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Background 95% of men with spinal cord injuries exhibit difficulties with sexual function, including erectile dysfunction, anejaculation, retrograde ejaculation, poor ejaculatory force, and poor sperm quality. Aim The primary goal is to determine if well-established interventions, such as spinal cord epidural stimulation, are a feasible treatment for sexual dysfunction and if locomotor recovery training can be used to improve ejaculatory function in a rodent model of spinal cord injury (SCI). Methods Male Wistar rats underwent thoracic laminectomies (shams), spinal cord transections, or moderate spinal cord contusion injuries. In urethane-anesthetized rodents, terminal spinal cord epidural stimulation was performed to target the mid-lumbar level spinal generator for ejaculation (SGE) in animals with transection spinal cord injuries at 3-, 14-, or 70-days post-injury and in animals with sham surgeries and spinal cord contusions at 70 days post-injury. The impact of locomotor training frequency was examined in two groups of rats with spinal cord contusion, which underwent 1-hr of assisted plantar stepping on a treadmill, training two or five times weekly for 6 weeks. Terminal experiments in all groups were followed by measures of sperm concentration and post-mortem testicular weight and morphology. Outcomes Spinal cord epidural stimulation consistently induced the expulsion phase of ejaculation, and occasionally the emission phase of ejaculation in rats with chronic SCI. Results All animals were most responsive to spinal cord epidural stimulation combined with manual stimulation to induce ejaculation, with chronic injury resulting in the most consistent responses. Locomotor training improved response rates to spinal cord epidural stimulation, with intermittent training resulting in the most consistent induction of both the emission and expulsion phases of ejaculation. Sperm concentration was impacted by injury completeness and time-post injury, which was lowest in the chronic complete transection group of rats. Locomotor training resulted in an overall increase in sperm concentration, with 2 days per week of training resulting in a significant improvement of sperm motility. Clinical implications Spinal cord epidural stimulation combined with locomotor training is a feasible intervention for individuals with SCI who seek to regain sexual function. Strengths and limitations Although we have anecdotal reports of non-targeted L3 spinal cord epidural stimulation inducing ejaculation in humans having spinal cord injuries, the current outcomes may be underestimated as stimulation was carried out in anesthetized animals. Conclusion Spinal cord epidural stimulation to target the SGE is a feasible intervention for sexual dysfunction following SCI. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect on sexual function of ejaculation-sparing enucleation of the prostate using Thulium: YAG laser (ES-ThuLEP) versus continuous-wave Thulium Fiber Laser (ES-ThuFLEP). Methods: 112 patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia who wished to preserve ejaculation were treated. 58 patients underwent ES-ThuLEP (Group A) using the Cyber TM generator. 54 patients underwent ES-ThuFLEP (Group B) using the Fiber Dust generator. Sexual function was evaluated through the International Index of Erectile Function 5 (IIEF-5) score, the four-item Male Sexual Health Questionnaire (MSHQ-EjD), personal satisfaction and the occurrence of haemospermia and painful ejaculation 3 and 6 months after surgery. Results: Mean age of patients was 65.8 years in Group A and 66.7 years in Group B. Groups were comparable according to preoperative features. Mean preoperative IIEF-5 score was 18.8 in Group A and 17.9 in Group B (p = 0.14). In all cases an ejaculation-sparing procedure was performed sparing the tissue around the veru montanum and near the prostate apex. Three months after surgery mean IIEF-5 score was 19.3 in Group A and 18.0 in Group B (p = 0.12). Six months after surgery mean IIEF-5 score was 17.8 in Group A and 18.1 in Group B (p = 0.09). No significant differences were observed according to anterograde ejaculation (81.0% vs. 81.5%, p = 0.07), subjective satisfaction (72.4% vs. 74.1%, p = 0.10), painful ejaculation (10.3% vs. 11.1%, p = 0.14) and haemosparmia rate (12.1% vs. 14.8%, p = 0.08). Ejaculation and satisfaction rate were significantly higher with prostates ≥ 80 ml in both groups. Conclusion: Ejaculation-sparing enucleation of the prostate effectively preserved sexual function in the majority of patients, with high rate of anterograde ejaculation and subjective satisfaction, low rates of painful ejaculation and haemospermia and no significant differences between Thulium: YAG and Thulium Fiber Laser. Preservation of ejaculation and personal satisfaction were significantly higher with prostates ≥ 80 ml compared to smaller ones. [ABSTRACT FROM AUTHOR]

Abstract\nLAY SUMMARYIn rare cases, men have reported being capable of achieving multiple orgasms (MOs) during sexual activities. Here, we qualitatively documented the experience of 12 such men (52 ± 15 years old) using an anonymous online survey. In a single sexual activity session, five claimed to experience three to ten orgasms, and seven reported experiencing uncountable orgasms. During MOs, four men felt pleasurable sensations localized in their genitals, and seven felt pleasurable sensations radiating beyond their genitals. Ten participants reported being able to achieve non-ejaculatory MOs; five of whom stated their orgasms were within the first 60 s. Those with ejaculatory orgasms claimed to have a large variation in the timing between orgasms. Six participants reported being able to reach MOs during both solo and partnered sex, and the other participants could achieve MOs only during either solo masturbation or partnered sex. Five participants were able to achieve MOs without any training or aid. The remaining participants reported using a variety of techniques to reach MOs, including abstinence before sex, sex toys, mental and breathing control, and pelvic floor contraction control. In conclusion, the MOs experiences in men varied widely. Future studies to better understand the mechanisms of MOs are warranted.We documented the experience of 12 men who reported being capable of achieving multiple orgasms (MOs) during sexual activities. We noted the number of orgasms reported, presence of ejaculation, pleasurable sensation, and how they achieved MOs. The MOs experiences in men widely varied. [ABSTRACT FROM AUTHOR]

Sperm competition is known to favor the evolution of male traits that confer an advantage in gaining fertilizations when females mate multiply. Ejaculate production can be costly and the strategic allocation of sperm in relation to the sperm competition environment is a taxonomically widespread phenomenon. However, variation among males in their ability to adjust ejaculate allocation has rarely been explored. Here, we manipulated the phenotypic condition of male seed beetles, Callosobruchus maculatus , via larval diet quality and measured ejaculate allocation across varying levels of sperm competition manipulated using olfactory cues. Furthermore, we asked how strategic ejaculation was impacted by previous ejaculation. We found no variation in ejaculate allocation in response to experimentally manipulated cues to sperm competition. Ejaculate allocation was reduced by a male's previous mating history but was unaffected by the larval diets on which males were reared. We suggest that either male seed beetles are unable to adjust ejaculate size to the immediate competitive environment, or that sperm displacement strategies employed by males favor maximal investment at all mating events, especially when unmated females are infrequently encountered. As our study is one of few to examine condition dependence in strategic ejaculation, emphasis should be placed on future studies investigating this possibility across a wider range of taxa and animal mating systems. [ABSTRACT FROM AUTHOR]

Introduction: Morphological changes in the prostatic urethra and bladder cavity resulting from Aquablation treatment are still unknown. This study aims to assess the safety and efficacy of Aquablation within one-year post-surgery, focusing on both functional and endoscopic outcomes. Methods: Prospective enrollment of patients undergoing Aquablation (10/2018–04/2023) included those with baseline International Prostate Symptom Score (IPSS) ≥ 10, prostate volume from 40 to 80 mL, and Qmax ≤ 12 mL/s. Functional outcomes were evaluated at 1, 3, 6, and 12 months using uroflowmetry (Qmax), and dedicated questionnaires. Cystoscopy at three months assessed ablation quality on a Likert scale (1-poor; 5-excellent). Measurements included cavity length post-treatment and preserved prostatic tissue length at the apex. Additional evaluations encompassed veru-montanum preservation, presence of residual fluffy tissue or mucous flaps, ureteral orifices and bladder trigone injuries. Results: Out of 109 enrolled patients, one-year follow-up displayed significant improvements in Qmax (+ 103.08%), IPSS (-86.36%), and IPSS-QoL (-80.00%). Aquablation had no impact on erectile function and continence, preserving ejaculation in 96.3%. Of the 106 patients undergoing cystoscopy, prostatic urethra patency was satisfactory to perfect in 96.2%, with a median cavity length of 24 ± 8.2 mm. Residual median lobe was found in 11.3%, without significant impact on micturition outcomes. Positive outcomes included minimal fluffy tissue and mucosal flaps, and well-preserved ureteral meatuses, verumontanum, and bladder trigone. Conclusions: Aquablation showed efficacy in solving urinary symptoms with minimal impact on ejaculation up to one year post-surgery. A three-month post-surgery endoscopic evaluation supports its safety, efficacy, and conformity with the ablative planning. [ABSTRACT FROM AUTHOR]

