Article Information

Hisataka Fujimoto^*, Junichi Kiryu

Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192 Okayama, Japan

*Corresponding author: Hisataka Fujimoto, Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192 Okayama, Japan.

Received: 04 June 2022; Accepted: 12 June 2022; Published: 16 June 2022

Citation: Hisataka Fujimoto, Junichi Kiryu. A Case of Spontaneous Halt during Ejaculation in a Juvenile Genius Mathematician with Asperger Syndrome and Bilateral Keratoconus. Journal of Ophthalmology and Research 5 (2022): 92-96.

Abstract

Keywords

spontaneous halt, ejaculation, mathematician, Asperger syndrome, keratoconus

Article Details

1. Intruduction

Anejaculation, defined as the complete absence of antegrade or retrograde ejaculation, is caused by a failure of semen emission from the seminal vesicles, prostate, and ejaculatory ducts into the urethra (1). Anejaculation is usually associated with a normal orgasmic sensation and is always associated with central or peripheral nervous system dysfunction or drug use (2). Drug treatment or interventions for anejaculation caused by lymphadenectomy and neuropathy, or psychosexual therapy for anorgasmia, are not effective. In these cases, and in men who have a spinal cord injury, penile vibratory stimulations (PVSs) are considered the first-line therapy. In anejaculation, PVS evokes the ejaculation reflex (2), which requires an intact lumbosacral spinal cord segment. If semen quality is poor or ejaculation is retrograde, couples may seek in vitro fertilization program if children are desired. In cases in which PVSs fail, electro-ejaculation can be the therapy of choice (3). When electro-ejaculation fails or cannot be performed, other methods such as sperm-retrieval techniques may be utilized (4). Anejaculation following retroperitoneal surgery for testicular cancer or total mesorectal excision can be prevented by performing unilateral lymphadenectomy and/or autonomic nerve preservation (5).

2. Case Description

This case involved a man middle age. His previous medical history included pneumothorax at 22 years of age. Regarding his current medical history, the patient visited a local ophthalmology clinic with a chief complaint of bilateral blurred vision. The slit-lamp examination during his first visit to the hospital revealed typical bilateral corneal thinning and keratoectasia. Bilaterally, one set of hard contact lenses (HCLs) was prescribed.

Following treatment, the patient’s visual acuity reached normal levels, similar to corrected visual acuity using HCLs. He is currently a prominent educational specialist and professor of mathematics. The patient also had an eccentric history of spontaneous halting during ejaculation as a juvenile to the present. He is a genius mathematician and was diagnosed with Asperger syndrome during high school.

3. Discussion

Autism spectrum disorder (ASD) is categorized based on impairments in social interaction and communication, as well as repetitive and stereotyped interests and behaviors (6). Up to 1.7% of the population is affected by ASD (7,8). Most individuals with ASD exhibit average intellectual functioning and are increasingly diagnosed as adults (9). As in other neurodevelopmental disorders, male preponderance has been reported in ASD, with an estimated male to female ratio of around 4:1 (10,11). However, these reported sex differences are controversial and the differences may be largely attributable to gender-biased differences in a male and female symptom-based diagnosis of ASD.

Individuals with ASD have difficulties in interpreting non-verbal cues, such as decoding and interpreting eye contact expressions, and have limited capabilities in the theory of mind skills (6). In the present case, the patient’s bilateral keratoconus and blurred vision prevented his eye contact and personal communications or conversations, in addition to his personality attributed to his ASD.

Throughout development, social interactions become more complex, romantic and sexual relationships become increasingly important, and the learned social skills often cannot keep up with the social demands needed for the initiation and maintenance of romantic peer relationships (12). The patient’s eccentric episodes of spontaneous halt during ejaculation from adolescence to the present might be hieroglyphic iconic aspects in the sexual or autistic action pattern and personality. Thus, many stereotypes have arisen concerning sexuality-related issues in individuals with ASD, including that ASD individuals are only sparsely interested in sexual and romantic relationships or are mainly asexual (14,15).

Contrary to these stereotypes, however, a growing body of recent research has shown that most individuals with ASD report a general interest in solitary and dyadic sexual behaviors and show the full range of sexual behaviors, similar to their clinically and pathologically normal counterparts (16-19). Deficits in intuitively understanding social and nonverbal communication cues, difficulties in perspective-taking, inflexibility, dominant dysregulation, repetitive and stereotyped actions, and peculiarities in sensitive perception leading to underreactions to sensory sensation could hamper the development of sexual relationships and may be associated with impaired sexual functioning and the development of sexual disorders (20-22). The present case had a history of pneumothorax at 22 years of age as well as bilateral keratoconus. Both diseases are related to the vulnerability and fragility of collagen cross-links. Extracellular matrix components such as collagen or related glycans are related to neural systems and developments (23-25).

4. Conclusion

Spontaneous ejaculation in the present case might have been accompanied by bilateral keratoconus, possibly due to collagen instability considering his history of pneumothorax. The findings suggested the need to examine a large cohort of patients with keratoconus, especially those with concurrent ASD and ejaculation abnormalities, to examine the prognosis and pathogenesis of mild to severe pathogeneses related to systemic collagen synthesis.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Author Contributions

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Funding

This study was supported in part by Research Project Grant 03B-002 from Kawasaki Medical School (to H.F.).

Acknowledgments

We thank Asakura T. and Saitoh B. for their discussions, advice, and criticism, which greatly benefited this project.

Data Availability Statement

The data supporting the findings of this study are available from the corresponding author, HF, upon reasonable request.

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