Ketanserin potentiates the prejunctional inhibitory effect of 5-hydroxytryptamine on rat vas deferens

Management Options for Premature Ejaculation and Delayed Ejaculation in Men

INTRODUCTION

Many men experience distressing issues regarding the timing of orgasm and ejaculation, such as premature ejaculation (PE) and delayed ejaculation (DE). Despite being highly prevalent, both PE and DE are poorly understood and present a management challenge for sexual medicine specialists.

AIM

To summarize existing data on the medical management of PE and DE.

METHODS

A comprehensive literature review pertaining to the management of PE and DE was conducted using PubMed and clinicaltrials.gov for data published up until May 2019. Our focus was on double-blind, placebo-controlled trials and meta-analyses of such studies.

MAIN OUTCOME MEASURE

Peer-reviewed studies on treatment options for PE and DE were critically analyzed for results and methodological rigor.

RESULTS

The peer-reviewed data on PE management continue to evolve. Psychotherapy, pharmacotherapy, and procedural interventions have all been associated with some degree of efficacy. A strong evidence base supports the off-label use of selective serotonin reuptake inhibitors and local anesthetics in PE given consistent increases in ejaculation latency time. Education and mental health assessments remain important components of PE management despite a dearth of peer-reviewed data on these interventions. Numerous treatment strategies have been evaluated for DE; limited data support psychotherapy, pharmacotherapy, and/or penile vibratory stimulation as management options.

CONCLUSION

A number of management options for PE or DE exist but none has been formally approved by the US Food and Drug Administration. New and novel treatments would be of great value in managing issues regarding the timing of ejaculation/orgasm. Martin-Tuite P, Shindel AW. Management Options for Premature Ejaculation and Delayed Ejaculation in Men. Sex Med Rev 2020; 8:473-485.

The drug treatment of delayed ejaculation

Delayed ejaculation (DE) is an uncommon and a challenging disorder to treat. It is often quite concerning to patients and it can affect psychosocial well-being. Here we reviewed how DE is treated pharmacologically .We also highlighted specific settings where drugs could be introduced to medical practice. Electronic databases were searched from 1966 to February 2016, including PubMed MEDLINE, EMBASE, EBCSO Academic Search Complete, Cochrane Systematic Reviews Database, and Google Scholar using key words; delayed ejaculation, retarded ejaculation, inhibited ejaculation, drugs, treatment, or pharmacology. To achieve the maximum sensitivity of the search strategy and to identify all studies, we combined “delayed ejaculation” as Medical Subject Headings (MeSH) terms or keywords with each of “testosterone” or “cabergoline” or “bupropion” or “amantadine” or “cyproheptadine” or “midodrine” or “imipramine” or “ephedrine” or “pseudoephedrine” or “yohimbine” or “buspirone” or “oxytocin” or “bethanechol” as MeSH terms or keywords. There are a number of drugs to treat patients with DE including: testosterone, cabergoline, bupropion, amantadine, cyproheptadine, midodrine, imipramine, ephedrine, pseudoephedrine, yohimbine, buspirone, oxytocin, and bethanechol. Although there are many pharmacological treatment options, the evidence is still limited to small trials, case series or case reports. Review of literature showed that evidence level 1 (Double blind randomized clinical trial) studies were performed with testosterone, oxytocin, buspirone or bethanechol treatment. It is concluded that successful drug treatment of DE is still in its infancy. The clinicians need to be aware of the pathogenesis of DE and the pharmacological basis underlying the use of different drugs to extend better care for these patients. Various drugs are available to address such problem, however their evidence of efficacy is still limited and their choice needs to be individualized to each specific case.

The ovarian and cervical regions of the rat uterus display a different contractile response to serotonin and prostaglandin F2alpha. I. The estrous cycle

In pharmacological studies using isolated tissues, the sensitivity to different agonists may vary depending on the anatomical region. The aim of the present study was to evaluate the in vitro contractile response to serotonin, prostaglandin F2alpha, and oxytocin of the ovarian and the cervical uterine segments isolated from rats in the four different stages of the rat estrous cycle. Non-cumulative curves were recorded for both, the ovarian and the cervical uterine segments. The cervical portion displayed a higher contractile response to serotonin and a lower response to PGF2alpha than the ovarian portion. Oxytocin induced similar responses in both uterine segments. The uterine ovarian segment displayed a similar sensitivity to serotonin in all the estrous cycle stages, whereas in the cervical segment, influenced by estrogens in diestrus and proestrus, an increase in contractility was observed. According to these findings, serotonin might participate in the spermatozoa transport toward the oviduct. The higher response of the ovarian portion to prostaglandin F2alpha is in line with its role during labor and delivery.

