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Chung E, Hui J, Xin ZC, Kim SW, Moon DG, Yuan Y, Nagao K, Hakim L, Chang HC, Mak SK, Duarsa GWK, Dai Y, Yao B, Son H, Huang W, Lin H, Nguyen Q, Mai DBT, Park K, Lee J, Tantiwongse K, Sato Y, Jiann BP, Ho C, Park HJ. Management of Male Infertility with Coexisting Sexual Dysfunction: A Consensus Statement and Clinical Recommendations from the Asia-Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men's Health and Aging (ASMHA). World J Mens Health 2024; 42:471-486. [PMID: 37853539 PMCID: PMC11216964 DOI: 10.5534/wjmh.230180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/01/2023] [Accepted: 07/09/2023] [Indexed: 10/20/2023] Open
Abstract
Male infertility (MI) and male sexual dysfunction (MSD) can often coexist together due to various interplay factors such as psychosexual, sociocultural and relationship dynamics. The presence of each form of MSD can adversely impact male reproduction and treatment strategies will need to be individualized based on patients' factors, local expertise, and geographical socioeconomic status. The Asia Pacific Society of Sexual Medicine (APSSM) and the Asian Society of Men's Health and Aging (ASMHA) aim to provide a consensus statement and practical set of clinical recommendations based on current evidence to guide clinicians in the management of MI and MSD within the Asia-Pacific (AP) region. A comprehensive, narrative review of the literature was performed to identify the various forms of MSD and their association with MI. MEDLINE and EMBASE databases were searched for the following English language articles under the following terms: "low libido", "erectile dysfunction", "ejaculatory dysfunction", "premature ejaculation", "retrograde ejaculation", "delayed ejaculation", "anejaculation", and "orgasmic dysfunction" between January 2001 to June 2022 with emphasis on published guidelines endorsed by various organizations. This APSSM consensus committee panel evaluated and provided evidence-based recommendations on MI and clinically relevant MSD areas using a modified Delphi method by the panel and specific emphasis on locoregional socio-economic-cultural issues relevant to the AP region. While variations exist in treatment strategies for managing MI and MSD due to geographical expertise, locoregional resources, and sociocultural factors, the panel agreed that comprehensive fertility evaluation with a multidisciplinary management approach to each MSD domain is recommended. It is important to address individual MI issues with an emphasis on improving spermatogenesis and facilitating reproductive avenues while at the same time, managing various MSD conditions with evidence-based treatments. All therapeutic options should be discussed and implemented based on the patient's individual needs, beliefs and preferences while incorporating locoregional expertise and available resources.
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Affiliation(s)
- Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- AndroUrology Centre, Brisbane, QLD, Australia.
| | - Jiang Hui
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhong Cheng Xin
- Male Reproductive and Sexual Medicine, Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Sae Woong Kim
- Department of Urology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Yiming Yuan
- Andrology Centre, Peking University First Hospital, Peking University, Beijing, China
| | - Koichi Nagao
- Department of Urology, Toho University, Tokyo, Japan
| | - Lukman Hakim
- Department of Urology, Universitas Airlangga Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Siu King Mak
- Department of Surgery, Union Hospital, Hong Kong, China
| | | | - Yutian Dai
- The Department of Andrology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Yao
- Department of Urology, Affiliated Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - William Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Haocheng Lin
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Quang Nguyen
- Centre of Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
| | - Dung Ba Tien Mai
- Department of Urology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Joe Lee
- Department of Urology, National University Hospital, Singapore
| | | | - Yoshikazu Sato
- Department of Urology, Sanjukai Hospital, Sapporo, Japan
| | - Bang-Ping Jiann
- Department of Urology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Christopher Ho
- School of Medicine, Taylor's University, Subang, Selangor, Malaysia
| | - Hyun Jun Park
- Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Gao Q, Chen J, Wang B, Hang Y, Gao S, Yang J, Dai Y. Application of the sexual therapy combined with vacuum negative pressure hydropneumatic/pneumatic bubble massage in primary intravaginal anejaculation. Andrology 2024. [PMID: 38439166 DOI: 10.1111/andr.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/19/2024] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Primary intravaginal anejaculation (PIAJ) is a relatively uncommon male sexual dysfunction characterized by an inability to achieve intravaginal ejaculation during all sexual intercourse. Effective treatment options for this condition are lacking. We aimed to explore the clinical effect of the sexual therapy combined with vacuum negative pressure hydropneumatic/pneumatic bubble massage (VNPHP/PBM) on primary intravaginal anejaculation, and its possible mechanism. METHODS A total of 95 PIAJ patients were randomly divided into three groups, including group A with 32 patients treated with the sexual therapy combined with VNPHP/PBM, group B with 32 patients treated with the sexual therapy and group C with 31 patients treated with VNPHP/PBM. The efficacy of therapeutic regimes, latency of the somatosensory evoked potentials of dorsal nerve (DNSEP), glans penis (GPSEP) and penile shaft sensory threshold (PSST), measures of sexual behavior of patients, as well as the self-rating anxiety scale (SAS) sores of patients and their partners, were compared before and after treatment among three groups. RESULTS The total effective rate of group A (84.38%) was higher than those of groups B and C (53.13% and 41.94%), however, no differences were found between groups B and C. The ratios of patients and their partners with anxiety, frequency of observing erotic films of patients, ratios of patients with special self-masturbation and frequency of masturbation decreased significantly in the three groups after the treatment. The decrease in the ratios of patients and their partners with anxiety, frequency of observing erotic films of patients in groups A and B were higher than those of group C, however, no differences were identified between groups A and B. The decrease in the ratios of patients with special self-masturbation and frequency of masturbation in group A were higher than those of group B, however, no differences were found between groups A and C, B and C. There were no differences in the latency of DNSEP, GPSEP, and PSST among the three groups before and after treatment. CONCLUSION The sexual therapy combined with VNPHP/PBM has good therapeutic effects on PIAJ, which might be achieved by reducing the anxiety level of patients and their partners, improving sexual behavioral patterns, rather than increasing the sensitivity of penis including dorsal nerve and glans penis.