Background: Recurrent pregnancy loss (RPL), defined as two or more failed clinical pregnancies, affects 1%–3% of couples trying to conceive. Nowadays up to 50% of cases remain idiopathic. In this context, paternal factors evaluation is still very limited. The aim is to address the topic of the male factor in RPL with a broad approach, analyzing collectively data on sperm DNA fragmentation (SDF) and semen parameters. We systematically searched in Pubmed/MEDLINE and Google Scholar from inception to February 2023. A protocol has been registered on PROSPERO (ID number CRD42022278616). PRISMA guidelines were followed. Methods: Pooled results from 20 studies revealed a higher DNA fragmentation rate in the RPL group compared to controls (mean difference [MD] 9.21, 95% CI 5.58–12.85, p < 0.00001, I2 98%). Age, body mass index (BMI), smoking, and alcohol intake were not associated with DNA fragmentation. Subgroup analysis by different SDF assays (TUNEL and COMET at a neutral pH vs. indirect assessment with other assays) and ethnicity did not highlight different results (p = 0.25 and 0.44). Results: Results pooled from 25 studies showed a significant difference comparing RPL and control groups regarding ejaculation volume (MD −0.24, 95% CI −0.43; −0.06, p 0.01, I2 66%), total sperm number (MD −10.03, 95% CI −14.65; −5.41, p < 0.0001, I2 76%), total sperm motility (MD −11.20, 95% CI −16.15; −6.25, p < 0.0001, I2 96%), progressive sperm motility (MD −7.34, 95% CI −10.87; −3.80, p < 0.0001, I2 97%), and normal sperm morphology (MD −5.99, 95% CI −9.08; −2.90, p 0.0001, I2 98%). A sub‐analysis revealed that Asian and Africans, but not white‐European RPL men had lower progressive sperm motility compared to controls. Conclusion: In conclusion, current review and meta‐analysis findings suggested that SDF and some specific semen parameters were associated with RPL in a multi‐ethnic evaluation. This effort opens future direction on a growing awareness of, first, how the male factor plays a key role and, second, how appropriate would be to establish a direct dialogue between the gynecologist and the urologist. Patient summary: We performed a systematic review and meta‐analysis on the male component of RPL. We found that sperm DNA fragmentation and some specific sperm parameters are significantly associated with RPL. [ABSTRACT FROM AUTHOR]

Background: Posterior urethral valves (PUVs) represent the most common cause of male congenital lower urinary tract obstruction, often responsible for renal dysplasia and chronic renal failure. Despite recent improvements in patients' outcomes thanks to prenatal ultrasound early diagnosis, PUVs can still impact sexual function and fertility. This study aims to review the available evidence on fertility in PUV patients, examining paternity rates and semen parameters. Methods: A review was conducted of the PubMed, Cochrane, Scopus, and Embase databases. Studies focusing on fertility and paternity outcomes in PUV patients were selected, including case reports, case series, and retrospective and prospective studies. Results: A total of 15 studies met the inclusion criteria. The review revealed that PUV patients often exhibit compromised semen parameters, including low sperm count, reduced motility, and abnormal morphology, as well as alterations in seminal plasma. PUV diagnoses are common in adults exhibiting infertility and ejaculation disorders, suggesting PUVs cannot be considered only a pediatric disease. Paternity rates among PUV patients were rarely reported in extenso, hampering the correct assessment of the overall medium paternity rate and its comparison with that of healthy individuals. Lastly, seminal parameters were assessed in a minimal cohort of patients, therefore, they could not be considered representative. Conclusions: Fertility and seminal parameters in PUV patients represent an under-investigated area. PUVs can variably and non-univocally affect fatherhood, and they may be associated with compromised semen quality. Early intervention and long-term follow-up are essential to address potential fertility issues. Future research should focus on developing targeted strategies to preserve and enhance fertility in this patient population. [ABSTRACT FROM AUTHOR]

Background Aim Materials and methods Results Discussion Conclusion Although some studies suggest that sleep deprivation may affect ejaculation regulation, related research is limited, and the mechanisms remain unclear.This study aimed to explore whether sleep deprivation influences ejaculation regulation through amyloid‐beta and to investigate its potential mechanisms.Normal ejaculating rats were randomly distributed into three separate groups for the study, and treated with sleep deprivation combined with saline gavage, sleep deprivation combined with sodium butyrate gavage, and control with saline gavage. The levels of amyloid‐beta and 5‐HT1A receptors were assessed through Western blotting, PCR, and immunohistochemical techniques. The levels of interleukin‐4 and serotonin (5‐hydroxytryptamine) in the brain were determined by enzyme‐linked immunosorbent assay.The experiment showed that the rats in the sleep deprivation combined with saline gavage group rats had a significantly faster ejaculation compared to the control combined with saline gavage group rats. Meanwhile, sleep deprivation combined with saline gavage group had the highest levels of amyloid‐beta oligomers in the brain tissue. Correlation results revealed that the levels of amyloid‐beta oligomers in brain tissue were inversely related to ejaculation latency and positively associated with ejaculation frequency. Furthermore, we found that elevated levels of amyloid‐beta oligomers in brain tissue led to upregulation of 5‐HT1A receptor expression. Additionally, elevated levels of amyloid‐beta oligomers in brain tissue were found to increase interleukin‐4 levels, thereby reducing 5‐hydroxytryptamine levels.Sleep deprivation indeed accelerates ejaculation, and this acceleration is closely related to amyloid‐beta. Sleep deprivation can increase amyloid‐beta levels in brain tissue, mediating a decrease in 5‐hydroxytryptamine levels and overexpression of 5‐HT1A receptors, thereby accelerating ejaculation.There is a significant correlation between elevated amyloid‐beta levels in brain tissue because of sleep deprivation and accelerated ejaculation. This study's main findings offer insights into the development of acquired premature ejaculation linked to poor sleep and establish a theoretical framework for investigating potential treatments for this condition. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus (HCV) reinfection rates are substantially higher than primary infection rates among men who have sex with men (MSM) with human immunodeficiency virus (HIV) in European cohorts. The behaviors mediating this high rate of transmission among MSM are poorly characterized. Methods We performed a prospective cohort study in New York City (NYC) of MSM with HIV who cleared HCV to determine the incidence of and risk factors for HCV reinfection. We assessed the risk behaviors for primary HCV in NYC: receipt of semen in the rectum, and sexualized methamphetamine use, along with route of use. Multivariable analysis was performed with Andersen-Gill extension of the Cox proportional hazards model. Results From 2000 through 2018, among 304 MSM with HIV who cleared HCV, 42 reinfections occurred over 898 person-years, for an incidence rate of 4.7 per 100 person-years. Assessing 1245 postclearance visits, only receipt of semen into the rectum was associated with reinfection (hazard ratio, 9.7 [95% confidence interval: 3.3–28.3], P <.001); methamphetamine use was not. Conclusions The high HCV reinfection rate over almost 2 decades demonstrates that sexual transmission of HCV is not inefficient or unusual and that direct-acting antiviral treatment is not sufficient for HCV elimination among MSM in NYC. The contrasts between both the rates of and risk factors for primary and HCV reinfection suggest that HCV prevalence is highly heterogenous among sexual networks and that sexualized methamphetamine use, rather than mediating transmission, is instead a surrogate marker for the highest HCV prevalence networks. As neither condoms nor treatment have been successful strategies for HCV prevention in NYC, novel interventions are needed to stem this sexually transmitted HCV epidemic. [ABSTRACT FROM AUTHOR]

Monochamus alternatus is a notorious pest of the pine forests across East Asian countries. Both large and small individuals of either sex coexist in the wild. However, whether and how body size affects sexual selection outcomes and longevity remains unknown. In this study, we allowed a male or a female of small or large size to choose between two mates of varying sizes, which were from a wild-caught population. Our results revealed that mating latency and frequency of mating attempts varied across different social environments. Both large males and large females preferred larger mates, whereas this preference was not observed for the small males and small females. Male–male competition had no significant effect on ejaculation duration and frequency or sperm number in ejaculates. When a single male had an opportunity to choose between two females of different sizes, the reproductive investment of small males towards the small females was almost doubled compared to that of the large males, i.e., longer ejaculation duration, higher ejaculation frequency, and greater numbers of sperm transferred. However, the greater mating efforts of small males did not translate to greater fecundity/fertility of small females. We also showed that regardless of their body size, females always had greater fertility when they mated with large males but evidence for a trade-off between fecundity and longevity was not found. Alternatively, female fecundity was positively associated with longevity, and fertility was negatively associated with longevity and fecundity. We discussed these results placing it in a broader context of mate choice evolutionary dynamics. [ABSTRACT FROM AUTHOR]

