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Chen Z, Yuan M, Ma Z, Wen J, Wang X, Zhao M, Liu J, Zhang X, Zhao S, Guo L. Significance of piezo‐type mechanosensitive ion channel component 2 in premature ejaculation: An animal study. Andrology 2020; 8:1347-1359. [PMID: 32100938 DOI: 10.1111/andr.12779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/09/2020] [Accepted: 02/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Zhenghao Chen
- Institution of Urology The Second Hospital of Shandong University Jinan China
| | - Mingzhen Yuan
- Shandong Provincial Hospital Affiliated to Shandong University Jinan China
| | - Zhen Ma
- School of Medicine Shandong University Jinan China
| | - Jiliang Wen
- School of Medicine Shandong University Jinan China
| | | | | | - Jiaxin Liu
- The First Affiliated Hospital of Zhejiang University Hangzhou China
| | - Xiulin Zhang
- Institution of Urology The Second Hospital of Shandong University Jinan China
| | - Shengtian Zhao
- Shandong Provincial Hospital Affiliated to Shandong University Jinan China
| | - Liqiang Guo
- Shandong Provincial Hospital Affiliated to Shandong University Jinan China
- School of Medicine Shandong University Jinan China
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Simsek A, Kirecci SL, Kucuktopcu O, Ozgor F, Akbulut MF, Sarilar O, Ozkuvanci U, Gurbuz ZG. Comparison of paroxetine and dapoxetine, a novel selective serotonin reuptake inhibitor in the treatment of premature ejaculation. Asian J Androl 2015; 16:725-7. [PMID: 24830690 PMCID: PMC4215669 DOI: 10.4103/1008-682x.128467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dapoxetine hydrochloride is a selective serotonin reuptake inhibitor and the first drug approved for the on-demand treatment of premature ejaculation (PE). Our objective in this study was to characterize the efficacy of on-demand dapoxetine (30 and 60 mg) and daily paroxetine (20 mg) usage in treating PE. We conducted a 1 month study involving a total of 150 patients. Patients were divided into three groups of 50. Group 1 were treated with on-demand dapoxetine (30 mg), Group 2 with on-demand dapoxetine (60 mg) and Group 3 with daily paroxetine (20 mg). Our outcome measurement was increased from baseline intravaginal ejaculatory latency time (IELT) after treatment. The IELT increased from baseline to posttreatment by 117%, 117% and 170% in the paroxetine group (P < 0.01), 30 mg dapoxetine group (P < 0.01) and 60 mg dapoxetine group (P < 0.01), respectively. The increase from baseline IELT were similar for the 30 mg dapoxetine and paroxetine groups (P > 0.05), while the 60 mg dapoxetine group had a larger posttreatment IELT increase compared with the 30 mg dapoxetine (P < 0.05) and paroxetine (P < 0.01) groups. Dapoxetine (60 mg) 1-3 h before planned intercourse is a very effective treatment modality for PE. However, an on-demand dose of 30 mg dapoxetine is no more effective than the currently prescribed paroxetine treatment.
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Affiliation(s)
- Abdulmuttalip Simsek
- Department of Urology, Haseki Research and Training Hospital, Fatih, Istanbul, Turkey
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Gur S, Sikka SC. The characterization, current medications, and promising therapeutics targets for premature ejaculation. Andrology 2015; 3:424-42. [DOI: 10.1111/andr.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 02/03/2015] [Accepted: 02/21/2015] [Indexed: 01/06/2023]
Affiliation(s)
- S. Gur
- Department of Pharmacology; School of Pharmacy; Ankara University; Ankara Turkey
- Department of Urology; Tulane University Health Sciences Center; New Orleans LA USA
| | - S. C. Sikka
- Department of Urology; Tulane University Health Sciences Center; New Orleans LA USA
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Serefoglu EC, Hawley WR, Lasker GF, Grissom EM, Mandava SH, Sikka SC, Dohanich GP, Hellstrom WJ. Effect of Botulinum‐A Toxin Injection into Bulbospongiosus Muscle on Ejaculation Latency in Male Rats. J Sex Med 2014; 11:1657-63. [DOI: 10.1111/jsm.12553] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ückert S, Kuczyk MA, Oelke M. Phosphodiesterase inhibitors in clinical urology. Expert Rev Clin Pharmacol 2014; 6:323-32. [DOI: 10.1586/ecp.13.16] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Morris BJ, Krieger JN. Does male circumcision affect sexual function, sensitivity, or satisfaction?--a systematic review. J Sex Med 2013; 10:2644-57. [PMID: 23937309 DOI: 10.1111/jsm.12293] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Circumcision of males is commonly carried out worldwide for reasons of health, medical need, esthetics, tradition, or religion. Whether circumcision impairs or improves male sexual function or pleasure is controversial. AIMS The study aims to conduct a systematic review of the scientific literature. METHODS A systematic review of published articles retrieved using keyword searches of the PubMed, EMBASE, and Cochrane databases was performed. MAIN OUTCOME MEASURES The main outcome measure is the assessment of findings in publications reporting original data relevant to the search terms and rating of quality of each study based on established criteria. RESULTS