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The article presents a review of Russian and international literature dedicated to the problem of painful ejaculation. Mentions of this type of disorders are quite rare. Its real incidence remains unknown. Connections between painful ejaculation and infectious and inflammatory diseases (orchitis, epididymitis, prostatitis, vesiculitis, urethritis), previous surgeries (in particular, transurethral resection of the prostate), administration of certain drugs (for example, antidepressants), rare congenital developmental anomalies are considered. Data on the effectiveness of conservative and surgical treatment are presented.

A triad of seminal vesical cyst, ipsilateral renal agenesis and ipsilateral ejaculatory duct obstruction is known as Zinner Syndrome. First described in 1914, only about 200 cases have been reported in literature. Usually it stays undiagnosed until the second to third decade of life due to lack of symptoms or nonspecific symptoms such as lower urinary tract symptoms, dysuria or painful ejaculation. In this report we present the case of a 22-year-old patient with a Zinner syndrome as an incidental finding and underlie a review of literature to show the main clinical and imaging implications. Keywords: Zinner syndrome, Seminal vesical cyst, Mesonephric duct abnormality, Epididymitis, MRI

Pain during sexual activity and ejaculation are the unspoken long-term complications of groin hernia repair. Laparoscopic surgical techniques are associated with decreased post-operative pain and earlier return to daily activities, but its effect on these complications is unclear. This study aims to investigate the effect of transabdominal preperitoneal repair (TAPP) on de-novo pain during sexual intercourse and ejaculation and to compare with open repair. For this reason, two groups were determined according to the surgical technique: the Lichtenstein repair and the TAPP groups and a questionnaire was sent to the patients a minimum of 6 months following the surgery. A total of 317 patients included, as 115 in TAPP and 202 in Lichtenstein repair group. No significant difference was observed concerning pre-operative pain during sexual activity and ejaculation in both groups (p = .75, p = .56). Following the surgery, the number of patients experiencing painful sexual activity was significantly higher in the Lichtenstein repair group compared to the TAPP group (19.3% vs. 11.3%, respectively, p = .03). The post-operative painful ejaculation rate was also significantly lower for the TAPP group (p = .04). The lower rates of post-operative dysejaculation and pain during sexual activity can be achieved with the advantage of laparoscopic surgery.

The purpose of this review is to summarize the pathophysiology of ejaculation and look into prevalence, aetiology, diagnosis, and treatment of painful ejaculation. We carried out a comprehensive search of PubMed in order to look for literature on male painful ejaculation using keywords post-orgasmic pain, painful ejaculation, dysejaculation, odynorgasmia, post-orgasmic pain, or dysorgasmia. Painful ejaculation has an alarming prevalence throughout the world, between 1 to 25%. It has a detrimental effect on patients' quality of life as it reduces individual self-esteem and is associated with sexual dysfunction. Its aetiology includes simple infection or inflammation of the urinary tract, benign prostate hyperplasia, ejaculatory duct obstruction, post-radical prostatectomy and side effects of certain medications. Once reported, it should be investigations and treatments should be tailored according to the etiology. Both medical and surgical treatment is available depending on the cause of painful ejaculation. Due to the sensitive nature of its presentation, it is a symptom that can be identified best when specifically asked. Our understanding regarding painful ejaculation is very limited and only a few articles have revealed insight into this topic. Further research is required in order to set proper guidelines for diagnosis and treatment of painful ejaculation.

