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What Are the Causes and Symptoms?

The main symptoms of Peyronie’s disease are:

• Penile pain on erection
• A thickening in the shaft of the penis
• A curvature of the erect penis
• Sometimes erectile dysfunction (ED or impotence) as well

The first symptom tends to be penile pain and discomfort, which occurs with an erection as the plaque is stretched. This pain with an erection usually goes within a few months. The next thing the affected man notices is a thickened feeling or lump (plaque) in the shaft of his penis. After this he may notice that the penis tends to become more curved when erect. This can make sexual intercourse more difficult and uncomfortable and it may eventually become impossible. Erectile dysfunction is commonly seen in men with Peyronie’s disease.

How Is Peyronie’s Disease Treated?

Fortunately, many men with Peyronie’s disease have a mild form of the condition, which doesn’t interfere with sexual intercourse. These men need no treatment. For men with more severe forms of the condition, several treatment options can be tried, including injections into the penile plaques or surgery to try to straighten the penis. Unfortunately there is no guarantee of success, as the underlying cause of Peyronie’s disease remains unknown.

What Is a Vasectomy?

A vasectomy is a simple and highly effective method of contraception. It is sometimes known as male sterilisation. A vasectomy is a procedure that involves cutting the two tubes leading away from the testes, called the vas deferens, so that sperm can no longer get into the semen. A vasectomy is usually considered to be a permanent form of contraception, although in some cases the procedure can be reversed, if necessary (but with difficulty).

A vasectomy works by preventing sperm from reaching the semen that is ejaculated from the man’s penis during sex. It is a quick and usually painless surgical procedure, which is carried out under local anaesthetic. This means that, in most cases, you will be able to return home within an hour or so of your procedure.

What Are the Risks of a Vasectomy?

The risk of side effects or complications after a vasectomy is low and these are usually minor; they may include some bleeding or bruising at the scrotum. Mild infection is uncommon. Less commonly, a swelling called a sperm granuloma may occur due to an inflammatory reaction to sperm released into the bloodstream or tissue during the procedure. Much rarer is when the ends of the vas deferens may reconnect with one another, which could result in your partner getting pregnant.

There is currently no evidence of any increased risks of prostate cancer or other long-term health complications. However, these matters are the subject of ongoing research.

A vasectomy shouldn’t affect your sex drive or ability to have erections or orgasm. The only difference is that the semen you ejaculate will not contain sperm. The body continues to produce sperm after the procedure, but the testicles naturally reabsorb the unneeded sperm.

Emission Phase

The anatomical structures involved in emission include the epididymis, vas deferens, seminal vesicles, prostate gland, prostatic portion of the urethra, and bladder neck. These structures have both sympathetic and parasympathetic innervation with nerve fibers that arise predominately from the pelvic plexus. These nerve fibers are located in the retroperitoneum, traveling alongside the rectum and also lying posterolateral to the seminal vesicles. Pelvic plexus nerve fibers come superiorly from the hypogastric and pelvic nerves, and inferiorly from the caudal paravertebral sympathetic chain.

Emission is initiated when afferent stimulatory input, primarily arising from sensory fibers within the glans penis, is integrated at the level of the spinal cord. Sympathetic nerves (T10-L2) mediate the release of several neurotransmitters, including norepinephrine, causing epithelial cell secretion and smooth muscle cell contraction throughout the excurrent ductal system. As a result, accessory gland secretions  are admixed with spermatozoa and ejected into the posterior urethra.

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Expulsion Phase

The anatomical structures involved in seminal expulsion include the bladder neck, urethra, and striated pelvic muscles. Expulsion is a spinal cord reflex triggered once inevitability, or “the point of no return” is reached during sexual activity. During expulsion, the bladder neck smooth muscle fibers, under sympathetic fiber stimulation, forcibly contact to prevent retro-grade ejaculation. Next, the striated pelvic floor muscles, in particular the ischiocavernosus and bulbocavernosus muscles, contract in an intermittent, rhythmic fashion, and the external ure-thral sphincter relaxes.

