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Niu C, Santtila P. Effects of physical exercise interventions on ejaculation control. Sex Med Rev 2023; 12:106-113. [PMID: 37786366 DOI: 10.1093/sxmrev/qead042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Premature ejaculation is a prevalent male sexual dysfunction that causes significant distress for men and their partners on a global scale. Despite its widespread impact, effective treatment options without undesirable side effects remain limited. OBJECTIVES The present review aimed to provide an overview of experimental studies that analyzed the effects of physical exercise interventions on premature ejaculation. METHODS The inclusion criteria for the review included: Population: Adult men. Intervention: An intervention designed to increase physical exercise was delivered in the study. Comparison: Before versus after intervention with or without a comparison group receiving a drug treatment or an active or no control intervention. Outcomes: Self-reported or clinician-rated premature ejaculation or its symptoms. Study type: Experimental designs. We conducted the search process in 9 databases: APA PsycNET, PubMed, Scopus, SPORTDiscus, JSTOR, ScienceDirect, Web of Science, Embase, and CAB Direct. This review included six intervention studies that included 433 participants (307 men with premature ejaculation) ranging from 18 to 50 years of age. All participants had a stable female sexual partner and had not any other physical or mental problems. RESULTS The synthesized results indicated that yoga, running, and high-intensity interval training alleviate premature ejaculation symptoms in men with premature ejaculation after varying intervention duration times. The effectiveness of physical exercise for premature ejaculation symptoms was similar to that of drug treatments. CONCLUSION Physical exercise can be one of the potential treatment modalities for premature ejaculation. The intensity of physical exercise and the effort of participants during exercise are key factors affecting improvements in ejaculation control. A potential limitation was that the review did not include any literature written in non-English languages.
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Affiliation(s)
- Caoyuan Niu
- School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, People's Republic of China
- Faculty of Arts and Sciences, NYU Shanghai, Shanghai 200126, People's Republic of China
| | - Pekka Santtila
- School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, People's Republic of China
- Faculty of Arts and Sciences, NYU Shanghai, Shanghai 200126, People's Republic of China
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Park JJ, Doo SW, Kwon A, Kim DK, Yang WJ, Song YS, Shim SR, Kim JH. Effects of Sexual Rehabilitation on Sexual Dysfunction in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis. World J Mens Health 2023; 41:330-341. [PMID: 36593706 PMCID: PMC10042662 DOI: 10.5534/wjmh.220124] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Cardiovascular disease (CVD) is one of the leading causes of death, accounting for one-third of all deaths worldwide. Patients with CVD are three times more likely to complain of sexual dysfunction than healthy people. Causes of sexual dysfunction in patients with CVD include physical/mental changes and drug side effects. The prevalence of sexual dysfunction in patients with CVD has been estimated to be up to 89%. Ordinary treatments such as pharmacotherapy cannot effectively reduce sexual problems. Therefore, sexual rehabilitation has a broad spectrum, including exercise therapy such as pelvic floor muscle treatment, appropriate counseling, a multidisciplinary approach, and partner rehabilitation. In this study, systematic review and meta-analysis was performed to investigate the effect of sexual rehabilitation on sexual problems in patients with CVD. MATERIALS AND METHODS Comprehensive literature searches were conducted using MEDLINE, Cochrane Library electronic database, and EMBASE through June 2022. Questionnaire scores at the end point as outcomes of the study were recorded as were standardized mean difference (SMD) with their 95% confidence intervals (CIs). Meta-regression analysis was conducted for each moderator. We performed a risk of bias evaluation for included studies using the RoB 2 tool. RESULTS The overall SMD in the meta-analysis for sexual rehabilitation versus no-sexual rehabilitation was 0.430 (95% CI, 0.226-0.633). There was a statistical difference between groups. SMD changes were 0.674 (95% CI, 0.308-1.039) at one month and 0.320 (95% CI, 0.074-0.565) at six months. The regression analysis with all variables (number of patients, study duration, and questionnaire types) revealed no significance. CONCLUSIONS This study indicates that sexual rehabilitation is an effective method with high therapeutic potential for sexual dysfunction of patients with CVD. However, for clinical application, well-designed studies with many patients should be conducted in the future and the standardization of rehabilitation protocols is required.
