mid-piece volume) in mammals, we may further enquire as to whether other components of the male reproductive tract have been likewise affected by sperm competition. Rapid transport of many millions of spermatozoa during copulation is a complex process, and especially so for those species where the numbers of gametes ejaculated and frequencies of ejaculation may be greater due to competition between males for access to a given set of ova. Beyond the cauda epididymis, where sperm are pooled and stored, lays the vas deferens, the most muscular tubular duct in the human body (Figure 3.12). During sexual activity, sperm are transported rapidly through the vas deferens, by peristaltic contractions of its muscular walls. There are usually three muscle layers in the wall of the vas def-erens these can be seen in a transverse section of In all...

Transurethral Resection of the Prostate Skills A Potential Training Crisis

Much like any procedural skill in medicine, when a urologist becomes board certified, the ability to perform technically challenging procedures such as transurethral resection of the prostate is not discriminated from the urologist's judgment and cognitive skills, which are measured via oral and written examinations. This fact as well as financial incentives has led many practicing urologists to pursue alternative or minimally invasive methods to deal with bladder outlet obstructive symptoms. While promising, and useful in many settings, none of these procedures has ever outperformed transurethral resection of the prostate in treating either the subjective symptoms of bladder outlet obstruction or objective measurements such as peak urinary flow rates and ability to empty one's bladder completely (51). In fact, depending on the series, transurethral resection of the prostate gives symptom relief anywhere from five to 20 years and the minimally invasive treatments follow-up data are...

What are the 5alpha reductase inhibitors

What are the side effects of 5-alpha reductase inhibitors Side effects found in the first year of 5-alpha reductase inhibitor use include decreased sexual drive (libido), increased ejaculatory dysfunction (such as smaller amount of semen ejaculated), difficulty getting an erection, breast tenderness or enlargement. One large study demonstrated that after a year of treatment, finasteride resulted in the same level of decreased sex drive and inability to get an erection as placebo. Ejaculatory dysfunction was higher with finasteride than with placebo.

Efferent Autonomic Pathways

The prevertebral ganglia innervate the abdominal, pelvic, and perineal organs. Preganglionic fibers from T5-T12 levels are carried by the thoracic splanchnic nerves, which pierce the diaphragm and enter the abdomen to synapse on the celiac and superior mesenteric ganglia. These form the celiac plexus, which innervates all abdominal viscera except the descending colon. Sympathetic activation produces splanchnic vasoconstriction, inhibition of secretion and motility of the gut, as well as secretion of epinephrine, renin, and glucagon. Preganglionic axons from L1-L3 levels, carried by the lumbar splanchnic nerves, synapse on the inferior mesenteric ganglion. The postganglionic axons innervate the descending colon, rectum, bladder, and genitalia via the hypogastric plexus. Sympathetic nerves inhibit muscle contractility of the bladder and bowel, thus allowing storage of urine and feces. These postganglionic neurons also produce the contraction of the vas deferens that is necessary for...

Dopamine and Sexual Behavior

Dopamine Levels Adderall

Regarding sexual behavior and dopamine, it has long been known that, for example, injections of dopamine-related drugs into the hypothalamus of laboratory animals can influence the interaction between male and female rats and the number of ejaculations produced by the male. Another experiment has associated sexual activity with dopamine in the nucleus accumbens, a brain region well known to be connected to drugs. The far left side of Figure 6-2 shows the In a study of human subjects who had recently fallen in love, there were activations in the ventral tegmental area, part of the dopamine mesolimbic system. In studies of male orgasms, the ventral tegmental area was one of the regions activated.4 In a paper entitled Prelude to passion limbic activation by 'unseen' drug and sexual cues, Drs. Anna Rose Childress, Charles O'Brien, and others from the University of Pennsylvania found that there was limbic activation in subjects that received cues about drugs and sex outside of their...

Male Genital Organs And Glands

Seminal Gland

A thick-walled tube in the spermatic cord that transports sperm from the epididymis to the ejaculatory ducts in the prostate gland. The ductus deferens traverses the superficial inguinal ring, coursing through the inguinal canal, and enters the pelvis through the deep inguinal ring lateral to the inferior epigastric artery. En route to the ejacu-latory duct, the ductus deferens crosses the medial side of the umbilical artery and the obturator neurovascular structures. Sympathetic nerves from the inferior hypogastric plexus cause peristaltic contractions in the thick smooth muscle wall and propel sperm during ejaculation. Ejaculatory ducts. Formed by the union of the ductus deferens and ducts from the seminal vesicles. The ejaculatory ducts open into the prostatic urethra. Seminal vesicles. Lobular glands located on the base of the bladder. During emission and ejaculation, the seminal vesicles empty their secretions (e.g., fructose, citric acid, prostaglandins, and...

