Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-16T18:03:06.618Z Has data issue: false hasContentIssue false

Chapter 5 - Erection, Emission, and Ejaculation

from Section 1 - Scientific Foundations of Male Infertility

Published online by Cambridge University Press:  08 July 2023

By
Ramy Abou Ghayda  and
Martin N. Kathrins
Edited by
Larry I. Lipshultz ,
Stuart S. Howards ,
Craig S. Niederberger  and
Dolores J. Lamb
Larry I. Lipshultz
Affiliation:
Baylor College of Medicine, Texas
Stuart S. Howards
Affiliation:
University of Virginia
Craig S. Niederberger
Affiliation:
University of Illinois, Chicago
Dolores J. Lamb
Affiliation:
Weill Cornell Medical College, New York
Get access

Summary

This chapter deals with clinically relevant aspects of sexual function relating to erection and ejaculation. Such a discussion naturally begins with an exploration of the penile anatomy.

Type
Chapter
Information
Infertility in the Male , pp. 77 - 93
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further Reading

Andersson, KE. Mechanisms of penile erection and basis for pharmacological treatment of erectile dysfunction. Pharmacol Rev 2011;63:811–59.CrossRefGoogle ScholarPubMed
Lue, TF. Physiology of penile erection and pathophysiology of erectile dysfunction. In: Wein, AJ, Kavoussi, LR, Partin, AW, Peters, CA, eds. Campbell-Walsh Urology, 11th ed. Philadelphia, PA: Elsevier, 2016; pp. 612–42.Google Scholar

References

Herbenick, D, Reece, M, Schick, V, Sanders, SA. Erect penile length and circumference dimensions of 1,661 sexually active men in the United States. J Sex Med 2014;11:93–101.Google Scholar
Gontero, P, Oderda, M, Filippini, C, et al. Does kidney transplantation onto the external iliac artery affect the haemodynamic parameters of the cavernosal arteries? Asian J Androl 2012;14:621–5.CrossRefGoogle ScholarPubMed
Parthiban, S, Hotaling, JM, Kathrins, M, Baftiri, AP, Freels, S, Niederberger, CS. A novel method to determine perineal artery occlusion among male bicyclists. Peer J 2015;3:e1477.CrossRefGoogle ScholarPubMed
Grossman, JAI, Caldamone, A, Khouri, R, Kenna, DM. Cutaneous blood supply of the penis. Plast Reconstr Surg 1989;83:213–16.CrossRefGoogle ScholarPubMed
Hsieh, C-H, Huang, Y-P, Tsai, M-H, et al. Tunical outer layer plays an essential role in penile veno-occlusive mechanism evidenced from electrocautery effects to the corpora cavernosa in defrosted human cadavers. Urology 2015;86:1129–36.CrossRefGoogle Scholar
Dean, RC, Lue, TF. Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am 2005;32:379–95.CrossRefGoogle ScholarPubMed
Brow, SL, Seftel, AD, Strohl, KP, Herbener, TE. Vasculogenic impotence and cavernosal oxygen tension. Int J Impot Res 2000;12:19–22.CrossRefGoogle ScholarPubMed
Golijanin, D, Singer, E, Davis, R, Bhatt, S, Seftel, A, Dogra, V. Doppler evaluation of erectile dysfunction – Part 2. Int J Impot Res 2007;19:43–8.Google ScholarPubMed
Arnow, BA, Desmond, JE, Banner, LL, et al. Brain activation and sexual arousal in healthy, heterosexual males. Brain 2002;125:1014–23.Google Scholar
Simonsen, U, Comerma-Steffensen, S, Andersson, K-E.. Modulation of dopaminergic pathways to treat erectile dysfunction. Basic Clin Pharmacol Toxicol 2016;119:63–74.Google Scholar
Bala, A, Minh, H, Nguyen, T, Hellstrom, WJG. Post-SSRI sexual dysfunction: a literature review. Sex Med Rev 2018;6:29–34.CrossRefGoogle ScholarPubMed
Buvat, J. Hyperprolactinemia and sexual function in men: a short review. Int J Impot Res 2003;15:373–7.Google Scholar
Eggleston, JC, Walsh, PC. Radical prostatectomy with preservation of sexual function: pathological findings in the first 100 cases. J Urol 1985;134:1146–8.CrossRefGoogle ScholarPubMed
Lue, TF, Schmidt, RA, Tanagho, EA. Electrostimulation and penile erection. Urol Int 1985;40:60–4.Google Scholar