Searches identified 2,675 publications describing the effects of male circumcision on aspects of male sexual function, sensitivity, sensation, or satisfaction. Of these, 36 met our inclusion criteria of containing original data. Those studies reported a total of 40,473 men, including 19,542 uncircumcised and 20,931 circumcised. Rated by the Scottish Intercollegiate Guidelines Network grading system, 2 were 1++ (high quality randomized controlled trials) and 34 were case-control or cohort studies (11 high quality: 2++; 10 well-conducted: 2+; 13 low quality: 2-). The 1++, 2++, and 2+ studies uniformly found that circumcision had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration. Support for these conclusions was provided by a meta-analysis. Impairment in one or more parameters was reported in 10 of the 13 studies rated as 2-. These lower-quality studies contained flaws in study design (11), selection of cases and/or controls (5), statistical analysis (4), and/or data interpretation (6); five had multiple problems. CONCLUSION The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
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A clinical study to assess the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. Int J Impot Res 2013; 25:117-20. [PMID: 23552577 PMCID: PMC3655259 DOI: 10.1038/ijir.2013.13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Premature ejaculation is a sexual debilitating condition affecting a large number of men worldwide and leading to important dysfunctions influencing the patients' affective and emotional life. Hyaluronic acid is a natural and safe compound that has been widely used not only in the aesthetic medicine clinic, but also for treatment of osteoarthritis. The present study shows the effectiveness of a hyaluronic acid-based procedure for treatment of premature ejaculation. A hundred and ten male patients were treated with hyaluronic acid injections in the deep dermis of their glans penis to increase the volume and the circumference of their penis to prevent male premature ejaculation and improve the patients' and their partners' sexual satisfaction. The intravaginal ejaculation latency time increased significantly from a baseline value of 88.34±3.14 s to 293.14±8.16 s after 6 months from the procedure. Maximal glandular circumference increased from 98.51±0.71 mm to 114.35±0.66 mm after 6 months from the procedure. At 6-month follow-up, patients' self-rated satisfaction was 5.3±0.07 (range: 4–6). At the follow-up, partners' self-rated satisfaction was 5.1±0.09 (range: 3–6). The present clinical study showed that hyaluronic acid injection is a promising treatment for premature ejaculation. The effect of the procedure in the long-term follow-up needs to be clarified.
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Serefoglu EC, Saitz TR, Trost L, Hellstrom WJ. Premature ejaculation: do we have effective therapy? Transl Androl Urol 2013; 2:45-53. [PMID: 26816723 PMCID: PMC4708597 DOI: 10.3978/j.issn.2223-4683.2013.01.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 01/10/2013] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Premature ejaculation (PE) is the most common sexual dysfunction, with the majority of PE patients remaining undiagnosed and undertreated. Despite its prevalence, there is a current paucity of data regarding available treatment options and mechanisms. The objective of the current investigation is to review and summarize pertinent literature on therapeutic options for the treatment of PE, including behavioral/psychologic, oral pharmacotherapy, and surgery. METHODS A pubmed search was conducted on articles reporting data on available treatment options for PE. Articles describing potential mechanisms of action were additionally included for review. Preference was given towards randomized, controlled trials, when available. RESULTS PE remains an underdiagnosed and undertreated disease process, with limited data available regarding potential underlying mechanisms and long-term outcomes of treatment options. Psychological/behavioral therapies, including the stop-start, squeeze, and pelvic floor rehabilitation techniques have demonstrated improvements in short-term series, with decreased efficacy with additional follow-up. Topical therapies, which are commonly utilized result in prolonged intravaginal ejaculatory latency time (IELT) at the expense of potential penile/vaginal Hypothesia. Oral therapies similarly demonstrate improved IELTs with variable side effect profiles and include selective serotonin reuptake inhibitors (daily or on demand), phosphodiesterase-5 inhibitors, alpha-1 adrenergic antagonists, and tramadol. Alternative therapies such as acupuncture have shown benefits in limited studies. Surgery is not commonly performed and is not recommended by available guidelines. CONCLUSIONS PE is a common condition, with limited data available regarding its underlying pathophysiology and treatment. Available therapies include topical, oral, behavioral/psychologic modification, or a combination thereof. Additional research is required to assess the optimal treatment strategies and algorithms as well as to better define the mechanisms for PE and its management.