The prevalence of premature ejaculation (PE) across different cultures and nationalities has long been a topic of debate, with early studies suggesting that men in such regions as the Middle East and Asia experience higher rates. However, the validity of these claims has been questioned due to methodological inconsistencies and the lack of comparative studies that apply uniform diagnostic criteria across different populations. This narrative review aims to analyze the existing literature to assess whether justifiable support for cultural or national differences regarding PE prevalance truly exists. The review focused on empirical studies spanning from 1995 to 2024 that included men from multiple nationalities or cultures. Studies on patient or specialized populations or that assessed only ejaculation latencies (EL) were excluded. Three categories of studies were reviewed: (1) studies including multiple nationalities within a single analysis, (2) studies from different countries that used an identical method to determine PE status, and (3) studies employing varied methodologies to determine PE status. The review found that differences in PE prevalence across cultures are more likely due to methodological variations than true cultural or national differences. While some trends, such as slightly higher rates in Latin American and Asian countries, were noted, no consistent patterns emerged. Studies using standardized methods, like the PEDT, generally showed prevalence rates between 5% and 15%, with no clear outliers across regions. Thus, current evidence does not support significant cultural or national differences in PE prevalence. Methodological inconsistencies, such as reliance on self-report and non-standardized diagnostic criteria, likely contribute to perceived differences. Future research should focus on using standardized methodologies and include more studies from underrepresented regions, such as Latin America and sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Zinner syndrome (ZS) was first described by Zinner in 1914. This condition includes unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. ZS treatments ranging from medical drug therapy to laparoscopic interventions have been investigated in the literature. A 21-year-old patient presented with scrotal pain after ejaculation. The diagnosis was Zinner’s syndrome, and the patient underwent transperitoneal laparoscopic excision of the left seminal vesicle cyst. After 2 years, transurethral ejaculatory duct resection (TUR-ED) was performed at a single center because of symptomatic dilatation in the seminal vesicles. The patient’s 1-year urological follow-up after TUR-ED remained normal. This presentation is a case report of a single patient and two cases that are rare in the literature. Cyst aspiration and seminal cyst excision may be considered as first-line treatment options, but the possibility of recurrence should not be forgotten. Even if seminal cyst excision is performed, it should be kept in mind that TUR-ED may be required in the future. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of thyroid function on male fertility, focusing on hypo- and hyperthyroidism. Methods: A PubMed/MEDLINE, Web of Science, and Scopus research was performed. Original studies in English published online up to 31 May 2023 were selected and reviewed. The final reference list was defined based on the relevance of each paper to the scope of this review. Results: The available data in animals (31 studies) and human (26 studies) showed conflicting results. However, thyroid dysfunction altered erection and ejaculation both in animal models than in men. Conclusion: Both hypothyroidism and hyperthyroidism seem to cause ejaculation and erectile dysfunction. Hence, Guidelines recommend against the systematic screening for thyroid disorders in the men in sub-fertile couples, but only in men with ejaculation and erectile dysfunction and/or altered semen parameters. [ABSTRACT FROM AUTHOR]

Background Although the normal intravaginal ejaculation latency time (NIELT) as subjectively perceived by patients with premature ejaculation (PE) and expected IELT (EIELT), which represents the individual's expectations of what treatment for PE would achieve, are critically influential in the treatment of patients with PE, there is a significant dearth of exploratory research on NIELT and EIELT among patients with PE. Aim To explore the NIELT and EIELT of patients with PE, understand why patients with PE perceive such a long IELT as normal, and identify factors associated with EIELT. Methods We recruited both patients with PE and control subjects, and analyzed the parameters related to IELT using detailed interviews and questionnaires. Outcomes Parameters related to IELT. Results A total of 592 individuals (mean age 29.6 ± 6.2) were included in the study, comprising 466 patients with PE (mean age 28.3 ± 5.4) and 126 non-PE individuals (mean age 34.6 ± 6.5). The actual perceived intravaginal ejaculation latency time (PIELT), referring to the patient's self-assessed IELT at baseline, as well as NIELT, and EIELT of patients with PE, were 1.0 (1.0 − 2.0), 14.0 (10.0 − 15.0), and 15.0 (10.0 − 20.0), respectively. The control group's PIELT and EIELT were 15.0 (10.0 − 20.0) and 20.0 (15.0 − 24.3), respectively, showing statistical differences compared with the PIELT and EIELT in the PE group. In the PE group and the control group, 31.5% and 57.9% of individuals, respectively, have an EIELT greater than the average actual normal ejaculatory latency time of 15.0 minutes. Among patients with PE, 51.3% expressed a NIELT >10 minutes, identical to the EIELT in a higher percentage (59.4%). The control group's EIELT is 5 minutes longer than the PE group's EIELT. Multivariable linear regression analysis showed that age, marital status, education level, BMI, satisfaction evaluation of PIELT, PEDT score, and IIEF-6 score were not associated with EIELT; only NIELT (beta = 0.817, P  < 0.001) and PIELT (beta = 0.056, P  = 0.044) were related to EIELT. Clinical implications Sexual health care providers should be aware that patients with PE have excessively high expectations for IELT. Strengths and limitation The first study explores why patients with clinically diagnosed PE perceive long IELT as normal and examines factors associated with EIELT. Further validation is needed in different cultural contexts. Conclusion Patients with PE often have excessively high expectations regarding IELT, primarily due to their insufficient understanding of IELT. [ABSTRACT FROM AUTHOR]

Epigenetic mechanisms, including DNA methylation and histone modifications, govern chromatin arrangement in sperm, enhancing motility and safeguarding DNA integrity for accurate epigenetic inheritance. Abnormal methylation is linked to poor sperm quality and fertility issues, underscoring the need to study sperm DNA methylation and its impact on sperm function and embryo development in assisted reproductive technology. In this study, processed spermatozoa from 75 normozoospermic and 15 abnormal ejaculates were examined for sperm global DNA methylation levels using a colourimetric absorbance method. Although semen characteristics were poor in abnormal ejaculates, no significant correlation was found between sperm global DNA methylation levels and sperm characteristics in either normozoospermic or abnormal cohorts. However, mean global DNA methylation levels were significantly lowered in abnormal sperm samples compared to normozoospermic samples (p < 0.05). Furthermore, injecting spermatozoa from these patients (N = 50) into donor oocytes did not show a significant relationship between sperm global DNA methylation and embryo developmental competence. These findings highlight the limitation of sperm global DNA methylation as a biomarker for embryo development and quality. [ABSTRACT FROM AUTHOR]

This study aims to compare the embryological and clinical parameters of intracytoplasmic sperm injection (ICSI) cycles using testicular versus ejaculated sperm in male patients with elevated sperm DNA fragmentation (SDF). A total of 73 ICSI cycles were examined in couples where the male partner exhibited high levels of SDF. ICSI was performed using either ejaculated or testicular sperm. The primary outcomes were rates of blastocyst formation, high-quality embryo development, and clinical pregnancy. The DNA fragmentation index (DFI) for testicular sperm (16.81 ± 17.51) was significantly lower than that of ejaculated sperm (56.96 ± 17.56). While the blastocyst formation rate was significantly higher in the testicular sperm group compared to the ejaculated sperm group, no statistically significant differences were noted in fertilization rate (72.15% vs. 77.23%), rate of high-quality embryo formation (47.17% vs. 46.53%), clinical pregnancy (50% vs. 56.52%), Cumulative pregnancy (70.2% vs. 55.6%), or live birth rate (43.75% vs.43.48%). Testicular spermatozoa have no additional advantage over ejaculated spermatozoa except for blastocyst quality in patients with high SDF, the use of testicular spermatozoa for the first ICSI cycle in male infertility patients with high SDF should be undertaken after much consideration at present. [ABSTRACT FROM AUTHOR]

Objectives: The vacuum erection device (VED) is a second‐line treatment tool recommended in erectile dysfunction (ED) guidelines but has long been unavailable in Japan. A new VED, Vigor 2020® (A & HB Company Limited, Tokyo, Japan), has now been manufactured and received medical approval from the Pharmaceuticals and Medical Devices Agency in Japan. We conducted a retrospective observational study of ED patients who used Vigor 2020 in clinical practice. Methods: We analyzed male ED patients aged ≥20 years treated with Vigor 2020 in our outpatient clinics. The primary endpoint was improvement of erection as evaluated by an Erection Hardness Score (EHS) of ≥1 point. Secondary endpoints were improvement of sexual function and adverse events as evaluated by the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire for assessing ejaculatory dysfunction (MSHQ‐EjD). Results: Thirty‐three patients (mean age, 57.21 [27–86] years) could be evaluated before and after using Vigor 2020. Among the 16 patients with baseline EHS ≤2, 14 (93.33%) improved by ≥1 point, and 10 of these 16 patients (62.50%) improved to EHS ≥3 and could insert vaginally. Significant improvement was observed for IIEF total score and for the MSHQ‐EjD in patients with an EHS of ≥3 after use of Vigor 2020. No patient experienced significant adverse events. Conclusions: The Vigor 2020 may be an efficacious treatment tool for ED. Patients with significant ED experienced not only significant improvement of erection but also improvement of ejaculation with its use. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Premature Ejaculation (PE) occurs in 31% of men aged 18-59 years, leading to disappointment and avoidance of sexual relations. The current guideline of treatment for PE is Dapoxetine, which possesses several adverse effects causing the limitation of its long-term use. Silodosin, an alpha-1 blocker, has been proposed as a new option for treating PE due to its minimal side effects. Therefore, our study aims to assess the efficacy of silodosin in treating PE. Materials and methods: This systematic review and meta-analysis was in accordance with Cochrane Handbook guidelines. Comprehensive literature search was conducted in several databases including PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials. The studies were included if they met the following criteria: (1) Involving premature ejaculation patients; (2) Intervention using silodosin; (3) Comparing placebo or other therapies for PE (4) Outcome includes the Intravaginal Ejaculation Latency Time (IELT) and reported adverse events related to the therapy. Study quality was assessed using Cochrane risk-of-bias criteria. Statistical analysis in this study was performed using Review Manager 5.4 Results: A total of four studies were included in this meta-analysis. Our study showed that patients who received silodosin had a significantly longer IELT compared to control (MD: 132.54, 95% CI 51.51-213.57, p < 0.001). However, patient treated with silodosin also possessed significantly higher risk of adverse event for developing reduced semen ejaculation (OR 10.79, 95% CI 3.46-33.67, p < 0.0001). Conclusions: Silodosin significantly increased IELT. However, it also reduced semen ejaculation as its drug adverse effect. This result supports the clinical use of silodosin as an alternative treatment for premature ejaculation. [ABSTRACT FROM AUTHOR]

