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Rowland DL, Kӧvi Z, Hevesi K. Age-related differences in the prevalence of premature ejaculation: taking a second and more detailed look. Sex Med 2024; 12:qfae057. [PMID: 39224133 PMCID: PMC11368441 DOI: 10.1093/sexmed/qfae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/22/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background Research indicates an inconsistent relationship between age and the prevalence of premature ejaculation (PE), with studies reporting an increase, decrease, or no change with age. Aim To reexamine the possible relationship between age and PE prevalence, implementing methodological improvements that enhance the likelihood of detecting real effects. Methods From a sample of 2772 men, we analyzed a subset of 418 classified as having probable or definite PE based on the Premature Ejaculation Diagnostic Tool. We not only analyzed men with lifelong PE (LPE; n = 316) and acquired PE (APE; n = 102) separately but assessed prevalence differences across age groups using an omnibus measure to establish PE status and specific PE diagnostic criteria, individually and in multifactorial combination. Outcome Prevalence of PE in younger vs older men. Results LPE, but not APE, showed age-related differences in prevalence, with LPE being lower in the higher age group. This pattern was most discernible when a multifactorial approach was used to establish PE status. Clinical Translation Older men may be less distressed about their dysfunction or may benefit from diminishing ejaculatory function with age. Strengths and Limitations This cross-sectional study used an improved methodology to detect age-related differences in PE prevalence. Future studies would benefit from a larger sample size that enables a breakdown of prevalence using a greater number of age categories. Conclusion According to an improved methodology, men with LPE showed a decline in prevalence with aging. A methodology aimed at exploring this relationship should-at the very least-not only distinguish between LPE and APE subtypes but also consider using a multifactorial method of determining PE status that includes a measure of bother/distress.
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, United States
| | - Zsuzsanna Kӧvi
- Institute of Psychology, Károli Gáspár University of the Reformed Church, Budapest 1091, Hungary
| | - Krisztina Hevesi
- Institute of Psychology, Eötvös Loránd University, Budapest 1075, Hungary
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Rowland DL, Tamas S, Hevesi K. Updating, correcting, and calibrating the narrative about premature ejaculation. Sex Med Rev 2024; 12:401-410. [PMID: 38798049 DOI: 10.1093/sxmrev/qeae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/20/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The narrative surrounding premature ejaculation (PE) has developed and solidified over the past 25 years. Unfortunately, portions of that narrative are outdated and do not reflect more recent conceptualizations or empirical findings regarding this disorder. OBJECTIVE In this review we sought to identify existing narratives about PE in need of updating and to provide revised narratives based on the recent research literature. METHOD Five PE narratives in need of revision were identified, including: the prevalence of PE, age-related differences in PE prevalence, a validated ejaculation latency (EL) for diagnosing PE, differences between lifelong and acquired PE subtypes, and the application of PE definitions beyond penile-vaginal intercourse. Extensive literature searches provided information supporting both the original narrative and the need for a revised narrative based on both consideration of more recent studies and reinterpretation of studies conducted since the establishment of the original narratives. RESULTS For each selected topic, the prevailing narrative based on the extant literature was first presented, followed by discussion of accumulating evidence that challenges the existing narrative. Each section ends with a suggested revised PE narrative. In 2 instances, the revised narrative required significant corrections (eg, PE prevalence, validated EL for diagnosing PE); in 2 instances, it expanded on the existing narrative (eg, PE subtype differences, inclusion of partnered sexual activities beyond penile-vaginal intercourse); and in 2 other instances, it backed off prior conclusions that have since required rethinking (eg, age-related changes in PE, PE subtype differences). Finally, a brief review of the 3-pronged criteria for PE (EL, ejaculatory control, and bother/distress) is presented and discussed. CONCLUSION This review reiterates the dynamic state of research on PE and demonstrates the need for and value of ongoing research that not only addresses new issues surrounding this dysfunction but also challenges and revises some of the existing narratives about PE.
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN 46383, United States
| | - Stella Tamas
- Institute of Psychology, Eötvös Loránd University, Budapest 1075, Hungary
| | - Krisztina Hevesi
- Institute of Psychology, Eötvös Loránd University, Budapest 1075, Hungary
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Chin CW, Tsai CM, Lin JT, Chen YS, Chen IH, Jiann BP. A Cross-Sectional Observational Study on the Coexistence of Erectile Dysfunction and Premature Ejaculation. Sex Med 2021; 9:100438. [PMID: 34571325 PMCID: PMC8766268 DOI: 10.1016/j.esxm.2021.100438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The interplay between erectile dysfunction (ED) and premature ejaculation (PE) needs more studies to clarify. AIM To evaluate the risk factors and temporal relationship for the coexistence of ED and PE. METHODS The data were derived from clinical history. MAIN OUTCOME MEASURE The diagnosis of ED and PE was based on self-report and validated questionnaires. RESULTS Based on the chief complaint, 1,893 participants were recruited as ED group and 483 participants as PE group from 2014 to 2020. One third of ED and PE groups reported comorbid PE and ED. Of the ED group, 4.1% (n = 77) had lifelong PE, 18.0% (n = 341) had acquired PE and 9.7% (n = 184) had subjective or natural variable PE. Of the PE group, ED was reported in 22.0% (n = 40) of lifelong PE, 33.9% (n = 65) of acquired PE, and 37.6% (n = 41) of subjective or natural variable PE, P < .01. With adjustment of potential confounders, the ED severity was associated with increased risk of acquired PE, while acquired PE was associated with higher risk of ED than lifelong PE. In cases of comorbid lifelong PE and ED (n = 117), 22.2% reported the onset of both dysfunctions being about the same time, whereas 77.8% reported ED occurred behind PE with an average 23.3 years lag. In cases of comorbid acquired PE and ED (n = 406), 52.2% reported the onset of both dysfunctions being about the same time, 34.2% reported ED happened behind PE and 13.5% reported PE emerged behind ED. CONCLUSION Organic pathogenesis was least likely to be responsible for the link between PE and ED. When acquired PE and ED coexist, treating ED first or concomitantly according to their temporal order is an appropriate management algorithm. Chieh‑Wen Chin, Chia Mu Tsai, Jen-Tai Lin, et al. A Cross-Sectional Observational Study on the Coexistence of Erectile Dysfunction and Premature Ejaculation. Sex Med 2021;9:100438.
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Affiliation(s)
- Chieh-Wen Chin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Chia Mu Tsai
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Yin-Shen Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - I-Hsuan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Bang-Ping Jiann
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung; School of Medicine, National Yang-Ming University, Taipei; and College of Health and Nursing, Meiho University, Pingtung, Taiwan.