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Bodakçi MN, Bozkurt Y, Söylemez H, Hatipoglu NK, Penbegül N, Atar M, Sancaktutar AA. Relationship between premature ejaculation and postcircumcisional mucosal cuff length. Scand J Urol 2013; 47:399-403. [PMID: 23356828 DOI: 10.3109/21681805.2013.764350] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aims of this study were to investigate the effect of circumcision conditions on postcircumcisional mucosal cuff length (MCL), and to determine the relationship between premature ejaculation (PE) and MCL. MATERIAL AND METHODS Circumcision histories and penile measurements were taken for 200 circumcised men. They were asked to complete the Premature Ejaculation Diagnostic Tool (PEDT) questionnaire, and to measure and report intravaginal ejaculation latency time (IELT). RESULTS The mean age of all participants was 35.1 ± 8.5 (19-46) years. The mean MCL, penile skin length and total penile length of all participants were 14.6 ± 3.4 mm, 122 ± 11.8 mm and 136.6 ± 13.9 mm, respectively. Mean age at circumcision was 6.5 ± 5.8 years. Only 26 (13%) of the participants had been circumcised by a surgeon, and they had significantly shorter MCL than those who had been circumcised by others (p = 0.041). All 200 men enrolled in the study completed a PEDT, but only 141 of them measured correctly and reported their IELT. The mean PEDT score was 5.6 ± 5.9 and IELT was 3.8 ± 1.9 min. There was a strong and a negative correlation between PEDT scores and IELT (p = 0.000, and r = -0.785), but no correlation was shown between the mean penile measurements and PEDT and IELT scores of volunteers (p > 0.05). CONCLUSIONS Although the MCL did not change according to the place where it was performed, it was shorter in patients who had been circumcised by surgeons. The study results also demonstrated that there was no relationship between MCL or penile length and PE in terms of PEDT score and IELT in circumcised men.
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Eassa BI, El-Shazly MA. Safety and efficacy of tramadol hydrochloride on treatment of premature ejaculation. Asian J Androl 2013; 15:138-42. [PMID: 23103596 PMCID: PMC3739134 DOI: 10.1038/aja.2012.96] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 05/17/2012] [Accepted: 07/25/2012] [Indexed: 01/02/2023] Open
Abstract
Premature ejaculation (PE) is the most common sexual disorder. It affects 20%-30% of adult men; the aetiology of this condition has not yet been elucidated. The aim of this study is to evaluate the efficacy, safety, tolerability, undesirable effects and improved satisfaction with sexual intercourse with tramadol hydrochloride at different dosages for the treatment of PE. A total of 300 patients who presented with lifelong (primary) PE were included in this study. The study was performed for 28 weeks, in which placebo (starch tablet) was given for 4 weeks, and active ingredient (tramadol hydrochloride) was administered at different therapeutic dosages for 24 weeks. Patients were divided into three equal groups, each consisting of 100 patients. The first group (A) was given tramadol hydrochloride capsule 25 mg. The second group (B) was given tramadol hydrochloride capsule 50 mg. The third group (C) was given tramadol hydrochloride capsule 100 mg. All of the 300 participants included completed the study voluntarily. The age of the patients varied from 25 to 50 years. After the treatment period, the recorded data were collected for each group and analysed. The results showed a highly significant increase in the mean intravaginal ejaculatory latency time (IELT) in all groups compared to baseline data (P<0.0001). We concluded that using tramadol hydrochloride at different doses on demand for the treatment of PE is effective, safe and tolerable, with minimal undesirable effects, and approval for this indication should be sought.
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Affiliation(s)
- Bayoumy I Eassa
- Department of Dermatology, Venereology and Andrology, Al-Azhar University, Cairo 11884, Egypt.
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McMahon CG, Jannini E, Waldinger M, Rowland D. Standard Operating Procedures in the Disorders of Orgasm and Ejaculation. J Sex Med 2013; 10:204-29. [DOI: 10.1111/j.1743-6109.2012.02824.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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12
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Yang L, Qian S, Liu H, Liu L, Pu C, Han P, Wei Q. Role of Tramadol in Premature Ejaculation: A Systematic Review and Meta-Analysis. Urol Int 2013; 91:197-205. [DOI: 10.1159/000348826] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/25/2013] [Indexed: 11/19/2022]
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Wu T, Yue X, Duan X, Luo D, Cheng Y, Tian Y, Wang K. Efficacy and Safety of Tramadol for Premature Ejaculation: A Systematic Review and Meta-analysis. Urology 2012; 80:618-24. [DOI: 10.1016/j.urology.2012.05.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 05/23/2012] [Accepted: 05/29/2012] [Indexed: 11/25/2022]
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Corona G, Jannini EA, Vignozzi L, Rastrelli G, Maggi M. The hormonal control of ejaculation. Nat Rev Urol 2012; 9:508-19. [PMID: 22869001 DOI: 10.1038/nrurol.2012.147] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hormones regulate all aspects of male reproduction, from sperm production to sexual drive. Although emerging evidence from animal models and small clinical studies in humans clearly point to a role for several hormones in controlling the ejaculatory process, the exact endocrine mechanisms are unclear. Evidence shows that oxytocin is actively involved in regulating orgasm and ejaculation via peripheral, central and spinal mechanisms. Associations between delayed and premature ejaculation with hypothyroidism and hyperthyroidism, respectively, have also been extensively documented. Some models suggest that glucocorticoids are involved in the regulation of the ejaculatory reflex, but corresponding data from human studies are scant. Oestrogens regulate epididymal motility, whereas testosterone can affect the central and peripheral aspects of the ejaculatory process. Overall, the data of the endocrine system in regulating the ejaculatory reflex suggest that widely available endocrine therapies might be effective in treating sexual disorders in these men. Indeed, substantial evidence has documented that treatments of thyroid diseases are able to improve some ejaculatory difficulties.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
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Deleterious effects of selective serotonin reuptake inhibitor treatment on semen parameters in patients with lifelong premature ejaculation. Int J Impot Res 2012; 24:171-3. [PMID: 22573230 DOI: 10.1038/ijir.2012.12] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Premature ejaculation (PE), the most common sexual dysfunctions in men, is characterized by loss or absence of ejaculatory control. PE can be classified as either a lifelong or acquired condition. Although the prevalence of lifelong PE is rather low in the general male population, recent studies demonstrated that the patients who seek treatment for their rapid ejaculation mostly report lifelong PE. Although no drug for PE has been approved by regulatory bodies, chronic selective serotonin reuptake inhibitors (SSRIs) proved to be effective in treating lifelong PE. Despite the rising use and known effects of antidepressants on ejaculation, only a few reports have evaluated the impact of these drugs on the male fertility. Thus, the aim of this review is to evaluate the efficacy and adverse effects of SSRIs on semen parameters of patients with lifelong PE as well as to assess the safety of this treatment among sexually active couples who desire to have a child.