To report real-world experience of 4-year safety and efficacy outcomes of Aquablation procedure for the treatment of men with symptomatic benign prostatic hyperplasia (BPH). This is a prospective single-center, observational study evaluating the outcomes of robotic-assisted Aquablation therapy for moderate-to-severe BPH between December 2019 and December 2023. Patient-level data included age, prostate volume, IPSS score, peak urinary flow rate (Qmax), post-void residual (PVR) were evaluated at 3 M, 6 M, and Years 1-4. Primary outcomes included change in IPSS score, change in Qmax, change in PVR, preservation of antegrade ejaculation, and complications. In this cohort of 330 men, mean prostatic volume was 110.3 mL (range 38-330 mL) at baseline. International Prostate Symptom Score (IPSS) improved from a baseline of 23.8 (SD 8.4) to 6.9 (SD 2.9) at 4 years. Mean peak urinary flow rate (Qmax) also demonstrated improvement and increased from 6.4 mL/sec (SD 4.2) to 17.4 mL/sec (SD 5.5) at 4 years. At 1 year, mean prostate volume reduction was 45.5 mL (−41.3%). Postoperative antegrade ejaculation was preserved in 249/250 men (99.6)% of men. Complications included urinary tract infection within first month after procedure in 37 (11.2%) and bleeding requiring blood transfusion in 11 (3.3%). Thirteen patients (3.9%) required a second procedure including 2 for post-operative bleeding, 1 for a bladder neck disruption and 10 (3.0%) for transurethral resection of residual anterior tissue. We demonstrate Aquablation to not only be safe but also providing durable outcomes at 4 years for men with BPH. [ABSTRACT FROM AUTHOR]

Purpose of Review: To synthesize the current literature and contemporary landscape about promising advancements in clinical interventions targeting post-orgasmic illness syndrome (POIS). Recent Findings: PubMed search was performed, and articles were screened for relevance. 24 articles were deemed suitable for inclusion. Various pathophysiological mechanisms for POIS have been proposed, including immunologic hypersensitivity and sympathetic dysregulation. This syndrome may manifest post-intercourse, post-masturbation, or following spontaneous ejaculations, with flu-like symptoms persisting for a span of up to 7 days. Summary: Recurrent presentations of these symptoms significantly deteriorate both quality of life and sexual function in patients diagnosed with POIS, often leading to cognitive impairment and mood disturbances. While various therapeutic modalities have demonstrated efficacy in providing short-term relief, the management of acute episodes remains contentious. Furthermore, the dearth of longitudinal data hampers the establishment of definitive long-term management strategies for POIS sufferers. [ABSTRACT FROM AUTHOR]

Retrograde ejaculation (RE) consists of the reflux backwards, towards the bladder, of the ejaculate, during the emission phase of ejaculation, causing a total or partial absence of sperm emission, with the consequent diversion of semen into the bladder during the emission phase of ejaculation. Evaluating the ejaculate may not be sufficient for identifying RE in some patients. Hence, the management of infertility may involve the use of invasive methods such as epididymal fluid retrieval or testicular biopsy. This paper defines RE and methods for its diagnosis. A description is also provided of the techniques used for the detection of sperm in post-ejaculatory urine (PEU), the preparation and retrieval of sperm from urine and their subsequent use in assisted reproductive techniques. The diagnosis of RE is based on the detection of spermatozoa in PEU in patients with aspermia or oligozoospermia and low or normal seminal volume. Although the presence of sperm in PEU could be sufficient for a diagnosis of RE, there is a lack of consensus regarding the diagnostic criteria for PEU, and the literature available is very limited. A correct diagnosis of RE allows the use of PEU for recovering sperm and its subsequent use in assisted human reproduction techniques, thus avoiding invasive techniques. A significant number of patients with RE may remain undiagnosed. Therefore, it is essential to conduct an RE study in patients with suspicion, through the analysis of PEU, and to properly interpret the results for accurate diagnosis. [ABSTRACT FROM AUTHOR]

The current narrative review aims to summarize the relation of mitochondrial content (MC) and mitochondrial DNA copy number (MDCN) in spermatozoa with sperm penetrability, and to discuss the various determining factors during the process of spermatogenesis in mammals. There are many potential factors associated with the quantitative alteration of MC and MDCN in male gametes from spermatogenesis to ejaculation. Particularly, spermatogenesis may be the first step to jointly contribute to an incomplete reduction of MC and MDCN in spermatozoon. It appears to be now quite clear that some abnormalities during spermatogenesis and oxidative stress are the main factors highly associated with the quantitative change of MC and MDCN in spermatozoa, consequently affecting sperm quality and their penetrability into oocytes. Currently, a series of proteins contributing to form sperm midpiece during spermatogenesis and cytoplasmic elimination during spermiation have been currently identified. The present review provides insight into how these factors interact with sperm MC and MDCN, and handholds to gain a better understanding of their roles. This review also highlights the uniqueness of normal fertile spermatozoa which have relatively lower MC and MDCN, but have mitochondria that function completely in multiple pivotal physiological pathways. • Mitochondrial content (MC) and DNA copy number (MDCN) in sperm are summarized. • Higher sperm MC and MDCN reduce the penetrability. • Abnormal spermatogenesis and oxidative stress may also increase sperm MC and MDCN. • Some genes to induce cytoplasmic elimination at spermiation may affect sperm MC and MDCN. • This study provides insights into the mechanisms of how these factors interact with MC/MDCN. [ABSTRACT FROM AUTHOR]

After ejaculation, mammalian sperm undergo a series of molecular events conducive to the acquisition of fertilizing competence. These events are collectively known as capacitation and involve acrosomal responsiveness and a vigorous sperm motility called hyperactivation. When mimicked in the laboratory, capacitating bovine sperm medium contains bicarbonate, calcium, albumin and heparin, among other components. In this study, we aimed at establishing a new capacitation protocol for bovine sperm, using calcium ionophore. Similar to our findings using mouse sperm, bovine sperm treated with Ca2+ ionophore A23187 were quickly immobilized. However, these sperm initiated capacitation after ionophore removal in fresh medium without heparin, and independent of the Protein Kinase A. When A23187-treated sperm were used on in vitro fertilization (IVF) procedures without heparin, eggs showed cleavage rates similar to standardized IVF protocols using heparin containg synthetic oviduct fluid (IVF-SOF). However, when A23187 pre-treated sperm were further used for inseminating eggs in complete IVF-SOF-heparin, a significantly higher percentage of embryo development was observed, suggesting a synergism between two different signaling pathways during bovine sperm capacitation. These results have the potential to improve current protocols for bovine IVF that could also be applied in other species of commercial interest. • Exposure calcium ionophore improves bovine sperm hyperactivation after washing. • Sperm capacitation is achieved by transient exposure to calcium ionophore. • Exposure calcium ionophore trigger capacitation events independent of PKA. • Calcium ionophore capacitated sperm improve embryo production when used in IVF. [ABSTRACT FROM AUTHOR]