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Burnett AL, Edwards NC, Barrett TM, Nitschelm KD, Bhattacharyya SK. Addressing Health-Care System Inequities in the Management of Erectile Dysfunction: A Call to Action. Am J Mens Health 2021; 14:1557988320965078. [PMID: 33045918 PMCID: PMC7557698 DOI: 10.1177/1557988320965078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Erectile dysfunction (ED) is a common, burdensome, and costly urologic condition strongly related to all aspects of general health, from physical to mental. ED has profound consequences as it may interfere physical well-being, quality of life (QoL), self-esteem, relationships, self-worth, and productivity. It is therefore important to ensure that all types of effective ED treatments are consistently accessible to patients. While federal and state mandates ensure access to treatment for women’s breast health, female-factor infertility, and gender affirmation to ensure that these individuals do not experience a diminished QoL, there are no comparable mandates for men’s sexual and reproductive health. The burden of ED necessitates a call to action to improve the accessibility of ED treatments. The call to action steps include: (a) coverage for pharmacological, surgical, and other ED treatments should be viewed in the same way as coverage for other health issues, whether male or female and regardless of the stages of treatment, physical dysfunction, or physical changes; (b) American Urological Association (AUA) guidelines for the management of ED should be followed, including implementation of templates in electronic medical records (EMRs) to support adherence to the guidelines; and (c) coverage criteria should explicitly state that the criteria are intended to support gender equity for sexual and reproductive health care and should not be used to prevent men from receiving medically necessary ED treatments. This call to action offers a pathway to support every man who seeks treatment for ED as a medically necessary intervention by removing systemic health-care barriers.
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Affiliation(s)
- Arthur L Burnett
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Natalie C Edwards
- Health Economics and Outcomes Research, Health Services Consulting Corporation, Boxborough, MA, USA
| | - Tonya M Barrett
- Global Health Economics & Market Access, Women's Health & Prosthetic Urology-Men's Health, Boston Scientific Corporation, Urology Pelvic Health Division, Marlborough, MA, USA
| | - Krista D Nitschelm
- Global Health Economics & Market Access, Women's Health & Prosthetic Urology-Men's Health, Boston Scientific Corporation, Urology Pelvic Health Division, Marlborough, MA, USA
| | - Samir K Bhattacharyya
- Health Economics and Market Access, Boston Scientific Corporation, Marlborough, MA, USA
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Characteristics of men who are bothered by rapid ejaculation: results from clinical intake surveys. Int J Impot Res 2020; 33:369-375. [PMID: 32332929 DOI: 10.1038/s41443-020-0277-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/11/2020] [Accepted: 03/31/2020] [Indexed: 02/08/2023]
Abstract
The objective of this study is to identify factors associated with bother with rapid ejaculation in a cohort of men presenting to a sexual dysfunction clinic, independent of a diagnosis of PE. A prospective institutional database has been maintained on patients completing an 89-item intake questionnaire querying various areas of sexual dysfunction. Regarding ejaculatory dysfunction, patients are asked "Do you feel bothered, annoyed, and/or frustrated by ejaculating too quickly?" Statistical modeling was performed to identify associations. A total of 1359 men completed the intake survey, and 694 responded to the question on bother with rapid ejaculation. Overall, 42.9% (298/694) of respondents reported bother with rapid ejaculation. Men reporting bother were more likely to report lower intravaginal ejaculatory latency (IELT) time (4.2 vs 12.2 min, p < 0.0001), problems with depression (32% vs 21%, p = 0.001), negative impact on relationship (73% vs 51%, p < 0.0001), and negative impact on partner's sexual satisfaction (26% vs 15%, p < 0.001). These results highlight the importance of asking all men presenting with sexual health concerns about their bother with rapid ejaculation for complete assessment of sexual and mental wellbeing.
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Ramli FF, Shuid AN, Pakri Mohamed RM, Tg Abu Bakar Sidik TMI, Naina Mohamed I. Health-Seeking Behavior for Erectile Dysfunction in Methadone Maintenance Treatment Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214249. [PMID: 31683816 PMCID: PMC6862227 DOI: 10.3390/ijerph16214249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
Background: Erectile dysfunction (ED) is commonly associated with methadone usage. However, little data is known regarding the health-seeking behavior for ED in the methadone maintenance treatment (MMT) population. This study aimed to determine the health-seeking behavior of MMT patients with ED who perceived themselves as having ED. We aimed to assess the attitudes and health-seeking behavior, the effectiveness of the treatment and the factors associated with treatment-seeking behavior. Methods: This was an observational questionnaire-based study. Patients were first screened for ED (n = 154) using the International Index of Erectile Function-5 (IIEF-5). Fifty patients with ED were evaluated for health-seeking behavior for ED. Results: More than half of the patients who thought they had ED (78%) believed their sex life was affected. Most patients (48%) did not seek any information regarding ED. Education level (p = 0.017) and marital status (p = 0.008) were predictive factors of health-seeking behavior. Conclusions: The health-seeking rate among MMT patients with ED needs to be improved. Measures to increase awareness of ED in MMT patients should be taken to overcome the barrier to health-seeking behavior. Health practitioners should take action to screen ED in this population to increase the detection rate and offer appropriate management according to the patients’ needs.
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Affiliation(s)
- Fitri Fareez Ramli
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
| | - Ahmad Nazrun Shuid
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
| | - Rashidi Mohamed Pakri Mohamed
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
| | - Tg Mohd Ikhwan Tg Abu Bakar Sidik
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
| | - Isa Naina Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Kuala Lumpur, Malaysia.
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Song WH, Yoo S, Oh S, Park J, Cho SY, Cho MC, Jeong H, Son H. Ten-Year Interval Changes in the Prevalence of Self-Identified Premature Ejaculation and Premature Ejaculation Based on an Estimated Intravaginal Ejaculation Latency Time of <3 Minutes in the General Population: The Korean Internet Sexuality Survey (KISS) 2016. J Sex Med 2019; 16:512-521. [DOI: 10.1016/j.jsxm.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 01/23/2023]
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Santos JC, Rolim N, Fonseca R, Mota R, Monteiro H. [Andrology - Whom and how are patients being referred?]. Rev Int Androl 2019; 17:31-36. [PMID: 30691589 DOI: 10.1016/j.androl.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/21/2017] [Accepted: 12/30/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Andrology focuses in male sexual and fertility diseases. Its referral should be thoughtful and tailored in order to select the correct cases. OBJECTIVES The aim of this work was to evaluate the referral to our department and improvement points. MATERIAL AND METHODS A retrospective analysis was performed of the Andrology consults between January 2014 and December 2015. RESULTS We evaluated 96 of the 102 consults performed. About 60% of patients were referred with erectile dysfunction complaints, 15% with penile curvature and 8% with ejaculatory dysfunction. About 27% had previously tried phosphodiesterase 5 inhibitor, and 40% lacked recent metabolic workup. DISCUSSION The high prevalence of sexual complaints coupled with a high number of naïve patients could be due to difficulties by the referral doctors when analyzing and characterizing male sexual dysfunction according to the current sexual response cycle model. The lack of patient categorization accordingly to Princeton criteria (III) shows the difficulties found when selecting patients to start the first line of treatment for erectile dysfunction. CONCLUSION Sexual dysfunction are highly prevalent in the general population. Healthcare providers should improve diagnostic and treatment skills in this field of Urology.
