CLINICAL OBSERVATIONS OF EJACULATORY DISTURBANCE

Abstract

For the past 4 years and half 39 cases with ejaculatory disturbance were experienced in our clinic.
1) Age and Incidence. The incidence of ejaculatory disturbance was 0.5% of the whole outpatients of our clinic. The age of the patients ranged between 17 to 40 years with the highest incidence in the thirties.
2) Classification of ejaculatory disturbance. In this report ejaculatory disturbance was classified into 4 groups: Group A; the patients who complained of abscence of both ejaculation and orgasm; Group B, the patients who complained of absence of ejaculation but maintained orgasm; Group C, the patients who maintained both ejaculation and orgasm; Group D, the patients who maintained ejaculation but complained of loss of orgasm. The incidence of these 4 groups were as follows: Group A, 15 cases (38%); Group B, 8 cases (21%); Group C, 13 cases (33%); and Group D, 3 cases (8%).
3) Past history. In Group A, 6 cases had past history of mental diseases; 1 case, polyomyelitis; and 1 case, stomach ulcer. In these cases ejaculatory disturbance occurred during the medication for the diseases. Therefore, these diseases or the medication for them were suspected to be the causative factors of ejaculatory disturbance. No specific history which was suspected of relation to ejaculatory disturbance was found in Group B, C, and D.
4) Physical examinations. No remarkable findings were obtained in the physical examinations throughout the groups.
5) X-ray examinations. Plain films of lumbo-pelvic region. Spina bifida occulta was seen in 4 cases of 39 cases with ejaculatory disturbance; abnormal enlargement of the intravertebral space, in 1 case; and deformity in the lumbar vertebra, in 1 case. The relation between these anomalies and ejaculatory disturbance could not be clarified.
Cystography. No remarkable finding was seen in Group A, C, and D. In Group B patency of the internal urethral orifice was seen in 7 cases. In 6 of these 7 cases the internal urethral orifice opened slightly by abdominal straining and in 1 case the orifice was seen patent without the straining. In one case irregularity of the internal urethral orifice was seen. Retrograde ejaculation occurred by masturbation in these cases. Therefore, cystography was found to be effective in diagnosis of retrograde ejaculation.
Urethro-vesicography. In 1 case of Group B patency of the internal urethral orifice was seen and in 1 case irregularity of the posterior urethra was seen. In Groups A, C, and D no remarkable finding was seen.
6) Reflexes and sensory and motor disturbances. Some cases of ejaculatory disturbance showed abnormality in reflexes, sensory and/or motor disturbances. However, the relation between these disturbances and ejaculatory disturbance was not clarified.
7) Cystometrogram. In 13 of 15 cases of Group A some abnormalities were suspected in the higher center of the urinary bladder. The cystometrogram in these cases was hypotonic without micturition contraction. Both the effect of nitrazepam administration and respiratory effect on the cystometrogram were clearly seen. Two of 15 cases showed disturbance of the peripheral nerves in addition to them. In Group B there was no case which showed abnormal cystometrogram except for a case in which the lesion was suspected in the lower region of the spinal cord. In Group C and D there was no case which showed abnormal cystometrogram.
8) Treatment. In Group A vitamin B₁, vitamin E, androgen, tranquilizers and imipramine hydrochloride were administered, but no remarkable effect was obtained by them. However, trihydroxpropiophenone, a COMT inhibitor, showed marked effect on 2 cases of Group A. In Group B the internal urethral orifice was narrowed by plastic operation. After the operation ejaculation became normal with normal orgasm. In the cases of Group C and D, the same drugs as in the Group A were used. But no remarkable effect was obtained by these drugs except for a case of Group C