Introduction Of the many causes of male infertility, ejaculatory dysfunction is relatively uncommon. Likewise, in cancer patients, it accounts for a small number of the total visits to practitioners. Nevertheless, there are certain situations in which the inability to ejaculate prevents fertility preservation or restoration in men before and after cancer treatment. This chapter will review the causes of ejaculation difficulties among this patient population, and potential treatments to circumvent the problem. Physiology of ejaculation During ejaculation sperm travel distally via the vasa deferentia, which join the seminal vesicles to form the ejaculatory ducts. These then enter the prostatic urethra just lateral to the verumontanum. The site of entry into the prostatic urethra is distal to the bladder neck and proximal to the external urethral sphincter, and this location is relevant in preventing retrograde ejaculation into the bladder, as the bladder neck contracts during ejaculation. The ejaculate that emerges from the urethra is a mixture of secretions from these various organs, with the majority coming from the seminal vesicles (approximately two-thirds) and the prostate. Sperm from the testes and mucoid bulbourethral gland secretions account for 1–2% of the volume . After initial coagulation of the ejaculate, liquefaction is achieved by the proteolytic enzyme, prostate-specific antigen (PSA).
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