Components of the tract and their innervation

Cavernosal Smooth Muscle The Penis

Vasa deferentia and ejaculation Each vas deferens is a continuation of the duct of the epididymis. Initially, the vas deferens is tortuous, but it becomes straighter as it passes back along the testis and up through the spermatic cord and the inguinal canal into the pelvic cavity. Here it runs between the peritoneum and the lateral wall of the pelvis, from whence it runs backwards, downwards and medially, crossing the ureter to run behind the bladder, approaching its pair between the seminal vesicles at the base of the bladder. Here the tube swells into the wider ampulla of the vas deferens. On each side, the vas deferens then begins to penetrate into the substance of the prostate, and joins the duct from the seminal vesicle to form an ejaculatory duct. These ducts run through the prostate and open upwards into the prostatic urethra on the top of the urethral crest, close to the openings of the prostatic utricle. These paired organs do not in fact store sperm (they are stored in the...

Extent of surgery after chemotherapy

Historically, RPLND encompassed a full bilateral suprahilar dissection from ureter to ureter, from the crus of the diaphragm to the bifurcation of the common iliac arteries 63 . In the early 1980s it was shown that right testicular tumors were more likely to have metastatic tumor deposits in the interaortocaval zone, just below the left renal vein. Left-sided primary testicular tumors were more likely to have tumor spread in the preaortic and left para-aortic areas. The right and left suprahilar zones were rarely involved in low-stage disease 64 . Surgical techniques were modified to omit routine suprahilar dissection for low-volume disease 65 . Earlier treatment of lower-stage, low-volume disease with smaller residual masses led to an increase in the role of template dissections and nerve-sparing techniques, which improved the chance of retaining antegrade ejaculation 2,66 . These template approaches are balanced with the risk for residual germ cell tumor or teratoma outside the...

Treatment of the Underlying Cause of Sperm Oxidative Stress

Testicular sperm extraction is a new and controversial treatment for sperm oxidative stress damage. It is generally recognised that the primary site at which sperm oxidative attack occurs is while sperm are being stored in the epididymis. Here, the sperm sit for many days before ejaculation, unprotected from oxidative attack by supportive Sertoli cells or seminal plasma derived antioxidants. It has been proposed that by surgically collecting sperm direct from the testicle, it is possible to still obtain sperm that have yet to be damaged by ROS attack as they are fresh off the sperm production line . Three studies have now shown that such a surgical approach can result in improved sperm DNA integrity and pregnancy outcomes 172-174 . However, surgical sperm aspiration can only be performed in conjunction with IVF-ICSI and does of course have some potential adverse effects (haemorrhage, infection, pain). Therefore, it is our practice to only offer this type of treatment when the use of...

Influence of sexual behaviour on testosterone

The general concept that behaviour can feed back to hormone levels was first described with regard to sexual behaviour in an often cited publication (Anonymous 1970). A man working on an island attributed his increased beard growth immediately prior and during his visits to his girlfriend on the mainland to elevated androgen levels induced by sexual anticipation and sexual activity. Since then, numerous empirical studies dealt with effects of sexual behaviour (e.g., sexual stimulation, masturbation and coitus with or without orgasm) on testosterone levels. It could be demonstrated that almost any sexual behaviour can significantly alter sex hormone levels however, cognitive factors and emotional involvement of the subjects produced mixed results. The majority of data on eugonadal men reports on effects of ejaculation. Orgasmic frequency in males, whether through masturbation or coitus, correlated positively with free, non SHBG-bound testosterone and serum testosterone (Christiansen et...