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Affiliation(s)
- José Carlos Santos
- Serviço de Urologia, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal.
| | - Nídia Rolim
- Serviço de Urologia, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Rita Fonseca
- Serviço de Urologia, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Renato Mota
- Serviço de Urologia, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Hélder Monteiro
- Serviço de Urologia, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
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Development and single dose clinical pharmacokinetics investigation of novel zein assisted- alpha lipoic acid nanoencapsulation of vardenafil. Sci Rep 2018; 8:15802. [PMID: 30361675 PMCID: PMC6202340 DOI: 10.1038/s41598-018-34235-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/15/2018] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to utilize the biocompatibility of the natural ingredients zein and alpha lipoic acid (ALA) as a novel nanosphere matrix formulation that encapsulates vardenafil (VRD) for improved drug delivery and bioavailability. Three formulations were prepared using zein: ALA ratio of 1:1, 2:1 and 3:1 by liquid-liquid phase separation method. Physicochemical characterization and in vitro diffusion evaluation were carried out for the prepared formulations. A single dose clinical pharmacokinetic study was carried out for the selected formulation. Results revealed VRD formulations showed particle size of 836.7 ± 191.3, 179.8 ± 18.4 and 147.3 ± 18.1 nm and encapsulation efficiency of 55.72 ± 4.36, 65.33 ± 7.82 and 69.38 ± 6.83% for F1, F2 and F3, respectively. Single dose clinical pharmacokinetic results, in healthy human volunteers, showed improved VRD bioavailability by 2.5 folds from nanosphere formula (F3) compared with the marketed tablets. The formulation of novel zein-ALA nanospheres offers the possibility for application of a biocompatible nano-carrier system in drug delivery for improved drug delivery and efficacy.
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Nimbi F, Rossi R, Simonelli C. Telephone sexual counselling and current technologies: Are helplines still effective in the social media era? SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Nimbi F, Rossi R, Simonelli C. Conseils sexuels par téléphone et technologies actuelles : les lignes d’assistances téléphoniques sont-elles encore efficaces à l’ère des médias sociaux ? SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Graugaard C, Nielsen VML, Jensen SØ, Koch H, Ogstrup AJ, Jakobsen MF, Hald J. What Do Danish Youth Want to Know About Sex? Twenty Years of Telephone Counseling on Sexual and Reproductive Issues. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:159-168. [PMID: 26821739 DOI: 10.1080/0092623x.2016.1141819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Young people's need for sexual counseling is well documented, and both website and hotline-based services have been established as means of health promotion in this field. Such measures, however, are rarely evaluated, so this article offers data from the world's presumably oldest sexuality helpline aimed at young people. With an observation time of two decades and a total of 42,325 questions asked, the study provides a unique glance into the sexual landscapes of Danish youth. It shows an overall male predominance among callers and reveals that the counseling themes change over time and differ between both age groups and genders. The article suggests that telephone counseling-although more resource demanding than online alternatives-provides a secure, anonymous, and dialogue-based arena for discussing delicate sexual issues and therefore may constitute a viable supplement to web-based media for young people with the need to talk rather than just chat.
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Affiliation(s)
- Christian Graugaard
- a Center for Sexology Research, Department of Clinical Medicine, Aalborg University , Aalborg , Denmark
| | - Vibe Maria L Nielsen
- a Center for Sexology Research, Department of Clinical Medicine, Aalborg University , Aalborg , Denmark
| | - Solveig Ø Jensen
- a Center for Sexology Research, Department of Clinical Medicine, Aalborg University , Aalborg , Denmark
| | - Henning Koch
- a Center for Sexology Research, Department of Clinical Medicine, Aalborg University , Aalborg , Denmark
| | - Anna J Ogstrup
- a Center for Sexology Research, Department of Clinical Medicine, Aalborg University , Aalborg , Denmark
| | - Mathias F Jakobsen
- a Center for Sexology Research, Department of Clinical Medicine, Aalborg University , Aalborg , Denmark
| | - Jeppe Hald
- b The Danish Family Planning Association , Copenhagen , Denmark
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Jiann BP. The office management of ejaculatory disorders. Transl Androl Urol 2016; 5:526-40. [PMID: 27652225 PMCID: PMC5001990 DOI: 10.21037/tau.2016.05.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022] Open
Abstract
Premature ejaculation (PE), delayed ejaculation (DE), anejaculation (AE) and retrograde ejaculation (RE) are four main ejaculatory disorders (EjDs) observed in clinical practice. Despite their high prevalence, EjDs remain underdiagnosed and undertreated. Primary care physicians should incorporate the discussion of sexual health topics into routine visits to facilitate EjD diagnosis and treatment. Because the causes of EjDs are multifactorial, the management of EjDs is etiology-specific and may require a holistic approach. Dapoxetine, a selective serotonin reuptake inhibitor, is the only drug approved for on-demand treatment of lifelong and acquired PE. In clinical practice, scheduled follow-up visits, risk factor treatment, appropriate dose escalation, adequate sexual attempts, patient education, and partner involvement are critical factors responsible for optimal overall management of PE and dapoxetine treatment outcomes.
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Affiliation(s)
- Bang-Ping Jiann
- Division of Basic Medical Research, Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Hatzimouratidis K, Hatzichristou D. How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment. Curr Diab Rep 2014; 14:545. [PMID: 25193347 DOI: 10.1007/s11892-014-0545-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Erectile dysfunction (ED) is highly prevalent affecting at least 50 % of men with diabetes mellitus (DM). DM may cause ED through a number of pathophysiological pathways. These include neuropathy, endothelial dysfunction, cavernosal smooth muscle structural/functional changes, and hormonal changes. Lifestyle changes, diabetes control, and treatment of hypogonadism are important as the first step in ED management since there is no curative treatment for ED. Phosphodiesterase type 5 inhibitors (PDE5i) are the first-line treatment option. Intracavernous administration of vasoactive drugs is commonly used as a second-line medical treatment when PDE5i have failed. Alprostadil is the most widely used drug in this second-line setting. The combination of papaverine, phentolamine, and alprostadil represents the most efficacious intracavernous pharmacologic treatment option that may save non-responders to alprostadil. Penile prosthesis implantation can be considered in treatment refractory cases, with excellent functional and safety results in the properly informed patients.