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Affiliation(s)
- Qingqiang Gao
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Jianhuai Chen
- Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Bin Wang
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Youfeng Hang
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Songzhan Gao
- Department of Andrology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Yang
- Department of Urology, Jiangsu Provincial People's Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, People's Hospital of Xinjiang Kizilsu Kirgiz Autonomous Prefecture, Xinjiang uygur autonomous region, China
| | - Yutian Dai
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
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Saffati G, Naeem T, Kaaki B, Khera M. First-time orgasm in a young man with lifelong anorgasmia after flibanserin use: a case report. Sex Med 2023; 11:qfad066. [PMID: 38222292 PMCID: PMC10786674 DOI: 10.1093/sexmed/qfad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Anorgasmia is a poorly understood phenomenon defined as either a lifelong or acquired consistent inability to achieve ejaculation. Despite the prevalence of anorgasmia, there is currently no established treatment for the condition. Aims To report a unique case of a patient with lifelong anorgasmia who was able to achieve his first orgasm with off-label use of flibanserin. Methods The present case study relies on the patient's self-report and a review of the relevant literature. The patient provided written informed consent. Results A 28-year-old male presented to our office with complaints of lifelong anorgasmia, without any signs of erectile dysfunction. He reported good libido and energy levels and denied any urinary symptoms or history of depression. The patient failed medical management with numerous off-label medications, including bupropion and bremelanotide. Despite having received 4 or 5 sex therapy sessions over 3 months, the patient reported that this treatment approach was not effective. Off-label use of flibanserin was then initiated, and after 28 to 32 doses over 4 weeks, he achieved his first orgasm. Notably, the patient experienced nocturia and insomnia. The follow-up International Index of Erectile Function score marginally improved by 2 points without any improvement in the overall satisfaction subdomain. Conclusion This case highlights the challenges of managing anorgasmia and anejaculation in a young male patient. A stepwise approach involving pharmacotherapy and sex therapy was not successful. However, the off-label use of flibanserin ultimately resulted in the patient achieving his first orgasm, albeit with some side effects. Further studies are needed to evaluate the efficacy and safety of flibanserin in men for this indication.
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Affiliation(s)
- Gal Saffati
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Taher Naeem
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Basil Kaaki
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
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Rowland DL, McNabney SM, Attinger DR, Harrold KJ, Kӧvi Z, Hevesi K. Similarities and differences between men with self-reported lifelong and acquired difficulty reaching ejaculation. Int J Impot Res 2023:10.1038/s41443-023-00752-y. [PMID: 37592174 DOI: 10.1038/s41443-023-00752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
Men with delayed ejaculation are often categorized into lifelong and acquired subtypes, yet little is known about similarities and differences between these groups. In this study, we examined whether delayed ejaculation subtypes differed on various demographic, diagnostic, relationship, and sexual activity/satisfaction variables. We drew 140 men reporting moderately-severe to severe difficulty reaching ejaculation during partnered sex (occurring during ≥75% of sexual events) from a convenience sample of over 3000 respondents obtained through an opt-in, multinational, online survey. Respondents were further classified as having lifelong or acquired delayed ejaculation based on self-report. A series of alpha-adjusted analyses of covariance were then made between subtypes on subsets of variables. In addition, the extent to which two potential confounding variables, age and erectile function, might have been responsible for subtype differences was explored. Results indicated that compared with men with acquired delayed ejaculation, men with lifelong delayed ejaculation were younger (28.6 vs 44.7 years, η2p = 0.30, P < 0.001), reported greater delayed ejaculation symptomology (4.31 vs 3.98, P < 0.01, η2p = 0.02), were less likely to attribute their problem to a medical issue or medication (1.7% vs 12.2%, P < 0.05), and more likely to masturbate for anxiety/distress reduction than for pleasure. In contrast, delayed ejaculation subtype differences related to masturbation frequency, pornography use during masturbation, and condom use disappeared when age and erectile functioning differences were statistically controlled. Overall, lifelong and acquired delayed ejaculation subtypes showed more similarities than differences. Findings worthy of clinical note were the lower level of endorsement of medical issues/medication by the lifelong subtype, their higher level of delayed ejaculation symptomology, and-despite a high level of anxiety/distress reported by both groups-their particular vulnerability to anxiety/distress as indicated by their strong motive to masturbate for anxiety/distress reduction (44.3% vs 19.6%, P < 0.05). Other differences between delayed ejaculation subtypes were better explained by group differences in age and erectile function than by subtype membership per se.
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA.
| | - Sean M McNabney
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Drew R Attinger
- Department of Psychology, Valparaiso University, Valparaiso, IN, USA
| | - Kathryn J Harrold
- Department of Mathematics and Statistics, Valparaiso University, Valparaiso, IN, USA
| | - Zsuzsanna Kӧvi
- Institute of Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
| | - Krisztina Hevesi
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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Rowland DL, Padilla S, Kӧvi Z, Hevesi K. Self-reported reasons for having difficulty reaching orgasm in men with diverse etiologies. Sex Med 2023; 11:qfad030. [PMID: 37408873 PMCID: PMC10318491 DOI: 10.1093/sexmed/qfad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
Background Difficulty reaching orgasm/ejaculation during partnered sex, a primary characteristic of delayed or absent ejaculation, affects about 5% to 10% of men, but the reasons underlying this problem are poorly understood. Aim The study sought to gain insight into possible etiologies of delayed ejaculation by assessing men's self-perceptions as to why they experience difficulty reaching orgasm. Methods We drew 351 men reporting moderately severe to severe difficulty reaching orgasm during partnered sex from a sample of over 3000 respondents obtained through an online survey. As part of the 55-item survey, participants responded to 2 questions asking about their self-perceived reasons for having difficulty reaching orgasm and selected from a list of 14 options derived from the research literature, a series of men's focus groups, and expert opinion. The first question allowed respondents to select all the reasons that they felt contributed to the problem, the second to select only the most important reason. In addition, both men with and without comorbid erectile dysfunction were investigated and compared. Outcomes Hierarchical ordering of men's self-pereceived reasons for having difficulty reaching orgasm, including typal reasons established through principal component analysis. Results The major reasons for difficulty were related to anxiety/distress and lack of adequate stimulation, with relationship and other factors endorsed with lower frequency. Further exploration using principal components analysis identified 5 typal reasons, in descending order of frequency: anxiety/distress (41%), inadequate stimulation (23%), low arousal (18%), medical issues (9%), and partner issues (8%). Few differences emerged between men with and without comorbid ED other than ones related to erectile problems, such as higher level of endorsement of medical issues. Typal reasons showed correlations, albeit mostly weak, with a number of covariates, including sexual relationship satisfaction, frequency of partnered sex, and frequency of masturbation. Clinical Implications Until supplemental medical treatments for delayed ejaculation are developed and approved, a number of men's purported reasons for difficult or absent ejaculation/orgasm-anxiety/distress, inadequate stimulation, low arousal, relationship issues-fall into areas that can be addressed in couples counseling by a trained sex therapist. Strengths and Limitations This study is unique in scope and robust in sample size. Drawbacks include those associated with online surveys, including possible bias in sample selection, limitation to Western-based samples, and the lack of differentiation between men with lifelong and acquired difficulty. Conclusion Men who have difficulty reaching ejaculation/orgasm identify putative reasons for their problem, ranging from anxiety/stress, inadequate stimulation, and low arousal to partner issues and medical reasons.