Oxidative Stress DNA Damage and Protamines

Role in configuring a compact and hydrodynamic nucleus which plays a crucial role in protecting the paternal genome during migration through the male and female reproductive tract. The quasi-paracrystalline packaging of the sperm chromatin renders the DNA molecule virtually inaccessible to nucleases or mutagens that may be present in the internal or in the external media where the sperm have to endure for variable periods of time. Variations in the levels of protamination by an unbalanced P1 P2 ratio may result in male infertility. In infertile humans, where these aspects have been more deeply analyzed, these unbalance differentially impacts on the integrity of the DNA and in the reproductive outcome of these couples 59, 60 . It has been recently reported that the P1 P2 ratio in human sperm correlates with the levels of sperm DNA fragmentation and also with the rate of sperm DNA damage after ejaculation. Statistical differences were found between fertile controls and patients with...

Modulators of ROS Generation

Ros Generation

At this point, we are again confronted to a situation, where we cannot determine the initial event (see above, which of the ROS is first synthesized). Sg blocks ROS synthesis and ROS are needed to dispose of Sg in spermatozoa 90 . We can hypothesize that Sg adsorbs on, and enters into, spermatozoa at ejaculation and, as a result, prevents premature capacitation. Sperm transit in the female genital tract, or incubation in vitro with inducers, promotes the release of Sg and Zn2+ from the cell surface, which allows the initiation of ROS synthesis. ROS would favor further Sg processing, and the reduction of sperm Sg then would amplify ROS formation. Whether this cycle starts with degradation and or release of Sg or with the formation of

Metabolic Strategy of Human Spermatozoa 1011 Introduction

The primary function of the spermatozoon is to carry and introduce the intact DNA into the oocyte. For that purpose, after ejaculation the spermatozoon must propel itself from the vagina into the uterus in order to meet the oocyte at the site of fertilization in the ampullar region of the oviduct. Prior to oocyte fertilization, sperm must undergo in the isthmic region of the oviduct a series of biochemical changes known as capacitation that allow sperm to bind and penetrate the oocyte in vivo. Therefore, the spermatozoon could be considered as a self-propelled specialized DNA carrier. However, in order to fully accomplish its function of delivering the paternal genome to the oocyte, the fertilizing spermatozoon, through a phospholi-pase Czeta that carries in its nuclear membrane, must first activate the oocyte and trigger the expression of homeobox genes that encode proteins responsible for binding specific DNA sequences of the zygote that ultimately determines embryo and fetal...

Infections Inflammations

Both, male genital tract infections and inflammations are medical conditions that are seriously affecting spermatogenesis and sperm transit during ejaculation in terms of an obstruction of the relevant ducts. Their effects can be seen in clinical findings in cases of oligozoospermia (decreased number of sperm), asthenozoo-spermia (decreased sperm motility) or azoospermia (absence of sperm in the ejaculate) 98, 99 . Moreover, they are also the cause of dysfunctional male accessory glands 59 and significantly impaired sperm functions 100, 101 . Reportedly, the prevalence of male genital tract infection related infertility amounts to up to 35 of patients consulting for infertility 24 .

Dynamic Sperm DNA Damage

The comparative analysis of the dynamics of sperm DNA damage in different mammalian species indicates that the resistance of the chromatin to external stressors is different for each species once the sperm is incubated ex vivo for ART. In other words, the extent of sperm DNA damage as a function of time is different for each species when the sperm in handled ex vivo, accumulating DNA impacts of different intensities at different times. While in species such as the boar or deer, the calculated rate of sperm DNA damage is of the order of 0.05 per hour this value is 15.2 in the case of the ram, which is close to a 300-fold higher 47 . Of course, before ejaculation and when mature spermatozoa are retained in the epididymis, these rates of sperm DNA damage are not assumable. Therefore, in light of this scenario, the concept of sperm DNA damage needs to be redefined, since in all mammalian species we may discriminate between two different types of sperm DNA damage. The constitutive sperm...

AxSelective antagonists

Selective aj-blockers include prazosin, doxazosin, indoramin, phenoxybenzamine and urapidil. Doxazosin has succeeded prazosin as the most commonly used agent in this class as it has a more prolonged duration of action. Reflex tachycardia and postural hypotension are less common than with direct-acting vasodilators (e.g. hydralazine) and the non-selective a-blockers, but may still occur on initiating therapy. Nasal congestion, sedation and inhibition of ejaculation may occur. Phenoxybenzamine binds covalently (i.e. irreversibly and non-competitively) to the receptor so that its effects last up to several days, and may be cumulative on repeated dosing. It is used for the preoperative preparation of patients with phaeochromocytoma (see Ch. 55).