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Affiliation(s)
- Jae Joon Park
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Whan Doo
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Allison Kwon
- Department of Biochemistry, College of Biological Science, University of California, Davis, CA, USA
| | - Do Kyung Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yun Seob Song
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Ryul Shim
- Department of Health and Medical Informatics, Kyungnam University College of Health Sciences, Changwon, Korea.
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
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Labate C, Panunzio A, De Carlo F, Zacheo F, De Matteis S, Barba MC, Carbonara U, Rizzo FL, Leo S, Forte S, Ditonno P, Tafuri A, Pagliarulo V. Current Knowledge on Radiation-Therapy-Induced Erectile Dysfunction in Prostate-Cancer Patients: A Narrative Review. URO 2023. [DOI: 10.3390/uro3020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Prostate cancer is the most frequently diagnosed cancer in men in the United States. Among the different available treatment options, radiation therapy is recommended for localized or even advanced disease. Erectile dysfunction (ED) often occurs after radiation therapy due to neurological, vascular, and endocrine mechanisms resulting in arterial tone alteration, pudendal-nerve neuropraxia, and lastly fibrosis. Considering the influence of quality of life on patients’ treatment choice, radiation-therapy-induced ED prevention and treatment are major issues. In this narrative review, we briefly summarize and discuss the current state of the art on radiation-therapy-induced ED in PCa patients in terms of pathophysiology and available treatment options.
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Affiliation(s)
- Connie Labate
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
- Department of Emergency and Organ Transplantation, Urology and Andrology Section, University of Bari, 70124 Bari, Italy
| | - Andrea Panunzio
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | | | - Federico Zacheo
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Sara De Matteis
- Department of Radiation Therapy, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | | | - Umberto Carbonara
- Department of Emergency and Organ Transplantation, Urology and Andrology Section, University of Bari, 70124 Bari, Italy
- Department of Urology, Royal Surrey NHS Trust, London NW3 2PS, UK
| | | | - Silvana Leo
- Department of Oncology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Saverio Forte
- Department of Emergency and Organ Transplantation, Urology and Andrology Section, University of Bari, 70124 Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology and Andrology Section, University of Bari, 70124 Bari, Italy
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Yaacov D, Nelinger G, Kalichman L. The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review. Sex Med Rev 2021; 10:162-167. [PMID: 33931383 DOI: 10.1016/j.sxmr.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Increasing evidence has suggested that pelvic floor exercises and manual physical therapy may improve premature ejaculation (PE) and erectile dysfunction (ED) in males. OBJECTIVES To examine the effects of pelvic floor physical therapy treatment in men suffering from PE and ED. METHODS We searched Google Scholar, PubMed, Medline, PEDro databases from inception till January 2020 applying the following keywords: pelvic floor, erectile dysfunction, impotence, physiotherapy, exercises, rehabilitation, and pelvic floor muscle exercises. RESULTS The review included 37 papers reporting on PE and ED, of which 5 were randomized controlled trials, 2 meta-analyses, and 4 observational studies. Pelvic floor physical therapy treatment included education and rehabilitation. The rehabilitation part encompassed manual therapy techniques that contribute to the normalization of muscle tone and improvement of muscle relaxation. Moreover, exercises, according to the patients' clinical assessment were presented. Most of the studies reported that by strengthening the pelvic floor muscles (PFMs), ED and PE can be improved if manual physical therapy treatments are combined with PFM training. CONCLUSIONS A multifaceted approach should be chosen by physical therapists when evaluating and treating ED and PE and contending with both musculoskeletal dysfunction and behavioral contributions. It is recommended that exercises be monitored and situations involving, that is, hyperactivity/increased tone of the PFMs should be avoided. PFM training is simple, safe, and noninvasive; therefore, it should be a preferred approach in the management of ED and PE. This paper presents narrative reviews with a potential bias that systematic reviews or meta-analyses do not have, however, we strove to be all-encompassing and unbiased. There is a demand for high-quality scientific reviews examining the effectiveness of PFM training, manual therapy, and the rationale of pelvic floor physical therapy, in general, in treating individuals with PE and ED.