Background: Premature ejaculation (PE) is a common sexual problem, resulting in adverse effects on the quality of life, of both the patient and the partner. The idea of muscular contraction inhibition during the ejection phase of ejaculation by Botulinum toxin-A injection may delay ejaculation. Aim of study: This study was performed to assess the efficacy and safety of Botulinum toxin-A injection in PE treatment. Material and methods: This study included 45 married male patients diagnosed with primary PE. All included patients were injected with 75 units of Dysport equal efficacy of 25 units of Botulinum toxin-A (Botox) into three sites: the root of the penis (Group 1), glans penis (Group 2), and each side of the ischiocavernosus muscle (Group 3). All patients were subjected to an assessment of intravaginal ejaculation latency time (IELT) using a stopwatch and answering the Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire before and after treatment. Results: There was a statistically significant improvement in IELT after treatment in all groups. The most significant improvement was shown in Group 3 (average 108% increase), followed by Group 1 (74%) and Group 2 (40%), respectively. There was a positive correlation between age and the improvement in improved IELT. There was a statistically significant improvement in PEDTq scores in Group 1 and Group 3. Conclusion: Botulinum toxin-A injection into the root of the penis and ischiocavernosus muscle could be recommended in the treatment of premature ejaculation. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of ejaculatory dysfunction (EjD; failure of emission or retrograde ejaculation) on health‐related quality of life (HRQoL) after retroperitoneal lymph node dissection (RPLND) for testicular cancer and explore the efficacy of pseudoephedrine hydrochloride as treatment. Patients and Methods: In a single arm, phase II trial, patients at ≥6 months after RPLND were invited to complete patient‐reported outcome measures (European Organisation for Research and Treatment of Cancer [EORTC] quality of life questionnaire [QLQ]‐30‐item core, EORTC QLQ‐testicular cancer‐26, and Brief Male Sexual Function Inventory) evaluating HRQoL and sexual function in follow‐up (ACTRN12622000537752/12622000542796). If EjD was reported, post‐ejaculatory urine ± semen analysis was undertaken. In eligible patients, pseudoephedrine hydrochloride 60 mg was administered orally every 6 h for six doses. The primary endpoint was sperm count >39 million sperm/ejaculate (>5th centile) following treatment. The trial was powered to detect a clinically relevant 36% achieving sperm count of >39 million sperm/ejaculate. Secondary endpoints included semen volume >1.5 mL, total motile sperm count, safety, and HRQoL impacts. Results: Of the 58 patients enrolled, the median (interquartile range [IQR]) age was 35 (29–41) years, with a median (IQR) of 37 (18–60) months from RPLND. EjD was reported in 33 (57%), including 27/52 (52%) receiving follow‐up at our centre. There were no differences in global HRQoL; however, role functioning (P = 0.045), sexual problems (P < 0.005), and sexual enjoyment (P = 0.005) was poorer if EjD was present. In all, 24/33 (73%) patients with EjD consented to pseudoephedrine treatment. Of 22 evaluable patients, four (18%) achieved a sperm count of >39 million/ejaculate (P = 0.20), and four (18%) had a semen volume of >1.5 mL (P = 0.20). There was a mean increase of 105 million sperm/ejaculate (P = 0.051) and 1.47 mL increase in semen volume (P = 0.01). No safety concerns arose. Conclusion: Ejaculatory dysfunction is common after RPLND but did not impact global HRQoL in our cohort. Pseudoephedrine improved EjD for some; however, its efficacy was lower than expected. Pseudoephedrine may be considered on an individualised basis. [ABSTRACT FROM AUTHOR]

• Semen drainage may not be seen on underwear of a female in the supine position. • Activity post intercourse results in different distributions of seminal staining. • Sampling the gusset of underwear in layers may assist interpretation. • The likelihood of detecting semen drainage staining decreases over time. • Vaginal drainage was detected in underwear 36 h post intercourse. The UK and Ireland Association of Forensic Science Providers' (AFSP) Body Fluid Forum (BFF) conducted this research to investigate the occurrence of seminal fluid draining from the vagina onto underwear worn after penile-vaginal sexual intercourse with internal ejaculation. This study shows the differing effects of the female being either supine or upright and active on possible patterns of seminal staining on underwear, and the effect of time since intercourse on the deposition of seminal fluid on underwear in a limited study. Here, we demonstrate that post vaginal intercourse different distributions of semen staining can be observed on underwear. [ABSTRACT FROM AUTHOR]

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Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aimed to develop a laboratory method that allows the in vitro maintenance of honey bee drones for several days while preserving their reproductive capacity and to create a new open-source software for the automatic analysis of their sperm quality. Three experiments were performed. The first experiment was designed to validate the new open-source software named CASABee for sperm quality assessment specifically designed for the honey bee. The software was able to identify motile and static spermatozoa with high precision. Results showed a high correlation between the results of sperm quality obtained both manually and by the CASABee system (0.95 and 0.96 for sperm motility and concentration, respectively, p < 0.001). In the second and third experiments, the effect of in vitro maintenance of drones without attendant workers for four days on their ejaculatory capacity and sperm quality, respectively, was evaluated. Survival rate was 98.68%, 89.48%, 75.93%, and 60.97% on average on days 1, 2, 3, and 4 after capturing, respectively. A high proportion of the drones (80.37% on average) were able to ejaculate providing semen, and there were no significant differences in the ejaculatory capacity and sperm quality of drones on the different days of in vitro maintenance, except for sperm viability, which decreased slightly on day 4 (71.71% vs 82.8% on day 0, p < 0.05). It was concluded that the new CASABee system and the method for laboratory maintenance of honey bee drones facilitate the study of reproduction in this species. [ABSTRACT FROM AUTHOR]

Introduction: Benign prostatic hyperplasia (BPH) is a common urological condition, particularly among middle-aged and elderly men. Trans urethral resection of prostate (TURP) has some drawbacks, particularly concerning ejaculatory function. Ejaculation preserving TURP (Ep-TURP) is one such technique that aims at preserving the tissues that are primarily responsible for antegrade ejaculation. Methods and material: In this prospective study, patients with bothersome LUTS were randomized into Ep-TURP and standard TURP groups. Supramontal tissue was preserved in Ep-TURP while standard TURP group had resection of the entire prostatic tissue up to the verumontanum. The outcomes with regard to IPSS, Qmax, IIEF(Q9), Ejaculation and PVR were studied. Ejaculation projection score was separately calculated and assessed. Results: About 60 patients were studied, with 30 in each group. At 6 months' follow-up, complication rates were the same in both groups. The IPSS, Qmax, IIEF were similar and comparable. There was no change in erection in all patients (P = 0.559). The ejaculation was well preserved in Ep-TURP (p<0.001). Ejaculation projection score was maintained at 3.77 in the Ep-TURP group while in the standard group it was 0 (P<0.001). Conclusions: Ep-TURP is a safe and a cost-effective method of preserving ejaculation in patients undergoing TURP. This procedure adds a better quality of life that greatly aids in enhancing the improving his psychological outlook towards life. Ep-TURP has now emerged as the standard procedure of choice in sexually active young males needing TURP, as the degree of ejaculation is largely well preserved in patients undergoing this procedure. [ABSTRACT FROM AUTHOR]

Background Objective Method Results Conclusion Sexual position is one of the several aspects that affects ejaculation control, which is essential for sexual pleasure. Still little is known, nevertheless, about the connection between sexual positions and ejaculation duration.To investigate the impact of various sexual positions on the duration of ejaculation and gain a deeper understanding of the elements that influence the ability to control ejaculation.An online survey was carried out on a sample of 1904 heterosexual men between the ages of 18–65 years. Premature ejaculation (PE) diagnostic tool was used to define PE. Demographic, behavioral, and physiological traits that are linked to PE and non‐PE groups were collected. The participants listed their preferred sexual positions and the ones they changed to during ejaculating. Also, analyses were performed between male/female active or deep/shallow thrust positions and PE status.Although there were no appreciable variations in age or circumcision between PE and non‐PE groups, the age of first sexual experience was associated with PE status. Groups also varied in the number of weekly ejaculations, the duration of the favored ejaculations, and the characteristics of the erection. The most preferred sexual posture was the doggy style regardless of the group. When the non‐PE group felt to ejaculate, they preferred to change the position significantly more than the PE group (74% vs 67.2%; p < 0.05). However, when participants felt ejaculate, non‐PE participants tended to switch to shallow thrusting positions significantly more than PE participants, who preferred deeper positions (27.1% vs. 18%; p < 0.05).This study underlines the relevance of considering sexual positions in controlling PE. Modifying positions during sexual intercourse may offer a non‐pharmacological therapeutic alternative for improving ejaculation control. Future studies in this field might help to create tailored PE treatment strategies. [ABSTRACT FROM AUTHOR]

Objective : Amoxapine was previously recommended for the treatment of retrograde ejaculation ; however, its discontinuation led to the reintroduction of imipramine. This study aimed to evaluate the therapeutic effects of imipramine on retrograde ejaculation. Methods : Patients initiated on imipramine for retrograde ejaculation between September 1, 2022, and May 31, 2023 were retrospectively analyzed. Nineteen patients were switched from amoxapine to imipramine, and eight patients were newly initiated on imipramine. Imipramine dosage was adjusted as needed based on efficacy and patient preference. Efficacy was determined through patient interviews and was considered effective if antegrade ejaculation was possible. Results : The efficacy rate was 94.7 % for patients who switched from amoxapine ; however, eight patients showed reduced efficacy compared with amoxapine. Newly initiated therapy showed an efficacy rate of 25.0 %. Imipramine was increased in five patients who switched from amoxapine and in three newly initiated patients; however, none of them showed any effect from the increased dose. Four patients wanted to have a baby, and one case of antegrade ejaculation with imipramine resulted in pregnancy and delivery using ejaculated sperm. Conclusions : Imipramine may be an alternative, albeit less effective, treatment for patients for whom amoxapine was effective. However, the effect in newly initiated patients was small. [ABSTRACT FROM AUTHOR]