Introducción y Objetivos La litiasis en vesículas seminales es una entidad rara, diferentes alteraciones anatómicas que obstruyen los ductos eyaculadores favorecen la precipitación y formación de cálculos. Nuestro objetivo es actualizar el enfoque diagnóstico y terapéutico a propósito de un paciente con esa patología. Materiales y Métodos Se describe el caso de un paciente de 42 años con sintomatología urinaria no específica, asociado a dolor perineal, diagnosticado posteriormente con Síndrome de Löfgren. Dada la persistencia de síntomas, se le realiza UROTAC con evidencia de calcificaciones bilaterales en vesículas seminales. Por tratarse de un hallazgo infrecuente y sintomático, realizamos una revisión de la literatura que nos permitiera orientar el tratamiento. Resultados La litiasis vesicular se presenta con sintomatología poco específica. Existen ciertos factores que favorecen la formación de cálculos en las vesículas seminales como lo son el microambiente propio de las vesículas seminales y alteraciones anatómicas que favorecen la obstrucción del tracto urinario. El método de elección para el diagnóstico es la ultrasonografía transrectal, la cual se debe realizar en todos los pacientes con sospecha clínica y síntomas urinarios no específicos. El tratamiento de elección es la vesiculoscópia transuretral con litotricia. Actualmente se está evaluando la realización de la vesiculoscópia transuretral. Conclusiones La litiasis de vesículas seminales es una entidad rara, con presentación clínica variable. Su diagnóstico y manejo se convierten en un desafío para el urólogo, debido a que no existe una alternativa de manejo estándar, el manejo dependerá de la experiencia en técnicas endourológicas y disponibilidad de equipos.

Although there has been an increased interest on premature ejaculation in the recent years, our understanding regarding the disorders of retrograde ejaculation, painful ejaculation and hematospermia remain limited. All three of these conditions require a keen clinical acumen and willingness to engage in thinking outside of the standard established treatment paradigm. The development of novel investigational techniques and treatments has led to progress in the management of these conditions symptoms; however, the literature almost uniformly is limited to small series and rare randomised trials. Further investigation and randomised controlled trials are needed for progress in these often challenging cases.

A large body of literature on diminished ejaculatory disorders has been generated without the use of a clear diagnostic definition. Many studies have not distinguished between the orgasm and ejaculation disorders leading to doubtful results. Delayed ejaculation (DE) is one of the diminished ejaculatory disorders, which range from varying delays in ejaculatory latency to a complete inability to ejaculate. The present review is aimed at providing a comprehensive overview of the current knowledge on the definition and epidemiology of diminished ejaculatory disorders. We focus on the acquired diseases, such as benign prostatic hyperplasia (BPH) and specific drug regimens that may cause an iatrogenic form of ejaculatory disorder. In addition, the impact of aging is discussed since the prevalence of DE appears to be moderately but positively related to age. Finally, we also focus on the importance of the hormonal milieu on male ejaculation. To date, evidence on the endocrine control of ejaculation is derived from small clinical trials, but the evidence suggests that hormones modulate the ejaculatory process by altering its overall latency.

Although ejaculatory dysfunction is common for patients undergoing benign prostatic hyperplasia surgery, no clear evidence is present to counsel men seeking to preserve ejaculation. Our aim was to evaluate ejaculatory dysfunction in relation to benign prostatic hyperplasia surgery. We carried out a web and manual search using MEDLINE and Embase including randomized controlled trials reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery: 42 randomized controlled trials comprising a total of 3857 patients were included. Only one study had ejaculatory dysfunction as a primary outcome, and just 10 evaluated ejaculatory dysfunction before and after surgery. The definition of ejaculatory dysfunction was not standardized. Similarly, just seven studies used internationally validated questionnaires to address ejaculatory dysfunction. The reported rates of ejaculatory dysfunction after resectional electrosurgery, laser procedures, coagulation, ablation and implant techniques were assessed and compared. Transurethral resection of the prostate and recent laser procedures including holmium, thulium and GreenLight cause similar rates of ejaculatory dysfunction, occurring in almost three out of four to five men. Although providing less symptomatic benefit compared with transurethral resection of the prostate, transurethral incision of the prostate, transurethral needle ablation and transurethral microwave thermotherapy should be considered for men aiming to maintain normal ejaculation. UroLift is also a recent promising option for this category of patients. The vast majority of studies reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery used poor methodology to investigate this complication. Future studies able to address clear hypothesis and considering ejaculatory dysfunction anatomical and pathophysiological features are required to develop ejaculation preserving techniques and to increase the evidence to counsel men aiming to preserve ejaculation.

The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side effects following the treatment of prostate cancer. Orgasmic dysfunction covers a range of issues including premature ejaculation, anorgasmia, dysorgasmia, and climacturia. This review provides an overview of prevalence and management options to deal with orgasmic dysfunction. A Medline Pubmed search was used to identify articles relating to these problems. We found that orgasmic dysfunction has a very large impact on patients’ lives following prostate cancer treatment and there are ways for physicians to treat it. Management of patients’ sexual health should be focused not only on erectile dysfunction, but on orgasmic dysfunction as well in order to ensure a healthy sexual life for patients and their partners.