Clinical Applications In Urology

The dissection time was comparable to the conventional technique. The mean estimated blood loss was 450 mL. There were no intraoperative or postoperative complications. The pathology revealed residual embryonal carcinoma in one, teratoma in two and fibrosis in two. At a mean follow-up of 24 months, all patients reported return of ejaculation and no retroperitoneal recurrences have occurred.

Nonpharmacologic Therapy Lifestyle Modifications

Alprostadil Administration

Onset of action is slow at around 30 minutes, which limits spontaneity. In addition, patients and partners may complain of a cold, lifeless, discolored penis that has a hinge-like feel. Painful ejaculation or inability to ejaculate are additional adverse effects. VEDs are contraindicated in persons with sickle cell disease and should be used with caution in patients on oral anticoagulants or who have bleeding disorders due to the increased possibility of priapism.

Fertilization

Mature spermatozoa (sperm) pass from the seminiferous tubules of the testes into the epididymis where they undergo a maturation period within the cauda epididymis. During ejaculation they are propelled up the ductus deferens into the urethra, through the penis and into the female tract. The

Spermatic Cord

During ejaculation, functions to transport sperm from the testes, through the spermatic cord and inguinal canal to the ejaculatory duct in the prostate. Much of the ductus deferens is composed of smooth muscle and, as a result, feels rigid and hard to the touch. Therefore, the duc-tus deferens is easy to palpate in the spermatic cord.

Results

We demonstrated that bilateral nerve identification and sparing RPL resulted in return of normal ejaculation in 90 to 97 of patients and that the number of nerves spared did not necessarily correlate with positive results 11,26 . This encouraging decrease in morbidity was not associated with retroperitoneal recurrences at 18-month follow-up. Before this report, most patients became infertile as a result of nerve damage and loss of antegrade ejaculation. Subsequently, DeBruin and colleagues 27 reported 86 and 95 12-month antegrade ejaculation rates in clinical Stage I NSGCT patients who underwent bilateral and unilateral nerve-sparing RPL, respectively. Finally, the largest cohort reported is from the Indiana group, whose data span the evolution of RPL template modification and the adoption of prospective nerve-sparing techniques 16 . Of 2200 cases, 483 had primary nerve-sparing RPLs for clinical Stage I disease. All patients surveyed in this sample...

Morbidity

With LRPLND, major and minor intraoperative complications occurred in 4 and 2 of cases, respectively, while major and minor postoperative complications occurred in 1 and 6 of cases, respectively (see Table 2). Vascular injury was responsible for most intraoperative complications and the need to convert to open surgery, whereas the most common postoperative complication was lymphocele formation (2.3 of all cases). Antegrade ejaculation rates were between 97 and 100 . Complication rates vary considerably though. One of the larger experiences with LRPLND was recently updated, but the series also contained patients who underwent LRPLND for residual disease after chemotherapy 40 . Among 77 patients, intraoperative complications occurred in 10 (13 ). Vascular injuries to the vena cava (5.4 ), renal hilum (3.1 ), and external iliac artery (1 ) occurred most commonly. Overall, the complication rates for LRPLND compare favorably to contemporary series of open RPLND. The reported minor and...

Conclusions

Much less is known about mechanisms of cryptic female choice in mammals than is the case for sperm competition. However, the limited evidence presented in this chapter is consistent with the conclusions reached in Chapter 3 concerning sperm competition and the origins of human sexual behaviour. Thus, there is little credible evidence that orgasm in women or in females of non-human primate species plays any role in sperm transport or fertility. Likewise, the evolution of human penile morphology and copulatory patterns is not connected to any requirement to induce female orgasm, in order to increase the likelihood of fertilizing ova. Rather, it appears that female orgasm, which occurs in a number of anthropoids besides Homo sapiens, represents a functionless homologue of responses which accompany ejaculation in the male. Func-tionless homologues of female structures (such as

Copulatory durations

North America, Kinsey, Pomeroy, and Martin (1948) found that 'for perhaps three-quarters of all males, orgasm is reached within two minutes after initiation of the sexual relation.' They also noted that 'for a not inconsiderable number of males the climax may be reached in less than a minute or even within ten or twenty seconds of coital entrance.' Kinsey et al. were well aware, however, that intercourse may last for much longer than this. Earlier studies carried out in the USA, by Dickinson and Beam (1931), had shown that in 362 married couples 17 per cent of men engaged in sexual intercourse for 15-20 min, and 9 per cent for 30 min or longer prior to ejaculation. In a small number of cases (3 ), husbands reported that they could prolong intercourse and control attainment of orgasm as desired. Cross-cultural studies show that some societies favour the acquisition of such techniques of prolonged intercourse and delayed orgasm by males (e.g. among the Tro-briand Islanders, Balinese,...