Simple Summary: As the incidence of colorectal cancer (CRC) increases among younger adults, the need for discussions regarding treatment-related infertility is growing. Treatment-related infertility is distressing to patients, and data show that patients desire pre-treatment fertility counseling and would take advantage of opportunities for fertility preservation. That said, counseling occurs far too infrequently, and surgeons are vastly underutilized for these conversations. In this review, we highlight the current knowledge regarding infertility and counseling in patients undergoing CRC treatment and provide an overview of the connection between abdominal and pelvic surgery on male and female infertility. Further, we identify topics of importance when conducting infertility counseling and elucidate the role of surgeons in these important conversations. As the incidence of colorectal cancer (CRC) increases among younger adults, the need for discussions regarding treatment-related infertility is growing. The negative impacts of gonadotoxic chemotherapy and pelvic radiation are well documented, but the role that surgical intervention for CRC plays in infertility is less clear. Additionally, treatment-related infertility counseling occurs infrequently. This review provides an overview of the connection between abdominal and pelvic surgery on male and female infertility and elucidates the role of surgeons in counseling to alleviate psychological distress in newly diagnosed patients. A review of the literature revealed that pelvic surgery leads to increased adhesion formation, which is known to be associated with female infertility. Furthermore, nerve damage from pelvic surgery has significant implications for ejaculatory issues in males and sexual dysfunction in both males and females, which ultimately impact pregnancy success. Patients have significant distress related to treatment-related infertility, and pre-treatment fertility counseling has been shown to alleviate some of this psychological burden. Nevertheless, many patients do not receive counseling, particularly in surgical clinics, despite surgeons often being the first providers to see newly diagnosed non-metastatic patients. Efforts should be made to enact protocols that ensure fertility conversations are being had with patients in surgical clinics and that patients are being referred to fertility specialists appropriately. This patient-centered approach will lessen the psychological burden placed on patients during a vulnerable time in their lives. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been growing interest in the use of hyaluronic acid (HA) for the treatment of premature ejaculation (PE). The efficacy of this treatment is quite controversial. Aim: This study intended to evaluate the efficacy and safety of glans penis augmentation with HA gel for PE. Methods: This systematic review includes randomized controlled trials (RCTs), primary clinical trials, prospective and retrospective studies, case series, and case reports. Searches in Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov were performed blindly by 2 reviewers. Outcomes: Intravaginal ejaculation latency time (IELT), questionnaires about PE, glans circumference (millimeters), and adverse events. Results: Thirteen studies were included in the evaluation: 4 RCTs, 8 prospective observational studies, and 1 restrospective study. The number of patients who received HA gel on the glans penis was 706. According to the results of 2 placebo-controlled RCTs, HA gel treatment significantly improved IELT at the end of the first month (mean difference [MD], 65.44 seconds). In the first month after the HA gel injection procedure, IELT increased vs before the procedure (MD, 176.18 [95% CI, 146.89-205.48]; P <.001, I2 = 83%). When the IELT values ​​were compared at 6 months after HA gel application, IELT improved vs before the procedure (MD, 143.93 [95% CI, 124.78-163.09]; P <.001, I2 = 82). The glans circumference expanded by approximately 1.5 cm after the procedure (MD, 14.82 mm [95% CI, 12.75-16.90]; P <.001, I2 = 65%). When the side effect profile of other studies was examined, side effects were observed in 91 patients after HA gel injection applied to 598 patients (15.22%). Among these side effects, the most common were pain (n = 46, 7.69%), bulla/nodule formation (n = 25, 4.18%), and ecchymosis (n = 20, 3.34%). Conclusion: While HA shows promise as a therapeutic option for PE, ongoing research is essential to elucidate its clinical utility, mechanisms of action, and comparative efficacy. [ABSTRACT FROM AUTHOR]

Purpose: Optimal sperm DNA integrity is essential for fertilization and embryo health. Research indicates that testicular sperm (TS), obtained via TESA or TESE, typically show lower sperm DNA fragmentation (SDF) than ejaculated sperm after standard abstinence. Shortening abstinence to less than 2 days might reduce SDF, offering a less invasive and more cost-effective alternative to surgical sperm retrieval. Yet, no studies have directly compared the efficacy of shorter abstinence against TS extraction for lowering SDF. Our meta-analysis aims to address this gap by comparing SDF levels in TS to those in ejaculated sperm after a short abstinence period. Methods: Meta-analysis of 16 randomized controlled and prospective observational studies included 4 on TS and 12 on short abstinence ejaculation. The meta-analysis followed MOOSE guidelines, scrutinizing databases including Cochrane Library, Web of Science, Embase, MEDLINE(R), and PUMBED up to November 16, 2023. The analysis was conducted using RevMan. The observational studies' methodological quality was assessed using the Newcastle–Ottawa Scale, and the overall evidence quality was evaluated following the GRADE criteria. To compare short ejaculation duration and TS (are not directly compared in the literature) for SDF levels, we analyzed relevant data from studies of each method. We adjusted the participant numbers in the TS group by 1/3 and included each TS study three times, to perform a comparison against the short duration studies which were in a ratio of 1:3. This approach maintained an unaltered cumulative subject count for the meta-analysis of TS studies. Results: A total of 641 patients were included, comprising 120 and 521 patients with SDF measurements following TS and ejaculation after a short abstinence period, respectively. The studies had varied inclusion criteria, with not all patients having an initial elevated SDF. Some studies had incomplete details on age and other demographics. However, the mean ± SD age of 93 TS patients was 38.15 ± 5.48 years vs. 37.7 ± 6.0 years of 444 short abstinence patients, demonstrating no significant difference (P = 0.544). Short abstinence durations ranged from 1 to 48 h. Diverse DNA fragmentation tests were used: TUNEL assay in three testicular sperm studies, SCD assay in one, and in the short abstinence group, four used TUNEL and six used SCD assays, along with one each using SCSA and Halosperm. The mean ± SD SDF was lower in the TS group than in the short abstinence group (mean difference − 9.48, 95%CI − 12.45 to − 6.52, P < 0.001, I2 = 85%). Sensitivity analysis revealed that no single study significantly influenced the results. Employing the GRADE criteria, the initial assessment categorized the overall quality of evidence as low due to the observational nature of the acquired data. All studies were of medium to high quality. Conclusion: This study suggests testicular sperm may be better than ejaculated sperm for improving SDF in infertility cases. Direct comparisons are needed, before deeming short abstinence less effective. Future research should directly compare reproductive outcomes using both methods. [ABSTRACT FROM AUTHOR]

Objective: Atomoxetine (ATX), a selective noradrenaline re-uptake inhibitor, is a preferred drug with sufficient efficacy and favorable safety profile for the treatment of attention-deficit hyperactivity disorder. Ejaculatory dysfunctions have been reported in the patients receiving ATX as sexual side effects, of which underlying mechanisms are largely unknown. The present study aimed to investigate the effect of ATX on mouse isolated vas deferens (VD) contractility as a potential mechanism of ATX-induced ejaculatory dysfunction. Material and Methods: Isolated organ bath studies were performed on prostatic parts of VD obtained from adult male Balb/c mice. The effect of ATX (10-6, 10-5, 3x10-5 and 10-4 M) on KCl (80 mM)-, phenylephrine (PhE, 3x10-4 M)-, adenosine 5'-triphosphate (ATP, 10-2 M)- and electrical field stimulation (EFS; 100 V, 64 Hz)-induced contractions of VD strips were evaluated in concentration dependent manner. Results: ATX at 10-6 and 10-5 did not alter the contractile responses (p > 0.05), however, higher concentrations of ATX (3x10-5 or 10-4 M) significantly inhibited the KCl-, PhE-, ATP- and EFSinduced contractions of VD strips (p < 0.05). Conclusion: The present study demonstrated for the first time that ATX decreased the contractile responses of mouse isolated VD concentration-dependently. Our results suggest that ejaculatory dysfunction might be related to the inhibitory effect of ATX on VD. [ABSTRACT FROM AUTHOR]

