Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Urology, Weill Cornell Medicine, New York, NY, USA.
Sex Med Rev. 2018 Jul;6(3):419-428. doi: 10.1016/j.sxmr.2017.12.005. Epub 2018 Feb 17.
Ejaculation consists of the emission of semen from seminal vesicles and prostate, followed by expulsion. Ejaculatory dysfunction may take several forms including premature ejaculation, delayed or anejaculation, retrograde ejaculation, and painful ejaculation. Ejaculation is what we can see whereas orgasm is what we feel. The presence of ejaculate does not indicate the ability to experience orgasm. Hence, for the purpose of this work we consider orgasm and ejaculation as 2 separate neurobiological phenomena.
To review the role of advanced investigative techniques such as perineal ultrasound in the diagnosis and management of ejaculation and ejaculatory dysfunction.
We performed a PubMed search for key words individually and in combination: "ejaculation," "ejaculatory dysfunction," "delayed ejaculation," "painful ejaculation," "retrograde ejaculation," "perineal ultrasound," and "transrectal ultrasound." We also share our local experience using perineal ultrasound in assessing ejaculation.
Perineal ultrasound can be used as an aid in the investigation of ejaculatory dysfunction.
Evaluation of ejaculatory function hinges on a detailed psychosexual history and appropriate physical examination. Function of the ejaculatory center in the spine is androgen dependent; thus, hormonal evaluation is an important aspect of the workup. Disorders of ejaculation and orgasm require evaluation of neuromuscular reflexes activated during sexual activity. Dynamic ultrasonographic (US) ejaculatory-orgasmic studies allow for reproducible and detailed descriptions of the sexual response. Transrectal ejaculatory studies are useful in uncovering reasons for lack of antegrade semen emission, especially in men with poor sperm production or after vasectomy. Dynamic US studies contribute clinical utility in its non-invasive nature and can provide insight to the dynamic processes surrounding pelvic floor functioning in men.
Perineal US for men with delayed ejaculation or anejaculation, painful ejaculation, or retrograde ejaculation may be helpful in select cases. Further research using this modality may help advance our understanding of ejaculatory dysfunction. Forbes CM, Flannigan R, Paduch DA. Perineal Ultrasound: a Review in the Context of Ejaculatory Dysfunction. Sex Med Rev 2018;6:419-428.
射精包括精液从精囊和前列腺的射出，随后是排出。射精功能障碍可能有多种形式，包括早泄、延迟或无射精、逆行射精和射精疼痛。射精是我们能看到的，而高潮是我们能感觉到的。精液的存在并不表明能够体验到高潮。因此，为了本研究的目的，我们将高潮和射精视为两种独立的神经生物学现象。
综述高级影像学技术，如会阴超声在射精和射精功能障碍诊断和管理中的作用。
我们单独和组合使用关键词在 PubMed 上进行了搜索：“射精”、“射精功能障碍”、“延迟射精”、“射精疼痛”、“逆行射精”、“会阴超声”和“经直肠超声”。我们还分享了我们在评估射精时使用会阴超声的本地经验。
会阴超声可作为射精功能障碍的辅助检查手段。
对于延迟射精或无射精、射精疼痛或逆行射精的男性，会阴超声可能有助于选择病例。使用这种方式的进一步研究可能有助于加深我们对射精功能障碍的理解。