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Affiliation(s)
- David Yaacov
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gadi Nelinger
- Physical Therapy Outpatient Clinic, Maccabi Health Care Services, Holon, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Optale G, Burigat S, Chittaro L, Riva G. Smartphone-Based Therapeutic Exercises for Men Affected by Premature Ejaculation: A Pilot Study. Sex Med 2020; 8:461-471. [PMID: 32565067 PMCID: PMC7471091 DOI: 10.1016/j.esxm.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Smartphone-delivered healthcare interventions allow patients to access services on demand when needed, improving motivation and compliance. However, the use of mobile health apps has been scarcely explored in sexual medicine. AIM To evaluate the effects of integrating psychological treatment for premature ejaculation (PE) with a mobile coaching app that offers therapeutic exercises on the patient's smartphone. METHODS This study comprised 35 heterosexual men with primary psychogenic PE (mean age 34 years, standard deviation = 9.15). All patients entered a cycle of 15 sessions of psychodynamic psychotherapy integrating behavioral therapy, each lasting about 45 minutes. The patients were randomly assigned to 2 groups, each of which performed daily homework exercises (physiotherapy exercises for reinforcing the pelvic floor muscles and cognitive exercises for distancing from sexual failure.) The first group (15 patients) received verbal and printed instructions only (treatment as usual-TAU), whereas the second group (17 patients) experienced the exercises with guidance from the mobile app (app). In both groups, the exercises started after the seventh session. Patients were advised to perform the exercises 3 times a day for 3 months. MAIN OUTCOME MEASURES The primary outcome measures were the Premature Ejaculation Diagnostic Tool and the Premature Ejaculation Profile. RESULTS Analysis of the data revealed significant pre-post improvements in Premature Ejaculation Diagnostic Tool and Premature Ejaculation Profile scores for the app group compared with those of the TAU group (P < .01). The frequency of patients with no-PE condition for the app group after treatment was significantly higher than the frequency of patients with no-PE condition for the TAU group (P < .001). CONCLUSION Results suggest that a mobile coaching app performs better than TAU in improving both the behavioral skills of ejaculatory delay and sexual self-confidence within a psychological treatment for PE. Future studies should collect follow-up data and explore the potential of mobile coaching apps in combined pharmacotherapy and psychotherapy interventions. Optale G, Burigat S, Chittaro L. et al. Smartphone-Based Therapeutic Exercises for Men Affected by Premature Ejaculation: A Pilot Study. J Sex Med 2020;8:461-471.
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Affiliation(s)
- Gabriele Optale
- Male and Female Sexual Dysfunctions Center of the Regione Veneto, ASL3, Mestre-Venezia, Italy.
| | - Stefano Burigat
- HCI Lab, Department of Mathematics, Computer Science, and Physics, Università degli Studi di Udine, Udine, Italy
| | - Luca Chittaro
- HCI Lab, Department of Mathematics, Computer Science, and Physics, Università degli Studi di Udine, Udine, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Pavličev M, Romero R, Mitteroecker P. Evolution of the human pelvis and obstructed labor: new explanations of an old obstetrical dilemma. Am J Obstet Gynecol 2020; 222:3-16. [PMID: 31251927 PMCID: PMC9069416 DOI: 10.1016/j.ajog.2019.06.043] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/18/2022]
Abstract
Without cesarean delivery, obstructed labor can result in maternal and fetal injuries or even death given a disproportion in size between the fetus and the maternal birth canal. The precise frequency of obstructed labor is difficult to estimate because of the widespread use of cesarean delivery for indications other than proven cephalopelvic disproportion, but it has been estimated that at least 1 million mothers per year are affected by this disorder worldwide. Why is the fit between the fetus and the maternal pelvis so tight? Why did evolution not lead to a greater safety margin, as in other primates? Here we review current research and suggest new hypotheses on the evolution of human childbirth and pelvic morphology. In 1960, Washburn suggested that this obstetrical dilemma arose because the human pelvis is an evolutionary compromise between two functions, bipedal gait and childbirth. However, recent biomechanical and kinematic studies indicate that pelvic width does not considerably affect the efficiency of bipedal gait and thus is unlikely to have constrained the evolution of a wider birth canal. Instead, bipedalism may have primarily constrained the flexibility of the pubic symphysis during pregnancy, which opens much wider in most mammals with large fetuses than in humans. We argue that the birth canal is mainly constrained by the trade-off between 2 pregnancy-related functions: while a narrow pelvis is disadvantageous for childbirth, it offers better support for the weight exerted by the viscera and the large human fetus during the long gestation period. We discuss the implications of this hypothesis for understanding pelvic floor dysfunction. Furthermore, we propose that selection for a narrow pelvis has also acted in males because of the role of pelvic floor musculature in erectile function. Finally, we review the cliff-edge model of obstetric selection to explain why evolution cannot completely eliminate cephalopelvic disproportion. This model also predicts that the regular application of life-saving cesarean delivery has evolutionarily increased rates of cephalopelvic disproportion already. We address how evolutionary models contribute to understanding and decision making in obstetrics and gynecology as well as in devising health care policies.