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Affiliation(s)
- David L Rowland
- Corresponding author: Department of Psychology, Valparaiso University, Valparaiso IN 46383, United States.
| | - Sarah Padilla
- Department of Psychology, Valparaiso University, Valparaiso IN 46383, United States
| | - Zsuzsanna Kӧvi
- Institute of Psychology, Károli Gáspár University of the Reformed Church, Budapest 1037, Hungary
| | - Krisztina Hevesi
- Institute of Psychology, Eötvös Loránd University, Budapest 1053, Hungary
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6
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Desai A, Chen R, Cayetano A, Jayasena CN, Minhas S. Understanding and treating ejaculatory dysfunction in men with diabetes mellitus. Andrology 2023; 11:379-398. [PMID: 35933708 DOI: 10.1111/andr.13262] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 01/24/2023]
Abstract
Diabetes mellitus is a rapidly rising metabolic disorder with important systemic complications. Global figures have demonstrated the prevalence of diabetes mellitus has almost quadrupled from 108 million in 1980 to 422 million in 2014, with a current prevalence of over 525 million. Of the male sexual dysfunction resulting from diabetes mellitus, significant focus is afforded to erectile dysfunction. Nevertheless, ejaculatory dysfunction constitutes important sexual sequelae in diabetic men, with up to 35%-50% of men with diabetes mellitus suffering from ejaculatory dysfunction. Despite this, aspects of its pathophysiology and treatment are less well understood than erectile dysfunction. The main disorders of ejaculation include premature ejaculation, delayed ejaculation, anejaculation and retrograde ejaculation. Although ejaculatory dysfunction in diabetes mellitus can have complex multifactorial aetiology, understanding its pathophysiological mechanisms has facilitated the development of therapies in the management of ejaculatory dysfunction. Most of our understanding of its pathophysiology is derived from diabetic animal models; however, observational studies in humans have also provided useful information in elucidating important associative factors potentially contributing to ejaculatory dysfunction in diabetic men. These have provided the potential for more tailored treatment regimens in patients depending on the ejaculatory disorder, other co-existing sequelae of diabetes mellitus, specific metabolic factors as well as the need for fertility treatment. However, evidence for treatment of ejaculatory dysfunction, especially delayed ejaculation and retrograde ejaculation, is based on low-level evidence comprising small sample-size series and retrospective or cross-sectional studies. Whilst promising findings from large randomised controlled trials have provided strong evidence for the licensed treatment of premature ejaculation, similar robust studies are needed to accurately elucidate factors predicting ejaculatory dysfunction in diabetes mellitus, as well as for the development of pharmacotherapies for delayed ejaculation and retrograde ejaculation. Similarly, more contemporary robust data are required for fertility outcomes in these patients, including methods of sperm retrieval and assisted reproductive techniques in retrograde ejaculation.
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Affiliation(s)
- Ankit Desai
- Department of Andrology, Imperial Healthcare NHS Trust, London, UK
| | - Runzhi Chen
- Department of Andrology, Imperial Healthcare NHS Trust, London, UK
| | - Axel Cayetano
- Department of Andrology, Imperial Healthcare NHS Trust, London, UK
| | - Channa N Jayasena
- Department of Reproductive Endocrinology, Imperial Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Andrology, Imperial Healthcare NHS Trust, London, UK
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Hamdi G, Ben Ammar H, Charaa O, Brahmi L, Maamri A, Zalila H. The first Tunisian case of postorgasmic illness syndrome: A case report. Clin Case Rep 2021; 9:e05120. [PMID: 34824857 PMCID: PMC8605164 DOI: 10.1002/ccr3.5120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/11/2022] Open
Abstract
Postorgasmic illness syndrome (POIS) is a rare and singular syndrome. About fifty cases have been reported in the medical literature. Through a clinical observation, we illustrate the first case diagnosed in Tunisia and the difficulties in the etiological diagnosis and the therapeutic management of this syndrome. Given the shortage of cases reported in the literature, the syndrome of POIS remains poorly identified and subsequently misdiagnosed. The clinical diagnosis is relatively simple, yet etiological and therapeutic questions remain to overcome.
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Affiliation(s)
- Ghada Hamdi
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Hanen Ben Ammar
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Oumaima Charaa
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Lina Brahmi
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Amira Maamri
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
| | - Haifa Zalila
- Faculty of Medicine of TunisTunis El Manar UniversityTunisTunisia
- Psychiatry DepartmentRazi HospitalManoubaTunisia
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Rowland DL. A Conceptual Approach to Understanding and Managing Men's Orgasmic Difficulties. Urol Clin North Am 2021; 48:577-590. [PMID: 34602177 DOI: 10.1016/j.ucl.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Premature ejaculation (PE) and delayed/inhibited ejaculation (DE) are 2 ejaculatory problems that may negatively affect the sexual relationship and cause distress. Although no specific cause explains these problems when they have been lifelong conditions, understanding both biological and psychological factors may be relevant to treatment choices, with options ranging from pharmacologic to psychobehavioral. Integrating treatment modalities may lead to better outcomes but may also require greater psychological and resource investment from the patient or couple.
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, 1001 Campus Drive, Valparaiso, IN 46383, USA.
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Waqar M, Omar K, Moubasher A, Brunckhorst O, Ahmed K. Painful Ejaculation - An Ignored Symptom. Cureus 2020; 12:e11253. [PMID: 33269171 PMCID: PMC7707127 DOI: 10.7759/cureus.11253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 11/30/2022] Open
Abstract
The purpose of this review is to summarize the pathophysiology of ejaculation and look into prevalence, aetiology, diagnosis, and treatment of painful ejaculation. We carried out a comprehensive search of PubMed in order to look for literature on male painful ejaculation using keywords post-orgasmic pain, painful ejaculation, dysejaculation, odynorgasmia, post-orgasmic pain, or dysorgasmia. Painful ejaculation has an alarming prevalence throughout the world, between 1 to 25%. It has a detrimental effect on patients' quality of life as it reduces individual self-esteem and is associated with sexual dysfunction. Its aetiology includes simple infection or inflammation of the urinary tract, benign prostate hyperplasia, ejaculatory duct obstruction, post-radical prostatectomy and side effects of certain medications. Once reported, it should be investigations and treatments should be tailored according to the etiology. Both medical and surgical treatment is available depending on the cause of painful ejaculation. Due to the sensitive nature of its presentation, it is a symptom that can be identified best when specifically asked. Our understanding regarding painful ejaculation is very limited and only a few articles have revealed insight into this topic. Further research is required in order to set proper guidelines for diagnosis and treatment of painful ejaculation.