We reviewed previous publications on post-orgasmic pain with reference to prevalence, epidemiology and treatment options, using the Ovid and PubMed (updated May 2006) databases to comprehensively search MEDLINE for reports on post-orgasmic pain that included peer-reviewed English-language articles. Official proceedings of internationally known scientific societies were also assessed. Because of the heterogeneity of the studies we did not apply meta- analytic techniques to the data. The incidence of post-orgasmic pain is 1-9.7%. The ejaculatory pain is associated with prostatitis, chronic pelvic pain syndrome, benign prostatic hyperplasia, and ejaculatory duct obstruction; it is also described in patients after procedures like radical prostatectomy. Aetiopathogenic theories include those referring to bladder neck closure and pudendal neuropathy. The treatment options vary from self-care, a 'perineal hyperprotection programme' to medication with the alpha-blocker, topiramate, and even surgical procedures like removing a section of the sacrotuberous ligament, neurolysis of the pudendal nerve or removing a section of the sacrospinous ligament. This is the first update of the subject, with reference to prevalence, epidemiology and treatment options. There is a need for adequately powered, prospective randomized trials on aetiology and treatment options.

Zinner syndrome refers to the triad of ipsilateral renal agenesis, seminal vesicle cysts and ejaculatory duct obstruction. Ipsilateral renal agenesis may be associated with seminal vesicle cysts in 70% of cases, but a remnant ureteral bud has been shown to coexist in only 27% of these cases. While some patients may remain asymptomatic and are discovered incidentally, others present with symptoms related to seminal vesicle cysts or ejaculatory duct obstruction: voiding or ejaculatory difficulty or pain. The diagnosis is made with imaging findings, and differentiation from other pelvic cysts requires a multimodality approach. In this report, we present typical imaging findings of a patient who presented with painful ejaculation where there was a congenital seminal vesicle cyst with ipsilateral renal agenesis associated with a remnant ureteral bud draining into the seminal vesicle cyst and also associated with a cyst of the prostatic utricle. We discuss the relevant embryological basis for this unusual combination of findings.

Sexual dysfunction is one of the important and common side effects of the antidepressant drugs. It can sometimes result in early discontinuation of the treatment. Reboxetine was previously not known to cause sexual side effects. However, we present here a case who developed painful ejaculation shortly after initiation of reboxetine treatment. The patient, a 40 years old male, was prescribed reboxetine treatment for his depression. Before the treatment he did not have any sexual dysfunction. Three weeks after inititation of reboxetine 4 mg/day treatment the patient started to complain about painful ejaculation. After cessation of the treatment his painful ejaculation spontaneously subsided. Sexual side effects particularly in terms of ejaculation disorders including painful ejaculation should be kept in mind when treating male patients with reboxetine., Cinsel işlev bozuklukları antidepresan ilaçların önemli ve sık karşılaşılan yan etkilerinden olup bazen tedavinin erken bırakılmasına neden olabilir. Reboksetin önceleri cinsel yan etkisi olmayan bir ilaç olarak bilinmekteydi. Ancak, biz burada reboksetin tedavisine başladıktan kısa bir süre sonra ağrılı ejakülasyon geliştirmiş olan bir olguyu sunmaktayız. Kırk yaşındaki bu hastaya depresyonu nedeniyle reboksetin tedavisi başlanmıştı. Başlanan 4 mg/gün dozundaki reboksetin tedavisinden 3 hafta sonra hasta ağrılı ejakülasyondan şikayetçi olmaya başladı. Tedavinin kesilmesinden sonra hastanın ağrılı ejakülasyonu kendiliğinden düzeldi. Reboksetin ile erkek hastaların tedavisinde cinsel yan etkiler, özellikle de ağrılı ejakülasyon dahil ejakülasyon bozuklukları akılda bulundurulmalıdır.

Presentation of Case A 32-year-old man was evaluated for a lesion of the urinary bladder. The patient had been well until 16 months earlier, when he had an episode of perineal pain associated with painful ejaculation and a brown, curdled ejaculate. There was no hematuria. His condition improved after treatment with ciprofloxacin. He had had no previous genitourinary symptoms except for the long-standing presence of dribbling after voiding. Four months before the evaluation, the patient was seen at this hospital because of urinary frequency of four days' duration, with intermittent passage of small blood clots in the urine, vague discomfort . . .