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Sexual Dysfunctions as Self-Reported by Diabetic- Type-2 Men: An Andrology Clinic-Based Study in Alexandria, Egypt. ACTA ACUST UNITED AC 2013. [DOI: 10.12691/ajmbr-1-3-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Hwang I, Yang DO, Park K. Self-Reported Prevalence of and Attitudes toward Premature Ejaculation in a Community-Based Study of Married Couples. World J Mens Health 2013; 31:70-5. [PMID: 23658869 PMCID: PMC3640156 DOI: 10.5534/wjmh.2013.31.1.70] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/11/2013] [Accepted: 03/22/2013] [Indexed: 01/23/2023] Open
Abstract
PURPOSE We evaluated the self-reported prevalence of and attitudes toward premature ejaculation (PE) in a community-based study of married couples. MATERIALS AND METHODS A community-based cross-sectional study of PE was conducted among married couples in Gwangju, Korea. Self-reported data were collected through the use of questionnaires, which included demographic questions, the Premature Ejaculation Diagnostic Tool (PEDT), the intravaginal ejaculation latency time (IELT), patient-reported outcome (PRO), and the Female Sexual Function Index (FSFI). RESULTS Of the 290 couples who completed the survey, the prevalence of PEDT-diagnosed PE including probable PE was 23.7% of men. By IELT measure, the prevalence of PE was 21.7% as reported by the men and 23.9% as reported by their partners, respectively. PRO responses indicated that control over ejaculation and severity of PE were not reported significantly differently by the men and their partners. Satisfaction with sexual intercourse was poorer for the men's partners than for the men. Personal distress and interpersonal difficulty were higher for the men than for their partners. The partners of men in the PE group had significantly lower FSFI scores than did the partners of men in the non-PE group. CONCLUSIONS The reporting of the prevalence of PE did not differ significantly between the men in this study and their partners. However, PE in men tended to impact their partners' sexual function.
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Affiliation(s)
- Insang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Fan M, Xu X, He X, Chen L, Qian L, Liu J, Qing J, Chao Z, Sun X. Protective effects of hydrogen-rich saline against erectile dysfunction in a streptozotocin induced diabetic rat model. J Urol 2012; 190:350-6. [PMID: 23220246 DOI: 10.1016/j.juro.2012.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 02/03/2023]
Abstract
PURPOSE Hydrogen has antioxidative stress and anti-inflammatory effects. We investigated the effect of hydrogen on erectile dysfunction in streptozotocin induced diabetic rats. MATERIALS AND METHODS Diabetes was induced in Sprague-Dawley® rats by a single intravenous injection of streptozotocin. Diabetic rats were then randomized to a diabetes mellitus group and to a diabetic group that received hydrogen saline. The latter 8 rats were fed saturated hydrogen saline (5 ml/kg per day) by intragastric administration for 8 weeks. At the end of week 8 erectile function was assessed by measuring the increase in intracavernous pressure after cavernous nerve electrostimulation. We measured nitric oxide synthase activity, and malondialdehyde, 8-hydroxydeoxyguanosine, and nitrite and nitrate in the corpus cavernosum. eNOS protein immunolocalization in cavernous tissues was detected by immunohistochemistry. eNOS, Bcl-2 and Bax protein expression was determined by Western blot. We determined eNOS, Bcl-2 and Bax mRNA using real-time reverse transcriptase-polymerase chain reaction. RESULTS Oxidative stress is involved in the pathophysiological mechanism of erectile dysfunction. Maximum intracavernous pressure in diabetic rats decreased significantly compared to controls and increased significantly compared to untreated diabetic rats after hydrogen-rich saline treatment. Decreased nitric oxide synthase activity, nitrite and nitrate, and eNOS expression as well as increased 8-hydroxydeoxyguanosine and malondialdehyde were found in the diabetic group compared to controls. Hydrogen-rich saline improved nitric oxide synthase activity, and malondialdehyde, nitrite and nitrate, and 8-hydroxydeoxyguanosine levels in the diabetic rat corpus cavernosum. Decreased eNOS in diabetic rats was ameliorated by hydrogen-rich saline. Also, apoptosis in the diabetic rat corpus cavernosum was significantly enhanced compared with controls. Hydrogen-rich saline therapy may decrease apoptosis in cavernous tissues and it ameliorated erectile dysfunction in diabetic rats by inhibiting oxidative stress and apoptosis. CONCLUSIONS Hydrogen-rich saline effectively improved erectile function in a streptozotocin induced diabetic rat model of erectile dysfunction.
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Affiliation(s)
- Min Fan
- Department of Urology, Third Affiliated Hospital of Soochow University, Changzhou, People's Republic of China
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Jern P, Gunst A, Sandnabba K, Santtila P. Are early and current erectile problems associated with anxiety and depression in young men? A retrospective self-report study. JOURNAL OF SEX & MARITAL THERAPY 2012; 38:349-364. [PMID: 22712819 DOI: 10.1080/0092623x.2012.665818] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Erectile dysfunction (ED) has been extensively studied in the past few decades, and significant advances have been made in understanding its etiology. Most cases of this type of dysfunction have an organic etiology, and ED occurs primarily in older men. However, relatively little is known about erectile problems in young men or about the interconnection between psychiatric symptoms and ED etiology. In this study, the authors investigated ED symptoms in a large, population-based sample of 18-48-year-old men. Participants reported ED symptoms from their first intercourse experience as well as those occurring at present. The authors assessed the association between reported ED symptoms during early partnered sexual experiences and present ED symptoms. Furthermore, the authors investigated associations between age, symptoms of anxiety and depression, and erectile problems. Results indicated that age was a significant predictor of ED problems already in young age groups. ED problems were prevalent to a much higher extent during early sexual intercourse experiences and appeared to pass with time for most men. Anxiety and depression were significant predictors of present erectile problems. Implications of the results and potential limitations were discussed.
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Affiliation(s)
- Patrick Jern
- Abo Akademi University, Department of Psychology and Logopedics, Turku, Finland.