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Abstract
Premature ejaculation (PE) is a common male sexual dysfunction. Advances in PE research have been hampered owing to a nonstandardized definition of PE, until the definition by the International Society of Sexual Medicine (ISSM) in 2009. Once the diagnosis of PE is established through a thorough history, a variety of medical therapies is available, including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), centrally acting opiates, phosphodiesterase 5 inhibitors and topical desensitizing creams. Most of these treatments increase the intravaginal ejaculation latency time (IELT) and patient satisfaction scores, with the most convincing evidence for SSRIs and topical creams. Daily SSRIs such as paroxetine, although efficacious, do have a substantial and prolonged side effect profile. Dapoxetine, which is a on-demand SSRI, is the only licensed drug for the treatment of PE, increasing IELT by a factor of 2.5 to 3 with limited and tolerable side effects. In the near future, the topical aerosol PSD502 is due to be licensed for the treatment of PE, increasing IELT by up to a factor of 6 but having minimal local and negligible systemic side effects.
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Affiliation(s)
- Amar Mohee
- Pyrah Department of Urology, St James University Hospital, Leeds, UK
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McMahon CG, Porst H. Oral Agents for the Treatment of Premature Ejaculation: Review of Efficacy and Safety in the Context of the Recent International Society for Sexual Medicine Criteria for Lifelong Premature Ejaculation. J Sex Med 2011; 8:2707-25. [DOI: 10.1111/j.1743-6109.2011.02386.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Premature ejaculation (PE) is the most common male sexual dysfunction, occurring in 20-30% of men. Unlike erectile dysfunction, which increases with age, rates of PE remain constant across the adult life span. OBJECTIVE To review the prevalence of PE, its psychological sequelae and barriers to effective treatment, treatment options, and the effects of treatment on the psychological burden of PE. METHODS PubMed and Embase databases were searched to identify primary papers related to PE published between 1980 and 2010. Key words included premature ejaculation, prevalence, quality of life, interpersonal relationships, psychotherapy, drug therapy, and treatment barriers. RESULTS Men with PE often suffer from significant psychological distress including anxiety, depression, lack of sexual confidence, poor self-esteem, impaired quality of life, sexual dissatisfaction, and interpersonal difficulties. Due to various reasons, however, most men do not seek treatment for PE. Many physicians are unaware of the distressful nature of PE and might be reluctant to ask patients about their sexual function. Nevertheless, increasing clinical research on pharmacologic treatment of PE, and the use of on-demand orally administered short-acting selective serotonin reuptake inhibitors or topically applied local anesthetics, appears promising. Although few rigorous studies assessing psychotherapeutic treatments have been conducted, many clinicians report the success of psychological treatments for PE. SUMMARY AND CONCLUSIONS Conclusions drawn from this review are limited due to inherent variations across studies, including criteria to define PE, study designs, outcome measures, populations, survey instruments, and study settings. While the psychological distress associated with PE suggests the appropriateness of at least minimal counseling for couples, limited data are available to support a combined psychotherapeutic and pharmacologic treatment approach. The paucity of well-designed psychotherapy or combination studies represents an important unmet need in the treatment of PE.
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Affiliation(s)
- David L Rowland
- The Graduate School and Office of Continuing Education, Valparaiso University, Valparaiso, IN, USA.