Involvement of the muscarinic receptors in the postsynaptic potentiation of neurogenic twitch contraction in the mouse vas deferens

Muscarinic agonists and three selective antagonists were used in an attempt to characterize the muscarinic receptor subtypes which regulate the electrically evoked, neurogenic twitch contraction of the mouse vas deferens. The neurogenic contraction was concentration-dependently potentiated by both carbachol and oxotremorine, but not McN-A-343. These agonists also potentiated the contraction of unstimulated preparations elicited by exogenous ATP. However, potentiation of the neurogenic twitch contraction was strongly antagonized by pretreatment with 4-DAMP (IC50 = 1.38 nM for carbachol, and 4.79 nM for oxotremorine). The inhibitory effects of methoctramine and pirenzepine (PRZ) were about 100 times lower than those of 4-DAMP; the descending order of antagonistic potencies was: 4-DAMP much greater than methoctramine approximately equal to PRZ. These results suggest that muscarinic receptors are involved in the postsynaptic potentiation of the neurogenic twitch contraction in the mouse vas deferens. Classifications for the muscarinic receptor subtypes were discussed.

Release of 5-hydroxytryptamine, dopamine and noradrenaline in the rat vas deferens in the presence of compound 48/80, veratridine or K+

1. The release of 5-hydroxytryptamine (5-HT), dopamine and noradrenaline (NA) from the rat isolated vas deferens was estimated by high performance liquid chromatography with electrochemical detection. 2. Compound 48/80, which is known to release 5-HT and histamine from mast cells, induced a concentration-related, rapid overflow of 5-HT from the rat isolated vas deferens, releasing about 50% of the 5-HT present in the tissue at a concentration of 300 micrograms ml-1. The drug did not induce the release of either dopamine or NA. 3. The depolarizing agents veratridine (10 microM) or K+ (100 mM) induced the release of 5-10% of the 5-HT present in the vas deferens, but did not evoke the overflow of 5-HT from isolated mast cells. 4. Veratridine induced the release of a greater proportion of the dopamine than of the NA contained in the vas deferens (41.0 +/- 5.5 vs 17.9 +/- 2.0%, after 20 min of exposure to the drug, n = 6). In contrast, K+ evoked the release of both amines equally. 5. It is concluded that in the rat vas deferens 5-HT is stored in mast cells and also in cells responsive to depolarizing stimuli. It is suggested that 5-HT could be a neuromodulator or a neurotransmitter in this organ. Veratridine and K+ induce the release of dopamine in addition to NA.

Regional distribution of dopamine, 5-hydroxytryptamine, and noradrenaline in the rat vas deferens

The concentrations of dopamine (DA), 5-hydroxytryptamine (5-HT) and noradrenaline (NA) in the rat vas deferens divided in eight or four sections were determined by high performance liquid chromatography with electrochemical detection. Dopamine and NA had the same regional distribution; their concentrations were maximal near the prostatic end and decreased towards the epididymis. The concentration of 5-HT also decreased from the prostatic to the epididymal end, but 5-HT did not follow the same regional distribution as DA and NA. Reserpine (0.02 or 0.2 mg/kg, i.p., 24 hr) and 6-hydroxydopamine (2 x 80 mg/kg, i.v., 6 days) decreased the contents of DA and NA; the concentrations of both amines were modified to a similar extent. Reserpine also diminished the content of 5-HT. Pargyline (200 mg/kg, i.p., 2 hr) increased the concentration of 5-HT while p-chlorophenylalanine (300 mg/kg, oral, 3 days) decreased the contents of the amine in some sections of the vas deferens. This study suggests that DA and NA co-exist in the same sympathetic neurons. Some of the 5-HT could be stored in mast cells as previously proposed, but the finding that tissue content of 5-HT changes after inhibiting the deamination or synthesis of the amine suggests that other source(s) of 5-HT distinct from mast cells exist in the rat vas deferens.

Age-related change in serotonin-mediated prejunctional inhibition of rat vas deferens

The effect of age on the serotonin (5-HT)-induced prejunctional inhibition of twitch contractions induced in rat vas deferens by single-pulse field stimulation at 0.1 Hz was studied. The inhibitory effect of 5-HT gradually decreased with increasing age of the rats (4-15 weeks old) and was no longer detectable in preparations from rats over 15 weeks old. Moreover, on a further increase in age to 45 weeks, 5-HT conversely enhanced the twitch response of the vas deferens. The 5-HT2 antagonists ketanserin and mianserin potentiated the 5-HT-induced inhibition of contractions of the vas deferens of young rats (8-15 weeks old), and attenuated the amplifying effect of 5-HT on the responses of preparations from old rats (95 weeks old). Thus unmasking of the inhibition depended on the age of rats. This change occurred earlier in life in the prostatic portion of the vas deferens than in the epididymal portion. A functional decrease in 5-HT-mediated prejunctional inhibition and the resultant increase in amplification of the twitch response by 5-HT are probably responsible for the age-related decrease in prejunctional inhibition.