Baradaran, N, Awad, M, Gaither, TW, et al. The association of bicycle-related genital numbness and Sexual Health Inventory for Men (SHIM) score: results from a large, multinational, cross-sectional study. BJU Int 2019;124:336–41.CrossRefGoogle ScholarPubMed
Krassioukov, A, Elliott, S. Neural control and physiology of sexual function: effect of spinal cord injury. Top Spinal Cord Inj Rehabil 2017;23:1–10.CrossRefGoogle ScholarPubMed
Traish, A, Kim, NN, Moreland, RB, Goldstein I. Role of alpha adrenergic receptors in erectile function. Int J Impot Res 2000;12 Suppl 1:S48–63.CrossRefGoogle ScholarPubMed
Martínez-Salamanca, JI, La Fuente, JM, Martínez-Salamanca, E, et al. α 1A-adrenergic receptor antagonism improves erectile and cavernosal responses in rats with cavernous nerve injury and enhances neurogenic responses in human corpus cavernosum from patients with erectile dysfunction secondary to radical prostatectomy. J Sex Med 2016;13:1844–57.CrossRefGoogle ScholarPubMed
Toda, N, Ayajiki, K, Okamura, T. Nitric oxide and penile erectile function. Pharmacol Ther 2005;106:233–66.Google Scholar
Lin, C-S, Lau, A, Tu, R, Lue, TF. Expression of three isoforms of cGMP-binding cGMP-specific phosphodiesterase (PDE5) in human penile cavernosum. Biochem Biophys Res Commun 2000;268:628–35.Google Scholar
Chitaley, K, Webb, RC, Mills, TM. RhoA/Rho-kinase : a novel player in the regulation of penile erection. Int J Impot Res 2001;13:67–72.Google Scholar
Burnett, AL, Nehra, A, Breau, RH, et al. Erectile dysfunction – AUA Guideline – unabridged. Am Urol Assoc Guideline 2018;April:1–36.Google Scholar
Rosen, RC, Riley, A, Wagner, G, Osterloh, IH, Kirkpatrick, J, Mishra, A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–30.Google Scholar
Cappelleri, JC, Rosen, RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res 2005;17:307–19.CrossRefGoogle Scholar
Derby, C, Araujo, A, Johannes, C, Feldman, H, McKinlay, J. Measurement of erectile dysfunction in population-based studies: the use of a single question self-assessment in the Massachusetts Male Aging Study. Int J Impot Res 2000;12:197–204.Google Scholar
Sweet, G, Shindel, AW. Erectile dysfunction in younger man. AUA Updat Ser 2015;34:1–8.Google Scholar
Shindel, AW, Nelson, CJ, Naughton, CK, Ohebshalom, M, Mulhall, JP. Sexual function and quality of life in the male partner of infertile couples: prevalence and correlates of dysfunction. J Urol 2008;179:1056–9.Google Scholar
Satkunasivam, R, Ordon, M, Hu, B, et al. Hormone abnormalities are not related to the erectile dysfunction and decreased libido found in many men with infertility. Fertil Steril 2014;101:1594–8.Google Scholar
O’Brien, JH, Lazarou, S, Deane, L, Jarvi, K, Zini, A. Erectile dysfunction and andropause symptoms in infertile men. J Urol 2005;174:1932–4; discussion 1934.Google Scholar
Nehra, A, Jackson, G, Miner, M, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012;87:766–78.CrossRefGoogle ScholarPubMed
Korenman, SG. Epidemiology of erectile dysfunction. Int J Impot Res 2003;15:63–71.Google Scholar
Snyder, PJ, Bhasin, S, Cunningham, GR, et al. Effects of testosterone treatment in older men. N Engl J Med 2016;374:611–24.CrossRefGoogle ScholarPubMed
Silva, AB, Sousa, N, Azevedo, LF, Martins, C. Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. Br J Sports Med 2017;51:1419–24.Google Scholar
Jorgenson, E, Matharu, N, Palmer, MR, et al. Genetic variation in the SIM1 locus is associated with erectile dysfunction. Proc Natl Acad Sci U S A 2018;115:11018–23.Google Scholar
Melnik, T, Soares, BGO, Nasselo, AG. Psychosocial interventions for erectile dysfunction. Cochrane Database Syst Rev 2007;3:CD004825.Google Scholar
