Sexual dysfunctions induced by stress of timed intercourse and medical treatment.

OBJECTIVE: To understand the effect of stress incurred by timed intercourse (TI) on sexual dysfunction in relation to anxiety and aggression in men facing TI. PATIENTS AND METHODS: This study involved 439 men and was conducted during a 3-year period between 1 July 2008 and 30 June 2011. Various characteristics were evaluated, including newly acquired erectile dysfunction (ED), ejaculatory dysfunction (EjD), anxiety levels (using the Beck Anxiety Inventory [BAI]), self-reported aggression (using the Buss Perry Aggression Questionnaire [BPAQ]), hormone levels (such as follicle-stimulating hormone, luteinizing hormone, testosterone, prolactin and oestradiol) and semen parameters. RESULTS: A total of 188 men (42.8%) and 26 men (5.92%) experienced ED and EjD, respectively. Luteinizing hormone, testosterone and oestradiol were significantly lower in men with ED (P < 0.05). The men who required high doses of tadalafil had significantly higher scores on both the BAI and the BPAQ subscales (P < 0.001). BAI and subscales of BPAQ were higher in males with delayed ejaculation (P < 0.001). CONCLUSIONS: TI imposes a great deal of stress on male partners, potentially causing ED and EjD, and elevates anxiety levels, which leads to aggression. Physicians and clinicians should acknowledge the potentially harmful effects of TI on men. Furthermore, both female and male patients should be cautioned about the increased likelihood of ED and EjD as the number of incidents of TI increases.

Impaired spermatogenesis and gr/gr deletions related to Y chromosome haplogroups in Korean men.

Microdeletion of the Azoospermia Factor (AZF) regions in Y chromosome is a well-known genetic cause of male infertility resulting from spermatogenetic impairment. However, the partial deletions of AZFc region related to spermatogenetic impairment are controversial. In this study, we characterized partial deletion of AZFc region in Korean patients with spermatogenetic impairment and assessed whether the DAZ and CDY1 contributes to the phenotype in patients with gr/gr deletions. Total of 377 patients with azoo-/oligozoospermia and 217 controls were analyzed using multiplex polymerase chain reaction (PCR), analysis of DAZ-CDY1 sequence family variants (SFVs), and quantitative fluorescent (QF)-PCR. Of the 377 men with impaired spermatogenesis, 59 cases (15.6%) had partial AZFc deletions, including 32 gr/gr (8.5%), 22 b2/b3 (5.8%), four b1/b3 (1.1%) and one b3/b4 (0.3%) deletion. In comparison, 14 of 217 normozoospermic controls (6.5%) had partial AZFc deletions, including five gr/gr (2.3%) and nine b2/b3 (4.1%) deletions. The frequency of gr/gr deletions was significantly higher in the azoo-/oligozoospermic group than in the normozoospermic control group (p = 0.003; OR = 3.933; 95% CI = 1.509-10.250). Concerning Y haplogroup, we observed no significant differences in the frequency of gr/gr deletions between the case and the control groups in the YAP+ lineages, while gr/gr deletion were significantly higher in azoo-/oligozoospermia than normozoospermia in the YAP- lineage (p = 0.004; OR = 6.341; 95% CI = 1.472-27.312). Our data suggested that gr/gr deletion is associated with impaired spermatogenesis in Koreans with YAP- lineage, regardless of the gr/gr subtypes.

Erectile dysfunction and extramarital sex induced by timed intercourse: a prospective study of 439 men.

During the fertile window of a woman's menstrual cycle, the effect of impending timed intercourse (TI) on the psychological well-being and behavior of male partners has not been thoroughly investigated, despite the fact that men comprise one half of each couple endeavoring to achieve natural conception. This prospective study consisting of 439 men was conducted during a 3-year period between July 1, 2008, and June 30, 2011. Various characteristics were evaluated, including newly acquired erectile dysfunction (ED); extramarital sex (EMS); intake of soft drinks (SD); levels of hormones, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), prolactin, and estradiol (E2); and semen parameters. A total of 188 men (42.8%) experienced ED and 47 men (10.7%) engaged in EMS. As the number of TI episodes increased, the number of men with ED and EMS and those who wanted to avoid TI also increased (all, P < .0001). All 47 men who reported EMS experienced ED with their spouses. Men who consumed SDs produced significantly smaller volumes of semen (P = .0363). Among the hormones investigated, the levels of LH, T, and E2 were significantly lower in men with ED (all, P < .05) whereas the level of FSH was higher in contrast to E2, which was significantly higher in men who had EMS (both, P < .01). TI imposes a great deal of stress on male partners evoking ED and, in some cases, causing these men to seek EMS. Physicians and clinicians should acknowledge the potential harmful effects of TI on men. Furthermore, both female and male partners should also be cautioned about the increased possibilities of ED and EMS as TI incidents increase.

