Disorders of Ejaculation and Orgasm: Difference between revisions
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== Normal Ejaculatory Process == | == Normal Ejaculatory Process == | ||
=== | === <span style="color:#ff0000">Phases (3)</span> === | ||
# '''<span style="color:#ff0000">Emission and bladder neck closure</span>''' | # '''<span style="color:#ff0000">Emission and bladder neck closure</span>''' | ||
# '''<span style="color:#ff0000">Ejection (or penile expulsion)</span>''' | # '''<span style="color:#ff0000">Ejection (or penile expulsion)</span>''' | ||
# '''<span style="color:#ff0000">Orgasm</span>''' | # '''<span style="color:#ff0000">Orgasm</span>''' | ||
=== <span style="color:#ff0000">Emission</span> === | ==== <span style="color:#ff0000">Emission</span> ==== | ||
* '''<span style="color:#ff0000">Involves deposition of seminal fluid into the prostatic urethra</span>''' | * '''<span style="color:#ff0000">Involves deposition of seminal fluid into the prostatic urethra</span>''' | ||
*'''<span style="color:#ff0000">In response to cerebral stimulation, the thoracolumbar (T10-L2) sympathetic nerves stimulate contraction of</span>''' | *'''<span style="color:#ff0000">In response to cerebral stimulation, the thoracolumbar (T10-L2) sympathetic nerves stimulate contraction of</span>''' | ||
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**'''<span style="color:#ff0000">This results in swelling of the bulbar urethra</span>''' | **'''<span style="color:#ff0000">This results in swelling of the bulbar urethra</span>''' | ||
* '''<span style="color:#ff0000">Bladder neck closure occurs concurrently with emission</span>''' in response to alpha-sympathetic stimulation by the sympathetic innervations | * '''<span style="color:#ff0000">Bladder neck closure occurs concurrently with emission</span>''' in response to alpha-sympathetic stimulation by the sympathetic innervations | ||
**'''Sympathetic nerve fiber damage, such as that which can occur during a RPLND, can result in failure of the bladder neck to contract effectively''' '''allowing semen deposited into the prostatic urethra to pass in a retrograde fashion into the bladder (i.e., RE).[https://pubmed.ncbi.nlm.nih.gov/33295257/ §]''' | |||
=== Ejection === | ==== Ejection/Expulsion ==== | ||
* '''Distension of the bulbar urethra stimulates the somatic pudendal nerve (S2-S4 nerve roots (Onuf's nucleus)) resulting in | * '''Antegrade flow of semen throw the urethral meatus''' | ||
*'''Due to the combined action of sympathetic and somatic pathways''' | |||
*'''Distension of the bulbar urethra stimulates the somatic pudendal nerve (S2-S4 nerve roots (Onuf's nucleus)) resulting in''' | |||
**'''Rhythmic contractions of the bulbocavernosus and pelvic floor muscles''' | |||
**'''Relaxation of the external urinary sphincter''' | |||
**'''This results in semen being projected in an antegrade fashion.''' | |||
* Ejection also involves a sympathetic spinal cord reflex, on which there is limited voluntary control. The bladder neck closes to prevent retrograde flow; the bulbocavernous, bulbospongiosus, and other pelvic floor muscles contract rhythmically, and the external urinary sphincter relaxes. Intermittent contraction of the external urethral sphincter prevents retrograde flow into the proximal urethra | * Ejection also involves a sympathetic spinal cord reflex, on which there is limited voluntary control. The bladder neck closes to prevent retrograde flow; the bulbocavernous, bulbospongiosus, and other pelvic floor muscles contract rhythmically, and the external urinary sphincter relaxes. Intermittent contraction of the external urethral sphincter prevents retrograde flow into the proximal urethra | ||
*Failure of emission is a condition whereby semen fails to be deposited into the prostatic urethra. | |||
**Differentiating between retrograde ejaculation and failure of emission '''[https://pubmed.ncbi.nlm.nih.gov/33295257/ §]''' | |||
***Requires analysis of a urinalysis after the achievement of orgasm. | |||
****Patients should be instructed to urinate before masturbating to orgasm. | |||
***Can guide treatment | |||
****α-sympathomimetic agonists have been shown to improve bladder neck closure and may be of benefit to men with retrograde ejaculation after retroperitoneal surgery | |||
*****Common oral treatment with α agonists involves 60 mg of pseudoephedrine given orally 4 times a day for two days prior to production of a sample. | |||
=== Orgasm === | ==== Orgasm ==== | ||
* Orgasm is the result of cerebral processing of pudendal nerve sensory stimuli resulting from increased pressure in the posterior urethra, sensory stimuli arising from the verumontanum, and contraction of the urethral bulb and accessory sexual organs. | * Orgasm is the result of cerebral processing of pudendal nerve sensory stimuli resulting from increased pressure in the posterior urethra, sensory stimuli arising from the verumontanum, and contraction of the urethral bulb and accessory sexual organs. | ||
=== Effect of spinal cord injury of ejaculation === | ==== Effect of spinal cord injury of ejaculation ==== | ||
* '''SCI above L2: no ejaculation''' | * '''SCI above L2: no ejaculation''' | ||
** Emission will not be intact but ejection will be | ** Emission will not be intact but ejection will be | ||