While these muscles are innervated solely by the somatic nervous system (S2–4), the expulsion phase of ejaculation Viagra Australia does not appear to have any component of volitional control. In the setting of tight bladder neck con-traction, the series of striated pelvic muscular contractions leads to antegrade propulsion of semen through the prostatic, bulbar, and penile urethra and out the urethral meatus. To date, the specific trigger for the expulsion phase has not been clearly elucidated. Early work in a rat model suggested that the presence of semen in the bulbous urethra is the predominant factor that triggers seminal expulsion. Subsequent manuscripts describe the presence of a spinal ejaculatory generator that leads to the expulsion of seminal fluid once a critical level of spinal activation has been achieved.

The spinal ejaculatory center is believed to integrate stimuli from peripheral and central sites, with efferent output through both parasympathetic and somatic pathways. In 2002, Truitt and Coolen reported that neurons having a role in generating ejaculation are located within lamina X and the medial portion of lamina VII of lumbar segments 3 and 4. These neurons receive descending input from the nucleus paragigantocellularis, the medial preoptic area, and the paraventricular nucleus of the hypothalamus, each providing supraspinal modulatory effects on the spinal ejaculatory generator. While descending cortical input may influence ejaculation, it is not essential for ejaculation to occur.

Men with complete spinal cord transection superior to the tenth thoracic segmental level (superior to the location of the spinal ejaculatory generator) exemplify this point; in these men, the ejaculatory reflex is typically still feasible. Penile vibratory stimulation is routinely used in such patients to induce the ejaculatory response for reproductive purposes, in order to collect sperm for assisted reproductive techniques, such as intrauterine insemination or in vitro fertilization. The intact function of the spinal ejaculatory generator neurons is essential for normal ejaculatory function, as their ablation leads to the complete loss of ejaculatory function.

Until the last 10 years we have had little detailed information concerning the prevalence of ED. The first modern study was the Massachusetts Male Aging Study (MMAS), published in 1994, and since then a number of similar epidemiological studies have been undertaken in other countries. Although the methodology has varied a number of common themes have emerged, which are outlined below. Erectile dysfunction is common. The MMAS study suggested that around 50% of men over the age of 40 suffered from ED. However, it was also clear that many of these cases were not severe, and this has been confirmed in subsequent studies. Overall, in the MMAS 35% of men between the ages of 40 and 70 had moderate or severe ED.

The prevalence of erectile dysfunction increases with age

The prevalence of ED increases with increasing age, such that, if we restrict ourselves to patients with moderate and severe ED, then around 10% of men in their 40s, around 20% of men in their 50s, around 40% of men in their 60s and 60% of men in their 70s are affected. Similarly, the incidence of newly developing cases of ED also increases with increasing age. Erectile dysfunction shows some geographical and cultural variation The prevalence of ED is broadly similar across a range of countries with different cultures. However, there is variation, with some countries (such as Turkey) appearing to have a substantially higher incidence, particularly in older men.The possible reasons for these differences are multiple, and include different cultural attitudes towards sexual activity and differing rates of vascular disease. Unfortunately, the methods of assessing ED were not the same in each study, so any comparisons cannot be definitive. Erectile dysfunction is associated with other conditions, including vascular disease and its risk factors.

Most of the studies looked at risk factors for erectile dysfunction and most found significant associations with a variety of diseases, including:

• Cardiovascular disease (approximately increased relative risk×2),
• Diabetes (approximately increased relative risk×3–4)
• Hypertension (approximately increased relative risk×1.5–2)
• Depression (approximately increased relative risk×2–3.5)
• Lower urinary tract symptoms (approximately increased relative risk×1.5–2).

Erectile function is associated with a number of lifestyle issues

There is increasing evidence that exercise is beneficial for sexual function, as is modest alcohol consumption, whereas increasing body mass index (BMI) and excessive alcohol consumption lead to increased erectile dysfunction. Although intuitively we would expect to find that ED is associated with cigarette smoking, the data are inconclusive in this respect.

Summary

■ Significant erectile dysfunction is present in around a third of men over 40 years of age
■ The prevalence of ED:
■ Increases with age
■ Is strongly associated with vascular risk factors
■ Is also associated with psychosocial issues
■ Is broadly similar in different races and cultures
■ Normal erectile function is associated with ‘healthy’ living