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Affiliation(s)
- Muhammad Waqar
- Urology, King's College Hospital NHS Foundation Trust, London, GBR
| | - Kawa Omar
- Urology, King's College Hospital NHS Foundation Trust, London, GBR
| | - Amr Moubasher
- Urology, King's College Hospital NHS Foundation Trust, London, GBR
| | - Oliver Brunckhorst
- Urology, MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, GBR
| | - Kamran Ahmed
- Urology, King's College Hospital NHS Foundation Trust, London, GBR
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Chovanec M, Vasilkova L, Petrikova L, Obertova J, Palacka P, Rejlekova K, Sycova-Mila Z, Kalavska K, Svetlovska D, Mladosievicova B, Mardiak J, Mego M. Long-term sexual functioning in germ-cell tumor survivors. BMC Cancer 2020; 20:779. [PMID: 32819309 PMCID: PMC7439516 DOI: 10.1186/s12885-020-07301-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 08/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Survivors of germ-cell tumors (GCT) may suffer from long-term adverse consequences. Our study was conducted to assess a long-term sexual functioning in GCT survivors. METHODS GCT survivors (N = 170) from the National Cancer Institute in Slovakia completed a Sexual Function Questionnaire that was modified from PROMIS Sexual Function and Satisfaction Questionnaire 9-year median follow up (range 5-32) as a primary exploratory aim. Study groups consisted of 17 survivors (10%) who had active surveillance (AS, controls), and 153 (90%) survivors who received treatment beyond orchiectomy (Tx), including cisplatin-based chemotherapy (CT, N = 132; 78%), radiotherapy to the retroperitoneal lymph nodes (RT, N = 12; 7%) or both (CTRT, N = 9; 5%). RESULTS In univariate analysis, treatment of any type resulted in difficulty to maintain erection during sexual intercourse compared to patients treated with AS (P = 0.04). Survivors who received CTRT had lower ability to achieve orgasm during sexual activities (P = 0.04) and they reported disappointment with their overall quality of sex life (P = 0.002). The number of attempts to initiate sexual intercourse did not differ. Sexual relationships caused none or mild anxiety and the desire to be sexually active was higher after CTRT (P = 0.05). Multivariable analysis confirmed that orgasmic dysfunction after ≥400 mg/m2 of cisplatin and issues in maintaining erection after Tx were independent of retroperitoneal lymph-node dissection (P = 0.03 and P = 0.04, respectively). Survivors were disappointed with the quality of sex life and had stronger desire to be sexually active independent of age, (P = 0.01 and P = 0.05, respectively). CONCLUSIONS This study identified an impairment in sexual function may represent an issue for long-term GCT survivors. Treatment with chemotherapy plus radiotherapy were associated with disappointment and stronger sexual desire, while a higher cumulative dose of cisplatin may be responsible for orgasmic dysfunction.
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Affiliation(s)
- M Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Klenova 1, Bratislava, 833 10, Slovak Republic. .,2nd Department of Oncology, Faculty of Medicine, Translational Research Unit, Comenius University, Bratislava, Slovak Republic. .,Department of Medical Oncology, National Cancer Institute, Bratislava, Slovak Republic.
| | - L Vasilkova
- Department of Medical Oncology, National Cancer Institute, Bratislava, Slovak Republic.,Department of Psychology, Faculty of Philosophy, Comenius University, Bratislava, Slovak Republic
| | - L Petrikova
- Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic.,Department of Oncohematology I, Oncohematology Clinic, National Cancer Institute, Bratislava, Slovak Republic
| | - J Obertova
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Klenova 1, Bratislava, 833 10, Slovak Republic.,Department of Medical Oncology, National Cancer Institute, Bratislava, Slovak Republic
| | - P Palacka
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Klenova 1, Bratislava, 833 10, Slovak Republic.,Department of Medical Oncology, National Cancer Institute, Bratislava, Slovak Republic
| | - K Rejlekova
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Klenova 1, Bratislava, 833 10, Slovak Republic.,Department of Medical Oncology, National Cancer Institute, Bratislava, Slovak Republic
| | - Z Sycova-Mila
- Department of Medical Oncology, National Cancer Institute, Bratislava, Slovak Republic
| | - K Kalavska
- 2nd Department of Oncology, Faculty of Medicine, Translational Research Unit, Comenius University, Bratislava, Slovak Republic
| | - D Svetlovska
- 2nd Department of Oncology, Faculty of Medicine, Translational Research Unit, Comenius University, Bratislava, Slovak Republic
| | - B Mladosievicova
- Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - J Mardiak
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Klenova 1, Bratislava, 833 10, Slovak Republic.,Department of Medical Oncology, National Cancer Institute, Bratislava, Slovak Republic
| | - M Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Klenova 1, Bratislava, 833 10, Slovak Republic.,2nd Department of Oncology, Faculty of Medicine, Translational Research Unit, Comenius University, Bratislava, Slovak Republic.,Department of Medical Oncology, National Cancer Institute, Bratislava, Slovak Republic
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Rowland DL, Cote-Leger P. Moving Toward Empirically Based Standardization in the Diagnosis of Delayed Ejaculation. J Sex Med 2020; 17:1896-1902. [PMID: 32828700 DOI: 10.1016/j.jsxm.2020.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Criteria for delayed ejaculation (DE) rely on a long ejaculation latency (EL) time, lack of control/advancement regarding ejaculation, and associated bother/distress; yet, few studies have investigated these criteria in men who indicate the desire to ejaculate sooner during partnered sex. AIM To help standardize criteria for DE by better understanding characteristics of men who desire to ejaculate sooner during partnered sex in terms of their EL, reported ejaculatory control, and level of bother/distress, as well as their perceptions of typical and ideal ELs for men in general and of ELs for men with premature ejaculation (PE). METHODS A total of 572 men recruited through social media responded to an online survey regarding their EL, as well as typical, ideal, and PE ELs of men in general. They also rated (i) their ability to control and/or advance ejaculation and (ii) their level of associated bother/distress. 4 comparison groups were then established: men with probable DE (with [DE1] and without [DE2] ejaculatory control issues), a reference group with no ejaculatory disorders, and men who identified as having PE. OUTCOMES To demonstrate differences in EL, ejaculatory control, and bother/distress between men with delayed ejaculation and the control and PE reference groups. RESULTS ELs for men with probable DE were twice as long as those with no ejaculatory disorders. When probable DE men were further subdivided into DE2 and DE1, differences were greater for the DE2 group. DE2 men also differed significantly from the reference group on ejaculatory control/advancement but not on bother/distress. Both DE and reference groups differed from the PE group. CLINICAL IMPLICATIONS Using both EL and ejaculatory control are useful in distinguishing men with delayed ejaculation from men without delayed ejaculation. STRENGTHS & LIMITATIONS A sizable sample drawn from a multinational population powered the study, whereas the use of social media for recruitment limited the generalizability of findings. CONCLUSION Both EL and ejaculatory control differentiate men with probable DE from a control reference group having no ejaculatory disorders. Differences in bother/distress did not emerge as significant. Implications for diagnosing men with DE are presented. Rowland DL, Cote-Leger P. Moving Toward Empirically Based Standardization in the Diagnosis of Delayed Ejaculation. J Sex Med 2020;17:1896-1902.