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Jeon HJ, Kim HS, Lee CH, Lee YG, Choi SM, Sohn YS, Shin CY, Kim J, Shim HJ, Kang KK, Ahn BO, Kim SH. Candidate Molecule for Premature Ejaculation, DA-8031: In Vivo and In Vitro Characterization of DA-8031. Urology 2011; 77:1006.e17-21. [DOI: 10.1016/j.urology.2010.11.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 11/26/2010] [Accepted: 11/26/2010] [Indexed: 11/25/2022]
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Burnett AL, Goldstein I, Andersson KE, Argiolas A, Christ G, Park K, Xin ZC. Future sexual medicine physiological treatment targets. J Sex Med 2011; 7:3269-304. [PMID: 21029380 DOI: 10.1111/j.1743-6109.2010.02025.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Sexual function in men and women incorporates physiologic processes and regulation of the central and peripheral nervous systems, the vascular system, and the endocrine system. There is need for state-of-the-art information as there is an evolving research understanding of the underlying molecular biological factors and mechanisms governing sexual physiologic functions. AIM To develop an evidence-based, state-of-the-art consensus report on the current knowledge of the major cellular and molecular targets of biologic systems responsible for sexual physiologic function. METHODS State-of-the-art knowledge representing the opinions of seven experts from four countries was developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURES Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS Scientific investigation in this field is needed to increase knowledge and foster development of the future line of treatments for all forms of biological-based sexual dysfunction. This article addresses the current knowledge of the major cellular and molecular targets of biological systems responsible for sexual physiologic function. Future treatment targets include growth factor therapy, gene therapy, stem and cell-based therapies, and regenerative medicine. CONCLUSIONS Scientific discovery is critically important for developing new and increasingly effective treatments in sexual medicine. Broad physiologic directions should be vigorously explored and considered for future management of sexual disorders.
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Affiliation(s)
- Arthur L Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Exposure of Human Seminal Vesicle Tissue to Phosphodiesterase (PDE) Inhibitors Antagonizes the Contraction Induced by Norepinephrine and Increases Production of Cyclic Nucleotides. Urology 2010; 76:1518.e1-6. [DOI: 10.1016/j.urology.2010.07.461] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 06/07/2010] [Accepted: 07/09/2010] [Indexed: 11/15/2022]
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Jannini EA, McCabe MP, Salonia A, Montorsi F, Sachs BD. Organic vs. psychogenic? The Manichean diagnosis in sexual medicine. J Sex Med 2010; 7:1726-33. [PMID: 20537061 DOI: 10.1111/j.1743-6109.2010.01824.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Manichean diagnosis, psychogenic or organic, is the first and most frequent diagnostic scope managing sexual disorders. The aim of this Controversy is to discuss if this philosophy is still useful both in the conceptual and clinical perspective. METHODS Five scientists (an endocrinologist, two psychologist, and two urologists) with expertise in the area of psychosexology and sexual medicine were asked to contribute with their opinions. MAIN OUTCOME MEASURE Expert opinion supported by the critical review of the currently available literature. RESULT Expert # 1, who is Controversy's section Editor, suggests that the term psychogenic is redundant, because all sexual dysfunctions involve the mind and the relationship with (at least) one partner. Furthermore, he is strongly against the exclusion diagnosis, in agreement with the Expert # 5. The idea that the psychogenic etiology is always present is also sustained with good arguments by the Expert # 2. On the other hand, the two Experts # 3 and 4 argue that a pharmacological treatment such as type 5 phosphodiesterase inhibitors or dapoxetine work in both organic and psychogenic conditions and that the attempt to perform a diagnostic effort is frequently useless. Last but not least, the Expert # 5 concludes that the mind-body dualism is to be considered obsolete and unhelpful in a modern approach to the patient with a sexual dysfunction. CONCLUSIONS The reader of the Journal will judge if there is still a room for the Manichean diagnosis of different sexual dysfunctions or if it is time to completely change our perspective on this essential aspect of clinical sexual medicine.
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Affiliation(s)
- Emmanuele A Jannini
- Course of Endocrinology and Medical Sexology, University of L'Aquila, L'Aquila, Italy.
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Alghobary M, El-Bayoumy Y, Mostafa Y, Mahmoud EHM, Amr M. Evaluation of Tramadol on Demand Vs. Daily Paroxetine as a Long-Term Treatment of Lifelong Premature Ejaculation. J Sex Med 2010; 7:2860-7. [DOI: 10.1111/j.1743-6109.2010.01789.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pfaus JG, Wilkins MF, Dipietro N, Benibgui M, Toledano R, Rowe A, Couch MC. Inhibitory and disinhibitory effects of psychomotor stimulants and depressants on the sexual behavior of male and female rats. Horm Behav 2010; 58:163-76. [PMID: 19837072 DOI: 10.1016/j.yhbeh.2009.10.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Revised: 09/24/2009] [Accepted: 10/01/2009] [Indexed: 11/20/2022]
Abstract
Drugs of abuse comprise several pharmacological classes, including psychomotor stimulants, such as amphetamine and cocaine, and CNS depressants, such as morphine and alcohol. Few studies have examined the effects of those drugs systematically on human sexual behavior, although substantial clinical and epidemiological literatures suggest that drugs in both classes either inhibit sexual responding or can be "prosexual" in certain situations, thereby increasing the potential of risky sexual activity and the spread of sexually transmitted diseases. This paper reviews original data in rats showing that both classes of drug inhibit or disinhibit sexual behavior depending on the animal's baseline level of sexual responding, hormonal status, whether the drug is given acutely or chronically, and whether the animal has learned to inhibit sexual responding toward nonreceptive partners or in the presence of conditioned olfactory cues that predict sexual nonreward.