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Kim HK, Choi BR, Bak YO, Zhao C, Lee SW, Jeon JH, So I, Park JK. The role of capillarisin from Artemisia capillaris on penile erection. Phytother Res 2011; 26:800-5. [PMID: 22072532 DOI: 10.1002/ptr.3635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/13/2011] [Indexed: 11/09/2022]
Abstract
The objective of this study was to evaluate the effect and mechanism of capillarisin from Artemisia capillaris (A. capillaris) on rabbit penile corpus cavernosum (PCC). The pre-contracted New Zealand White rabbit (2.5-3.0 kg) penis with phenylephrine (Phe; 10⁻⁵ M) was treated with various concentrations of ethanol extract of A. capillaris (0.1, 0.5, 1, and 2 mg/mL) and capillarisin, the active component of A. capillaris (10⁻⁷, 10⁻⁶, 10⁻⁵ and 10⁻⁴ M). Capillarisin was also applied to PCC tissues contracted with Phe, which were pre-incubated with phosphodiesterase type 5 inhibitors (PDE5 Is). Cyclic nucleotides in the perfusate were measured by radioimmunoassay. The tissues were pre-incubated with Nω nitro-l-arginine-methyl ester (L-NAME, 10⁻³ M) and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ, 10⁻⁵ M) to block nitric oxide (NO) synthase and guanylate cyclase, respectively. Capillarisin induced penile relaxation and enhanced PDE5 Is-induced relaxation. Capillarisin increased cGMP and cAMP in the perfusate. The application of capillarisin on PCC pre-treated with L-NAME and ODQ significantly inhibited the relaxation. Capillarisin exerts the relaxing effect on PCC by activating the NO-cGMP and adenylyl cAMP signaling pathways and may become an alternative medicine for patients who want to use natural products to improve erectile function or do not completely respond to PDE5 Is.
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Affiliation(s)
- Hye Kyung Kim
- Department of Urology of Medical School and Institute for Medical Sciences, Chonbuk National University, and Research Institute and CTC of Medical Device of Chonbuk National University Hospital, Jeonju 561-712, Republic of Korea
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McMahon CG, Lee G, Park JK, Adaikan PG. Premature ejaculation and erectile dysfunction prevalence and attitudes in the Asia-Pacific region. J Sex Med 2011; 9:454-65. [PMID: 22023395 DOI: 10.1111/j.1743-6109.2011.02507.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Premature ejaculation (PE) is a common male sexual dysfunction. The prevalence of PE in the Asia-Pacific region has not been comprehensively studied. AIM The aim of this study is to evaluate PE prevalence in nine Asia-Pacific countries and the impact of PE on sufferers. METHODS A random sample of heterosexual males aged 18-65 years in a stable sexual relationship currently or in the past 2 years completed a 48-question survey by computer-assisted interviewing, online, or in-person; the survey and recruitment methodologies varied by location. The survey included demographic questions, the five-question Premature Ejaculation Diagnostic Tool (PEDT), the five-question Sexual Health Inventory for Men (SHIM), and the 10-question Index of Premature Ejaculation (IPE). Separately, men self-reported having PE (lifelong or acquired) or erectile dysfunction (ED). MAIN OUTCOME MEASURES The PEDT was used to diagnose PE or probable PE; the SHIM was used to diagnose ED; and the IPE was used to assess respondent's attitudes toward PE. RESULTS Of the 4,997 men who completed the survey, the prevalences of PEDT-diagnosed PE, PEDT-diagnosed probable PE, and self-reported PE were 16%, 15%, and 13%, respectively. Less than half of men with PEDT-diagnosed PE (N = 816) or probable PE (N = 738) self-reported the condition (40% and 19%, respectively), and 6% of men with a PEDT diagnosis of no PE self-reported PE. In contrast, more respondents self-reported ED (8%) than had SHIM-diagnosed moderate or severe ED (5%). IPE responses indicated that 45%, 46%, and 23% of men with PEDT-diagnosed PE were somewhat or very dissatisfied with the length of intercourse before ejaculation, their control over ejaculation, and with sexual intercourse, respectively. CONCLUSIONS In this study, PE was more prevalent than ED in the Asia-Pacific countries surveyed, but only 40% of men with PEDT-diagnosed PE self-reported PE.
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Affiliation(s)
- C G McMahon
- Australian Centre for Sexual Health, Sydney, Australia.
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Tomlinson JM, Fernandes LC, Wylie KR. An e-mail and telephone helpline for sexual problems - results of a 2-year survey of men's sexual concerns. Int J Clin Pract 2011; 65:1085-91. [PMID: 21801284 DOI: 10.1111/j.1742-1241.2011.02729.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sexual problems are relatively common in the community. The under-reporting of such problems calls for alternative ways of getting a true perspective of the prevalence of sexual dysfunction. AIM To assess and investigate the concerns, ages and nationality of male users of a electronic helpline using it over 2 years (2009-2010). METHODS Detailed records were kept of all emails and telephone calls to the helpline which included administrative and clinical queries. The clinical calls and some of the emails were answered by the administrator, while the majority of the emails were answered by a physician. This presentation will deal with the users who emailed for assistance with male sexual dysfunction. (n = 673). RESULTS The helpline received a total of 6142 calls over the period of investigation, including administrative and press calls. Men accounted for 88% of the callers about sexual dysfunction. Erectile dysfunction accounted for 68% of the complaints by men who used the e-mail service. Premature ejaculation, loss of sex drive, genital problems and masturbation worries were other concerns that were received. A large number of men from the Middle East and the Indian sub-continent used the email service, mostly for premature ejaculation and masturbation worries, related to their arranged marriage. CONCLUSIONS We found confirmation that the commonest sexual complaints in men were of erectile dysfunction and loss of sex drive. Significant correlations were identified between the types of sexual dysfunction and the age and ethnicity of the men who presented with them.
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Affiliation(s)
- J M Tomlinson
- Men's Health Clinic, Royal Hampshire County Hospital, Winchester, UK.
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Paduch DA, Bolyakov A, Beardsworth A, Watts SD. Factors associated with ejaculatory and orgasmic dysfunction in men with erectile dysfunction: analysis of clinical trials involving the phosphodiesterase type 5 inhibitor tadalafil. BJU Int 2011; 109:1060-7. [PMID: 21883853 DOI: 10.1111/j.1464-410x.2011.10504.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine frequencies of, and risk factors for, ejaculatory dysfunction (EjD) and orgasmic dysfunction (OD) in men with different degrees of erectile dysfunction (ED). PATIENTS AND METHODS Baseline data from 28 ED trials were integrated and analysed. The International Index of Erectile Function Question 9 (IIEF-Q9; 'When you had sexual stimulation or intercourse, how often did you ejaculate?') and IIEF-Q10 ('How often did you have the feeling of orgasm with or without ejaculation?') were used to evaluate ejaculatory and orgasmic functions. Responses of 'almost never or never' or 'a few times (much less than half the time)' were taken as evidence of EjD or OD, respectively, whereas responses of 'almost always or always' or 'most times (much more than half the time)' were taken as evidence of normal function. Estimates of the relative risks (RRs) of EjD or OD were determined for multiple patient characteristics. RESULTS Among 12,130 study participants with available data, only 5117 (42.2%) reported normal ejaculatory function, and 4321 (35.6%) normal orgasm, regardless of ED severity. Among subjects with poor ejaculatory function, 16.7% had mild ED, and among subjects with poor sensation of orgasm, 21.9% had mild ED. Frequencies of EjD and OD increased with increasing ED severity. Of the 5117 individuals with normal ejaculatory function, 796 (15.6%) had poor sensation of orgasm. Of the 4321 subjects with normal orgasm, 226 (5.2%) had poor ejaculatory function. Men with (vs without) EjD or OD tended to be younger: 53.7 vs 56.9 years and 54.2 vs 56.2 years, respectively. Factors associated with increased RRs of EjD and OD included cardiomyopathy (RR for EjD 1.74; RR for OD 1.59); cardiac failure (RR 1.40; 1.22); and baseline use (or history of use) of antipsychotics (RR 1.45; 1.30), selective serotonin reuptake inhibitors (RR 1.31; 1.27), and tricyclic antidepressants (RR 1.34; 1.28). CONCLUSIONS EjD and OD occurred at baseline in more than one in three men enrolled in tadalafil trials. Even men with mild ED reported EjD or OD. Further studies are warranted to better understand the impacts of EjD and OD on male sexuality and quality of life.