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Affiliation(s)
- Mihaela Pavličev
- Division of Human Genetics, Cincinnati Children`s Hospital Medical Center, Ann Arbor, MI; Department of Pediatrics, University of Cincinnati College of Medicine, Ann Arbor, MI; Department of Philosophy, University of Cincinnati, Ann Arbor, MI.
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Ann Arbor, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Detroit Medical Center, Detroit, MI; Department of Obstetrics and Gynecology, Florida International University, Miami, Florida
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Martin-Tuite P, Shindel AW. Management Options for Premature Ejaculation and Delayed Ejaculation in Men. Sex Med Rev 2019; 8:473-485. [PMID: 31668585 DOI: 10.1016/j.sxmr.2019.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/06/2019] [Accepted: 09/21/2019] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
| | - Alan W Shindel
- Department of Urology, University of California, San Francisco, CA, USA.
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Calabrò RS, Naro A, Pullia M, Porcari B, Torrisi M, La Rosa G, Manuli A, Billeri L, Bramanti P, Quattrini F. Improving Sexual Function by Using Focal Vibrations in Men with Spinal Cord Injury: Encouraging Findings from a Feasibility Study. J Clin Med 2019; 8:E658. [PMID: 31083543 PMCID: PMC6571747 DOI: 10.3390/jcm8050658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 12/18/2022] Open
Abstract
Erectile dysfunction (ED) is a frequent and disabling condition in patients with spinal cord injury (SCI). Spasticity can negatively affect sexual intercourse, as it may interfere with positioning, mobility, and muscle activation and strength, leading to ED. The aim of our study was to evaluate the feasibility and efficacy of muscle vibration (MV) applied to the pelvic muscles in improving ED in men with SCI. Ten adult men with traumatic SCI were submitted to 15 sessions of MV, applied on the perineum and the suprapubic and sacrococcygeal areas, using a pneumatic vibrator. MV was performed three times a week for five consecutive weeks, each session lasting 30 min. Muscle tone and sexual function were assessed before and after MV using the Modified Ashworth Scale (MAS) and International Index of Erectile Function (IIEF). We assessed the cremasteric and bulbocavernosus reflexes, as well as the electrophysiological bulbocavernosus reflex (eBCR) and pudendal nerve somatosensory-evoked potential (PSEP). MV was safe and well tolerated. All the patients reported an improvement in MAS and IIEF, with better reflexive responses, and a significant increase in eBCR and PSEP amplitude. In conclusion, MV of the pelvic floor is a promising method to reduce segmental spasticity and improve ED in men with incomplete SCI. However, our findings require confirmation through a randomized clinical trial with a larger sample size and longer trial period to examine long-term after effects.
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Affiliation(s)
- Rocco Salvatore Calabrò
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Antonino Naro
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Massimo Pullia
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Bruno Porcari
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Michele Torrisi
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Gianluca La Rosa
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Alfredo Manuli
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Luana Billeri
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Placido Bramanti
- Department of Robotic Neurorehabilitation, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy.
| | - Fabrizio Quattrini
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy.