Objective To investigate the efficacy and safety of transurethral seminal vesiculoscopy in the diagnosis and treatment of intractable seminal vesiculitis. Methods This prospective observational study enrolled patients with intractable seminal vesiculitis. The transurethral seminal vesiculoscope was inserted into the bilateral ejaculatory ducts and seminal vesicles, via the urethra. The ejaculatory ducts and seminal vesicles were visualized to confirm the diagnosis of seminal vesiculitis and to determine the cause of the disease. The seminal vesicles were washed repeatedly using 0.90% (w/v) sodium chloride before a 0.50% (w/v) levofloxacin solution was injected into the seminal vesicles. Results A total of 114 patients participated in the study and 106 patients underwent bilateral seminal vesiculoscopy. Six patients with postoperative painful ejaculation were treated successfully with oral antibiotics and α-blockers. Two patients with postoperative epididymitis were treated successfully with a 1-week course of antibiotics. Haematospermia was alleviated in 94 of 106 patients (89%), and their pain and discomfort had either disappeared or had been obviously relieved, following treatment. Conclusion Transurethral seminal vesiculoscopy is effective for diagnosing and treating intractable seminal vesiculitis.

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Antidepressant drugs cause a variety of sexual side-effects. Painful ejaculation is a rarely reported side-effect of antidepressants, especially the newer drugs. A 59-year-old man with recurrent depression had normal sexual function while euthymic and mild decrease in libido while depressed.

Seminal vesicle stones are extremely rare, and few cases have been reported. Treatment requires removal of the stone, generally through an open vesiculectomy. A 31-year-old man presented with perineal pain, painful ejaculation, and infertility of several years' duration. Multiple stones in the seminal vesicle duct system were diagnosed by radiologic examination. We treated the patient by seminal vesicle endoscopic stone removal, thereby obviating organ loss. The composition of the stones was whewellite. To our knowledge, this approach has not been previously reported, and our result may be encouraging for treatment of such pathologic conditions of the seminal vesicles.

To the Editor. — Blythe and de Sylva1are erroneous in their belief that they are reporting the first case "of a breastfed infant having a clinical syndrome compatible with ciguatera toxicity." We noted in preparing a recent review of the subject2that affected mothers have been reported to transmit the illness through breast milk.3Furthermore, it appears that the disease may also be transmitted through semen, producing painful ejaculation in the man and dyspareunia in the woman.4

Ciguatera is a type of food poisoning associated with the consumption of contaminated marine fish. We report two cases in which painful ejaculation in an affected male and dyspareunia in an unaffected female following her partner's ejaculation suggest the sexual transfer of the responsible agent, ciguatoxin (CTX). Immunoassay of semen samples for CTX were not diagnostic, but the sensitivity and timing of the test employed may have precluded detection of small quantities of the toxin. We conclude that CTX may be present in the semen of men affected with ciguatera toxicity and be capable of producing symptomatology in both males and females during sexual intercourse.

Urethroscopy of the posterior urethra has been comparatively slow in developing, and not until the last few years has sufficient attention been directed to this important field. One result of this increased study has been the recognition of the important part which diseases of the verumontanum play in the production of severe and often distressing symptoms, generally classed as prostatic neuroses. In the milder cases remedial results were obtained by massage of the prostate, dilatations, instillations, etc. In others only temporary relief could be obtained by these measures, while in the aggravated cases frequently no amelioration was obtained.Wossidlo was the first to call attention to the manifold symptoms which resulted from inflamed conditions of the verumontanum. He found that various symptoms usually ascribed to chronic prostatitis were not infrequently encountered in individuals in whom no prostatitis could be demonstrated. Sexual disorders such as precocious ejaculation, painful ejaculation, frequent seminal

A case of congenital cyst of the seminal vesicle in association with an ectopic ureter is presented. The clinical, diagnostic and therapeutic aspects are discussed with special emphasis on the role played by ultrasound and computerized tomography in the evaluation of pelvic pain and painful ejaculation.