Background Women's experiences of the expulsion of fluids during sexual stimulation, commonly referred to as female ejaculation/squirting, are not well comprehended in the existing literature. Aim To investigate women's knowledge about and experiences of female ejaculation/squirting. Methods Data from 1568 women (aged 18 to 69) were collected using a cross-sectional online-based questionnaire (in Swedish). Outcomes The study focused on descriptive features of knowledge about, reactions to, occurrence of, and sensations around female ejaculation/squirting. Results Among the participants, 58% had experienced ejaculation/squirting (significantly more often among non-heterosexuals). Among women without such experience, only one-third would like it to happen. Among women with such experience, ejaculation/squirting occurred consistently during sexual practice for a small percentage (7%) and on a few occasions for about half (52%). Despite most (77%) rating it as primarily a positive sensation, many reacted with shock/shame (28%) or thought they had urinated (26%) the first time it occurred. Many (61%) reported orgasm occurring close to, or simultaneously, with ejaculation/squirting, and these women were more likely to report it as a positive sensation (P  < .001). Despite overall positive aspects, 58% had wanted to avoid it at some point, mainly because it got too wet or due to insecurities about the content of the fluid. Having wanted to avoid it at some point was more likely among those who sensed the fluid as being expelled from the urethra (P  < .001) or whose partner reacted negatively to it (P  < .001). Clinical Translation This study contributes with a nuanced understanding of women's experiences of ejaculation/squirting and related challenges. Strengths and Limitations This study is the first to explore women's desire for ejaculation/squirting, their initial reactions, and reasons for avoidance. There are limitations due to the nature of the data collection, such as missing data and potential overrepresentation of women who are informed and open-minded about ejaculation/squirting. Conclusion Ejaculation/squirting is a common occurrence among women and, despite being perceived predominantly positively, particularly when linked with an orgasm, initial reactions, and avoidance underscore complexities related to excessive wetness and insecurities about the fluid's content. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Antidepressants may lead to a series of sexual adverse effects (SAEs), among which ejaculation dysfunction (EjD) is often overlooked by clinicians. The purpose of the present network meta‐analysis was to assist drug adjustment by comparing and ranking the incidence of EjD among various antidepressants.Relevant studies were retrieved from PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov, and other additional records. Eligible randomized controlled trials (RCTs) assessed the rate of EjD in patients with major depressive disorder (MDD) and anxiety disorder after taking anti‐depressants. The incidences of EjD, erectile dysfunction (ED), decreased libido (DL), adverse events (AE), withdrawal due to adverse events (WDAE) and withdrawal due to lack of efficacy (WDLE) were pooled using odds ratio (OR) with their 95% confidence intervals (CI). The values of surface under the cumulative ranking curve (SUCRA) helped to rank the risk of each outcome in different antidepressants.Thirty RCTs comprising 18,157 patients were included. Results of all node‐splitting analysis demonstrated no statistical inconsistency (all P > 0.05). Clomipramine (OR 42.11, 95% CI [9.90, 179.08]), WS5570 (OR 28.99, 95% CI [1.48, 568.97]) and paroxetine (OR 18.63, 95% CI [9.33, 37.23]) had significant risk of EjD comparing to placebo. Additionally, duloxetine (OR 7.37, 95% CI [2.61, 20.78]), clomipramine (OR 5.29, 95% CI [1.72, 16.25]), paroxetine (OR 3.75, 95% CI [1.37, 10.26]) and escitalopram (OR 3.04, 95% CI [1.20, 7.71]) presented higher risk of ED comparing to placebo. Agomelatine, levomilnacipran, vortioxetine, trazodone, vilazodone, fluvoxamine and imipramine exhibited similar incidence of EjD with placebo (all P > 0.05). Besides, trazodone, vilazodone and vortioxetine had the top‐five SUCRA values in each of SAEs (EjD, ED and DL), and agomelatine might be alternative in EjD and DL. Considering about AE, WDAE and WDLE, vilazodone appeared to offer more satisfactory performance across all these aspects.For patients undergoing SAEs following the administration of antidepressants, trazodone, vortioxetine, vilazodone and agomelatine are alternative antidepressants. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Discussion and conclusion Anejaculation represents significant psychological distress and sexual and reproductive challenges among male individuals and couples. Effective fertility management options are available to address the reproductive challenges associated with anejaculation. However, there is a lack of methods to reverse the condition itself.This study aims to assess the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in patients suffering from anejaculation.A total of 94 patients with anejaculation individuals were randomly assigned to receive high‐frequency (HF) stimulation on the left dorsolateral prefrontal cortex (DLPFC), low‐frequency (LF) stimulation on the right DLPFC, and sham stimulation for 4 weeks, with daily sessions of stimulation occurring on five consecutive weekdays each week.After 4 weeks of rTMS treatment, the patients in both the HF and LF groups exhibited a similar reduction in their male sexual health questionnaire for ejaculatory dysfunction bother/satisfaction score, Hamilton Anxiety Scale score, Hamilton Depression Scale score, and Pittsburgh Sleep Quality Inventory score, which were statistically significant compared with sham treatment. Additionally, there were no significant differences observed in erectile function and cognitive function across the three groups. However, there were notable disparities in the cure rates between HF‐ and LF‐group patients (16.1% vs. 54.8%, p = 0.001). Additionally, it is worth noting that only two HF group patients and one LF group patient experienced spontaneously resolving minor adverse effects during the treatment process. At the 8‐week follow‐up, among patients who initially responded to the treatment, only one from the HF group experienced a relapse.The findings of this study demonstrate that rTMS represents a secure and efficacious remedy for anejaculation patients. [ABSTRACT FROM AUTHOR]

Simple Summary: In the Yucatán Peninsula, the availability and diversity of plants as food sources for bees vary throughout the year, which impacts dietary composition during the larval phase and compromises the development of their reproductive organs. We evaluated the eversion of the copulatory apparatus, ejaculation, and sperm quality of drones bred during flowering-scarcity (November–December) and flowering-onset periods (January–February). It was observed that more drones had a complete eversion of the copulatory apparatus during the flowering-onset period, with better ejaculation and sperm quality than those bred during the period of flowering scarcity. Insufficient protein intake during the larval phase of drones affects the development of reproductive organs and spermatogenesis. The aim of the study was to evaluate the effect of the flowering-scarcity and flowering-onset periods on the eversion of the copulatory apparatus, ejaculation, and sperm quality of drones (Apis mellifera L.). To stimulate the laying of drone eggs during the flowering-scarcity period, 1 L of sugar syrup was supplied weekly to the hives, along with a protein supplement made of 20% pollen and 80% brewer's yeast. During the periods of flowering scarcity and the onset of flowering, 800 drones were collected (200 per month). At the onset of flowering, 270 drones showed eversion of the copulatory apparatus, of which 162 ejaculated, compared to the flowering-scarcity period, where 112 drones showed eversion of the copulatory apparatus and 39 drones ejaculated. During the period of flowering onset, sperm parameters such as volume, concentration, motility, viability, acrosome integrity, and mitochondrial activity were higher compared to the period of flowering scarcity. In conclusion, we observed a greater number of drones with eversion of the copulatory apparatus and ejaculation, as well as better sperm quality with the drones bred during the period of flowering onset. These differences indicate that the flowering-scarcity period significantly impacts the reproductive parameters of drones. [ABSTRACT FROM AUTHOR]

Purpose: Mouse spermatozoa for archiving laboratory mice or for in vitro fertilization (IVF) are routinely obtained from the cauda epididymis of adult males sacrificed for this purpose. To avoid the death of the donor, we tested whether a precisely timed interruption of the mating act could be used for repeated sperm collection from laboratory mice. Methods: Sperm donors (B6D2F1) were mated with a receptive female, and mating behavior was observed. The stud was separated from the female 1–2 s after the onset of the ejaculatory shudder. The ejected copulatory plug with the yellowish viscous ejaculate was carefully removed from the penile cup. Results: A total of 80 ejaculates were successfully obtained from 100 ejaculations. The latency to first mount was 1.1 ± 1.1 min (mean ± SD) and to ejaculation 8.1 ± 4.7 min. The average number of mounts to ejaculation was 10.5 ± 5.8, and the mean number of spermatozoa per collected ejaculate was 1.86 ± 1.05 × 106. An average fertilization rate of 76% was observed after IVF. Conclusions: Separating the stud from the female just before ejaculation is feasible, easy to learn, and requires no special equipment. The sperm count of collected ejaculates is lower than natural ejaculations, but higher than previous in vivo sperm collection methods achieved. We recommend this simple sperm collection method in mice, especially when the donor cannot be sacrificed and/or repeated sperm collection from the same animal is required for experimental purposes. [ABSTRACT FROM AUTHOR]

Introduction: The primary objective of this investigation is to explore the impact of ejaculation on urinary flow rates in men experiencing lower urinary tract symptoms. Materials and Methods: This study involved the enrollment of 55 male patients who presented with lower urinary tract symptoms. An assessment encompassed components, including medical history, questionnaires related to sexual activity and lower urinary tract symptoms, bladder diary, physical examination, urinalysis, urine culture, ultrasound examination and measurements of serum prostate‐specific antigen, free flow uroflowmetry, and post‐void residual urine volume. All participants were instructed to abstain from ejaculation for 3 days before undergoing uroflowmetry (UF1). Subsequently, they were required to ejaculate. Subsequent uroflowmetry assessments were conducted at 2 to 4 h (UF2) and 48 to 50 h (UF3) after ejaculation. No further ejaculations were permitted during this timeframe. Results: The patients had a mean age of 50.97 ± 1.47 years. Statistically significant differences were observed in the mean values of Qmax and corrected Qmax (cQmax) between UF1 and UF2 measurements (p < 0.05). These differences were only in patients with benign prostatic enlargement (BPE) (p < 0.05). Furthermore, the number of patients with Qmax <15 mL/s showed a statistically significant difference between UF1 and UF2 measurements, specifically in the BPE group (p = 0.016). Conclusions: In this study, we have observed a significant and temporary increase in the Qmax following ejaculation, particularly among patients with BPE. This indicates that ejaculation can potentially complicate the interpretation of uroflowmetry results. Therefore, further research is necessary to gain a more comprehensive understanding of this phenomenon. [ABSTRACT FROM AUTHOR]