Kim, N, Azadzoi, KM, Goldstein, I, Saenz de Tejada, I. A nitric oxide-like factor mediates nonadrenergic-noncholinergic neurogenic relaxation of penile corpus cavernosum smooth muscle. J Clin Invest 1991;88:112–18.Google Scholar
Burnett, AL, Lowenstein, CJ, Bredt, DS, Chang, TSK, Snyder, SH. Nitric oxide: a physiologic mediator of penile erection. Science 1992;257:401–3.CrossRefGoogle ScholarPubMed
Goldstein, I, Burnett, AL, Rosen, RC, Park, PW, Stecher, VJ. The serendipitous story of sildenafil: an unexpected oral therapy for erectile dysfunction. Sex Med Rev 2019;7:115–28.Google ScholarPubMed
Boolell, M, Gepi-Attee, S, Gingell, JC, Allen, MJ. Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol 1996;78:257–61.CrossRefGoogle ScholarPubMed
Bella, AJ, Brant, WO, Lue, TF, Brock, GB. Non-arteritic anterior ischemic optic neuropathy (NAION) and phosphodiesterase type-5 inhibitors. Can J Urol 2006;13:3233–8.Google ScholarPubMed
Zucchi, A, Costantini, E, Scroppo, FI, et al. The first‐generation phosphodiesterase 5 inhibitors and their pharmacokinetic issue. Andrology 2019;7:804–17.Google Scholar
Hellstrom, WJG, Kaminetsky, J, Belkoff, LH, et al. Efficacy of avanafil 15 minutes after dosing in men with erectile dysfunction: a randomized, double-blind, placebo controlled study. J Urol 2015;194:485–92.Google Scholar
Goldstein, I. The hour lecture that changed sexual medicine – the Giles Brindley injection story. J Sex Med 2012;9:337–42.Google Scholar
Brindley, GS. Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence. Br J Psychiatry 1983;143:332–7.CrossRefGoogle ScholarPubMed
Seidmon, EJ, Samaha, AM. The pH analysis of papaverine-phentolamine and prostaglandin E1 for pharmacologic erection. J Urol 1989;141:1458–9.Google Scholar
Glina, S, Virag, R, Luis Rhoden, E, Sharlip, ID. Intracavernous injection of papaverine for erectile failure. J Sex Med 2010;7:1331–5.CrossRefGoogle Scholar
Shinn-Nan Lin, J, Lin, Y-M, Jou, Y-C, Cheng, J-T. Role of cyclic adenosine monophosphate in prostaglandin E(1)-induced penile erection in rabbits. Eur Urol 1995;28:259–65.CrossRefGoogle Scholar
Linet, OI, Ogrinc, FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. N Engl J Med 1996;334:873–7.Google Scholar
Baltaci, S, Aydos, K, Kosar, A, Anafarta, K. Treating erectile dysfunction with a vacuum tumescence device: a retrospective analysis of acceptance and satisfaction. Br J Urol 1995;76:757–60.Google Scholar
Chen, J, Mabjeesh, NJ, Greenstein, A. Sildenafil versus the vacuum erection device: patient preference. J Urol 2001;166:1779–81.Google Scholar
Barton, GJ, Carlos, EC, Lentz, AC. Sexual quality of life and satisfaction with penile prostheses. Sex Med Rev 2019;7:178–88.Google Scholar
Gruenwald, I, Kitrey, ND, Appel, B, Vardi, Y. Low‐intensity extracorporeal shock wave therapy in vascular disease and erectile dysfunction: theory and outcomes. Sex Med Rev 2013;1:83–90.Google Scholar
Capogrosso, P, Frey, A, Jensen, CFS, et al. Low-intensity shock wave therapy in sexual medicine – clinical recommendations from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1490–505.Google Scholar
Shin, DH, Spitz, A. The evaluation and treatment of delayed ejaculation. Sex Med Rev 2014;2(3–4):121–33.Google ScholarPubMed
Giuliano, F, Clement, P. Neuroanatomy and physiology of ejaculation. Annu Rev Sex Res 2005;16:190.Google Scholar
McMahon, CG, Abdo, C, Incrocci, L, et al. Disorders of orgasm and ejaculation in men. J Sex Med 2004;1:58–65.Google Scholar
Levin, R. Revisiting post-ejaculation refractory time – what we know and what we do not know in males and in females. J Sex Med 2009;6:2376–89.Google Scholar
Kinsey, AC, Pomeroy, WR, Martin, CE. Sexual behavior in the human male. Am J Public Health 2003;93:894–8.CrossRefGoogle ScholarPubMed
