Original investigations into the diagnosis and treatment of ejaculatory dysfunction - Fertility and Sterility

The method employed is simple, harmless and—above all—not objectionable to patients. In cases such as those described, it is preferable to other therapeutic measures, which are too often both prolonged and useless. —Schellen T. Induction of ejaculation by electrovibration. Fertil Steril 1968;19(4):566–9. Retrograde ejaculation was associated with stricture of the urethra of long standing. A tight stricture may allow passage of urine but not semen, which is more viscid. —Girgis SM, Etriby A, El-Hefnawy H, Kahil S. Aspermia: a survey of 49 cases. Fertil Steril 1968;19(4):580–8. While we now have several options for the management of men with severe ejaculatory dysfunction, two articles in Fertility and Sterility from summer 1968 shed light on how we arrived here. Dr. Ton Schellen, writing from the Netherlands (and adding a healthy dose of Latin medical terminology), provided a description of his experience with an electrovibrator—what today is described as penile vibratory stimulation (PVS). The use of such a device on humans was only first described in the pages of Fertility and Sterility in 1965 (1x1Sobrero, A.J., Stearns, H.E., and Blair, J.H. Technic for the induction of ejaculation in humans. Fertil Steril. 1965; 16: 765–767 Abstract | Full Text PDF | PubMed | Scopus (42) | Google ScholarSee all References)(1). Dr. Schellen used it on 11 patients with anejaculation, oddly excluding men with complete erectile dysfunction and absent nocturnal emission. We now know that such criteria would not preclude PVS. Unfortunately, there remains no record of whether any of the men studied suffered from neurological disorders, such as a spinal cord injury. His device was essentially a cup placed over the glans which served as both a collection apparatus for semen and the high-frequency vibratory stimulus—ironically, more user-friendly than our modern devices for PVS which are generally not designed to assist with collection of semen. He reported successful induction of antegrade ejaculation in 80% of men and a 50% pregnancy rate. Similarly, Girgis and colleagues described their experiences at an Egyptian hospital with 49 men presenting with aspermia. Their results are generally unremarkable when compared to our present understanding of the common etiologies behind that presentation. Surprisingly, they found that urethral stricture disease caused 26% of all cases of retrograde ejaculation. Unfortunately, the authors did not indicate whether the men had lower urinary tract symptoms which would be independently concerning for stricture disease. This finding is