Pelvic fracture is a serious injury, which has a profound impact on sexual function due to concurrent nervous and urethral injuries. In this case report, we describe a 29-year-old single man who had retrograde ejaculation as a result of a pelvic fracture-related posterior urethral stricture. The patient wanted to improve his ejaculatory ability after experiencing urethral stricture for 8 years and retrograde ejaculation for 3 years following the pelvic fracture. We precisely located and measured the patient's urethral stricture using a retrograde urethrogram, and we used transrectal color Doppler ultrasound to track the patient's ejaculation process in real time. Next, we used urethral balloon dilatation to relieve the urethral stricture. Urinary obstruction symptoms have completely resolved, and the patient was able to urinate without any obstructions. Meanwhile, the real-time transrectal color Doppler ultrasound result showed that some semen might ejaculate externally by passing through the initial stricture area, while some semen continued to flow retrogradely into the bladder. [ABSTRACT FROM AUTHOR]

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Male infertility (MI) and male sexual dysfunction (MSD) can often coexist together due to various interplay factors such as psychosexual, sociocultural and relationship dynamics. The presence of each form of MSD can adversely impact male reproduction and treatment strategies will need to be individualized based on patients’ factors, local expertise, and geographical socioeconomic status. The Asia Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men’s Health and Aging (ASMHA) aim to provide a consensus statement and practical set of clinical recommendations based on current evidence to guide clinicians in the management of MI and MSD within the Asia-Pacific (AP) region. A comprehensive, narrative review of the literature was performed to identify the various forms of MSD and their association with MI. MEDLINE and EMBASE databases were searched for the following English language articles under the following terms: “low libido”, “erectile dysfunction”, “ejaculatory dysfunction”, “premature ejaculation”, “retrograde ejaculation”, “delayed ejaculation”, “anejaculation”, and “orgasmic dysfunction” between January 2001 to June 2022 with emphasis on published guidelines endorsed by various organizations. This APSSM consensus committee panel evaluated and provided evidence-based recommendations on MI and clinically relevant MSD areas using a modified Delphi method by the panel and specific emphasis on locoregional socioeconomic- cultural issues relevant to the AP region. While variations exist in treatment strategies for managing MI and MSD due to geographical expertise, locoregional resources, and sociocultural factors, the panel agreed that comprehensive fertility evaluation with a multidisciplinary management approach to each MSD domain is recommended. It is important to address individual MI issues with an emphasis on improving spermatogenesis and facilitating reproductive avenues while at the same time, managing various MSD conditions with evidence-based treatments. All therapeutic options should be discussed and implemented based on the patient’s individual needs, beliefs and preferences while incorporating locoregional expertise and available resources.

Purpose: Prostatic urethral lift has been an effective ejaculation sparing treatment for benign prostatic hypertrophy. The aim of this study was to evaluate the effect on male semen parameters. Methods: Between July 2014 and January 2022, 20 young men with urinary symptoms of BPH, unresponsive to drug treatment and motivated to preserve ejaculation for eventual paternity, underwent UroLift. Semen analysis was performed before and 6 month after surgery with evaluation of pH, volume, sperm concentration, total motility, vitality and morphology according to WHO 2011. All underwent digital rectal examination, transrectal prostate ultrasound to measure prostate volume, PSA, uroflowmetry, cystoscopy and urodynamics test if necessary. Objective and subjective urinary function was scheduled at 1, 3, 6, 12 month than yearly with UFM, IPSS, IIEF-5, and MSHQ-EjD-SF. Results: At a mean follow-up of 36 month (range 12 to 63), no retroejaculation or changes in seminal parameters occurred. Mean age was 44.5 (range 36.5 to 48) years. Mean operative time was 15 (range 10 to 20) min and 2.5 (range 2 to 4) implants per patients were used. At 6 month there were no difference in terms of total sperm count, volume, pH, motility, vitality, morphology, liquefaction, leucocytes (p = 0.9; p = 0.8; p = 0.7; p = 1; p = 1; p = 1; p = 0,2; p = 0.5). At last, Q-max increased by 64.4% (p = 0.001), post-void residual volume decreased by 66.6% (p = 0.016), and IPSS decreased by 60% (p < 0.001). IIEF and MSHQ-EjD-SF were preserved (p = 0.14, p = 0.4). Conclusions: UroLift appears safe technique to correct LUTS from BPH in young men desirous to preserve seminal analysis. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and methods Results Discussion Conclusion The current cutoff values of intravaginal ejaculation latency time for diagnosing lifelong premature ejaculation do not always match clinical practice, and the inconsistency in the cutoff values of intravaginal ejaculation latency time among different definitions has also posed challenges to both clinical management and research of premature ejaculation.To re‐evaluate the intravaginal ejaculation latency time and to find evidence‐based cut‐off values for diagnosing lifelong premature ejaculation that can be widely accepted and match clinical practice.We addressed the flaws of previous studies. Lifelong premature ejaculation was diagnosed based on both patient self‐report of premature ejaculation status and scores on the Premature Ejaculation Diagnostic Tool, with a control group consisting of non‐premature ejaculation individuals included for comparison. Utilizing receiver operating characteristic curve analysis, the optimal self‐estimated cutoff value for intravaginal ejaculation latency time in diagnosing lifelong premature ejaculation was determined.A total of 307 heterosexual participants (mean age = 30.7 ± 6.4) were included, comprising 187 lifelong premature ejaculation patients (mean age = 28.0 ± 4.6) and 120 non‐premature ejaculation individuals (mean age = 35.0 ± 6.5). 2.7% of lifelong premature ejaculation patients experienced anteportal ejaculation. 59.9%, 92%, and 97.9% of lifelong premature ejaculation patients displayed intravaginal ejaculation latency times within 1, 2, and 3 min, respectively. The receiver‐operating characteristic curve's area under the curve was 0.996 with a 95% confidence interval of 0.991–1.000 (p < 0.0001). The perceived intravaginal ejaculation latency time cut‐off at 3.5 (sensitivity = 97.9%, specificity = 99.2%) showed the highest Youden index compared with other options.Although we found that 92.0% of lifelong premature ejaculation patients had a perceived intravaginal ejaculation latency time within 2 min, a perceived intravaginal ejaculation latency time cutoff value of less than 3.5 min for diagnosing lifelong premature ejaculation could encompass a larger proportion (97.9%) of patients seeking medical help for complaints of PE, and increasing the perceived intravaginal ejaculation latency time cutoff value to 3.5 min would not significantly increase the false‐positive rate.The perceived intravaginal ejaculation latency time cutoff value for diagnosing lifelong premature ejaculation within a clinical practice context is 3.5 min. [ABSTRACT FROM AUTHOR]

Premature ejaculation (PE) is a common male sexual dysfunction that can cause significant distress in the patient and partner. This study aimed to compare the current international guidelines on PE to highlight their similarities and differences. We examined the latest guidelines from the European Association of Urology (EAU), American Urological Association/Sexual Medicine Society of North America (AUA/SMSNA), and International Society of Sexual Medicine (ISSM) by comparing definitions, classifications, epidemiology, pathophysiology, and recommendations on diagnosis and therapy. The quality of guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) Global Rating Scale (GRS). We found significant variations in the definitions of PE and recommendations on management of patients. The EAU guidelines were the most recent, the AUA/SMSNA guidelines lacked detail in some areas, and the ISSM guidelines were the most complete but also the least updated. The search for a unified definition and the development of standardized diagnostic and therapeutic pathways remain concrete issues to improve the management of patients with PE worldwide. [ABSTRACT FROM AUTHOR]

6-Cyanodopamine is a novel catecholamine released from rabbit isolated heart. However, it is not known whether this catecholamine presents any biological activity. Here, it was evaluated whether 6-cyanodopamine (6-CYD) is released from rat vas deferens and its effect on this tissue contractility. Basal release of 6-CYD, 6-nitrodopamine (6-ND), 6-bromodopamine, 6-nitrodopa, and 6-nitroadrenaline from vas deferens were quantified by LC-MS/MS. Electric-field stimulation (EFS) and concentration-response curves to noradrenaline, adrenaline, and dopamine of the rat isolated epididymal vas deferens (RIEVD) were performed in the absence and presence of 6-CYD and /or 6-ND. Expression of tyrosine hydroxylase was assessed by immunohistochemistry. The rat isolated vas deferens released significant amounts of both 6-CYD and 6-ND. The voltage-gated sodium channel blocker tetrodotoxin had no effect on the release of 6-CYD, but it virtually abolished 6-ND release. 6-CYD alone exhibited a negligible RIEVD contractile activity; however, at 10 nM, 6-CYD significantly potentiated the noradrenaline- and EFS-induced RIEVD contractions, whereas at 10 and 100 nM, it also significantly potentiated the adrenaline- and dopamine-induced contractions. The potentiation of noradrenaline- and adrenaline-induced contractions by 6-CYD was unaffected by tetrodotoxin. Co-incubation of 6-CYD (100 pM) with 6-ND (10 pM) caused a significant leftward shift and increased the maximal contractile responses to noradrenaline, even in the presence of tetrodotoxin. Immunohistochemistry revealed the presence of tyrosine hydroxylase in both epithelial cell cytoplasm of the mucosae and nerve fibers of RIEVD. The identification of epithelium-derived 6-CYD and its remarkable synergism with catecholamines indicate that epithelial cells may regulate vas deferens smooth muscle contractility. [ABSTRACT FROM AUTHOR]