Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/andr.12366

The impact of drugs on male fertility: a review

In a prior [15O]-H2O positron emission tomographic study we reported brain regions involved in human male ejaculation. Here, we used another, more recently acquired data set to evaluate the methodological approach of this previous study, and discovered that part of the reported activation pattern was not related to ejaculation. With a new analysis of these ejaculation data, we now demonstrate ejaculation-related activations in the deep cerebellar nuclei (dentate nucleus), anterior vermis, pons, and ventrolateral thalamus, and, most importantly, ejaculation-related deactivations throughout the prefrontal cortex. This revision offers a new and more accurate insight into the brain regions involved in human male ejaculation.

Brain activation during human male ejaculation revisited.

Impact of a First Treatment with Phosphodiesterase Inhibitors on Men and Partners’ Quality of Sexual Life: Results of a Prospective Study in Primary Care

Doctors Talking About Sexuality: What Are the Patients' Feelings?

The libido is considered to be a sexual drive in individuals that can be determined and influenced by several factors, such as social, psychological, and hormonal factors. It is known that nutritional aspects are important hormone regulators and that sexual dysfunction may, in many cases, be reversed with simple lifestyle changes. The aim of the study is to describe the actions of herbal medicine on the libido with an appropriate level of scientific evidence. A systematic review of the PUBMED, Scielo, and EMBASE databases was conducted, using the keywords “libido, food, and nutrient.” This study identified 2798 articles, 34 of which were selected, as they discussed exclusive studies involving herbal medicine. Some herbal medicines stood out, including Tribulus terrestris, used to increase testosterone serum levels; Eurycoma longifolia, which, in addition to the increased testosterone serum levels, also leads to an increased biosynthesis of several androgens; ginseng, which increases energy levels and stimulates smooth muscle relaxation with nitrous oxide; Maca (Lepidium meyenii), which improves sexual performance, in addition to having androgenic effects; and Mondia whitei (ginger), which improves the libido and erection. In addition to these, one study has demonstrated the effective impact of a hypocaloric, hyperproteic, and hypolipidemic diet on the libido, both improving sexual and erectile functions and increasing testosterone levels. Herbal medicine analyzed in this study demonstrate positive effects on the libido, thus proving that, along with nutritional intervention, it is also a promising field in nutrition actions that provide support to combat sexual dysfunctions.

https://link.springer.com/content/pdf/10.1186/s41110-017-0051-0.pdf

The action of herbal medicine on the libido: aspects of nutritional intervention in increasing sexual desire

Recommandations aux médecins généralistes pour la prise en charge de première intention de la dysfonction érectile (réactualisation 2010)

Guidelines for general practitioners for first-line management of erectile dysfunction (updated 2010)

Knowledge of the physiology of male and female sexuality has advanced considerably. Initially there is always desire with its biological neuroendocrine components and its emotional field which is particularly marked in women. There is a distinction between "spontaneous" sexual desire related to intrinsic affective, cognitive stimuli, and fantasies, and "reactive" sexual desire in response to physical arousal. There are similarities between men and women concerning the activation of cerebral zones in sexual arousal contexts in laboratory conditions. The neural pathways for sexual arousal are similar between men and women, bringing into play the sympathetic centres of the thoracic and lumbar spinal cord and, at the sacral level, the parasympathetic center and the motoneurons controlling the muscular contractions of the pelviperineal striated muscles. Genital sensitivity is mainly transmitted by the pudendal nerve in both men and women. Sexual arousal in men consists of penile erection, and ejaculation accompanied with orgasm. In women, sexual arousal causes increase in blood to flow to the vagina leading to lubrication and to the vulva leading to the erection of the clitoris and vulvar hyperaemia. The orgasm which can be multiple in women is accompanied by contractions of the striated perineal muscles. Several neurotransmitters are closely involved in the control of sexuality at the central level: dopamine, ocytocin, serotonin, and peripheral: nitric oxide and noradrenaline in men, vasoactive intestinal peptide and neuropeptide Y in women.

Anatomie et physiologie de la sexualité

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Recommandations aux médecins généralistes pour la prise en charge de première intention de la dysfonction érectile (réactualisation 2010)

Guidelines for general practitioners for first-line management of erectile dysfunction (updated 2010)

Anatomie et physiologie de la sexualité