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso IN, USA.
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12
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Abstract
Genital sensation (GS) is an essential component of male sexual function. Genital sensory disturbance (GSD) caused by spinal cord injury (SCI) has a severe impact on the patients' sexual function but has garnered little research focus. Under normal conditions, GS encompasses the erection, ejaculation, sexual arousal, and orgasm courses associated with physiological and psychological responses in male sexual activity. However, in SCI patients, the deficiency of GS makes the tactile stimulation of the penis unable to cause sexual arousal, disturbs the normal processes of erection and ejaculation, and decreases sexual desire and satisfaction. To provide an overview of the contemporary conception and management of male GS after SCI, we review the innervation and sexual function of male GS in this article, discuss the effects of GSD following SCI, and summarize the current diagnosis and treatment of GSD in male SCI patients.
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Affiliation(s)
- Hao Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Kasman AM, Bhambhvani HP, Eisenberg ML. Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study. Sex Med 2020; 8:454-460. [PMID: 32553504 PMCID: PMC7471068 DOI: 10.1016/j.esxm.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/22/2020] [Accepted: 05/07/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction Prevalence and bother of ejaculatory dysfunction (EjD) has yet to be evaluated in a men's health referral population. Aim To evaluate the prevalence and associated risk factors of EjD in men presenting to a men's health clinic. Methods A retrospective review examined patients presenting to an outpatient men's health clinic who completed the Sexual Health Inventory for Men and the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) Short Form. Patient factors including demographics, comorbidities, and medication were examined. Descriptive statistics and multivariable logistic regression were used. Main Outcome Measures The main outcomes of this study are Sexual Health Inventory for Men and MSHQ-EjD scores. Results A total of 63 (24%) of patients presenting to the urology clinic were characterized as having EjD based on questionnaire responses. The mean age for men with EjD was 53.8 years, while those without was 42.6 years (P < .001). Of men with EjD, 74.6% were at least moderately bothered (MSHQ-EjD ≥3). Men with EjD were more likely to have erectile dysfunction (77.8%) compared with those without (21%, P < .001) as well as a history of a pelvic cancer (20.6% vs 6%, P = .001). On multivariable regression, erectile dysfunction (odds ratio: 15.04, 95% confidence interval: 6.76–35.92, P < .0001) and alpha inhibitor prescription (odds ratio: 6.82, 95% confidence interval: 1.57–30.16, P = .01) were associated with a higher odds of EjD. ED was found to be a mediator of the relationship between EjD and age, as the age association was lost in the ED population on multivariable regression compared with the non-ED population where it remained significant. Conclusions EjD is common among patients presenting to a men's health clinic and may present at varying ages, though it is more common in those aged 50 years or older; it is independent of age and race. EjD is associated with erectile dysfunction, pelvic cancer history, and use of alpha inhibitors, presenting a population that could be considered for screening. Kasman AM, Bhambhvani HP, Eisenberg ML. Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study. J Sex Med 2020;8:454–460.
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Affiliation(s)
- Alex M Kasman
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Hriday P Bhambhvani
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
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14
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Hur MS, Lee HW, Yang HM, Kwon HJ, O J, Lee S, Oh CS. Longitudinal muscular column in the prostatic urethral wall: Its form, shape, and possible function based on mathematical simulation in ejaculation. Prostate 2020; 80:471-480. [PMID: 32049374 DOI: 10.1002/pros.23961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/04/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The shape and function of the longitudinal muscular column (LMC) of the prostate have not been established in detail. The present study was undertaken to elucidate the roles of the LMC of the posterior wall of the prostatic urethra (PSU) in the emission phase of ejaculation by investigating the form and muscular arrangement of the LMC. METHODS Prostates and urinary bladders were obtained from 14 Korean adult cadavers. Nine specimens were histologically analyzed using hematoxylin and eosin, Masson's trichrome, and Verhoeff-van Gieson staining. Two specimens were scanned using microcomputed tomography (micro-CT), and all scanned images were reconstructed into a three-dimensional model. RESULTS At the proximal level of the prostate, the ejaculatory ducts (EDs) and prostatic utricle (PU) together were surrounded by circular smooth-muscle fibers. However, at the seminal colliculus (SC) where the EDs and PU opened, they were mainly surrounded by an abundance of longitudinal fibers. The longitudinal fibers posterior to the EDs and PU formed a distinctive LMC in the posterior urethral wall. In histologic sections and micro-CT images, the LMC extended distally from the level of the SC to the level of the membranous urethra (MBU). We simulated a potential mechanism of LMC using a mathematical model of its movements. CONCLUSIONS Comprehensive analyses based on in-depth assessment of histologic characteristics and micro-CT images demonstrated extension of the LMC from the level of the SC to the level of the MBU, enabling a better understanding of ejaculation physiology involving the LMC. These results suggest that the LMC in the posterior wall of the PSU is a critical component of ejaculation by facilitating the ejection of seminal vesicle fluid into the PSU via well-coordinated contractions.
