Drug-Associated Spontaneous Orgasm: A Case Report and Systematic Review of Literature

Spontaneous Ejaculation: A Focused Review for the Clinicians

INTRODUCTION

The process of ejaculation has important meanings not only for its association with orgasm but also for the timing to ejaculate in the context of sexual activity. Spontaneous (involuntary) ejaculation (SE) without any sexual stimulation is a distressing symptom. Our understanding of SE is limited. Unfortunately, many physicians are not aware of these cases.

OBJECTIVES

The objective of this study is to describe the etiopathogenesis, clinical features, diagnosis, and treatment options for SE.

METHODS

We searched the literature for publications on "SE," "spontaneous emission" or "involuntary ejaculation," and factors influencing SE in the PUBMED/MEDLINE, Scopus, Cochrane Library, EMBASE, PsycINFO, ProQuest, Academic Search Complete database, Google Scholar, and CINAHL databases from inception to August 2020.

RESULTS

The literature search yielded 36 relevant publications reporting on 43 patients with SE. Attempts to explain the cause of pathologic SE have included 4 etiological groups (spinal cord lesions, psychological causes, rabies, and drug-induced). The underlying mechanisms responsible for induction of SE may include increased adrenergic activity, overactivity in dopaminergic system, decreased serotonergic activity, damage of descending inhibitory pathway, or penile hyperexcitability. SE may occur in the absence of an identifiable trigger or may be triggered by non-sexual circumstances (micturition, defecation, glans touch, anxiety, panic attack, or school examinations). Treatment options include psychoanalytic treatment, paroxetine, citalopram, sertraline, silodosin, and anxiolytics. In drug-induced SE, dose reduction and drug withdrawal with or without switching to another drug may relief SE.

CONCLUSIONS

SE is one of the least reported ejaculatory dysfunction. The key feature shared in common by these men is SE without any sexual thoughts or fantasies, may be triggered by non-sexual contexts, rarely associated with orgasm or erection. Treatment by psychoanalytic treatment and pharmacotherapy may be helpful. Further research might explore the definite underlying mechanisms. Abdel-Hamid IA, Ali OI. Spontaneous Ejaculation: A Focused Review for the Clinicians. Sex Med Rev 2021;9:406-422.

Persistent Genital Arousal Disorder: A Study on an Italian Group of Female University Students

There are very few studies in literature about Persistent Genital Arousal Disorder (PGAD) prevalence to date, and no one has ever been done in Italy. This study replicated the earlier Canadian research in order to investigate the prevalence of PGAD diagnostic criteria in an Italian group of 679 female university students and to compare the results with those obtained in the Canadian group. In addition, the research aimed at verifying if the type or number of PGAD criteria met and the intensity of symptoms are associated with more negative emotions, and if they can be related to age and sexual orientation. The results confirm that some women can experience spontaneous genital sensations that can vary in intensity and duration, and can be associated with a wide range of emotions. However, the results seem to suggest the importance of other factors in the evaluation of the symptoms, rather than factors related to their nature and intensity or age and sexual orientation. Moreover, 2 participants (0.29%) met all five criteria and reported high distress, confirming that there is a potential clinical condition called PGAD, in which the hypertrophic, intense and intrusive spontaneous genital arousal might determine the presence of extremely negative emotions.