Ejaculatory disorders

Summary: Urological referral not indicated for most patients

Advice: Urological referral not indicated for most patients.
Refer To: Mr KN Bullock for organic ejaculatory problems; Mr A Doble for haemospermia

Contents:

Impaired ejaculation

This rarely has a physical cause. If symptoms (e.g. retarded ejaculation with obstructive urinary symptoms) suggest an urethral stricture or prostatitis, referral should be considered. In most patients, urological referral is inappropriate.

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Retrograde ejaculation

This may occur as a result of bladder neck surgery or TURP. There is no simple surgical solution but, if fertility is compromised, consider referral to Department of Reproductive Medicine for retrieval of sperms from the urine and assisted conception. Treatment with alpha-agonists (e.g. ephedrine) may restore antegrade ejaculation in selected patients.

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Premature ejaculation, failed ejaculation and male anorgasmia

These abnormalities do not have an underlying urological cause & should be referred for Psycho-Sexual Counselling.

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Haematospermia & discoloured semen

Haematospermia does not require referral unless associated with haematuria, an abnormal prostate on rectal examination or a raised PSA. Most patients have low-grade seminal tract infection and are best managed using an NSAID and/or Ofloxacin for 6-8 weeks. Semen culture NOT indicated because of the high risk of contamination by urethral organisms.

Lumpy or discoloured semen may also be an indicator of low-grade seminal infection and does not require urological assessment. In rare cases, it may be a presenting symptom of Schistosomiasis in patients who are “at-risk”.

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