Neurogenic Ejaculatory Disorders: Focus on Current and Future Treatments

Abstract

Ejaculation is a complex and still poorly understood neurological mechanism, at both spinal and cerebral levels as it is closely associated with orgasm. Physiologically, ejaculation is defined as the expulsion of seminal fluid from the urethral meatus and consists of two phases, namely emission and expulsion. Ejaculation is mediated by a spinal control center, referred to as a spinal pattern generator that coordinates sympathetic, parasympathetic and motor (somatic) outflows, integrating the latter with the inputs from the supraspinal sites in brainstem, hypothalamus and preoptic area. Premature ejaculation (PE) is the most common sexual dysfunction among young men, and it has been considered mostly psychogenic in origin, although it can be associated to diverse urological and neurological diseases. On the contrary, retrograde ejaculation and anejaculation are predominantly related to organic causes, particularly to neurogenic ones. Since ejaculation is mostly a spinal reflex, it is comprehensible that ejaculatory disorders are more frequent in spinal cord injury than in other neurological disorders. Over the past decades, research has focused on PE, and evidence from clinical studies showed a beneficial effect of antidepressants for the treatment of men with PE. Other ejaculatory disorders, especially painful ejaculation, have been less investigated and the proper therapy is still controversial. Aim of this review is to provide a comprehensive description of both currently available treatments and most promising future therapies, including assigned patents, for the neurogenic ejaculatory disorders.

Is there a correlation between intravaginal ejaculatory latency time and enuresis? An exploratory study

“…Ejaculation is a complex neurological mechanism at both the spinal and cerebral levels [16]. Neurologically, the ejaculatory reflex requires sensory receptors, afferent pathways, cerebral, sensory, motor, and spinal motor centers, and efferent pathways [17, 18].…”

Oxcarbazepine-related retrograde ejaculation

“…Autonomic sympathetic efferents cause contraction of smooth muscle in the prostate, vas deferens and seminal fluid as well as bladder neck contraction that reaches a pressure up to 500 cm H 2 O to prevent retrograde flow of the semen into the bladder. Then, semen is expelled through rhythmic contractions and relaxations of striated perineal muscles, primarily the bulbospongiosus muscle [4].…”

“…Indeed, if this closure cannot occur because of anatomo-physiologic or medical reasons (surgical nerve damage, diabetic neuropathy, and spinal cord injury), the emitted semen takes the path of least resistance and flows backward into the bladder [1,4].…”

The infertility overcoming in men with retrograde ejaculation and anejaculation

“…В то же время в исследовании MSAM-7 снижение объема эякулята или его полное отсутствие в те-чение месяца, предшествующего анкетированию, отметили 30,1, 54,9 и 74,3 % респондентов в воз-расте 50-59, 60-69 и 70-80 лет соответственно. Эти нарушения семяизвержения снижали качество жизни каждому второму опрошенному мужчи-не [1], уменьшали степень сексуального удовлет-ворения их партнерш [2], а также нередко служи-ли поводом для обращения к врачу, в том числе и в связи с невозможностью добиться наступления беременности. За последние годы были получены и систематизированы знания о работе двух веду-щих и взаимосвязанных механизмов семяизвер-ISSN 2225-9074…”