Aa uojpunjsQ aiipajg

Male strategies to manage the premature ejaculation. The squeeze technique is the most common technique used to treat premature ejaculation. The male is instructed to interrupt sexual relations when he feels that he is about to experience premature orgasm and ejaculation. He or his partner then squeezes the shaft of the penis between a thumb and two fingers, applying light pressure for about 20 seconds, then letting go and resuming sexual relations. Behavioral therapy is successful in 60 to 90 of men with premature ejaculation, however, it requires the cooperation of both partners. Although pharmacologic therapy is used in men with premature ejaculation, none of the medications currently used in the management of premature ejaculation have been approved by the FDA for this specific indication. Premature ejaculation can be treated effectively with serotonin reuptake inhibitors (SRIs) or topical anesthetics (Table 17). A variety of SRIs including fluoxetine, paroxetene, sertaline, and...

Infertility

Infertility is the inability to conceive or to cause pregnancy. Infertility is a common problem found in as many as 10 of all marriages. A couple is said to be infertile when after 1 year of normal intercourse without the use of contraceptives, pregnancy does not occur. It has been estimated that almost 30 of all infertility is attributable to a male factor. Any patient with a history of infertility should be questioned regarding a history of mumps, testicular injury, venereal disease, history of diabetes, history of a varicocele (see Fig. 18-27), exposure to radiation, or any urologic surgical procedure. Diabetic men may be infertile because of retrograde ejaculation, or ejaculation into the urinary bladder. Determine the frequency of sexual intercourse and any difficulty in achieving or maintaining an erection. Document a careful history of general work habits, medications taken, alcohol consumption, and sleeping habits. ED is the inability of a man to achieve or maintain an...

Prostate Cancer

Prostate-specific antigen is a glycoprotein produced by prostatic epithelial cells. Its level increases with prostate adenocarcinoma, hyperplasia, inflammation, procedures, ejaculation, and massage. However, clinical DRE should not affect the PSA level (Barry, 2001). The most widely accepted upper limit of normal for total PSA is 4.0 ng mL. The Prostate Cancer Prevention Trial, using a biopsy standard, indicated that as PSA levels increase, sensitivity declines and specificity increases, and at no point is there a good balance between the two. Thus, cancer appears ubiquitous men with normal-range PSA levels may have prostate cancer 15 of men with a PSA less than 4.0 ng mL have cancer, 15 of which are high-grade tumors (Thompson et al., 2004). Furthermore, although some studies have concluded that a lower abnormal PSA cutoff level would detect more cancer (Punglia et al., 2003), these findings indicate that more men would have unnecessary biopsies. Thus, PSA testing suffers from both a...

The brain stem

Afferent sexual systems are closely associated with spinothalamic pathways in the anterolateral chord in the lateral medulla and pons, prior to their ascent to the thalamus (Boller & Frank, 1982 MacLean, 1975). In his extensive series of stimulation studies in the primate, MacLean noted that seminal discharge, sometimes preceding erection, was elicited only in those cases in which the electrodes impinged on the course of the spinothalamic pathway and its ancient medial ramifications into the caudal intralaminar region of the thalamus (MacLean, Dua, & Denniston, 1963). Stimulation at other sites could produce erection, but rarely ejaculation. Efferent systems to the spinal chord mainly pass from the hypothalamus with autonomic fibres in the dorsal longitudinal fasciculus and other descending pathways (Horn & Zasler, 1990).