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Affiliation(s)
- James G Pfaus
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, 7141 Sherbrooke W., Montréal, QC, Canada H4B 1R6.
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Porst H, Vardi Y, Akkus E, Melman A, Park NC, Seftel AD, Teloken C, Wyllie M. Standards for clinical trials in male sexual dysfunctions. J Sex Med 2010; 7:414-44. [PMID: 20092447 DOI: 10.1111/j.1743-6109.2009.01623.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Clinical trials in male sexual dysfunction (MSD) are expanding. Consequently, there is a need for consensus standards in this area. AIM To develop an evidence-based, state-of-the-art consensus report on standards for clinical trials in MSD. METHODS A literature review was performed examining clinical trials in erectile dysfunction (ED), premature ejaculation (PE), delayed/absent ejaculation, libido disorders/loss of desire, hypogonadism, and Peyronie's disease, focusing on publications published in the last 20 years. This manuscript represents the opinions of eight experts from seven countries developed in a consensus process. This document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. MAIN OUTCOME MEASURE Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS According to experience and recent publications in dealing with clinical trials in sexual dysfunction, recommendations have been made for conducting trials in patients with ED, PE, delayed ejaculation, libido disorders, hypogonadism, and Peyronie's disease. CONCLUSIONS It is important that future clinical trials are conducted using standards upon which investigators can rely when reading manuscripts or conducting new trials in this field.
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Linton KD, Wylie KR. Recent advances in the treatment of premature ejaculation. DRUG DESIGN DEVELOPMENT AND THERAPY 2010; 4:1-6. [PMID: 20368901 PMCID: PMC2846147 DOI: 10.2147/dddt.s6077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Premature ejaculation (PE) is the most common sexual problem affecting men. It can affect men at all ages and has a serious impact on the quality of life for men and their partners. Currently there are no pharmaceutical agents approved for use in the UK, and so all drugs used for this condition are off label. Behavioral therapy has been used to treat PE, but the results are not durable once therapy has been concluded. Several topical therapies have been used including severance-secret (SS) cream, lignocaine spray, lidocaine-prilocaine cream and lidocaine-prilocaine spray (TEMPE). There has been recent interest in the selective serotonin reuptake inhibitors (SSRIs) for the treatment of PE, due to the fact that one of their common side effects is delayed ejaculation. Currently used SSRIs have several non-sexual side effects and long half lives, therefore there has been interest in developing a short acting, efficacious SSRI that can be used on-demand for PE. Dapoxetine has been recently evaluated for the treatment of PE by several groups, and results so far appear promising.
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Morales A, Zargooshi J, Jern P, McCullough A, Hellstrom W, Shamloul R, Bella AJ, Becher EF, Rubio-Aurioles E, Perelman MA, Palmer N, Rothman M. Comments on “Considerations for an Evidence-Based Definition of Premature Ejaculation in the DSM-V”. J Sex Med 2010; 7:679-89. [DOI: 10.1111/j.1743-6109.2009.01682_1.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Salonia A, Rocchini L, Sacca' A, Pellucchi F, Ferrari M, Carro UD, Ribotto P, Gallina A, Zanni G, Deho' F, Rigatti P, Montorsi F. ORIGINAL RESEARCH—EJACULATORY DISORDERS: Acceptance of and Discontinuation Rate from Paroxetine Treatment in Patients with Lifelong Premature Ejaculation. J Sex Med 2009; 6:2868-77. [DOI: 10.1111/j.1743-6109.2009.01404.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zohdy W. Clinical parameters that predict successful outcome in men with premature ejaculation and inflammatory prostatitis. J Sex Med 2009; 6:3139-46. [PMID: 19751386 DOI: 10.1111/j.1743-6109.2009.01487.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Premature ejaculation (PE) is the most common sexual problem, and chronic prostatitis is an important cause of PE. AIM The aim of this study was to determine which clinical parameters predict successful outcomes following treatment of men with PE and chronic prostatitis (category II and IIIa). MAIN OUTCOME MEASURE Change in intravaginal ejaculatory latency time (IELT) and its relation to different clinical parameters. METHODS This study included 210 heterosexual men with PE and inflammatory prostatitis. PE was found to be acquired in 155 men (A-PE) and lifelong in 55 (LL-PE). All participants were asked to complete the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). Sequential microbiologic specimens were obtained. Antibiotics were given to 184 men for 4 weeks, guided by sensitivity tests. Twenty-six men refused or did not comply with the antimicrobial therapy and were used as the untreated group. Clinical reevaluation was conducted after 28 days. RESULTS Two of the 26 men (7.7%) from the untreated group experienced an increase in their ejaculatory latency compared with 109 of the 184 men (59.0%) who received antimicrobial therapy (P = 0.0001). After treatment, 90 of 155 men (58.0%) with A-PE reported ILET > 2 minutes compared with 21 of 55 men (38.2%) with LL-PE (P = 0.012). Based on a receiver operating characteristic curve, antimicrobial therapy is most effective if there are > or =19 pus cells per high-power field (HPF) in the expressed prostatic secretion (EPS) analysis, with a sensitivity of 85.6% and a specificity of 70.7% (area under the curve 0.783, 95% CI 0.716-0.850). Other clinical parameters were not useful in predicting outcomes. CONCLUSIONS Antimicrobial therapy is useful in the treatment of PE associated with inflammatory prostatitis. The treatment is most effective in men with A-PE and when there are > or =19 pus cells per HPF in an EPS analysis.
