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Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, Magri V, Mourmouris P, Ouattara A, Perletti G, Philipraj J, Trinchieri A, Buchholz N. Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis. Arch Ital Urol Androl 2022; 94:252-263. [PMID: 35775356 DOI: 10.4081/aiua.2022.2.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alpha-adrenoreceptor antagonists or alpha-blockers are used in the treatment of hypertension, in the therapy of benign prostatic hyperplasia and in medical expulsive treatment of ureteral stones. These agents may affect the sexual function, with differences between drugs within the same class, depending on their selectivity for receptor subtypes. The aim of this review was to analyze the effects of alpha-blockers on sexual function. MATERIALS AND METHODS We conducted a systematic review and meta-analysis by searching PubMed, EMBASE and other databases for randomized controlled trials (RCTs) reporting sexual adverse effects in patients treated with alpha-blockers. Odds ratios for sexual dysfunction were calculated using random effects Mantel-Haenszel statistics. RESULTS Out of 608 records retrieved, 75 eligible RCTs were included in the meta-analysis. Compared with placebo, alphablockers were associated with increased odds of ejaculatory disorders both in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH) (OR: 7.53, 95% CI: 3.77-15.02, Z = 5.73, p < 0.00001, I2 = 55%) and in patients with ureteral stones (OR: 2.88, 95% CI: 1.50-5.44, Z = 3.19, p < 0.001, I2 = 31%). Uroselective alpha-blockers showed higher odds of ejaculatory disorders. Conversely, nonselective alpha-blockers were not associated with higher odds of ejaculatory dysfunction. Silodosin was associated with increased odds of ejaculatory dysfunction compared with tamsulosin (OR: 3.52, 95% CI: 2.18-5.68, 15 series, 1512 participants, Z = 5.15, p < 0.00001, I2 = 0%). Naftopidil and alfuzosin showed lower odds of ejaculatory dysfunction compared to uroselective alpha-blockers.No statistically significant differences in the odds of erectile dysfunction were observed when alpha-blockers were compared to placebo.
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Affiliation(s)
- Rawa Bapir
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | - Kamran Hassan Bhatti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Urology Department, HMC, Hamad Medical Corporation.
| | - Ahmed Eliwa
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Zagazig University, Zagazig, Sharkia.
| | | | - Nazim Gherabi
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Faculty of Medicine Algiers 1, Algiers.
| | - Derek Hennessey
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Mercy University Hospital, Cork.
| | - Vittorio Magri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and ASST Nord Milano, Milan.
| | - Panagiotis Mourmouris
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens.
| | - Adama Ouattara
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Division of Urology, Souro Sanou University Teaching Hospital, Bobo-Dioulasso.
| | - Gianpaolo Perletti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese.
| | - Joseph Philipraj
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry.
| | - Alberto Trinchieri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Urology School, University of Milan.
| | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Sobeh's Vascular and Medical Center, Dubai Health Care City, Dubai.
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Painful Ejaculation: a Contemporary Review. CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-021-00324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Green TP, Saavedra-Belaunde J, Wang R. Ejaculatory and Orgasmic Dysfunction Following Prostate Cancer Therapy: Clinical Management. Med Sci (Basel) 2019; 7:medsci7120109. [PMID: 31835522 PMCID: PMC6950339 DOI: 10.3390/medsci7120109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023] Open
Abstract
The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side effects following the treatment of prostate cancer. Orgasmic dysfunction covers a range of issues including premature ejaculation, anorgasmia, dysorgasmia, and climacturia. This review provides an overview of prevalence and management options to deal with orgasmic dysfunction. A Medline Pubmed search was used to identify articles relating to these problems. We found that orgasmic dysfunction has a very large impact on patients’ lives following prostate cancer treatment and there are ways for physicians to treat it. Management of patients’ sexual health should be focused not only on erectile dysfunction, but on orgasmic dysfunction as well in order to ensure a healthy sexual life for patients and their partners.
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Affiliation(s)
- Travis P. Green
- Division of Urology, Department of Surgery, University of Texas Health Science Center – McGovern Medical School at Houston, Houston, TX 77030, USA; (T.P.G.); (J.S.-B.)
| | - Jose Saavedra-Belaunde
- Division of Urology, Department of Surgery, University of Texas Health Science Center – McGovern Medical School at Houston, Houston, TX 77030, USA; (T.P.G.); (J.S.-B.)
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Run Wang
- Division of Urology, Department of Surgery, University of Texas Health Science Center – McGovern Medical School at Houston, Houston, TX 77030, USA; (T.P.G.); (J.S.-B.)
- MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
- Correspondence:
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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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Delavierre D, Sibert L, Rigaud J, Labat JJ. [Painful ejaculation]. Prog Urol 2013; 24:414-20. [PMID: 24861680 DOI: 10.1016/j.purol.2013.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 11/09/2013] [Accepted: 11/12/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To clarify definition, epidemiology, diagnosis, evaluation, etiologies and treatment of painful ejaculation (PE). MATERIAL AND METHODS Review of the literature performed by searching the Medline database using keywords ejaculation, orgasm, pain, pelvic pain, sexual behavior. RESULTS PE is a pelviperineal pain caused by ejaculation or orgasm. Its prevalence rate is between 1 and 4% amongst the general population. Mainly located in the penis, pain usually lasts less than 5 minutes. Assessment is clinical and there is no level of evidence about the strategy of complementary investigations. Benign prostatic hyperplasia, chronic pelvic pain syndrome, radical prostatectomy, prostate brachytherapy and some antidepressant medications are the best estimated etiologies found in the literature. A link between urogenital infections and PE is likely but not clearly established. Alpha-blockers had good therapeutic results in few low level of evidence studies. CONCLUSION The assessment of PE is not clearly defined. Some etiologies are known but PE may be a functionnal pain. Only high level of evidence studies would validate the use of the alpha-blockers as an efficient therapeutic option.
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Affiliation(s)
- D Delavierre
- Service urologie-andrologie, CHR La Source, BP 86709, 45067 Orléans cedex 2, France.
| | - L Sibert
- Service d'urologie, CHU de Rouen, 76031 Rouen, France; EA 4308, université de Rouen, 76821 Rouen, France
| | - J Rigaud
- Clinique urologique, CHU de Nantes, 44093 Nantes, France; Centre fédératif de pelvi-périnéologie, CHU de Nantes, 44093 Nantes, France
| | - J-J Labat
- Clinique urologique, CHU de Nantes, 44093 Nantes, France; Centre fédératif de pelvi-périnéologie, CHU de Nantes, 44093 Nantes, France
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Seyam R. A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men. Ther Adv Urol 2013; 5:254-97. [PMID: 24082920 DOI: 10.1177/1756287213497231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed. OBJECTIVES The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports. METHODS A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded. RESULTS A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options. CONCLUSION There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions.
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Affiliation(s)
- Raouf Seyam
- King Faisal Specialist Hospital and Research Center, PO Box 3354, MBC 83, Riyadh 11211, Saudi Arabia
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Higano CS. Sexuality and Intimacy After Definitive Treatment and Subsequent Androgen Deprivation Therapy for Prostate Cancer. J Clin Oncol 2012; 30:3720-5. [DOI: 10.1200/jco.2012.41.8509] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There are more than 2 million prostate cancer survivors in the United States. Primary therapy with surgery or radiation results in permanent changes in sexual function. More than half of these men are subsequently treated with androgen deprivation therapy (ADT) at some point. The addition of ADT further compromises sexuality, intimacy, and a couple's relationship. This review will highlight the challenges faced by patients and couples and reveal the tremendous need for better education of physicians, patients, and couples as well as for more research in sexuality and intimacy with the goal of improving quality of life for this large population of survivors. Suggestions for clinicians to better help patients and their partners regarding sexuality and intimacy are offered.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
That sexual symptoms can signal serious underlying disease confirms the importance of sexual enquiry as an integral component of medical assessment. Data on sexual function are sparse in some medical specialties. However, increased scientific understanding of the central and peripheral physiology of sexual response could help to identify the pathophysiology of sexual dysfunction from disease and medical interventions, and also to ameliorate or prevent some dysfunctions. Many common general medical disorders have negative effects on desire, arousal, orgasm, ejaculation, and freedom from pain during sex. Chronic disease also interferes indirectly with sexual function, by altering relationships and self-image and causing fatigue, pain, disfigurement, and dependency. Current approaches to assessment of sexual dysfunction are based on models that combine psychological and biological aspects.
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Affiliation(s)
- Rosemary Basson
- University of British Columbia, Department of Psychiatry, BC Centre for Sexual Medicine, Vancouver General Hospital, Canada.
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Carson CC. Ejaculatory dysfunction: progress in a rarely recognized sexual problem. Int J Impot Res 2006; 18 Suppl 1:S3-4. [PMID: 16953245 DOI: 10.1038/sj.ijir.3901514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- C C Carson
- University of North Carolina, Department of Urology, Chapel Hill, NC 27599-7235, USA.
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