Ejaculatory dysfunction is one of the most common complaints of patients with sexual disorders. While it encompasses several ejaculatory disorders, weak ejaculation is seldom described in the literature. Since the pudendal nerve is the main nerve of ejaculation, we aim to hypothesize that pudendal nerve entrapment could be a cause of weak ejaculation, and that pudendal nerve release could contribute to the improvement of the ejaculatory stream. We presented two cases suffering from a weak ejaculatory stream and sensation of incomplete semen emptying, accompanied with clinical features of pudendal nerve entrapment. Both cases improved after pudendal nerve block and then laparoscopic transperitoneal pudendal release, with a sustained amelioration of the ejaculatory stream after 3 weeks of surgery. Pudendal canal entrapment is therefore a potentially curable cause for weak ejaculation.
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Phillips E, Carpenter C, Oates RD. Ejaculatory dysfunction. Urol Clin North Am. 2014;41:115–28.
Otani T. Clinical review of ejaculatory dysfunction. Reprod Med Biol. 2019;18:331–43.
McMahon CG. Management of ejaculatory dysfunction. Intern Med J. 2014;44:124–31.
Giuliano F. Neurophysiology of Erection and Ejaculation. J Sex Med. 2011;8:310–5.
Labat J-J, Riant T, Robert R, Amarenco G, Lefaucheur J-P, Rigaud J. Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria). Neurourol Urodyn. 2008;27:306–10.
Bollens R, Mjaess G, Sarkis J, Chemaly AK, Nemr E, Daher K, et al. Laparoscopic transperitoneal pudendal nerve and artery release for pudendal entrapment syndrome. Surg Endosc. (2020). https://doi.org/10.1007/s00464-020-08092-4.
Baran C, Mitchell GC, Hellstrom WJG. Cycling-related sexual dysfunction in men and women: a review. Sex Med Rev. 2014;2:93–101.
Aoun F, Mjaess G, Assaf J, Chemaly AK, Younan T, Albisinni S, et al. Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study. Scand J Urol. 2020;54:258–62.
Kasitinon D, Kelly B, Price TL, Chhabra A, Scott KM. Pudendal nerve injuries in sports and exercise: a case series of pudendal neuropathies from squats. J Women’s Health Phys Ther. 2020;45:3–9.
Alwaal A, Breyer BN, Lue TF. Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril. 2015;104:1051–60.
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.
Kinter KJ, Newton BW. Anatomy, abdomen and pelvis, pudendal nerve. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. http://www.ncbi.nlm.nih.gov/books/NBK554736/
Cvetanovich GL, Saltzman BM, Ukwuani G, Frank RM, Verma NN, Bush-Joseph CA, et al. Anatomy of the pudendal nerve and other neural structures around the proximal hamstring origin in males. Arthrosc J Arthrosc Relat Surg. 2018;34:2105–10.
Aoun F, Mjaess G, Akl B, Nassar D, Kallas Chemaly A, Haydar A, et al. Pudendal nerve release for lower urinary tract symptoms in young males. Low Urin Tract Symptoms. 2020;13:286–90.
Aoun F, Mjaess G, Daher K, Sakr G, Chemaly AK, Salameh M, et al. Laparoscopic treatment of pudendal nerve and artery entrapment improves erectile dysfunction in healthy young males. Int J Impot Res. 2020;33:1–5.
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Aoun, F., Mjaess, G., Lilly, E. et al. Is pudendal nerve entrapment a potential cause for weak ejaculation?. Int J Impot Res 34, 520–523 (2022). https://doi.org/10.1038/s41443-021-00443-6