Ejaculatory Dysfunction and Vasodynamics

  • Aleksey P. IgnatovEmail author
  • Paul J. Turek


Ejaculation begins approximately 12 months after the onset of puberty in the male. While its importance to reproductive fitness is clear, current knowledge of the physiology of ejaculation is limited. This chapter reviews the events of ejaculation, its anatomic and neuroanatomic underpinnings, the range of ejaculatory disorders, and clinical methods for evaluating and treating ejaculatory disorders. Our current understanding of reproductive tract physiology and function as well as ejaculatory duct obstruction is also reviewed.


Male infertility Ejaculatory duct obstruction Spinal cord injury Vasodynamics Ejaculatory dysfunction Ejaculatory disorders Müllerian duct cyst 



The authors would like to acknowledge the contributions of Melody Lowman MA of San Francisco, California, to this chapter. As a psychotherapist with 45 years of experience, her knowledge and experience in reproductive psychology has been invaluable to us.


  1. 1.
    Master VA, Turek PJ. Ejaculatory physiology and dysfunction. Urol Clin North Am. 2001;28:363–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Yang CC, Bradley WE. Somatic innervation of the human bulbocavernosus muscle. Clin Neurophysiol. 1999;110:412.PubMedCrossRefGoogle Scholar
  3. 3.
    Brackett NL, Ohl DA, Sønksen J, Lynne CM. Abnormalities of ejaculation. In: Lipshultz LI, Howards SS, Niederberger CS, editors. Infertility in the male. 4th ed. New York: Cambridge University Press; 2009. p. 454–73.CrossRefGoogle Scholar
  4. 4.
    Benson GS. Erection, emission and ejaculation: physiologic mechanisms. In: Lipshultz LI, Howards SS, editors. Infertility in the male. 3rd ed. St. Louis: Mosby; 1997. p. 155.Google Scholar
  5. 5.
    Eisenberg M, Walsh TJ, Garcia M, et al. Ejaculatory duct manometry in normal men and in patients with ejaculatory duct obstruction. J Urol. 2008;180:255–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Jarvi K, Zielenski J, Wilschanski M, et al. Cystic fibrosis transmembrane conductance regulator and obstructive azoospermia. Lancet. 1995;345:1578.PubMedCrossRefGoogle Scholar
  7. 7.
    Thorpe AC, Cleary R, Coles J, et al. Written consent about sexual function in men undergoing transurethral prostatectomy. Br J Urol. 1994;74:479.PubMedCrossRefGoogle Scholar
  8. 8.
    Dunsmuir WD, Emberton M, Neal DE. On behalf of the steering group of the National Prostatectomy Audit. There is significant sexual dissatisfaction following TURP. Br J Urol. 1996;77:161A.CrossRefGoogle Scholar
  9. 9.
    Lue TF, Giuliano F, Montorsi F, et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2004;1:6–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Purohit RS, Wu DS, Shinohara K, Turek PJ. A prospective comparison of 3 diagnostic methods to evaluate ejaculatory duct obstruction. J Urol. 2004;171:232–5, discussion 235–36.PubMedCrossRefGoogle Scholar
  11. 11.
    Hendry WF. Disorders of ejaculation: congenital, acquired and functional. Br J Urol. 1998;82:331.PubMedCrossRefGoogle Scholar
  12. 12.
    Hendry WF, Pryor JP. Mullerian duct (prostatic utricle) cyst: diagnosis and treatment in subfertile males. Br J Urol. 1992;69:79.PubMedCrossRefGoogle Scholar
  13. 13.
    Turek PJ. Seminal vesicle and ejaculatory duct surgery. In: Graham S, editor. Glenn’s urologic surgery. 6th ed. Philadelphia: Lippincott, Williams & Wilkins; 2006. p. 439–45.Google Scholar
  14. 14.
    Nguyen HT, Etzell J, Turek PJ. Normal human ejaculatory duct anatomy: a study of cadaveric and surgical specimens [see comments]. J Urol. 1996;155:1639.PubMedCrossRefGoogle Scholar
  15. 15.
    Jarow JP. Seminal vesicle aspiration in the management of patients with ejaculatory duct obstruction. J Urol. 1994;152:899.PubMedGoogle Scholar
  16. 16.
    Bird VG, Brackett NL, Lynne CM, et al. Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury. Spinal Cord. 2001;39:514–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Brackett NL. Semen retrieval by penile vibratory stimulation in men with spinal cord injury. Hum Reprod Update. 1999;5:216–22.PubMedCrossRefGoogle Scholar