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Affiliation(s)
- Darius A Paduch
- Department of Urology and Reproductive Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
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Yin TL, Yang J, Zhang B, Yan WJ, Xu WM, Li W, Yu L, Li SJ, Wu GX. Folic acid supplementation as adjunctive treatment premature ejaculation. Med Hypotheses 2011; 76:414-6. [DOI: 10.1016/j.mehy.2010.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/01/2010] [Accepted: 11/08/2010] [Indexed: 12/26/2022]
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Relative contributions of modifiable risk factors to erectile dysfunction: results from the Boston Area Community Health (BACH) Survey. Prev Med 2010; 50:19-25. [PMID: 19944117 PMCID: PMC2813912 DOI: 10.1016/j.ypmed.2009.11.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/13/2009] [Accepted: 11/18/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this study was to determine the relative contribution of modifiable risk factors (physical activity, smoking, and alcohol consumption) to inter-subject variation in erectile dysfunction (ED). METHODS The Boston Area Community Health (BACH) Survey used a multistage stratified random sample to recruit 2301 men age 30-79 years from the city of Boston between 2002 and 2005. ED was assessed using the 5-item International Index of Erectile Function (IIEF-5). Multiple linear regression models and R(2) were used to determine the proportion of the variance explained by modifiable risk factors. RESULTS In unadjusted analyses, lifestyle factors accounted for 12.2% of the inter-subject variability in IIEF-5 scores, comparable to the proportion explained by comorbid conditions (14.7%) and socioeconomic status (9%). Lifestyle factors were also significantly associated with age, comorbid conditions and socioeconomic status (SES). A multivariate model including all covariates associated with ED explained 29% of the variance, with lifestyle factors accounting for 0.9% over and above all other covariates in the model. Analyses repeated in a subgroup of 1215 men without comorbid conditions show lifestyle factors accounting for 2.5% of the variance after accounting for all other variables in the model. CONCLUSIONS Results of the present study demonstrate the contribution of modifiable lifestyle factors to the prevalence of ED. These results suggest a role for behavior modification in the prevention of ED.
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Kirana PS, Papaharitou S, Athanasiadis L, Nakopoulou E, Salpiggidis G, Moysidis K, Pipilaki C, Hatzimouratidis K, Tzotstzis V, Portseli A, Iraklidou M, Apostolidis A, Bekos A, Hatzichristou D. A Conceptual Framework for the Evolution of Sexual Medicine and a Model for the Development of Alternative Sexual Health Services: 10-Year Experience of the Center for Sexual and Reproductive Health. J Sex Med 2009; 6:2405-16. [DOI: 10.1111/j.1743-6109.2009.01320.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Hatzichristou D. Understanding individuals' response to erectile dysfunction. Int J Impot Res 2008; 20 Suppl 2:S15-20. [DOI: 10.1038/ijir.2008.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Jern P, Santtila P, Johansson A, Varjonen M, Witting K, Ålgars M, Alanko K, Von Der Pahlen B, Sandnabba K. Indicators of Premature Ejaculation and Their Associations with Sexual Distress in a Population-Based Sample of Young Twins and Their Siblings. J Sex Med 2008; 5:2191-201. [DOI: 10.1111/j.1743-6109.2008.00863.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Papaharitou S, Nakopoulou E, Moraitou M, Tsimtsiou Z, Konstantinidou E, Hatzichristou D. Exploring Sexual Attitudes of Students in Health Professions. J Sex Med 2008; 5:1308-16. [DOI: 10.1111/j.1743-6109.2008.00826.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kupelian V, Link CL, Rosen RC, McKinlay JB. Socioeconomic Status, Not Race/Ethnicity, Contributes to Variation in the Prevalence of Erectile Dysfunction: Results from the Boston Area Community Health (BACH) Survey. J Sex Med 2008; 5:1325-33. [DOI: 10.1111/j.1743-6109.2008.00822.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Salonia A. Editorial comment on: ejaculation elicited by microstimulation of lumbar spinothalamic neurons. Eur Urol 2008; 54:455-6. [PMID: 18394779 DOI: 10.1016/j.eururo.2008.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ejaculation elicited by microstimulation of lumbar spinothalamic neurons. Eur Urol 2008; 54:449-56. [PMID: 18394782 DOI: 10.1016/j.eururo.2008.03.043] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 03/18/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Neuroanatomical and lesion studies have identified lumbar spinothalamic (LSt) neurons to be essential for ejaculation, but their precise role remains elusive. OBJECTIVE To assess the role of LSt neurons as a spinal pattern generator for ejaculation (SGE) and their action on anatomical structures involved in the two ejaculation phases, the emission and expulsion of semen. DESIGN The bulbospongiosus muscle (BSM) was implanted with electrodes and the seminal vesicle (SV) or vas deferens (VD) lumen catheterized in adult anaesthetized rats. Spinal exposure at the fourth lumbar segment (L4) allowed lowering an electrode stereotaxically into area VII/X for brief (300-500ms) electrical stimulation of LSt neurons, while recording BSM-EMG and intraluminal SV or VD pressure. RESULTS Brief electrical microstimulation in the LSt neuron area evoked the expulsion of semen in 17 of 17 rats, with motile spermatozoa in 10 of 17 rats. After stimulation, SV/VD luminal pressure directly rose and fell, followed by rhythmic BSM contractions lasting approximately 25s. Acute T8-T9 spinalization (n=4) did not alter the activation pattern of the BSM-EMG response. Injection of the GABA(A)-receptor agonist muscimol, inhibiting neuronal activity into the LSt neuron area after LSt neuron microstimulation (n=5), stopped BSM contractions in midstream. CONCLUSIONS Electrical microstimulation of LSt neurons activates the entire sequence of ejaculation in rats in a coordinated fashion, ie the emission (SV/VD contraction) followed by expulsion (rhythmic BSM contractions) of living spermatozoa. Midcourse interruption of ejaculation following intraspinal muscimol injection establishes that LSt neurons are the SGE. This could help to identify spinal pharmacological targets for the treatment of ejaculatory disorders and provide the rationale for intraspinal stimulation to treat anejaculation in infertile spinal cord injured (SCI) patients.
