The Association between Varicocele, Premature Ejaculation and Prostatitis Symptoms: Possible Mechanisms

Impact of varicocelectomy on gonadal and erectile functions in men with hypogonadism and infertility

INTRODUCTION

Previous reports linked varicocele in infertile males with Leydig cell dysfunction and hypogonadism.

AIM

The aim of this study was to determine the impact of varicocelectomy on serum total testosterone (TT) level and erectile function in men with infertility and clinical varicocele.

METHODS

This study included 141 heterosexual infertile men diagnosed to have clinical varicocele. They were divided into two groups: group 1 (103 men), who had microsurgical varicocelectomy, and group 2 (38 patients), who decided to pursue assisted reproduction procedures. All participants completed the International Index of Erectile Function (IIEF)-5 questionnaire and underwent semen analysis. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and TT were measured both at recruitment time and 6 months later.

MAIN OUTCOME MEASURE

Changes in serum TT and IIEF-5 following varicocelectomy.

RESULTS

In group 1, the mean TT level increased significantly post-varicocelectomy (379.1 ± 205.8 to 450.1 ± 170.2 ng/dL, P < 0.0001). No similar change was found in group 2. Out of the 49 patients in group 1 with hypogonadism at baseline assessment (TT < 300 ng/dL), 37 (75.5%) exhibited a postoperative normalization of TT. However, only 3/15 hypogonadal men (20%) in group 2 had normal testosterone levels at the second visit. IIEF-5 scores improved significantly postoperatively in patients with hypogonadism (17.1 ± 2.6 to 19.7 ± 1.8, P < 0.001). Neither operating vein diameter 3.6 ± 0.57 mm nor testicular size 10.46 ± 3.3 mL correlated with the mean change in TT (71.1 ± 101.2 ng/dL) (r = 0.162, P = 0.183 and r = -0.077, P = 0.536, respectively).

CONCLUSIONS

Varicocele is associated with hypogonadism in some infertile patients. Varicocelectomy significantly improves serum testosterone in infertile men, especially those with hypogonadism. This improvement in TT level may be reflected in the IIEF score.

Autoeroticism, mental health, and organic disturbances in patients with erectile dysfunction

INTRODUCTION

Masturbation is a common, but often neglected, male sexual behavior.

AIM

To investigate the psychobiological correlates of self-reported masturbation in the last 3 months.

METHODS

A consecutive series of 2,786 heterosexual male patients (mean age 48.4 +/- 13.2) consulting an outpatient clinic for erectile dysfunction (ED) was studied.

MAIN OUTCOME MEASURES

Several hormonal, biochemical and instrumental parameters (penile Doppler ultrasound [PDU]) were investigated. Patients were interviewed, prior to the beginning of any treatment, with Structured Interview on Erectile Dysfunction (SIEDY) and ANDROTEST structured interviews. They also completed the Middlesex Hospital Questionnaire, a brief self-reported questionnaire for the screening of the symptoms of mental disorders in a nonpsychiatric setting.

RESULTS

Among the patients studied, 1,781 (61.9%) reported they had masturbated at least once per month in the preceding 3 months. The frequency of masturbation was inversely related to age (r = -0.329; P < 0.0001) and directly associated with education level (adj r = 0.052, P < 0.05 after adjustment for age). A feeling of guilt during masturbation was reported by 274 (15.4%) patients. After adjusting for age, masturbation was positively associated with testosterone levels, stressful conditions, and both unstable and long-lasting couple relationship. Urogenital problems such as varicocele and prostate abnormalities also increased the chance of masturbation. Reported guiltiness during autoeroticism was associated with psychological disturbances, low prolactin, low testosterone, and increased relational problems. An erection not normal during masturbation was declared by 1,361 (76.4%) patients and associated with a prevalent organic component of ED, because of lower peak systolic velocity PDU and higher SIEDY Scale 1 scores.

CONCLUSIONS

This study indicates that masturbation is a relatively frequent behavior in male subjects with ED. Inquiring about this sexual behavior is an important issue for understanding overall patients' sexual attitudes and behavior.