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Questions and Answers
What is the normal pH of semen?
Which syndrome can present with subvirilization and gynecomastia?
What causes primary infertility?
What is the first choice of treatment for prolactinoma?
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Which condition can cause congenital bilaterally aplasia of the vas deferens?
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What does the parasympathetic system cause during penile erection?
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What neurotransmitter helps relax the smooth muscle helicine arteries during penile erection?
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Which enzyme degrades nitric oxide to end the penile erection process?
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When should semen be collected for analysis?
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'Secondary infertility' occurs when:
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What is the purpose of a vacuum erection device?
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Which factor can lead to artherosclerotic or traumatic occlusive disease causing erectile dysfunction?
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What is the purpose of a tourniquet-like ring used with a vacuum erection device?
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Which function does Alprostadil injections serve in the management of erectile dysfunction?
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What is the nocturnal penile tumescence test primarily used for?
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Why is a vacuum erection device not to be used for longer than 30 minutes?
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What is the primary basis for diagnosing erectile dysfunction?
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What is the first-line treatment for premature ejaculation according to the text?
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What is the recommended duration for using a vacuum erection device?
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What is the main cause of gynecomastia in male patients that could lead to infertility?
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Which condition could a patient have if they display small, soft testicles?
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Which genetic condition is associated with reduce to no sperm in the sperm count?
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What is the first choice of treatment for abnormally high prolactin levels in male patients?
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Which artery supplies the penis with blood during penile erection?
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What is the main type of erectile dysfunction characterized by life-long inability to initiate an erection?
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What is the primary function of nitric oxide during penile erection?
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What do PDE-5 inhibitors primarily work by preventing?
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What neurotransmitter helps in inhibiting the ejaculation center and postponing premature ejaculation when pain signals are detected?
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Study Notes
Male Infertility
- Infertility is defined as the inability to achieve conception despite one year of frequent unprotected intercourse.
Causes of Male Infertility
- Patient history is crucial in diagnosing infertility, including timing and frequency of intercourse.
- Avoiding vaginal lubricants is recommended due to the potential of spermicide.
- Pediatric history, including orchitis, testicular torsion, and cryptorchidism, can contribute to infertility.
Physical Exam of the Male Patient for Infertility Causes
- Gynecomastia in male patients may be caused by hyperprolactinemia.
- Klinefelter syndrome can present with subvirilization and gynecomastia.
- Small, soft testicles may indicate Sertoli cells-only syndrome due to hypogonadism.
- Small, hard testicles are a finding linked to Klinefelter syndrome.
Semen Analysis Results
- Semen should be collected 2-7 days after sexual abstinence with 2 separate collections at least 7 days apart.
- Normal semen pH is 7.8, and more acidic semen fluid may indicate ejaculatory duct obstruction.
- A red colored semen could indicate prostate inflammation.
- At least 32% of sperm should be mobile in a semen sample under a microscope.
Genetic Evaluation
- Y chromosome microdeletions assessment can be used to determine non-obstructive azoospermia.
- Cystic Fibrosis can cause congenital bilaterally aplasia of the vas deferens.
- Klinefelter Syndrome is the most common cause of non-obstructive azoospermia.
- XYY (called Jacob’s syndrome) can cause reduced to no sperm in sperm count.
Endocrine Testing
- Endocrine testing is recommended in male infertility for abnormally low sperm concentrations, impaired sexual function, or physical exam findings of endocrinopathy.
- Initial tests include morning serum testosterone, serum follicle stimulating hormone, and luteinizing hormone.
- Cabergoline is the first choice of treatment for prolactinoma.
Types of Male Infertility
- Primary infertility is the failure to conceive at any time in the past year with any partner.
- Secondary infertility occurs when there was prior conception with current or previous partners, but now the inability to conceive despite one year of frequent unprotected intercourse.
Neurophysiology of Penile Erection
- The internal iliac artery supplies the penis with blood.
- In the flaccid state, the helicine arteries are tonically contracted with little blood in the cavernae.
- During the erect state, the helicine arteries dilate to allow the cavernae to fill with blood and compress the veins against the tunica albuginea.
- The parasympathetic system causes the vasodilation of the helicine arteries.
- Pain signals from pinching the glans of the penis will inhibit the ejaculation center and postpone premature ejaculation.
- The main neurotransmitter to relax the smooth muscle helicine arteries to allow for penile erection is nitric oxide.
- Nitric oxide does not keep the deep artery dilated permanently, and the active agent is degraded by PDE-5 enzyme to end the erection.
- PDE-5 inhibitors work by preventing the degradation of the active agent to allow for erection, but they do not work without sexual stimulation.
Physiology of Sexual Intercourse
- During the emission stage of ejaculation, the ductus deferens contracts and moves sperm into the urethra.
- During the expulsion stage of ejaculation, the internal urethral sphincters contract to push sperm out.
ED Classifications and Diagnostics
- Erectile dysfunction is the inability to maintain an adequate erection for vaginal entry in half or more of one's attempts.
- There are neurogenic, vasculogenic, endocrine, and drug-causes types of erectile dysfunction.
- Primary erectile dysfunction is the life-long inability to initiate erection beginning with the first sexual encounter.
- The main type of neurogenic erectile dysfunction is diabetes mellitus, with a three-time higher risk of ED in diabetic patients.
- Smoking, hyperlipidemia, and hypertension can cause artherosclerotic or traumatic occlusive disease leading to erectile dysfunction.
- Diagnosis of erectile dysfunction tends to be based on physical exam findings and patient history.
- Nocturnal penile tumescence test is rarely used, recording erections.
Management of ED
- A vacuum erection device creates negative pressure surrounding the penis to engorge it with blood, but a tourniquet-like ring must be placed to keep the blood in the penis.
- Alprostadil injections can lead to muscle relaxation and erections.
- SSRI (paroxetine) is a first-line treatment for premature ejaculation.
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Description
Learn about the causes of male infertility and the importance of patient history in assessing fertility issues. Understand the significance of timing, frequency of intercourse, and avoiding vaginal lubricants when trying to conceive. Explore the connection between past conditions like orchitis and current fertility problems.
