#15. Male Infertility. Male Sexual Disorders - Erectile and Ejaculatory Flashcards
What is the Definition of Infertility?
Inability of Couple to Achieve Pregnancy within 1 Year of Regular, Unprotected Sexual Intercourse
What is the Incidence of Infertility?
- 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
What is the Distribution of Male and Female Infertility?
- 40% = Couples with Male Infertility
- 40% = Couples with Female Infertility
What are the Genetic Causes of Male Infertility?
Chromosomal Abnormalities
- Which are NOT FOUND in Somatic Diploid Cells
- Trisomies, Kleinfelters = 47,XXY; 46,XY
- Y-Microdeletions
What is a Normal Temperature of the Scrotum?
- Must be 2-4C LOWER than the Body Temperature
- For Spermatogenesis to occur
What is a Variocele?
Dilation of Testicular Veins in Pampiniform Plexuses
What is the Incidence of Variocele in Healthy Men?
- Occurs in 12 - 15% of ALL Men!
- Occurs in 30-40% in Men with Male Infertility
What are the Reasons for the Variocele to be more often on the left?
- Left Testicular Vein joins with Left Renal Vein at a RIGHT Angle
- Whereas Right Testicular Vein joins with RRV at an ACUTE Angle
What are the Indications for Treatment of Variocele?
- Documents Testicular Growth Retardation VIA US Doppler Studies
- Or IMPAIRED Sperm Count
- INCREASED DNA Fragmentation
What are the Methods of Obtaining Sperm in case of Obstruction?
1) Microsurgical Epididymal Sperm Aspiration (MESA)
2) Percutaneous Epididymal Sperm Aspiration (PESA)
3) Testicular Sperm Aspiration (TESA)
4) Open Testicuar Sperm Extraction (TESE)
What are the Causes of Retrograde Ejaculation?
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
How is Premature Ejaculation Treated?
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