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Affiliation(s)
- Wael Zohdy
- Andrology Department, Cairo University, 17 Anas Ibn Malek street, El Mohandessin-12411, Giza, Egypt.
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Abstract
INTRODUCTION Complaints of premature ejaculation (PE) and its repercussions are culture-dependent. AIM To report the measured intravaginal ejaculatory latency time (IELT) and the impact of PE in Kermanshah, Iran. METHODS From November 1996 through October 2008, 3,458 patients presented to us with self-diagnosed PE. In the first visit, after obtaining a psychosocial and sexual history, PE-specific bother was self-rated by the patients and the patients were advised to measure their IELTs over the next 2-3 weeks. In the second visit, the measured IELTs were reported by the patients. MAIN OUTCOME MEASURES Patients' measured IELT and bother score. RESULTS Age range was 17-80 years (mean 34.1, standard deviation [SD] 9.1, median 32). Sixty-five percent were married. Primary and secondary PE was reported by 2,105 (60.8%) and 1,353 (39.1%) patients, respectively. Occasional PE was reported by 36 (0.01%). Of those with multiple partners, 6% had partner-specific PE. IELT distribution was positively skewed. Anteportal ejaculation was reported by 97 (2.8%). In 3,458 self-reported PE patients, IELT was 1-15 seconds in 542 (15.7%), 16-30 seconds in 442 (12.8%), 31-60 seconds in 978 (28.3%), > 1 <or= 2 minutes in 551 (15.9%), > 2 <or= 5 minutes in 712 (20.6%), and >5 minutes in 136 (3.9%). IELTs of <or=1 minutes and <or=2 minutes were reported by 59.5% and 75.5%, respectively. Median bother score was 3 of 4. Pearson's correlation between IELT and bother (r = -0.607) was highly negative, with shorter IELTs being correlated with more bother. Six hundred forty-three patients (18.6%) always consumed opium to lengthen their IELTs. All 21 patients who started to use Tramadol as a PE treatment became addicted to it. Of 168 divorced couples due to PE, 23 divorced because the sexually dissatisfied wives became involved in extramarital affairs. Applying the Diagnostic and Statistical Manual of Mental Disorders criteria for PE and a cutoff IELT point of <or=2 minutes, and thus excluding the patients with IELTs of longer than 2 minutes, the patients with occasional PE, and the patients who reported no personal bother, of 3,458 self-reported PE patients, 2,571 (74.3%) had PE. Including the 97 patients with anteportal ejaculation, arithmetic mean IELT in 2,571 patients was 45.87 seconds, SD 36.1, median 40, and range 0-120. Excluding the anteportal ejaculation, arithmetic mean IELT in the remaining 2,474 patients was 47.67 seconds, SD 35.71, median 42, range 1-120, and geometric mean 31.06. CONCLUSION PE has a devastating impact. In clinical practice, primary lifelong PE is by far the most common variety of PE. Occasional PE is a very rare cause of presentation. A significant proportion of the patients who consider themselves as premature ejaculators have IELTs of more than 2 minutes; the sexual medicine community should reach a consensus on the clinical diagnostic and therapeutic approach to these patients who consider themselves as premature ejaculators. The most important cause of bother in PE is the briefness of the ejaculatory latency, rather than the lack of control. Second-round ED (pseudoED) was reported for the first time. The worst type of PE, i.e., anteportal ejaculation, is not very rare; thus, geometric mean that excludes anteportal ejaculation is not suitable statistics to report the ejaculatory latency time; instead, median is the best measure of IELT reporting. Cutoffs of 0.5-2.5 percentiles are not suitable means to diagnose PE.
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Affiliation(s)
- Javaad Zargooshi
- Kermanshah University of Medical Sciences-Department of Urology, Kermanshah, Iran.
