![]() In his article, he described two forensic cases, one of which was of an 18-year-old worker who was accused of a sexual offence. The paroxysmal sexual phenomena purportedly occurring during sleep were first mentioned in 1955 by a forensic psychiatrist, Dr Albrecht Langeluddeke. Until fairly recently, it was generally considered that sexual arousal and its manifestation in the form of various sexual activities could occur only during the period of wakefulness, albeit at night, and not during sleep, ignoring the fact that some physiological phenomena, such as nocturnal emissions and nocturnal orgasms, are clearly associated with sleep. Shapiro, in Encyclopedia of Sleep, 2013 Historical Overview If this method fails, electroejaculation and catheterization of the bladder could be considered. It is also possible to cryopreserve the sample obtained. The final pellet is resuspended in ~0.5 mL of culture medium for insemination. Sperm are recovered from the urine by centrifugation, washed, and resuspended in an IVF culture medium. On the day of ovulation, the man ejaculates and passes urine. 118 Urinary pH is adjusted to above 7 and osmolality to between 200 and 400 mOsm/kg by administration of 80 g of sodium bicarbonate and 2.0 to 2.5 L of water daily for 3 days before the expected time of ovulation. Motile sperm may be obtained from the urine after retrograde ejaculation. Retrieval of Sperm with Retrograde Ejaculation Men without complete sensory deprivation require general anesthesia for electroejaculation. Careful monitoring of blood pressure and prophylactic nifedipine treatment usually prevents serious problems. 83 The resulting uncontrolled hypertension may cause cerebral hemorrhage. Assisted ejaculation may cause autonomic hyperreflexia with chronic spinal cord injuries above T6. If the semen quality is too poor for AIH or the risks associated with electroejaculation are considered unacceptable, aspiration of sperm from the testis and ICSI produces good results. 83 As with necrospermia, repeated ejaculation over several days can improve sperm motility. 83 In contrast, with chronic spinal cord injury, there is frequently low volume, high sperm concentration, and poor motility. Semen obtained by assisted ejaculation from able-bodied men or men in the acute stages of spinal cord injuries is often normal. A balloon catheter in the bladder is used to prevent retrograde ejaculation. ![]() The probe includes a thermal sensor, and proctoscopy is performed before and after the procedure to ensure that there are no burns or other damage to the rectum. Modern electroejaculation equipment is safe. Men with complete spinal cord injuries below T10 are unlikely to respond and will require electroejaculation. Vibrators with a 2-mm pitch and frequency of 60 Hz or more are most effective. Assisted EjaculationĮjaculation may be stimulated by applying a vibrator to the underside of the penis near the frenulum of the glans. Cryopreservation of samples for artificial insemination with husband’s semen (AIH) or ICSI may also be possible. The timing of ovulation can be determined by calendar and either symptoms of ovulation or luteinizing hormone surge detected with a urinary luteinizing hormone dipstick kit. If semen can be obtained by masturbation or by wearing nontoxic condoms to collect nocturnal emissions, the couple can be taught to inseminate samples at home. 83 If these are unsuccessful, sperm may be collected by needle biopsy of the testis. 116 Others require more powerful stimulation with vibrators or electroejaculation. Some men with failure of ejaculation or retrograde ejaculation may be able to ejaculate during intercourse with a full bladder or after the administration of type 5 phosphodiesterase inhibitors, imipramine, or cholinergic antihistamines such as brompheniramine or ephedrine. 48 Impotence may respond to sex behavior therapy, administration of type 5 phosphodiesterase inhibitors, intrapenile injections of vasodilators, and physical approaches with pumps and rubber occlusion devices to initiate and maintain erections or penile implants but these are seldom needed in men with infertility. ![]() Gordon Baker, in Endocrinology: Adult and Pediatric (Seventh Edition), 2016 Specific TreatmentĪ drug that may be contributing to the sexual disorder (e.g., antihypertensive, tranquilizer) should be stopped temporarily or permanently.
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