#15. Male Infertility. Male Sexual Disorders - Erectile and Ejaculatory

Question 1

What is the Definition of Infertility?

Answer 1

Inability of Couple to Achieve Pregnancy within 1 Year of Regular, Unprotected Sexual Intercourse

Question 2

What is the Incidence of Infertility?

Answer 2

• 15% = Couples Don’t Achieve Pregnancy within 1 year
• 40% = Couples with Male Infertility
• 40% = Couples with Female Infertility
• 20% = Couples with Both (M+F) Infertility

Question 3

What is the Distribution of Male and Female Infertility?

Answer 3

• 40% = Couples with Male Infertility
• 40% = Couples with Female Infertility

Question 4

What are the Genetic Causes of Male Infertility?

Answer 4

Chromosomal Abnormalities

• Which are NOT FOUND in Somatic Diploid Cells
• Trisomies, Kleinfelters = 47,XXY; 46,XY
• Y-Microdeletions

Question 5

What is a Normal Temperature of the Scrotum?

Answer 5

• Must be 2-4C LOWER than the Body Temperature
• For Spermatogenesis to occur

Question 6

What is a Variocele?

Answer 6

Dilation of Testicular Veins in Pampiniform Plexuses

Question 7

What is the Incidence of Variocele in Healthy Men?

Answer 7

• Occurs in 12 - 15% of ALL Men!
• Occurs in 30-40% in Men with Male Infertility

Question 8

What are the Reasons for the Variocele to be more often on the left?

Answer 8

• Left Testicular Vein joins with Left Renal Vein at a RIGHT Angle
• Whereas Right Testicular Vein joins with RRV at an ACUTE Angle

Question 9

What are the Indications for Treatment of Variocele?

Answer 9

• Documents Testicular Growth Retardation VIA US Doppler Studies
• Or IMPAIRED Sperm Count
• INCREASED DNA Fragmentation

Question 10

What are the Methods of Obtaining Sperm in case of Obstruction?

Answer 10

1) Microsurgical Epididymal Sperm Aspiration (MESA)

2) Percutaneous Epididymal Sperm Aspiration (PESA)

3) Testicular Sperm Aspiration (TESA)

4) Open Testicuar Sperm Extraction (TESE)

Question 11

What are the Causes of Retrograde Ejaculation?

Answer 11

Retrograde E = Sperm enters the bladder, instead of out of the penis, during an orgasm

• Prostate / Bladder Surgery
• Diabetic Neuropathy
• Retroperitoneal Lymph Node Dissection
• Diseases of Brain / Spinal Cord
• alpha-blockers

Question 12

How is Premature Ejaculation Treated?

Answer 12

Premature E = Inability to DELAY ejaculation, which always occurs immediately or within a minute of vaginal penetration

1) Selective SEROTONIN Transport Inhibitors
- Fluoxetine (2 - 20mg / Day)
- Paroxetine (10 - 40mg / Day)
- Fluoxatine (10 - 60mg / Day)

2) Non-Selective SEROTONIN Transport Inhibitor = Dapoxetine

3) Topical Anaesthetics = Lidocaine Cream / Spray, applied on GLANS PENIS 20-30mins before Sex

4) Centrally-Acting Analgesics = Tramadol