Clinical and social characteristics of Korean men with Klinefelter syndrome.

OBJECTIVES: To investigate the characteristics of Klinefelter syndrome in a consecutive series of men consulting for sexual as well as fertility problems in Korea. METHODS: A total of 179 men with non-mosaic 47,XXY Klinefelter syndrome of the 1876 azoospermic males who visited the fertility center of our university hospital between January 2002 and January 2010 were included in this analysis. Their semen characteristics, hormone profiles, size of the prostate gland, and education level were assessed and compared with an age-matched control group of 218 fertile males. Additionally, a histological evaluation was carried out. RESULTS: Prostate size, testicular volume, semen volume and symptom severity showed statistically significant differences in both groups (P < 0.0001). As the severity of signs and symptoms worsened, the education level decreased. Each degree of signs and symptoms was associated with a different level of education, as well as with significant differences in the level of testosterone and testicular volume (P < 0.05). Spearman's correlation coefficient showed the severity of signs and symptoms was associated with testosterone (P < 0.0001). CONCLUSIONS: Testosterone has the strongest negative association with the severity of signs and symptoms in patients with Klinefelter syndrome. It influences the reproductive capacity, as well as the manifested signs and symptoms of hypogonadism. Furthermore, it is also associated with various aspects of life in these patients.

Hormonal imbalances and psychological scars left behind in infertile men.

The effect of infertility on the psychological well-being of couples has been the subject of increasing attention in recent years. The frustration of couples of a relatively young age (ie, in their fourth decades) provokes not only anxiety and depression but also negative effects on the relationships. The objective of this study was to evaluate the effect of a diagnosis of male infertility on anxiety and depression in the men themselves and in fertile female spouses. The prospective cross-sectional study consisted of 264 participants, 72 males diagnosed with nonobstructive azoospermia (NOA) and their fertile spouses and 60 fertile couples attending our university between January 1, 2009, and April 30, 2010. The Beck Anxiety Inventory, Beck Depression Inventory (BDI), and hormone levels were measured during initial and follow-up visits. In NOA men, follicle-stimulating hormone and luteinizing hormone were positively associated with anxiety, in contrast to testosterone, which was inversely associated with anxiety. After the diagnosis of NOA, producing no testicular sperm, the panic intensity among men increased significantly, whereas their spouses exhibited less panic. By contrast, fertile female partners of NOA men reported higher BDI scores after the initial diagnosis of azoospermia, whereas their partners recorded higher levels of depression after the absence of testicular sperm was discovered. Insomnia was the most common complaint for both sexes after the diagnosis of azoospermia. Hormonal abnormalities had a negative effect on the quality of life. Physicians and clinicians should acknowledge the immense psychosocial effect of the diagnosis of male infertility on both males and their fertile female partners.

Chronic pelvic pain syndrome and semen quality of Korean men in their fourth decade.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition that adversely affects men across a wide range of ages. A number of pharmacologic and nonpharmacologic therapies for CP/CPPS have been investigated. Our study aimed to evaluate the prevalence of CPPS in Korean men in their thirties and to investigate the effect of CPPS and medical treatment on semen quality. Of 314 men with prostatitis, 74 patients with CPPS class IIIA (23.6%) were eligible for the study; these patients underwent combined α-blocker and cyclo-oxygenase 2 inhibitor therapy. These 74 men were prospectively studied at a medical center in Seoul, Korea. A number of parameters, including ejaculations per month, semen variables, and the levels of hormones (such as follicle-stimulating hormone, estradiol [E(2)], luteinizing hormone [LH], testosterone, and prolactin) were evaluated. The mean number of ejaculations per month, the mean number of daily hours spent sitting at work, smoking, body mass index, LH and E(2) levels, and semen parameters all showed significant differences (P < .0001) between the study patients and the controls. The combined regimen was effective in improving all aspects of semen quality except morphology (P < .05). CPPS class IIIA, which is notably prevalent among Korean men in the fourth decade of life, affects semen quality and poses a challenge to fertility. Proper treatment of CPPS class IIIA results in improved semen quality. Men with CPPS therefore require proper evaluation and treatment by andrologists/urologists before planning a natural conception.