Sexual Function

Reflexogenic erections occur in over 90 of men with complete and incomplete SCI, but ejaculation may be functional in only 10 of those with complete SCI and one-third of those with incomplete SCI.223 Severe headache may accompany ejaculation. Reflexive suboccipital and paraspinal muscle spasm, dysautonomia with hypertension, and migraine may account for the paroxysmal pain. Erectile function and seminal ejaculation can be aided by many techniques. Sildenafil and newer orally taken drugs enable an erection that permits penetration for 80 of pa-tients.224 Intracavernous injections of papaver-ine and other substances work for some, but priapism is a more common adverse reaction in the person with SCI. Vacuum techniques are often useful for maintaining an erection. Implanted, semirigid penile prostheses benefitted 52 of 63 veterans with sexual dysfunction, some of whom had skin lacerations from external appliances, but they carried an initial 33 complication rate.225 Infections occurred...

Surgical Treatment

There is very high patient and partner satisfaction with the quality of erection and sex life after penile prosthesis placement. Penile prosthesis placement, when performed correctly, does not alter sensation during sexual intercourse, nor does it interfere with ejaculation or fertility.

Antidepressants

The major side effects of the SSRIs referring to the CNS include nausea, headache, dry mouth, insomnia and somnolence, agitation, nervousness, sweating, dizziness, tremor, and sexual dysfunction.'.' Fluoxetine is often associated with anxiety, nervousness, insomnia, and anorexia. Paroxetine, fluvoxamine, and nefazodone are associated with sedation. Sexual dysfunction manifests itself as ejaculatory delay in men and anorgasmia in women. There have been reports suggesting that fluoxetine can induce or exacerbate suicidal tendencies, and several mechanisms have been proposed. However, because suicide is an important feature of depression, it is difficult to draw conclusions, whereas on the other hand, it is difficult to exclude the possibility that suicidal ideation occurs as a rare adverse reaction with some drugs.'7'

Adams Apple

Membrana Thyreoidea

Given that the larynx is markedly sexually dimorphic in adult human beings, and that testosterone stimulates laryngeal growth during puberty (Beckford et al. 1985 Hollien, Green and Massey 1994), it is important to determine whether sexual selection has influenced the evolution of these traits. Firstly, we may ask whether the human voice conveys any information concerning an individual's hormonal or physical status. The answer to these questions appears to be 'Yes'. Indeed, many years ago Eberhard Nieschlag showed that masculine vocal register, body condition, and circulating testosterone are correlated in the human male. Thus, he found that bass singers have higher testosterone oestradiol ratios and ejaculatory frequencies than tenors, as well as being, on average, taller and more athletic in their physique (Figure 8.2). Subsequently, Dabbs and Mallinger (1999) reported that men who have deeper voices also exhibit significantly higher levels of salivary testosterone. Low-pitched male...

Clinical History

Patients with gastrointestinal autonomic dysfunction have a variety of symptoms resulting from abnormal motility of the stomach and gut. The examiner should inquire about the presence of constipation, diarrhea, nausea, postprandial vomiting, bloating, belching, loss of appetite, and early satiety. Urinary bladder symptoms associated with autonomic dysfunction include hesitancy, poor stream production, increased intervals between micturition, and a sense of inadequate bladder emptying. Patients may also report symptoms associated with urinary retention and overflow incontinence. Male patients may additionally complain of impotence, which often is the earliest symptom of generalized autonomic failure. Sympathetically mediated ejaculatory failure may be an early complaint that precedes erectile failure.

Cigarette Smoking

The largest cross-sectional study, including 2,542 healthy males, on this issue was carried out and published by Ramlau-Hansen et al. 50 and it showed that with increasing smoking, a 20-30 reduction in sperm count, volume and motile spermatozoa were observed. A study on voluntary males of reproductive age showed that after ejaculation, sperm motility deteriorated much more rapidly in heavy smokers in comparison to controls 51 .

The Road to Truth

In fact, there is no robust evidence that female orgasm plays any role in human sperm transport or fertility. Unfortunately, this subject has not received the experimental attention it deserves, and some of the few studies which do exist have been cited selectively and given undue weight in the literature. A recent and most thorough critique of work in this area by Elisabeth Lloyd (2005) shows how limited evidence or flawed experiments have been over-interpreted to promote the view that women's orgasms might influence sperm transport. These matters were discussed in some detail in Chapter 4, so that it is not necessary to repeat the arguments here. Suffice it to say that whilst female orgasm certainly does occur in some primates, it probably represents a non-adaptive homologue of the male capacity to exhibit orgasm during ejaculation. Male primates also display non-adaptive homologues of feminine traits, such as nipples and (in some species) an atrophic uterus masculinus. What is...