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Kannan P, Winser SJ, Choi Ho L, Hei LC, Kin LC, Agnieszka GE, Jeffrey LH. Effectiveness of physiotherapy interventions for improving erectile function and climacturia in men after prostatectomy: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2019; 33:1298-1309. [PMID: 30983396 PMCID: PMC9178777 DOI: 10.1177/0269215519840392] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the effectiveness of physiotherapy interventions for postprostatectomy erectile dysfunction and climacturia. DATA SOURCES Multiple databases were searched from database inception to February 2019. REVIEW METHODS Randomized controlled trials comparing physiotherapy interventions to control were included. RESULTS The search yielded 127 potentially relevant articles; seven met the inclusion criteria and were included in the review. Meta-analysis of two studies revealed a statistically significant effect of pelvic floor muscle training (PFMT) plus biofeedback compared to the no treatment control group for erectile function at the12-month follow-up period (risk ratio (RR) = 3.65, 95% confidence interval (CI) = 1.02-13.05; P = 0.05). Data from one small study (n = 31) identified a greater number of men reporting improved climacturia in the PFMT plus electrical stimulation group compared to the no treatment control group, and the overall effect was significant (RR = 15.60, 95% CI = 0.95-254.91; P = 0.05). Meta-analyses of two studies found no statistically significant differences between groups receiving PFMT and no treatment control for erectile function or climacturia at long-term follow-up. CONCLUSIONS PFMT augmented with biofeedback improves erectile function after prostatectomy. Data from a single study found PFMT combined with electrical stimulation to be beneficial for postprostatectomy climacturia. However, electrical stimulation is recommended for terminally ill people only. The effect of PFMT alone on postprostatectomy erectile dysfunction and climacturia remains inconclusive. However, this is likely to be affected by the participant adherence and physiotherapy supervision. High-quality trials providing intensive supervision and due consideration of adherence factors are recommended.
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Affiliation(s)
- Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Lam Choi Ho
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Leung C Hei
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Lam C Kin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Garbien E Agnieszka
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Leung Hy Jeffrey
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Grunstra NDS, Zachos FE, Herdina AN, Fischer B, Pavličev M, Mitteroecker P. Humans as inverted bats: A comparative approach to the obstetric conundrum. Am J Hum Biol 2019; 31:e23227. [PMID: 30810261 PMCID: PMC6492174 DOI: 10.1002/ajhb.23227] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The narrow human birth canal evolved in response to multiple opposing selective forces on the pelvis. These factors cannot be sufficiently disentangled in humans because of the limited range of relevant variation. Here, we outline a comparative strategy to study the evolution of human childbirth and to test existing hypotheses in primates and other mammals. METHODS We combined a literature review with comparative analyses of neonatal and female body and brain mass, using three existing datasets. We also present images of bony pelves of a diverse sample of taxa. RESULTS Bats, certain non-human primates, seals, and most ungulates, including whales, have much larger relative neonatal masses than humans, and they all differ in their anatomical adaptations for childbirth. Bats, as a group, are particularly interesting in this context as they give birth to the relatively largest neonates, and their pelvis is highly dimorphic: Whereas males have a fused symphysis, a ligament bridges a large pubic gap in females. The resulting strong demands on the widened and vulnerable pelvic floor likely are relaxed by roosting head-down. CONCLUSIONS Parturition has constituted a strong selective force in many non-human placentals. We illustrated how the demands on pelvic morphology resulting from locomotion, pelvic floor stability, childbirth, and perhaps also erectile function in males have been traded off differently in mammals, depending on their locomotion and environment. Exploiting the power of a comparative approach, we present new hypotheses and research directions for resolving the obstetric conundrum in humans.