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Birowo P, Uckert S, Kedia GT, Scheller F, Meyer M, Taher A, Rahardjo D, Jonas U, Kuczyk MA. Evaluating the role of the serotoninergic system in the control of human seminal vesicle smooth muscle-an in vitro approach. J Sex Med 2009; 6:2672-9. [PMID: 19686430 DOI: 10.1111/j.1743-6109.2009.01423.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION It has been suggested that serotonin re-uptake inhibitors (SRIs) may retard the ejaculatory response by acting directly on the seminal vesicle (SV) and ductus deferens smooth muscle. However, until now, only a very few experimental studies have investigated such potential local (peripheral) effects. AIM To elucidate the effects of serotonin (5-HT) and the SRIs clomipramine, fluoxetine and imipramine on the tension induced by norepinephrine (NE) of isolated human SV smooth muscle, as well as on the production of tissue cyclic AMP and cyclic GMP. MAIN OUTCOME MEASURES To measure the inhibition exerted by serotonin and SRIs clomipramine, fluoxetine, and imipramine on the contractile response of isolated SV tissue. In addition, the effects of the drugs on the turn-over of cyclic nucleotides cAMP and cGMP were also elucidated. METHODS The effects of the cumulative addition of serotonin and the SRIs clomipramine, fluoxetine and imipramine (1 nM-10 microM) on the tension induced by the alpha(1)-adrenoceptor agonist NE (10 microM) of SV strip preparations were studied using the organ bath technique. Cyclic AMP and cyclic GMP were measured by means of specific radioimmunoassays. RESULTS The tension induced by NE was dose-dependently reversed by the drugs tested. The rank order of efficacy was: imipramine > or = fluoxetine > or = clomipramine > serotonin. Mean reversion of tension was measured between 66 +/- 6.6% and 52 +/- 6.6%. These effects were paralleled by a 1.3-fold to 2.7-fold increase in tissue cAMP in response to exposure to the drugs. In contrast, no significant enhancement in cGMP was noted. CONCLUSIONS The findings, for the first time, present evidence that SRIs may antagonize the sympathetic contraction of SV smooth muscle via stimulation of tissue cyclic AMP.
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Affiliation(s)
- Ponco Birowo
- Department of Urology & Uro-Oncology, Hannover Medical School, Hannover 30625, Germany
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Current World Literature. Curr Opin Obstet Gynecol 2009; 21:353-63. [DOI: 10.1097/gco.0b013e32832f731f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brock GB, Bénard F, Casey R, Elliott SL, Gajewski JB, Lee JC. Canadian Male Sexual Health Council Survey to Assess Prevalence and Treatment of Premature Ejaculation in Canada. J Sex Med 2009; 6:2115-23. [DOI: 10.1111/j.1743-6109.2009.01362.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Clément P, Pozzato C, Heidbreder C, Alexandre L, Giuliano F, Melotto S. Delay of Ejaculation Induced by SB-277011, a Selective Dopamine D3 Receptor Antagonist, in the Rat. J Sex Med 2009; 6:980-988. [DOI: 10.1111/j.1743-6109.2008.01173.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, Boddi V, Bandini E, Balercia G, Forti G, Maggi M. Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction. J Sex Med 2009; 6:1457-66. [PMID: 19210705 DOI: 10.1111/j.1743-6109.2008.01206.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The physiological role of prolactin (PRL) in male sexual behavior is poorly understood. Conversely, the association between PRL pathological elevation in both reproductive and sexual behavior is well defined. AIM The aim of the present study is to assess the correlates of normal PRL (PRL < 735 mU/L or 35 ng/mL), in male subjects consulting for sexual dysfunction. METHODS A consecutive series of 2,531 (mean age 52.0 +/- 12.9 years) subjects was investigated. Patients were interviewed using the structured interview on erectile dysfunction (SIEDY), a 13-item tool for the assessment of erectile dysfunction (ED)-related morbidities. Middlesex Hospital Questionnaire was used for the evaluation of psychological symptoms. MAIN OUTCOME MEASURES Several hormonal (testosterone, thyroid stimulation hormone, and PRL) and biochemical parameters (glycemia and lipid profile) were studied, along with penile Doppler ultrasound (PDU) and SIEDY items. RESULTS After adjustment for confounders anxiety symptoms decreased across PRL quartiles (I: <113 mU/L or 5 ng/mL; II: 113-156 mU/L or 5.1-7 ng/mL; III: 157-229 mU/L or 7.1-11 ng/mL; IV: 229-734 mU/L or 11.1-34.9 ng/mL). Patients in the lowest PRL quartile showed a higher risk of metabolic syndrome (MetS; odds ratio [OR] = 1.74 [1.01-2.99], P < 0.05), arteriogenic ED (peak systolic velocity at PDU < 35 cm/sec; OR = 1.43 [1.01-2.03], P < 0.05), and premature ejaculation (PE; OR = 1.38 [1.02-1.85]; P < 0.05). Conversely, comparing subjects with PRL-secreting pituitary adenomas (N = 13) with matched controls, no significant difference was observed, except for a higher prevalence of hypoactive sexual desire in hyperprolactinemia. CONCLUSIONS Our findings demonstrate that, in subjects consulting for sexual dysfunction, PRL in the lowest quartile levels are associated with MetS and arteriogenic ED, as well as with PE and anxiety symptoms. Further studies are advisable in order to confirm our preliminary results in different populations.
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Affiliation(s)
- Giovanni Corona
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Ückert S, Bazrafshan S, Sonnenberg JE, Kuczyk MA. Effects of Phosphodiesterase Inhibitors on the Contractile Responses of Isolated Human Seminal Vesicle Tissue to Adrenergic Stimulation. J Sex Med 2009; 6:408-14. [DOI: 10.1111/j.1743-6109.2008.01085.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ham WS, Kim WT, Choi HK, Choi YD. Recent Concepts of Premature Ejaculation. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.9.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Won Sik Ham
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Tae Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Ki Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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