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Affiliation(s)
- Mi-Sun Hur
- Department of Anatomy, Catholic Kwandong University College of Medicine, Gangneung, Korea
| | - Hye Won Lee
- Department of Hospital Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Hun-Mu Yang
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Jin Kwon
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
| | - Jehoon O
- Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea
| | - Seunggyu Lee
- Department of Mathematics and Research Institute of Natural Science, Gyeongsang National University, Jinju, Korea
| | - Chang-Seok Oh
- Department of Anatomy and Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea
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15
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Butcher MJ, Zubert T, Christiansen K, Carranza A, Pawlicki P, Seibel S. Topical Agents for Premature Ejaculation: A Review. Sex Med Rev 2020; 8:92-99. [DOI: 10.1016/j.sxmr.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/09/2019] [Accepted: 03/09/2019] [Indexed: 01/23/2023]
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16
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Pierce H, Fainberg J, Gaffney C, Aboukhashaba A, Khan A, Kashanian J. Postorgasmic illness syndrome: potential new treatment options for a rare disorder. Scand J Urol 2019; 54:86-88. [PMID: 31878818 DOI: 10.1080/21681805.2019.1704861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Hudson Pierce
- Department of Urology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
| | - Jonathan Fainberg
- Department of Urology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
| | - Christopher Gaffney
- Department of Urology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
| | - Ahmad Aboukhashaba
- Department of Urology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
| | - Aleem Khan
- Department of Urology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
| | - James Kashanian
- Department of Urology, Weill Cornell Medicine-New York Presbyterian, New York, NY, USA
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17
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Abdessater M, Elias S, Mikhael E, Alhammadi A, Beley S. Post orgasmic illness syndrome: what do we know till now? Basic Clin Androl 2019; 29:13. [PMID: 31508233 PMCID: PMC6721082 DOI: 10.1186/s12610-019-0093-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peri orgasmic dysfunctions are very rare and little information exists on their diagnosis and treatment. One of these conditions is post-orgasmic illness syndrome (POIS), manifesting by a debilitating cluster of symptoms affecting men within seconds, minutes, or hours after ejaculation. The aim of this article is to do a thorough literature review about POIS, in order to elucidate the pathophysiology, the diagnosis and the management of this rare disease. RESULTS Updated literature review on Pubmed was done, using the following terms: "orgasm illness", "post-orgasmic" and "postorgasmic illness syndrome". The references of the 17 identified publications were also reviewed for additional 8 relevant articles that were all included in the results.POIS has 5 preliminary diagnostic criteria and criterion 1 has 7 described clusters. Pathophysiological hypotheses include: immunological phenomenon (most relevant), opioid-like withdrawal, neuroendocrine response, transient deregulation of the autonomic nervous system, hypersensitivity and disordered cytokines. Differential diagnoses include: chronic prostatitis, orgasmolepsy, benign orgasmic cephalgia, sneezing and rhinorrhea, postcoital dysphoria, post-coital asthma and rhinitis. Patients have been symptomatically treated with antihistamines, non-steroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, and benzodiazepines. A trial of hyposensitization therapy with autologous semen was successful. CONCLUSION POIS is a rare condition that is underdiagnosed, most probably because of its unclear pathophysiology leading to a lack of treatment options. Further studies are warranted to investigate the prevalence, pathophysiology, and management of this debilitating condition.
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Affiliation(s)
- Maher Abdessater
- Groupe Hospitalier Diaconesses - Croix Saint Simon, 125 rue d’Avron, 75020 Paris, France
| | | | - Elie Mikhael
- Groupement hospitalier Eaubonne, Montmorency (Hôpital Simone Veil), Eaubonne, France
| | - Abdalla Alhammadi
- Groupe Hospitalier Diaconesses - Croix Saint Simon, 125 rue d’Avron, 75020 Paris, France
| | - Sebastien Beley
- Groupe Hospitalier Diaconesses - Croix Saint Simon, 125 rue d’Avron, 75020 Paris, France
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18
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Ongün Ş, Acar S, Koca P, Uzut M, Esen AA, Durmus N, Demir O. Can Botulinum-A Toxin Be Used to Delay Ejaculation: Results of an Ejaculation Model in Male Rats. J Sex Med 2019; 16:1338-1343. [PMID: 31277970 DOI: 10.1016/j.jsxm.2019.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/25/2019] [Accepted: 06/02/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Although premature ejaculation (PE) is the most common sexual dysfunction in young men, its true pathophysiology has not yet been clearly elucidated. AIM To investigate the quantitative changes that occurred in an ejaculation model induced by para-chloroamphetamine (PCA) after botulinum-A toxin injection into the bulbospongiosus (BS) muscle in rats. METHODS A total of 21 male rats weighing 300 to 350 grams were used in the study. The animals were divided into 3 groups: control, 1 unit of botulinum-A toxin injected, and 5 units of botulinum-A toxin injected. The botulinum-A toxin was percutaneously injected into the BS muscle, and the experiment was carried out 96 hours (5 days) after the injection. MAIN OUTCOME MEASURE The seminal vesicle (SV) was cannulated, and the BS muscle was dissected and connected to an amplifier (Biopac; Goleta, CA) to record the pressure and electromyography measurement. The ejaculation parameters were obtained after the PCA injection. RESULTS The ejaculation latency time of the group receiving 5 units of botulinum-A toxin was statistically significantly longer (1092 ± 657 seconds) compared to the control group (298 ± 81 seconds) and the group receiving 1 unit of botulinum-A toxin (439 ± 100 seconds) (P = .003). Furthermore, the BS EMG area under the curve values for the group receiving 5 units of botulinum-A toxin were significantly lower (7.4 ± 1.2 V/s × 10-4) than those of the control group (13.6 ± 4.0 V/s × 10-4) and the group receiving 1 unit of botulinum-A toxin (13.6 ± 5.0 V/s × 10-4) (P = .009). No statistically significant difference was found between the groups in terms of the basal SV pressure, number of SV phasic contractions, maximum amplitude of the SV phasic contraction, and intervals between the SV phasic contractions and the BS muscle contractions. CLINICAL IMPLICATIONS Botulinum-A toxin injection is a potential treatment option for PE and should be further investigated by future clinical studies. STRENGTHS AND LIMITATIONS Ease of administration and prolonged duration of botulinum-A toxin are advantages of the existing treatment options. The risk of anejaculation due to the dosage should be kept in mind. CONCLUSIONS Injection of botulinum-A toxin into the BS muscle in rats significantly delayed the ejaculation latency time and affected the expulsion phase. Ongün S, Acar S, Koca P, et al. Can Botulinum-A Toxin Be Used to Delay Ejaculation: Results of an Ejaculation Model in Male Rats. J Sex Med 2019;16:1338-1343.
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Affiliation(s)
- Şakir Ongün
- Department of Urology, Balikesir University Faculty of Medicine, Balikesir, Turkey.
| | - Selin Acar
- Department of Pharmacology, Dokuz Eylül Medical School, Izmir, Turkey
| | - Pelin Koca
- Department of Pharmacology, Dokuz Eylül Medical School, Izmir, Turkey
| | | | - Ahmet Adil Esen
- Department of Urology, Dokuz Eylül Medical School, Izmir, Turkey
| | - Nergiz Durmus
- Department of Pharmacology, Dokuz Eylül Medical School, Izmir, Turkey
| | - Omer Demir
- Department of Urology, Dokuz Eylül Medical School, Izmir, Turkey
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Strashny A. First assessment of the validity of the only diagnostic criteria for postorgasmic illness syndrome (POIS). Int J Impot Res 2019; 31:369-373. [PMID: 31171851 DOI: 10.1038/s41443-019-0154-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/16/2019] [Accepted: 05/02/2019] [Indexed: 11/09/2022]
Abstract
Postorgasmic illness syndrome (POIS) is a rare condition that affects men and about which little is known. According to Waldinger and colleagues, men with POIS fulfill three or more of five preliminary diagnostic criteria regarding symptoms, time to onset, setting, duration, and spontaneous disappearance. We conducted a self-report study to assess, for the first time, the validity of these criteria. One hundred and twenty-seven men with self-reported POIS have completed the survey, making this the largest study of such men to date. Almost all respondents fulfill a majority of the criteria for POIS; a large minority fulfills all five criteria. Almost all respondents always experience symptoms after ejaculating in at least one ejaculatory setting (sex, masturbation, or nocturnal emission), though only a small majority fulfill the criterion that symptoms occur after all ejaculations because a large minority always experience symptoms in one setting but not always in another. The most common symptom cluster from the criteria, involving fatigue, irritation, and concentration difficulties, is always experienced by 80% of respondents. Median symptom severity is 8 on a 0-10 scale. While almost all men with POIS fulfill a majority of the preliminary diagnostic criteria, there is room for refining some of the criteria.
