Novel presentation of retroperitoneal germ cell tumor with loss of ejaculation but preservation of erection in two patients  Claire A. Stark Toller, Gordon J.S. Rustin, M.D.  Fertility and Sterility  Volume 84, Issue 6, Pages 1744.e7-1744.e10 (December 2005) DOI: 10.1016/j.fertnstert.2005.06.038 Copyright © 2005 American Society for Reproductive Medicine Terms and Conditions

FIGURE 1 Sympathetic fibers (red) controlling ejaculation. An intact pudenal nerve (green) is required for orgasm. Reprinted with permission (6). Toller. Novel presentation of germ cell tumor. Fertil Sterile 2005. Fertility and Sterility 2005 84, 1744.e7-1744.e10DOI: (10.1016/j.fertnstert.2005.06.038) Copyright © 2005 American Society for Reproductive Medicine Terms and Conditions

FIGURE 2 Sympathetic fibers (red) from the superior hypogastric plexus are required for ejaculation and could be damaged by large volume retroperitoneal lymphadenopathy. Erection is under parasympathetic control via fibers of the pelvic splanchnic nerves (blue). As these nerves run a different course, they are unaffected by retroperitoneal lymphadenopathy so erection is preserved. The pelvic part of the sympathetic system is viewed from in front and the right side, a large part of the right hip bone having been removed. Reprinted with permission (8). Toller. Novel presentation of germ cell tumor. Fertil Sterile 2005. Fertility and Sterility 2005 84, 1744.e7-1744.e10DOI: (10.1016/j.fertnstert.2005.06.038) Copyright © 2005 American Society for Reproductive Medicine Terms and Conditions