  18. 18.
    Momose H, Hirao Y, Yamamoto M, et al. Electroejaculation in patients with spinal cord injury: first report of a large-scale experience from Japan. Int J Urol. 1995;2:326.PubMedGoogle Scholar
  19. 19.
    Brinsden PR, Avery SM, Marcus S, et al. Transrectal electroejaculation combined with in-vitro fertilization: effective treatment of anejaculatory infertility due to spinal cord injury. Hum Reprod. 1997;12:2687.PubMedCrossRefGoogle Scholar
  20. 20.
    Schatte EC, Orejuela FJ, Lipshultz LI, et al. Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection. J Urol. 2000;163:1717.PubMedCrossRefGoogle Scholar
  21. 21.
    Ohl DA. Electroejaculation. Urol Clin North Am. 1993;20:181.PubMedGoogle Scholar
  22. 22.
    Vanderschueren D, Spiessens C, Kiekens C, et al. Successful treatment of idiopathic anejaculation with electroejaculation after microsurgical vas aspiration. Hum Reprod. 1998;13:370.PubMedCrossRefGoogle Scholar
  23. 23.
    Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26:1553–79.PubMedCrossRefGoogle Scholar
  24. 24.
    Dunsmuir WD, Holmes SA. The aetiology and management of erectile, ejaculatory, and fertility problems in men with diabetes mellitus. Diabet Med. 1996;13:700.PubMedCrossRefGoogle Scholar
  25. 25.
    Sexton WJ, Jarow JP. Effect of diabetes mellitus upon male reproductive function. Urology. 1997;49:508.PubMedCrossRefGoogle Scholar
  26. 26.
    Hojo K, Vernava III AM, Sugihara K, et al. Preservation of urine voiding and sexual function after rectal cancer surgery. Dis Colon Rectum. 1991;34:532.PubMedCrossRefGoogle Scholar
  27. 27.
    Nesbakken A, Nygaard K, Bull-Njaa T, et al. Bladder and sexual dysfunction after mesorectal excision for rectal cancer. Br J Surg. 2000;87:206.PubMedCrossRefGoogle Scholar
  28. 28.
    Turek PJ, Lowther DN, Carroll PR. Fertility issues and their management in men with testis cancer. Urol Clin North Am. 1998;25:517.PubMedCrossRefGoogle Scholar
  29. 29.
    Holman E, Kovacs G, Flasko T, et al. Hand-assisted laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular cancer. J Laparoendosc Adv Surg Tech A. 2007;17:16–20.PubMedCrossRefGoogle Scholar
  30. 30.
    Neyer M, Peschel R, Akkad T, et al. Long-term results of laparoscopic retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testicular cancer. J Endourol. 2007;21:180–3.PubMedCrossRefGoogle Scholar
  31. 31.
    Styblo K, Bossers GT, Slot GH. Osteotomy for kyphosis in ankylosing spondylitis. Acta Orthop Scand. 1985;56:294.PubMedCrossRefGoogle Scholar
  32. 32.
    Berger Y, Blaivas JG, Oliver L. Urinary dysfunction in transverse myelitis. J Urol. 1990;144:103.PubMedGoogle Scholar
  33. 33.
    Decter RM, Furness III PD, Nguyen TA, et al. Reproductive understanding, sexual functioning and testosterone levels in men with spina bifida. J Urol. 1997;157:1466.PubMedCrossRefGoogle Scholar
  34. 34.
    Sønksen J, Ohl DA. Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction. Int J Androl. 2002;25:324–32.PubMedCrossRefGoogle Scholar
  35. 35.
    Kafetsoulis A, Brackett NL, Ibrahim E, et al. Current trends in the treatment of infertility in men with spinal cord injury. Fertil Steril. 2006;86:781–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Sønksen J. Assisted ejaculation and semen characteristics in spinal cord injured males. Scand J Urol Nephrol Suppl. 2003;213:1–31.PubMedCrossRefGoogle Scholar
  37. 37.
    Kennedy SH, Dickens SE, Eisfeld BS, et al. Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord. 1999;56:201.PubMedCrossRefGoogle Scholar
  38. 38.
    Seidman S. Ejaculatory dysfunction and depression: pharmacological and psychobiological interactions. Int J Impot Res. 2006;18 Suppl 1:S33–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Hellstrom WJ, Sikka SC. Effects of acute treatment with tamsulosin versus alfuzosin on ejaculatory function in normal volunteers. J Urol. 2006;176:1529–33.PubMedCrossRefGoogle Scholar
