Management of the Infertile Couple When the Male Partner Has Ejaculatory Dysfunction

Abstract

From time immemorial, man had always been entangled in the web of strong procreative instinct as the pillar of his existence in this planet. If he is unable to achieve an erection or ejaculate appropriately or if the desire is unduly compromised due to hormone upheavals, his fertility may suffer leading to serious implications on the quality of couple relationship. The sexual problems may be independent or interdependent with abnormalities in sperm parameters and fertility or sexual issues in the female partner. Indeed, difficulty in conceiving a child can arise because of the abnormality in man’s reproductive system or the woman’s or a combination of both. Male causes are in the region of about one-third of the total infertility. While the major or direct cause of male infertility is the result of insufficient amount or production of healthy spermatozoa, fertility can be compromised if the man suffering from premature ejaculation (PE) deposits the ejaculate outside the vagina/in the introitus or half way through the vagina in an incomplete penetration (the lower limit for male fertility is 20 million spermatozoa per milliliter). Furthermore, a lower amount of spermatozoa in migration to the fallopian tube will make the conception even more difficult The male physiological function of ejaculation comprises emission of semen into the prostatic urethra and expulsion of the ejaculate by coordinated contractions of muscles of the pelvic floor, lower extremities, and trunk. While ejaculatory dysfunction can be multifactorial leading to diminished sexual pleasure as well as fertility, cases of PE need to be evaluated for the severity; particularly whether ejaculation takes place before penetration of the vagina. Accordingly, one should treat premature ejaculation (see Chaps. 4, 5, and 6) and any other existing sexual dysfunction such as retrograde ejaculation (into the bladder) and erectile dysfunction, if any.