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20
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When Healthcare Providers do not Ask, Patients Rarely Tell: The Importance of Sexual Counselling in Multiple Sclerosis. J Natl Med Assoc 2019; 111:682-687. [PMID: 31155408 DOI: 10.1016/j.jnma.2019.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/06/2023]
Abstract
Multiple sclerosis (MS) is a relatively frequent inflammatory autoimmune illness of the central nervous system affecting about 2.5 million people around the world, and represents the most common cause of neurological disability among young adults. Indeed, the disease can affect sensory-motor, autonomic and cognitive function potentially leading to a high prevalence of sexual dysfunction (SD). Thus, the identification of barriers to help seeking for sexual concerns in patients with MS is an important, although still overlooked, issue. Aim of this overview is to briefly investigate the role of sexual counselling in managing SD in individuals with MS, highlighting the importance for the clinicians to get more knowledge about; the pathophysiology, assessment and treatment of MS-related SD.
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Opioid-Related Sexual Dysfunction in Men. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gray M, Zillioux J, Khourdaji I, Smith RP. Contemporary management of ejaculatory dysfunction. Transl Androl Urol 2018; 7:686-702. [PMID: 30211060 PMCID: PMC6127532 DOI: 10.21037/tau.2018.06.20] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although erectile dysfunction is the most common disorder of male sexual health, ejaculatory dysfunction is the most common form of sexual dysfunction experienced by men. Ejaculatory dysfunction covers a broad range of disorders that we have divided into four main categories: premature ejaculation, delayed ejaculation (DE)/anorgasmia, unsatisfactory sensation of ejaculation (including painful ejaculation and ejaculatory anhedonia), and absent ejaculate (including retrograde ejaculation and aspermia). We also cover several special scenarios including hematospermia, spinal cord injury and fertility with anejaculation. In this paper, we will review the anatomy and pathophysiology of normal ejaculation to establish the baseline knowledge of how this pathway can go awry. We will then briefly review the critical diagnostic criteria, pertinent steps in evaluation, risk factors, and causes (if known) for each of the ejaculatory disorders. Finally, the bulk of the paper will discuss current management strategies of each disorder.
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Affiliation(s)
- Marisa Gray
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | | | - Iyad Khourdaji
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Ryan P Smith
- Department of Urology, University of Virginia, Charlottesville, VA, USA
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23
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Male Orgasmic Dysfunction Post-Radical Pelvic Surgery. Sex Med Rev 2018; 6:429-437. [DOI: 10.1016/j.sxmr.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/08/2017] [Accepted: 12/11/2017] [Indexed: 01/13/2023]
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Abstract
Infertility affects up to 12% of all men, and sexual dysfunction occurs frequently in men of reproductive age, causing infertility in some instances. In infertile men, hypoactive sexual desire and lack of sexual satisfaction are the most prevalent types of sexual dysfunction, ranging from 8.9% to 68.7%. Erectile dysfunction and/or premature ejaculation, evaluated with validated tools, have a prevalence of one in six infertile men, and orgasmic dysfunction has a prevalence of one in ten infertile men. In addition, infertile men can experience a heavy psychological burden. Infertility and its associated psychological concerns can underlie sexual dysfunction. Furthermore, general health perturbations can lead to male infertility and/or sexual dysfunction. Erectile dysfunction and male infertility are considered proxies for general health, the former underlying cardiovascular disorders and the latter cancerous and noncancerous conditions. The concept that erectile dysfunction in infertile men might be an early marker of poor general health is emerging. Finally, medications used for general health problems can cause sperm abnormalities and sexual dysfunction. The treatment of some causes of male infertility might improve semen quality and reverse infertility-related sexual dysfunction. In infertile men, an investigation of sexual, general, and psychological health status is advisable to improve reproductive problems and general health.
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Affiliation(s)
- Francesco Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Nguyen HMT, Bala A, Gabrielson AT, Hellstrom WJG. Post-Orgasmic Illness Syndrome: A Review. Sex Med Rev 2017; 6:11-15. [PMID: 29128269 DOI: 10.1016/j.sxmr.2017.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/17/2017] [Accepted: 08/26/2017] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Post-orgasmic illness syndrome (POIS) is a rare but debilitating cluster of postejaculatory symptoms affecting men. It is a chronic disorder manifesting as a constellation of flulike and allergic symptoms within seconds, minutes, or hours after ejaculation. POIS can be followed by mental sequelae such as diminished concentration and irritability. POIS negatively affects the life of patients by limiting sexual encounters, dampening romantic prospects, creating internal struggles to avoid eroticism, and affecting patients' schedules. First described in 2002, the prevalence and incidence of POIS are still unknown owing to a paucity of studies but is likely under-reported. There are approximately 50 cases of POIS in the literature. Despite the debilitating effects of POIS, the pathophysiology of POIS is still not well elucidated. AIM To provide an update on the current literature on POIS, provide updated information on the pathophysiology of POIS, and discuss potential management options. METHODS Comprehensive review of literature pertaining to POIS. MAIN OUTCOME MEASURES The symptoms, classification, pathophysiology, diagnostic considerations, and management of POIS were reviewed. RESULTS There are 5 preliminary diagnostic criteria for diagnosing this condition. POIS is categorized as primary or secondary. The autoimmune-allergy hypothesis is the most accepted hypothesis explaining the pathogenesis of POIS. A competing hypothesis involves a disorder involving endogenous μ-opioid receptors. Another hypothesis invokes impairment of the cytokine and neuroendocrine responses. There are no known treatment modalities for POIS; patients have been symptomatically treated with antihistamines, selective serotonin reuptake inhibitors, and benzodiazepines. A trial of hyposensitization therapy with autologous semen was successful. A trial of non-steroidal anti-inflammatory medication helped 1 patient described in a single case report, but failed to successfully treat other patients. CONCLUSIONS POIS is a rare condition that is underdiagnosed and under-reported. Further studies are warranted to investigate the prevalence, pathophysiology, and treatment of this debilitating condition. Nguyen HMT, Bala A, Gabrielson AT, Hellstrom WJG. Post-Orgasmic Illness Syndrome: A Review. Sex Med Rev 2018;6:11-15.