Functions of PIWI proteins in spermatogenesis.

Recently, a significant understanding of the molecular mechanisms regulating spermatogenesis has been achieved utilizing small RNA molecules (small RNAs), including small interfering RNAs (siRNAs), microRNAs (miRNAs), and Piwi-interacting RNAs (piRNAs) which emerged as important regulators of gene expression at the post-transcriptional or translation level. piRNAs are only present in pachytene spermatocytes and round spermatids, whereas miRNAs are expressed abundantly in male germ cells throughout spermatogenesis. This review is aimed at providing a glimpse of piRNAs and their interacting family proteins such as PIWIL1, PIWIL2, and PIWIL4 in spermatogenesis.

Natural course of idiopathic oligozoospermia: comparison of mild, moderate and severe forms.

OBJECTIVES: To investigate the natural courses of mild, moderate and severe idiopathic oligozoospermia, and which factors or semen variables were of utmost importance in predicting the courses. METHODS: A total of 208 men (age 29-47years) who were diagnosed with mild, moderate and severe idiopathic oligozoospermia in a 9-year-period between January 2000 and December 2008 were followed up for more than 6months. RESULTS: Overall, 16 (24.6%) of 65 patients with severe oligozoospermia developed azoospermia, whereas two (3.1%) patients with moderate oligozoospermia developed azoospermia and none of the patients with mild oligozoospermia developed azoospermia. Initial follicle stimulating hormone level and testicular volume between the subgroups were significantly different (P=0.0071 and 0.0039, respectively). The subgroup of patients who became azoospermic (n=18) showed statistically significant differences in terms of body mass index and the level of prolactin (PRL) from the subgroup that maintained the initial lingering sperm count (n=190; P=0.0086 and 0.0154, respectively). As the vitality of semen variables increased 1%, the risk of progression to azoospermia diminished by 0.892-fold, according to Cox's proportional hazards model analysis. A receiver operating characteristic curve analysis showed that the area under the curve was 0.755 and the sperm concentration value with the highest sensitivity and specificity was the reference value of 3-5 million/mL, with a sensitivity of 0.746 and specificity of 0.711 (P=0.01). CONCLUSIONS: Patients with severe oligozoospermia should be warned of the possibility of becoming azoospermic and hence sperm freezing should be encouraged as early as possible.

Natural course of severe oligozoospermia in infertile male: influence on future fertility potential.

Most couples with severe male factor infertility are treated with assisted reproduction technology and little has been known about the prognosis of severe male factor infertility itself. We investigated the prognosis of infertile male patients with severe oligozoospermia. Thirty-nine patients with severe nonobstructive oligozoospermia were followed more than 6 months without any medical or surgical intervention. Retrospective analyses of the natural sequence of the condition and influences on the future fertility potential of the study participants were conducted. Sperm concentration, motility, and morphology between first semen analysis and last semen analysis were not significantly different. However, during the follow-up period, 5 (12.8%) patients became azoospermic. In 7 (17.9%) patients, the sperm count declined to a severe level that could be detected only after centrifugation. Three patients underwent microdissection testicular sperm extraction (TESE) for sperm retrieval after confirmation of azoospermia. The sperm retrieval was successful only in 1 of the 3 patients. Therefore, male patients diagnosed with severe oligozoospermia should be informed about possible aggravation of their residual spermatogenesis function and the necessity of intermittent follow-up semen analyses. If follow-up semen tests show a declining tendency, sperm cryopreservation may be recommended for these patients. If azoospermia develops during the follow-up period, early TESE procedure should be considered to improve the chance of sperm retrieval.

Effect of liquid nitrogen vapor storage on the motility, viability, morphology, deoxyribonucleic acid integrity, and mitochondrial potential of frozen-thawed human spermatozoa.