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Affiliation(s)
- Nicole D. S. Grunstra
- Department of Theoretical BiologyUniversity of ViennaViennaAustria
- Mammal CollectionNatural History Museum ViennaViennaAustria
| | - Frank E. Zachos
- Mammal CollectionNatural History Museum ViennaViennaAustria
- Department of Integrative ZoologyUniversity of ViennaViennaAustria
| | | | - Barbara Fischer
- Konrad Lorenz Institute for Evolution and Cognition ResearchKlosterneuburgAustria
| | - Mihaela Pavličev
- Cincinnati Children's Hospital Medical CenterCincinnatiOhio
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
- Department of PhilosophyUniversity of CincinnatiCincinnatiOhio
| | - Philipp Mitteroecker
- Department of Theoretical BiologyUniversity of ViennaViennaAustria
- Konrad Lorenz Institute for Evolution and Cognition ResearchKlosterneuburgAustria
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Stein A, Sauder SK, Reale J. The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment. Sex Med Rev 2019; 7:46-56. [PMID: 30503726 DOI: 10.1016/j.sxmr.2018.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/26/2018] [Accepted: 09/16/2018] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Many conditions of pelvic and sexual dysfunction can be addressed successfully through pelvic floor physical therapy (PFPT) through various manual therapy techniques, neuromuscular reeducation, and behavioral modifications. The field of pelvic rehabilitation, including sexual health, continues to advance to modify these techniques according to a biopsychosocial model. AIM To provide an update on peer-reviewed literature on the role of PFPT in the evaluation and treatment of pelvic and sexual dysfunctions in men and women owing to the overactive and the underactive pelvic floor. METHODS A literature review to provide an update on the advances of a neuromusculoskeletal approach to PFPT evaluation and treatment. MAIN OUTCOME MEASURE The use and advancement of PFPT methods can help in successfully treating pelvic and sexual disorders. RESULTS PFPT for pelvic muscle overactivity and underactivity has been proven to be a successful option for pelvic and sexual dysfunction. Understanding the role of the organs, nerves, fascia, and musculoskeletal system in the abdomino-pelvic and lumbo-sacro-hip region and how pelvic floor physical therapists can effectively evaluate and treat pelvic and sexual health. It is important for the treating practitioner to know when to refer to PFPT. CONCLUSION Neuromusculoskeletal causes of pelvic floor disorders affect a substantial proportion of men, women, and children and PFPT is a successful and non-invasive option. Pelvic floor examination by healthcare practitioners is essential in identifying when to refer to PFPT. Use of a biopsychosocial model is important for the overall well-being of each patient. Further research is needed. Stein A, Sauder SK, Reale J. The role of physical therapy in sexual health in men and women: Evaluation and treatment. Sex Med Rev 2019;7:46-56.
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Affiliation(s)
- Amy Stein
- Beyond Basics Physical Therapy, LLC, New York, NY, USA.
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Abdelaziz AS, Ghoneem AM, Elewesy EA. The impact of surgical hemorrhoidectomy on male sexual function: A preliminary study. Urol Ann 2019; 11:235-240. [PMID: 31413498 PMCID: PMC6676841 DOI: 10.4103/ua.ua_138_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Erectile dysfunction (ED) is a highly prevalent condition among men all over the world and commonly associated with undiagnosed medical diseases as chronic pelvic pain and hemorrhoid. Objective The purpose of this study was to study the impact of surgical hemorrhoidectomy on sexual function in men with erectile dysfunction (ED). Materials and Methods In a prospective manner, we studied the effect of surgical hemorrhoidectomy on erectile function (EF) in male patients with ED. Hemorrhoidectomy was carried out in 82 patients with clinical hemorrhoid associated with ED (Group 1) and compared with 81 patients without operative intervention (Group 2; control). The primary efficacy variable was the mean change in the International Index of Erectile Function (IIEF) questionnaire. Results In Group 1, the IIEF questionnaire increased significantly after hemorrhoidectomy, from 15.56 to 27.37 (P < 0.001), indicating improvement of EF. Thirty-six patients (41.1%) showed improvement of EF compared to 5.3% in the control group (P < 0.001). In Group I, but not in Group II, IIEF values increased significantly when compared with preoperative values (P < 0.001). Conclusion We concluded that surgical hemorrhoidectomy is clearly related to improvement of EF in male hemorrhoid patients with ED.