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Affiliation(s)
| | - Areeg Bala
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew T Gabrielson
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Clavell-Hernández J, Martin C, Wang R. Orgasmic Dysfunction Following Radical Prostatectomy: Review of Current Literature. Sex Med Rev 2017; 6:124-134. [PMID: 29108976 DOI: 10.1016/j.sxmr.2017.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/18/2017] [Accepted: 09/24/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The sexual problem after radical prostatectomy (RP) that has received the most focus in the current literature is erectile dysfunction. However, there are orgasmic complications that encompass orgasm-associated urinary incontinence (climacturia), anorgasmia, changes in orgasmic sensation, and painful orgasm (dysorgasmia). Although the body of research is still growing, there remains a need for physician and patient awareness of these potentially problematic complications. AIM To review the prevalence and management options for different orgasmic dysfunctions after RP. METHODS A Medline PubMed search was used to identify articles related to orgasmic dysfunction, including climacturia, dysorgasmia, anorgasmia, and altered sensation after RP. MAIN OUTCOME MEASURE Rates and types of orgasmic dysfunction after RP. RESULTS Orgasmic dysfunction encompasses a series of conditions that affect men after RP. These include climacturia, dysorgasmia, anorgasmia, and altered sensation. Although the etiologies and management options remain uncertain, their effect on the sexual health of patients is not negligible. CONCLUSION To provide proper counseling to patients, physicians should be aware of the prevalence of orgasmic side effects after RP. Post-prostatectomy sexual recovery should be focused not only on penile erectile function but also on a satisfactory and healthy sexual life for patients and their partners. Clavell-Hernández J, Martin C, Wang R. Orgasmic Dysfunction Following Radical Prostatectomy: Review of Current Literature. Sex Med Rev 2018;6:124-134.
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Affiliation(s)
- Jonathan Clavell-Hernández
- Division of Urology, Department of Surgery, University of Texas Health Science Center-McGovern Medical School at Houston, Houston, TX, USA; University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clay Martin
- Division of Urology, Department of Surgery, University of Texas Health Science Center-McGovern Medical School at Houston, Houston, TX, USA
| | - Run Wang
- Division of Urology, Department of Surgery, University of Texas Health Science Center-McGovern Medical School at Houston, Houston, TX, USA; University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Capogrosso P, Ventimiglia E, Cazzaniga W, Montorsi F, Salonia A. Orgasmic Dysfunction after Radical Prostatectomy. World J Mens Health 2017; 35:1-13. [PMID: 28459142 PMCID: PMC5419114 DOI: 10.5534/wjmh.2017.35.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/14/2017] [Accepted: 02/28/2017] [Indexed: 12/18/2022] Open
Abstract
In addition to urinary incontinence and erectile dysfunction, several other impairments of sexual function potentially occurring after radical prostatectomy (RP) have been described; as a whole, these less frequently assessed disorders are referred to as neglected side effects. In particular, orgasmic dysfunctions (ODs) have been reported in a non-negligible number of cases, with detrimental impacts on patients' overall sexual life. This review aimed to comprehensively discuss the prevalence and physiopathology of post-RP ODs, as well as potential treatment options. Orgasm-associated incontinence (climacturia) has been reported to occur in between 20% and 93% of patients after RP. Similarly, up to 19% of patients complain of postoperative orgasm-associated pain, mainly referred pain at the level of the penis. Moreover, impairment in the sensation of orgasm or even complete anorgasmia has been reported in 33% to 77% of patients after surgery. Clinical and surgical factors including age, the use of a nerve-sparing technique, and robotic surgery have been variably associated with the risk of ODs after RP, although robust and reliable data allowing for a proper estimation of the risk of postoperative orgasmic function impairment are still lacking. Likewise, little evidence regarding the management of postoperative ODs is currently available. In general, physicians should be aware of the prevalence of ODs after RP, in order to properly counsel all patients both preoperatively and immediately post-RP about the potential occurrence of bothersome and distressful changes in their overall sexual function.
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Affiliation(s)
- Paolo Capogrosso
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Eugenio Ventimiglia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Perelman MA. Psychosexual therapy for delayed ejaculation based on the Sexual Tipping Point model. Transl Androl Urol 2016; 5:563-75. [PMID: 27652228 PMCID: PMC5001992 DOI: 10.21037/tau.2016.07.05] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 07/03/2016] [Indexed: 01/23/2023] Open
Abstract
The Sexual Tipping Point(®) (STP) model is an integrated approach to the etiology, diagnosis and treatment of men with delayed ejaculation (DE), including all subtypes manifesting ejaculatory delay or absence [registered trademark owned by the MAP Educational Fund, a 501(c)(3) public charity]. A single pathogenetic pathway does not exist for sexual disorders generally and that is also true for DE specifically. Men with DE have various bio-psychosocial-behavioral & cultural predisposing, precipitating, maintaining, and contextual factors which trigger, reinforce, or worsen the probability of DE occurring. Regardless of the degree of organic etiology present, DE is exacerbated by insufficient stimulation: an inadequate combination of "friction and fantasy". High frequency negative thoughts may neutralize erotic cognitions (fantasy) and subsequently delay, ameliorate, or inhibit ejaculation, while partner stimulation (friction) may prove unsatisfying. Assessment requires a thorough sexual history including inquiry into masturbatory methods. Many men with DE engage in an idiosyncratic masturbatory style, defined as a masturbation technique not easily duplicated by the partner's hand, mouth, or vagina. The clinician's most valuable diagnostic tool is a focused sex history (sex status). Differentiate DE from other sexual problems and review the conditions under which the man can ejaculate. Perceived partner attractiveness, the use of fantasy during sex, anxiety-surrounding coitus and masturbatory patterns require meticulous exploration. Identify important DE causes by juxtaposing an awareness of his cognitions and the sexual stimulation experienced during masturbation, versus a partnered experience. Assist the man in identifying behaviors that enhance immersion in excitation and minimize inhibiting thoughts, in order to reach ejaculation in his preferred manner. Discontinuing, reducing or altering masturbation is often required, which evokes patient resistance. Coaching tips are offered on how to ensure adherence to this suspension, manage resistance and facilitate success. Depending on motivation level, masturbation interruption may be compromised and negotiated. Encourage a man who continues to masturbate to alter style ("switch hands") and to approximate the stimulation likely to be experienced with his partner. Success will require most men to be taught to learn bodily movements and fantasies that approximate the thoughts and sensations experienced in masturbation. Fertility issues, as well as patient/partner anger are important causational factors, which often require individual and/or conjoint consultation. Drug treatment would benefit men particularly with severe DE, regardless of concomitant psychosocial-behavioral and cultural complications. When and if a safe effective medication for DE becomes available, this author's transdisciplinary perspective supports appropriate medication use when integrated with counseling. This approach emphasizes the utility of a biopsychosocial-cultural perspective combined with special attention to the patient's narrative. Treatment is patient-centered, holistic and integrates a variety of therapies as needed.
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