Holstege, G, Georgiadis, JR, Paans, AM, Meiners, LC, van der Graaf, FH, Reinders, AS. Brain activation during human ejaculation. J Neurosci 2003;23:9185–93.Google Scholar
Dunn, ME, Trost, JE. Male multiple orgasms: a descriptive study. Arch Sex Behav 1989;18:377–87.Google Scholar
Turley, KR, Rowland, DL. Evolving ideas about the male refractory period. BJU Int 2013;112:442–52.Google Scholar
Georgiadis, JR, Reinders, AA, Van der Graaf, FH, Paans, AM, Kortekaas, R. Brain activation during human male ejaculation revisited. Neuroreport 2007;18:553.Google Scholar
Cooper, TG, Weidner, W, Nieschlag, E. The influence of inflammation of the human genital tract on secretion of the seminal markers alpha glucosidase, glyceryl-phosphocholine, carnitine, fructose and citric acid. Int J Androl 1990;13:329–36.Google Scholar
Wolff, H, Bezold, G, Zebhauser, M, Meurer, M. Impact of clinically silent inflammation on male genital tract organs as reflected by biochemical markers in semen. J Androl 1991;12:331–4.Google Scholar
Yokoyama, H. [Gamma-glutamyl transpeptidase (gamma-GTP) in the era of metabolic syndrome]. Nihon Arukoru Yakubutsu Igakkai Zasshi 2007;42:110–24.Google Scholar
Pero, ME, Lombardi, P, Longobardi, V, et al. Influence of gamma glutamyl transferase and alkaline phosphatase 55. activity on in vitro fertilization of bovine frozen/thawed semen. Ital J Anim Sci 2017;16:390–2.Google Scholar
Edström, AM, Malm, J, Frohm, B, et al. The major bactericidal activity of human seminal plasma is zinc-dependent and derived from fragmentation of the semenogelins. J Immunol 2008;181:3413–21.Google Scholar
Sheu, G, Revenig, LM, Hsiao, W. Physiology of ejaculation. In: Mulhall, JP, Hsiao, W, eds. Men’s Sexual Health and Fertility. New York, NY: Springer Science, 2014; pp. 13–29.Google Scholar
Master, VA, Turek, PJ. Ejaculatory physiology and dysfunction. Urol Clin North Am 2001;28:363–75.Google Scholar
Shafik, A, El-Sibai, A. Mechanism of ejection during ejaculation: identification of a urethrocavernosus reflex. Arch Androl 2000;44:77–83.Google Scholar
Shafik, A. Pelvic floor muscles and sphincters during erection and ejaculation: experimental study. Arch Androl 1997;39:71–8.Google Scholar
Müller, A, Mulhall, JP (n.d.). Erection, emission, and ejaculation: mechanisms of control. Infert Male, pp. 132–52.Google Scholar
Giuliano, F. Neurophysiology of erection and ejaculation. J Sex Med 2011;8(Suppl. 4):310.Google Scholar
Gerstenberg, TC, Levin, RJ, Wagner, G. Erection and ejaculation in man – assessment of the electromyographic activity of the bulbocavernosus and ischiocavernosus muscles. Br J Urol 1990;65:395–402.Google Scholar
McKenna, KE, Chung, SK, McVary, KT. A model for the study of sexual function in anesthetized male and female rats. Am J Physiol 1991;261:R1276–85.Google Scholar
McKenna, KE, Chung, SK, McVary, KT. A model for the study of sexual function in anesthetized male and female rats. Am J Physiol. 1991;261:R1276–85.Google Scholar
Larsson, K, van Dis, H. Seminal discharge following intracranial electrical stimulation. Brain Res 1970;23:381–6.Google ScholarPubMed
Alwaal, A, Breyer, BN, Lue, TF. Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril 2015;104:1051–60.Google Scholar
Bancila, M, Verge, D, Rampin, O, et al. 5-Hydroxytryptamine 2C receptors on spinal neurons controlling penile erection in the rat. Neuroscience 1999;92:1523–37.Google Scholar
Giuliano, F, Clement, P. Physiology of ejaculation: emphasis on serotonergic control. Eur Urol 2005;48:408–17.Google Scholar
Chehensse, C, Bahrami, S, Denys, P, Clement, P, Bernabe, J, Giuliano, F. The spinal control of ejaculation revisited: a systematic review and meta-analysis of anejaculation in spinal cord injured patients. Hum Reprod Update 2013;19:507–26.Google Scholar