OBJECTIVE: To evaluate the effectiveness of liquid nitrogen (LN(2)) vapor (indirect contact method) for the storage of human semen. DESIGN: Experimental study. SETTING: University hospital-based fertility center. PATIENT(S): We evaluated 150 patients with normal sperm parameters. INTERVENTION(S): Human semen (N = 120) was mixed with Semen Freezing Medium, divided into two groups, frozen, and stored in LN(2) or LN(2) vapor. Frozen semen from each group (n = 40) was thawed after storage for 1 week, 1 month, or 3 months and then analyzed. In the second experiment, semen (n = 30) was divided into four groups, frozen, and stored in LN(2) or stored 7 cm, 12 cm, or 17 cm above the surface of LN(2) for 1 week. MAIN OUTCOME MEASURE(S): The motility and viability of sperm were evaluated by basic analysis, the morphology was analyzed with use of staining, the DNA integrity was assessed with use of terminal deoxyuridine triphosphate nick end-labeling assays, and active mitochondria were detected with use of rhodamine 123 staining. RESULT(S): The LN(2) and LN(2) vapor groups did not differ with regard to sperm motility, viability, morphology, DNA integrity, or active mitochondria when the cryostorage periods were compared. Furthermore, the quality of sperm stored within 17 cm of the surface of LN(2) for 1 week did not change. CONCLUSION(S): The storage of human semen in LN(2) vapor, without direct contact with LN(2), may represent a useful alternative for the effective storage of human semen.

SRY-negative 46,XX infertile male with Leydig cell hyperplasia: clinical, cytogenetic, and molecular analysis and review of the literature.

OBJECTIVE: To describe a 46,XX male whose infertility is not accounted for by a translocation of the SRY gene to the X chromosome or to the autosomes. DESIGN: Case report. SETTING: Fertility Center of CHA Gangnam Medical Center, Seoul, South Korea. PATIENT(S): A 29-year-old male with normal male phenotype, in whom seminal analysis showed complete azoospermia. INTERVENTION(S): Laboratory evaluations, radiologic studies, testicular biopsy, G-banding karyotype, in situ fluorescence hybridization, and polymerase chain reaction. MAIN OUTCOME MEASURE(S): Clinical and laboratory findings. RESULT(S): Peripheral blood culture for chromosome studies revealed 46,XX chromosome complement. Cytogenetic and molecular analyses excluded the presence of SRY gene. Radiologic studies displayed male structures without Müllerian ducts. Gonadal biopsy showed testicular Leydig cell hyperplasia. CONCLUSION(S): This is a very rare case of testicular differentiation in a 46,XX chromosomal constitution without SRY. This finding suggests that some unknown genes downstream participate in sex determination.

Trauma to male genital organs: a 10-year review of 156 patients, including 118 treated by surgery.

OBJECTIVE: To assess testicular rupture, scrotal haematoma, penile fracture and penile injury, comparing the prognoses of surgery and conservative management, as trauma to male external genital organs can cause devastating effects on patients and their partners. PATIENTS AND METHODS: We reviewed the medical records of 156 male patients who presented to our emergency centre with trauma to the external genital organs between January 1996 and March 2006. RESULTS: In all, 74 patients had testicular rupture, 32 penile fracture, 26 a penile injury and 24 a scrotal haematoma (mean age 27.8 years). The main cause of trauma was assault (52, 33%). Four of 14 patients with penile trauma who were managed conservatively had complications. Of 20 patients, 17 had a partial orchidectomy and were followed for a month after surgery; scrotal ultrasonography showed three cases of testicular atrophy. The mean hospital stay was less for patients with surgical intervention, at 6.4 days, than for those managed conservatively, at 8.7 days (P < 0.05). A visual analogue pain scale showed less pain in patients who were surgically treated (P < 0.05). CONCLUSION: Prompt surgical intervention is crucial; it should be considered by urologists, and is strongly recommended. Ultrasonography was highly sensitive and specific, and should be used in all patients with trauma to the external genital organs, to aid diagnosis and evaluation before surgery.

Comparison of anxiety between patients with mixed incontinence and those with stress urinary incontinence.

OBJECTIVE: Some authors insist that patients with mixed incontinence (MI) suffer from more anxiety than those with pure stress urinary incontinence (SUI) due to the added emotional stress caused by various symptoms of an overactive bladder. We objectively evaluated and compared the degree of anxiety between the two groups. MATERIAL AND METHODS: Among 172 patients who presented with urinary incontinence, 118 showed MI and 54 SUI. They were surveyed regarding their anxiety using the Beck Anxiety Inventory (BAI) questionnaire. RESULTS: The mean BAI score was 12.0+/-8.8 in the MI group and 7.8+/-5.2 in the SUI group and this difference was statistically significant (p<0.05). CONCLUSIONS: This study provides objective evidence that patients with MI have a higher degree of anxiety than those with pure SUI. Therefore, we suggest that doctors should pay more attention to anxiety symptoms when caring for patients with MI.