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Salonia A, Abdollah F, Gallina A, Pellucchi F, Castillejos Molina RA, Maccagnano C, Rocchini L, Zanni G, Rigatti P, Montorsi F. Does educational status affect a patient's behavior toward erectile dysfunction? J Sex Med 2008; 5:1941-8. [PMID: 18399948 DOI: 10.1111/j.1743-6109.2008.00810.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Educational status has been investigated rarely as a potential factor affecting the behavior of patients with new onset erectile dysfunction (ED) toward seeking first medical help and subsequent compliance with prescribed phosphodiesterase type 5 inhibitor (PDE5) therapy. AIM To test whether the educational status of patients with new onset ED and naïve to PDE5 therapy may have a significant impact on the delay before seeking first medical help (DSH) and compliance with the suggested PDE5. MAIN OUTCOME MEASURES Assessing DSH and compliance with PDE5 in new onset ED patients according to their educational status by means of detailed logistic regression analyses. METHODS Data from 302 consecutive patients with new onset ED and naïve to PDE5s were comprehensively analyzed. Patients were segregated according to their educational status into low (elementary and/or secondary school education) and high (high school and/or university degrees) educational levels. Complete data were available for 231 assessable patients. Univariate (UVA) and multivariate (MVA) logistic regression analyses addressed the association between educational status and DSH after adjusting for age, relationship status, and Sexual Health Inventory for Men score. Likewise, UVA and MVA were performed to test the association between educational status and patient compliance with PDE5 at the 9-month median follow-up. RESULTS Median DSH was 24 months (range 1-350; mean 38.1 +/- 42.8). The lower the educational status, the shorter the DSH (P = 0.03). In contrast, a significantly (P < 0.0001) greater proportion of patients with a higher educational status showed compliance with the suggested PDE5 at the 9-month follow-up. Overall, educational status was not an independent predictor of either DSH or patient compliance with PDE5 therapy. CONCLUSIONS After adjusting for other variables, our findings suggest that in new onset ED patients, educational status does not independently affect the DSH and patient compliance with PDE5 therapy.
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Affiliation(s)
- Andrea Salonia
- Department of Urology, University Vita - Salute San Raffaele, Scientific Institute H. San Raffaele, Milan, Italy.
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Hatzimouratidis K. Sildenafil in the treatment of erectile dysfunction: an overview of the clinical evidence. Clin Interv Aging 2008; 1:403-14. [PMID: 18046917 PMCID: PMC2699643 DOI: 10.2147/ciia.2006.1.4.403] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Erectile dysfunction (ED) is a highly prevalent disease associated with aging as well as with several risk factors including hypertension, heart disease, obesity, dyslipidemia, diabetes, hypogonadism, drugs-related, and pelvic surgery. Many of these factors are components of the metabolic syndrome, a multiplex risk factor for cardiovascular disease (CVD). ED shares common risk factors with CVD. Endothelial dysfunction seems to be the early underlying pathophysiology across both conditions. The efficacy, tolerability and cardiovascular safety of sildenafil has been evaluated in numerous large, randomized, double-blind, placebo-controlled clinical studies in the broad population of men with ED including men with several co-morbid conditions. Sildenafil is effective in several specific patient populations including the difficult-to-treat subpopulations such as diabetes mellitus and after radical prostatectomy. It is associated with rapid onset of action – within 14 minutes for some men – and an extended duration of action for up to 12 hours. Sildenafil improves quality of life and satisfaction for treated men and is well tolerated with a favorable safety profile. New data suggest that sildenafil has beneficial effects in several chronic conditions. It has been approved for the treatment of idiopathic pulmonary hypertension. Numerous articles have suggested that it improves endothelial function and a possible role on premature ejaculation or treatment of lower urinary tract symptoms has been suggested.
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Affiliation(s)
- Konstantinos Hatzimouratidis
- 2nd Department of Urology, Papageorgiou General Hospital, and Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Hatzimouratidis K. Phosphodiesterase type 5 inhibitors, visual changes, and nonarteritic anterior ischemic optic neuropathy: Is there a link? Curr Urol Rep 2007; 8:482-90. [DOI: 10.1007/s11934-007-0053-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kupelian V, Link CL, McKinlay JB. Association between smoking, passive smoking, and erectile dysfunction: results from the Boston Area Community Health (BACH) Survey. Eur Urol 2007; 52:416-22. [PMID: 17383811 PMCID: PMC2139983 DOI: 10.1016/j.eururo.2007.03.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 03/06/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although previous studies report an association between erectile dysfunction (ED) and smoking, few have examined the impact of passive smoke exposure on ED. This analysis examines the association of active and passive smoking and ED and investigates a dose-response effect of smoking. METHODS The Boston Area Community Heath (BACH) survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2301 men, aged 30-79 yr, from the city of Boston. ED was assessed using the five-item International Index of Erectile Function. Smoking and passive smoking were assessed by self-report. Analyses adjusted for sociodemographic and lifestyle factors and important chronic illnesses. RESULTS An association between smoking and ED was observed with a significant trend in increased risk of ED with cumulative pack-years of smoking (adjusted odds ratio [OR]=1.68; 95% confidence interval [CI], 1.03, 2.30 for > or =20 pack-years). Compared to never smokers not exposed to passive smoking, men who never smoked but were exposed to passive smoking had a moderate, statistically nonsignificant, increase in risk of ED (adjusted OR=1.33; 95%CI: 0.69, 2.55) comparable to the OR observed for a cumulative exposure of 10-19 pack-years of active smoking (adjusted OR=1.25; 95%CI, 0.68, 2.30). CONCLUSIONS Results indicate a dose-response association between smoking and ED with a statistically significant effect observed with > or =20 pack-years of exposure. Passive smoking is associated with a small, statistically nonsignificant increase in risk of ED comparable to approximately 10-19 pack-years of active smoking.