Heeb, MM, Yahr, P. Anatomical and functional connections among cell groups in the gerbil brain that are activated with ejaculation. J Comp Neurol 2001;439:248–58.Google Scholar
Heeb, MM, Yahr, P. Anatomical and functional connections among cell groups in the gerbil brain that are activated with ejaculation. J Comp Neurol 2001;439:248–58.Google Scholar
Coolen, LM, Peters, HJ, Veening, JG. Anatomical interrelationships of the medial preoptic area and other brain regions activated following male sexual behavior: a combined fos and tract-tracing study. J Comp Neurol 1998;397:421–35.Google Scholar
Marson, L, McKenna, KE. Stimulation of the hypothalamus initiates the urethrogenital reflex in male rats. Brain Res 1994;638:103–8.Google Scholar
Arendash, GW, Gorski, RA. Effects of discrete lesions of the sexually dimorphic nucleus of the preoptic area or other medial preoptic regions on the sexual behavior of male rats. Brain Res Bull 1983;10:147–54.Google Scholar
Simerly, RB, Swanson, LW. Projections of the medial preoptic nucleus: a Phaseolus vulgaris leucoagglutinin anterograde tract-tracing study in the rat. J Comp Neurol 1988;270:209–42.Google Scholar
Rizvi, TA, Ennis, M, Shipley, MT. Reciprocal connections between the medial preoptic area and the midbrain periaqueductal gray in rat: a WGA-HRP and PHA-L study. J Comp Neurol 1992;315:1–15.Google Scholar
Marson, L, McKenna, KE. A role for 5-hydroxytryptamine in descending inhibition of spinal sexual reflexes. Exp Brain Res 1990;88:313–20.Google Scholar
Marson, L, McKenna, KE. The identification of a brainstem site controlling spinal sexual reflexes in male rats. Brain Res 1990;515:303–8.Google Scholar
Marson, L. Lesions of the periaqueductal gray block the medial preoptic area-induced activation of the urethrogenital reflex in male rats. Neurosci Lett 2004;367:278–82.Google Scholar
Saper, CB, Loewy, AD, Swanson, LW, Cowan, WM. Direct hypothalamo-autonomic connections. Brain Res 1976;117:305–12.Google Scholar
Luiten, PG, Ter Horst, GJ, Karst, H, Steffens, AB. The course of paraventricular hypothalamic efferents to autonomic structures in medulla and spinal cord. Brain Res 1985;329:374–8.Google Scholar
Truitt, WA, Coolen, LM. Identification of a potential ejaculation generator in the spinal cord. Science 2002;297:1566–9.Google Scholar
Brindley, GS, Sauerwein, D, Hendry, WF. Hypogastric plexus stimulators for obtaining semen from paraplegic men. Br J Urol 1989;64:72–7.Google Scholar
Coolen, LM, Veening, JG, Wells, AB, Shipley, MT. Afferent connections of the parvocellular subparafascicular thalamic nucleus in the rat: evidence for functional subdivisions. J Comp Neurol 2003;463:132–56.Google Scholar
Borgdorff, AJ, Bernabé, J, Denys, P, Alexandre, L, Giuliano, F. Ejaculation elicited by microstimulation of lumbar spinothalamic neurons. Eur Urol 2008;54:449–56.Google Scholar
Clement, P, Giuliano, F. Physiology and pharmacology of ejaculation. Basic Clin Pharmacol Toxicol 2016;119:18–25.Google Scholar
Nadelhaft, I, McKenna, KE. Sexual dimorphism in sympathetic preganglionic neurons of the rat hypogastric nerve. J Comp Neurol 1987;256:308–15.Google Scholar
Owman, C, Stjernquist, M. The peripheral nervous system. In: Bjorklund, A, Hokfelt, T, Owman, C, eds. Handbook of Chemical Neuroanatomy. Amsterdam: Elsevier Science, 1988; pp. 445–544.Google Scholar
Nadelhaft, I, Booth, AM. The location and morphology of preganglionic neurons and the distribution of visceral afferents from the rat pelvic nerve: a horseradish peroxidase study. J Comp Neurol 1984;226:238–45.Google Scholar
Schroder, HD. Anatomical and pathoanatomical studies on the spinal efferent systems innervating pelvic structures. 1. Organization of spinal nuclei in animals. 2. The nucleus X-pelvic motor system in man. J Auton Nerv Syst 1985;14:23–48.Google Scholar