  40. 40.
    Sharlip ID, Hellstrom WJG, Broderick GA. The ISSM definition of premature ejaculation: a contemporary, evidence-based definition. J Urol. 2008;179(Suppl):340.CrossRefGoogle Scholar
  41. 41.
    Read S, King M, Watson J. Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. J Public Health Med. 1997;19:387.PubMedCrossRefGoogle Scholar
  42. 42.
    Rowland DL, Haensel SM, Blom JH, et al. Penile sensitivity in men with premature ejaculation and erectile dysfunction. J Sex Marital Ther. 1993;19:189.PubMedCrossRefGoogle Scholar
  43. 43.
    Biri H, Isen K, Sinik Z, et al. Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study. Int Urol Nephrol. 1998;30:611.PubMedCrossRefGoogle Scholar
  44. 44.
    Haensel SM, Klem TM, Hop WC, et al. Fluoxetine and premature ejaculation: a double-blind, crossover, placebo-controlled study. J Clin Psychopharmacol. 1998;18:72.PubMedCrossRefGoogle Scholar
  45. 45.
    Kara H, Aydin S, Yucel M, et al. The efficacy of fluoxetine in the treatment of premature ejaculation: a double-blind placebo controlled study [see comments]. J Urol. 1996;156:1631.PubMedCrossRefGoogle Scholar
  46. 46.
    Kim SC, Seo KK. Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. J Urol. 1998;159:425.PubMedCrossRefGoogle Scholar
  47. 47.
    McMahon CG, Touma K. Treatment of premature ejaculation with paroxetine hydrochloride as needed: 2 single-blind placebo controlled crossover studies. J Urol. 1999;161:1826.PubMedCrossRefGoogle Scholar
  48. 48.
    Waldinger MD, Hengeveld MW, Zwinderman AH. Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: a double-blind, randomized, dose-response study. Br J Urol. 1997;79:592.PubMedCrossRefGoogle Scholar
  49. 49.
    Berkovitch M, Keresteci AG, Koren G. Efficacy of prilocaine-lidocaine cream in the treatment of premature ejaculation [see comments]. J Urol. 1995;154:1360.PubMedCrossRefGoogle Scholar
  50. 50.
    Andersen KH. A new method of analgesia for relief of circumcision pain. Anaesthesia. 1989;44:118.PubMedCrossRefGoogle Scholar
  51. 51.
    Choi HK, Jung GW, Moon KH, et al. Clinical study of SS-cream in patients with lifelong premature ejaculation. Urology. 2000;55:257.PubMedCrossRefGoogle Scholar
  52. 52.
    Annon J. The behavioral treatment of sexual problems, vol. 1. Honolulu: Enabling Systems; 1974.Google Scholar
  53. 53.
    Hendry WF, Rickards D, Pryor JP, et al. Seminal megavesicles with adult polycystic kidney disease. Hum Reprod. 1998;13:1567.PubMedCrossRefGoogle Scholar
  54. 54.
    Turek PJ, Magana JO, Lipshultz LI. Semen parameters before and after transurethral surgery for ejaculatory duct obstruction. J Urol. 1996;155:1291.PubMedCrossRefGoogle Scholar
  55. 55.
    Turek PJ, Aslam K, Younes AK, et al. Observations on seminal vesicle dynamics in an in vivo rat model. J Urol. 1998;159:1731.PubMedCrossRefGoogle Scholar
  56. 56.
    Sandler B. Idiopathic retrograde ejaculation. Fertil Steril. 1979;32:474.PubMedGoogle Scholar
  57. 57.
    Van der Linden PJQ, Nan PM, te Velde ER, et al. Retrograde ejaculation: successful treatment with artificial insemination. Obstet Gynecol. 1992;79:126.PubMedGoogle Scholar
  58. 58.
    Kim SW, Paick JS. Short-term analysis of the effects of as needed use of sertraline at 5 PM for the treatment of premature ejaculation. Urology. 1999;54:544.PubMedCrossRefGoogle Scholar
  59. 59.
    Hovav Y, Dan-Goor M, Yaffe H, et al. Nocturnal sperm emission in men with psychogenic anejaculation. Fertil Steril. 1999;72:364.PubMedCrossRefGoogle Scholar
  60. 60.
    Geboes K, Steeno O, De Moor P. Primary anejaculation: diagnosis and therapy. Fertil Steril. 1975;26:1018.PubMedGoogle Scholar
  61. 61.
    Denil J, Kupker W, Al-Hasani S, et al. Successful combination of transrectal electroejaculation and intracytoplasmic sperm injection in the treatment of anejaculation. Hum Reprod. 1996;11:1247.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.The Turek ClinicSan FranciscoUSA

Personalised recommendations