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Hackett G. Confusion still reigns in premature ejaculation management. Int J Clin Pract 2007; 61:884-5. [PMID: 17504349 DOI: 10.1111/j.1742-1241.2007.01331.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Clément P, Bernabé J, Gengo P, Denys P, Laurin M, Alexandre L, Giuliano F. Supraspinal Site of Action for the Inhibition of Ejaculatory Reflex by Dapoxetine. Eur Urol 2007; 51:825-32. [PMID: 17064843 DOI: 10.1016/j.eururo.2006.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 10/04/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of the study was to determine whether dapoxetine, a short-acting selective serotonin reuptake inhibitor, acts at the spinal or supraspinal level to inhibit the ejaculatory reflex. METHODS The pudendal motoneuron reflex discharges (PMRDs) model was used as an experimental paradigm of the ejaculatory expulsion reflex in anaesthetised male rats. A spinal site of action was evaluated by testing the effect of intrathecal delivery of dapoxetine on PMRDs elicited by electric stimulation of the dorsal nerves of the penis (DNP). A supraspinal site of action was evaluated by testing the effect of intravenous administration of dapoxetine on DNP-induced PMRDs in rats with chemical bilateral lesion of the lateral paragigantocellular nucleus (LPGi). RESULTS Compared with control (NaCl 0.9%, intrathecally), intrathecal injection of dapoxetine (1 and 80 microg) significantly increased amplitude of DNP-elicited PMRDs in a similar fashion than serotonin (5-HT; 10 and 100 microg, intrathecally). In rats having received bilaterally NaCl 0.9% into LPGi, intravenous treatment with dapoxetine (3mg/kg) induced significant delay in PMRD latency and decrease in PMRD amplitude compared with pretreatment values. These effects were abolished in rats having received bilaterally kainic acid into LPGi 1 d before testing. CONCLUSIONS The present study showed that dapoxetine inhibits ejaculatory expulsion reflex by acting at a supraspinal level with LPGi as a necessary brain structure for this effect.
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Dean J, de Boer BJ, Graziottin A, Hatzichristou D, Heaton J, Tailor A. Partner Satisfaction and Successful Treatment Outcomes for Men with Erectile Dysfunction (ED). ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eursup.2006.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Giuliano F, Clément P. Serotonin and Premature Ejaculation: From Physiology to Patient Management. Eur Urol 2006; 50:454-66. [PMID: 16844284 DOI: 10.1016/j.eururo.2006.05.055] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Accepted: 05/31/2006] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Premature ejaculation (PE), whose pathophysiology is still not clearly identified, is the most common male sexual dysfunction, yet it remains underdiagnosed and undertreated. The aims of this paper are to provide a scientific and pharmacologic rationale, and to discuss to what extent selective serotonin reuptake inhibitors (SSRIs) can help patients with PE. MATERIALS AND METHODS A comprehensive evaluation of available published data included analysis of published full-length papers that were identified with Medline and Cancerlit from January 1981 to January 2006. Official proceedings of internationally known scientific societies held in the same time period were also assessed. RESULTS The central ejaculatory neural circuit comprises spinal and cerebral areas that form a highly interconnected network. The sympathetic, parasympathetic, and somatic spinal centers, under the influence of sensory genital and cerebral stimuli integrated and processed at the spinal cord level, act in synergy to command physiologic events occurring during ejaculation. Experimental evidence indicates that serotonin (5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation. To date, three 5-HT receptor subtypes (5-HT1A, 5-HT1B, and 5-HT2C) have been postulated to mediate 5-HT's modulating activity on ejaculation. Pharmacologic manipulation of the serotonergic system has been performed in rats, with the antidepressant selective serotonin reuptake inhibitors (SSRIs) exhibiting the greatest efficacy in delaying ejaculation. The mechanism of action by which SSRIs modulate central 5-HT tone has been studied in depth, but gaps in this knowledge prevent an explanation of the efficacy of acute treatment in delaying ejaculation. Emerging clinical evidence indicates chronic and on-demand dosing of SSRIs has a beneficial effect for the treatment of men with PE, at least for paroxetine. On-demand dapoxetine, and SSRI with a short half-life, recently has been shown to significantly increase intravaginal latency time and PE patient-related outcomes in phase 3 clinical trials. CONCLUSIONS Nowadays there is no doubt that PE can be treated effectively by SSRIs. Nevertheless their mechanism of action is not yet well understood and deserves more research. In particular it is not understood why all the SSRIs are not equal in terms of their ability to delay ejaculation. Therefore, there is a need for more research to better characterize the mechanism of action of SSRIs as well their clinical benefit in patients affected by PE.
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Psychological, Social, and Behavioural Benefits for Men Following Effective Erectile Dysfunction (ED) Treatment: Men Who Enjoy Better Sex Experience Improved Psychological Well-Being. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eursup.2006.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Dean J, de Boer BJ, Graziottin A, Hatzichristou D, Heaton J, Tailor A. The Role of Erection Hardness in Determining Erectile Dysfunction (ED) Treatment Outcome. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eursup.2006.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hatzimouratidis K, Hatzichristou D. Phosphodiesterase type 5 inhibitors: the day after. Eur Urol 2006; 51:75-88; discussion 89. [PMID: 16949200 DOI: 10.1016/j.eururo.2006.07.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 07/14/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Review the literature on phosphodiesterase type 5 inhibitors (PDE5-Is), addressing critical issues in their current and future use, assessing unanswered questions, and identifying research needs. METHODS A MEDLINE search was conducted on PDE5-Is, with emphasis on clinical trials and experience, for interpretation and analysis of their present and future role. RESULTS Although approximately 40 million patients with erectile dysfunction have been treated successfully worldwide with the three available PDE5-Is, inappropriate instructions, lack of follow-up, and lack of patient-centered care models are the main reasons for "non-response," leading to drop-out rates of >50%. Patients with severe neurologic damage, diabetes mellitus, or severe vascular disease may be resistant to PDE5-Is. Preservation of corporal smooth muscle with chronic administration of PDE5-Is has been reported and substantial evidence indicates that these drugs have beneficial effects on endothelium and cardiovascular function; sildenafil has been approved for the treatment of idiopathic pulmonary hypertension. Improvement of lower urinary tract symptoms in men with benign prostatic hyperplasia after PDE5-I administration has been also suggested. CONCLUSIONS The data indicate the necessity for (1) exploration of the pharmacologic characteristics of the three PDE5-Is; (2) research on their pharmacologic differences because some actions seems to be drug-specific; (3) development of alternative management strategies, such as chronic, low, everyday doses of PDE5-Is, if the monthly cost is affordable; and (4) clinical trials on use of PDE5-Is to treat other chronic conditions. The door for innovative therapeutic approaches will open, specifically for cross-risk factor treatment with PDE5-Is or their use in combination treatments or new multimodal pills that take advantage of drugs that exert pleiotropic vascular actions.
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Affiliation(s)
- Konstantinos Hatzimouratidis
- 2nd Department of Urology, Papageorgiou General Hospital and Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Greece
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