Copulatory postures

Sex Selection Position

Foreplay or post-coital manipulation of the clitoris therefore plays a substantial role in enhancing orgasmic responsiveness in women. The missionary position alone provides no guarantee that female orgasm will be more likely to occur. In human societies where attitudes towards sexual intercourse are repressive, the incidence of female orgasm is probably low. For example, among the Yolngu of Arn-hem Land, in northern Australia, it is customary to arrange marriages between young women and much older men. Among the Sambia of Papua New Guinea, men frequently marry women from other villages, and these 'in marrying' women are often not trusted or treated affectionately by their husbands. In both these cultures, intercourse is said to be peremptory in nature and often lacking in orgasm for the female partners. We saw in the last chapter that female orgasm serves no established function in sperm transport or fertility in human beings. Rather, it is most likely to represent a non-adaptive...

Urethra

Prostatic Urethra

In the male, the urethra is often considered as comprising four sections, the preprostatic, the prostatic, the membranous and the penile urethra (Fig. 10.11). The preprostatic urethra is about 1.5 cm long, and extends from the bladder neck to the prostate. The smooth muscle is richly supplied with noradrenergic nerve fibres, and there is only a sparse cholinergic innervation. The prostatic urethra is about 3-4 cm long and runs through the substance of the prostate. It has a crescent-shaped cross-section due to the posteriorly positioned urethral crest, which protrudes into the lumen. The ejaculatory ducts open on the surface of this crest (called the verumon-tanum). On either side of the crest are the openings of the prostatic ducts. There are many mucosal glands opening around the entire circumference of the prostatic urethra. The thin smooth muscle coat of longitudinally and circularly arranged muscle bundles is continuous with the strands of smooth muscle pervading the prostate....

Janet Cde Baca

That keep men silent about being sexually assaulted suggest that men can't be sexually assaulted by women men can't be sexually assaulted because they are able to defend themselves only gay men are sexually assaulted and erection or ejaculation during sexual assault means you really wanted it or consented to it, which can feed into distressing issues of self-doubt about sexuality and manliness. Sixty percent of men felt the incident was not important enough to report, and 47 did not want anyone to know about the incident.12

Glycolysis

The enzymatic profile of human spermatozoa is not typical of cells that exhibit a high rate of aerobic glycolysis. This implies that certain metabolic changes must take place after ejaculation. This hypothesis was postulated based on the similarities in the enzymatic profile between human and bull spermatozoa. Early work by Lardy and Parks indicated that glycolysis in epididymal bull sperm sharply decreased when sperm were exposed to oxygen and increased after ejaculation, thus suggesting that a metabolic regulator may be released at the time of ejaculation that uncouples oxidative phosphorylation which, in turn, decreases the respiratory inhibition of glycolysis 3 .

Nonmotor Symptoms

As the autonomic system is disturbed in patients with PD, orthostatic hypotension and GI, urinary, sexual, and dermatologic symptoms are common. Patients with orthostatic hypotension may experience dizziness, lightheadedness, fainting upon standing, or fall-related injuries. GI symptoms include constipation and dysphagia due to a slowing of the automatic pattern of contraction and relaxation of the throat muscles. These swallowing difficulties may lead to weight loss, sialorrhea, and aspiration. Genitourinary symptoms include urinary incontinence, urgency, and frequency related to over activity of the bladder emptying reflex. Symptoms may be worse at night, causing nocturia. Sexual dysfunction includes decreased libido, erectile dysfunction, and delayed ejaculation. Skin symptoms include sweating and intolerance to heat and cold.6-8,11,12

Stones

Seminal vesicle calculi are typically brown in color and may comprise inspissated protein or contain a mucoepithelial core covered with stone forming components such as calcium carbonate, urates, and phosphate (Fig. 1) (22). Men typically present with hematospermia, hematuria, painful ejaculation (23), pain, or as an incidental finding (22). Reflux of urine into the seminal vesicle, obstruction, infection, or congential anomalies have all been described as predisposing factors. Intervention is only necessary if symptoms warrant it, the pain is lateralizing, and imaging with computed tomography or magnetic resonance imaging indicates a stone. If composed only of inspissated protein seminal vesicle stones will not be visible on a computed tomography scan, and a T2-weighted magnetic resonance imaging with coronal imaging is recommended (Fig. 2) (22).

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