Halata, Z, Munger, BL. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res 1986;371:205–30.Google Scholar
Baron, R, Janig, W. Afferent and sympathetic neurons projecting into lumbar visceral nerves of the male rat. J Comp Neurol 1991;314:429–36.Google Scholar
McKenna, KE, Nadelhaft, I. The organization of the pudendal nerve in the male and female rat. J Comp Neurol 1986;248:532–49.Google Scholar
Comarr, A. Sexual function among patients with spinal cord injury. Urol Int 1970;25:134–68.Google Scholar
Chapple, CR, Aubry, ML, James, S, et al. Characterization of human prostatic adrenoceptors using pharmacology receptor binding and localization. Br J Urol 1989;63:487–96.Google Scholar
Adrian, TE, Guj, Allen JM, et al. Neuropeptide Y in the human male genital tract. Life Sci 1984;35:2643–8.Google Scholar
Lincoln, J, Burnstocl, G. Autonomic innervation of the urinary bladder and urethra. In: Maggi, CA, ed. Nervous Control of the Urogenital System. Chur, Switzerland: Harwood Academic, 1993; pp. 33–68.Google Scholar
Morrison, J, Steers, WD, Brading, A, et al. Neurophysiology and neuropharmacology. In: Abrams, P, Cardozo, L, Khoury, S, Wein, A, eds. Incontinence. Plymouth: Health Publication, 2005: pp. 85–164.Google Scholar
Bates, JN, Kohn, TP, Pastuszak, AW. Effect of thyroid hormone derangements on sexual function in men and women. Sex Med Rev 2020;8:217–30.Google Scholar
Abu El-Hamd, M, Farah, A. Possible role of serum testosterone, gonadotropins and prolactin in patients with premature ejaculation. Andrologia 2018;50(1).Google Scholar
Corona, G, Jannini, EA, Vignozzi, L, Rastrelli, G, Maggi, M. The hormonal control of ejaculation. Nat Rev Urol 2012;9:508–19.Google Scholar
Schulster, M, Bernie, AM, Ramasamy, R. The role of estradiol in male reproductive function. Asian J Androl 2016;18:435–40.Google Scholar
Taylor, D, Paton, C, Kerwin, R (eds). The Maudsley Prescribing Guidelines. London: Informa Healthcare, 2007.Google Scholar
Higgins, A, Nash, M, Lynch, AM. Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug Healthc Patient Saf 2010;2:141–50.Google Scholar
Clément, P, Pozzato, C, Heidbreder, C, Alexandre, L, Giuliano, F, Melotto, S. Delay of ejaculation induced by SB-277011, a selective dopamine D3 receptor antagonist, in the rat. J Sex Med 2009;6:98–108.Google Scholar
Clément, P, Bernabé, J, Kia, HK, Alexandre, L, Giuliano, F. D2-like receptors mediate the expulsion phase of ejaculation elicited by 8-hydroxy-2-(di-N-propylamino) tetralin in rats. J Pharmacol Exp Ther 2006;316:830–4.Google Scholar
Clément, P, Bernabé, J, Gengo, P, et al. Supraspinal site of action for the inhibition of ejaculatory reflex by dapoxetine. Eur Urol 2007;51:825–32.Google Scholar
Stafford, SA, Bowery, NG, Tang, K, Coote, JH. Activation by p-chloroamphetamine of the spinal ejaculatory pattern generator in anaesthetized male rats. Neuroscience 2006;140:1031–40.Google Scholar
Giuliano, F, Clement, P. Serotonin and premature ejaculation: from physiology to patient management. Eur Urol 2006;50:454–66.Google Scholar
Martin, E, Berka, V, Tsai, AL, Murad, F. Soluble guanylyl cyclase: the nitric oxide receptor. Methods Enzymol 2005;396:478–92.Google Scholar
Hull, EM, Lumley, LA, Matuszewich, L, Dominguez, J, Moses, J, Lorrain, DS. The roles of nitric oxide in sexual function of male rats. Neuropharmacology 1994;33:1499–504.Google Scholar
Dixon, JS, Jen, PY. Development of nerves containing nitric oxide synthase in the human male urogenital organs. Br J Urol 1995;76:719–25.Google Scholar
Calzo, P, et al. Erectile dysfunction in a sample of sexually active young adult men from a U.S. cohort: demographic, metabolic and mental health correlates. J Urol 2021 Feb; 2015 (2):539–544. PMID: 32935616Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×