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Affiliation(s)
- Alsayed Saad Abdelaziz
- Department of Urological, Faculty of Medicine, Al-Azhar University, Damietta, Egypt.,Department of Surgical, Ibn Sina College Hospital, Jeddah, KSA
| | - Ayman Mohammed Ghoneem
- Department of Surgical, Ibn Sina College Hospital, Jeddah, KSA.,Department of Urological, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Emad Ades Elewesy
- Department of Surgical, Ibn Sina College Hospital, Jeddah, KSA.,Department of Surgical, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Kamnerdsiri WA, Rodríguez Martinez JE, Fox C, Weiss P. Clinical correlation between erectile function and ejaculatory function in the Czech male population. PLoS One 2018; 13:e0199588. [PMID: 30001388 PMCID: PMC6042713 DOI: 10.1371/journal.pone.0199588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/11/2018] [Indexed: 01/23/2023] Open
Abstract
Introduction This study explores the relationship between erectile function and ejaculatory function, to inform the clinical psychosexological and sexual medicine practice treatment protocols. Materials and methods A total of 1,004 Czech males aged between 15 and 84 years (m = 42.8 yrs; sd = 17.6 years) completed a sexual behavior questionnaire. A cross-sectional design was adopted. Erectile function was measured with the International Index of Erectile Function (IIEF-5) and ejaculatory function measured using self-report intravaginal ejaculation latency time and the Index of Premature Ejaculation (IPE). Linear regression analyses were used to explore the relationships between premature ejaculation and erectile dysfunction. Results The sample mean self-reported intravaginal ejaculatory latency time was 9.34 minutes. The overall mean on the IPE was 19.44 (sd = 2.368). The Control domain mean was 81.13 (sd = 17.22); Sexual Satisfaction domain mean 78.60 (sd = 20.59); and the Distress domain mean was 86.86 (sd = 18.32). The mean score on the IIEF-5 was 19.28 (sd = 2.53). The results indicate a relationship between premature ejaculation and erectile dysfunction. With age significantly associated with all measures. Conclusions Higher levels of erectile function are associated with a better control and sexual satisfaction, and less distress about ejaculation. This association supports the consideration of this relationship in the development of new clinical practice guidelines for erectile dysfunction and premature ejaculation.
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Affiliation(s)
| | | | - Christopher Fox
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Petr Weiss
- Institute of Sexology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Molina-Valencia E, Correa-Aristizabal L, Cantor E, Rivera F, Ocampo-Trujillo Á. Entrenamiento de la musculatura del piso pélvico como parte del tratamiento para la disfunción eréctil después de prostatectomía radical: serie de casos, experiencia en un centro médico de alta complejidad. UROLOGÍA COLOMBIANA 2018. [DOI: 10.1016/j.uroco.2017.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introducción La disfunción eréctil se ha reconocido como una complicación de la prostatectomía radical. El entrenamiento de los músculos del piso pélvico puede ser una opción terapéutica, sin embargo, existe poca evidencia sobre el efecto del entrenamiento en la función eréctil.Objetivo Describir el efecto de la rehabilitación de la musculatura de piso pélvico en la función eréctil en hombres > 40 años con disfunción eréctil después de prostatectomía radical.Métodos Estudio retrospectivo basado en la revisión de historias clínicas de pacientes con disfunción eréctil después de prostatectomía radical, sometidos a un protocolo de rehabilitación con ejercicios de músculos de piso pélvico, biofeedback y electroestimulación. La función eréctil se evaluó por el índice internacional de la función eréctil (IIEF-5). La presión de los elevadores del ano se midió con el equipo Myomed134 y la fuerza muscular con la escala modificada de Oxford.Resultados Se incluyeron 13 hombres con edad promedio de 63,2 ± 8 años, sin historia de consumo de tabaco y con índice de masa corporal de 24,9 ± 2,6 kg/m2. Antes de la intervención, se encontraron 10 casos con disfunción severa y 3 de leve a moderada, según el cuestionario IIEF-5. Después de la intervención, se encontró mejoría en 11 pacientes en la función eréctil: 7 con mejoría completa, 4 con disfunción eréctil leve. En 2 casos no se presentó mejoría.Conclusión El estudio muestra que el efecto del entrenamiento de la musculatura de piso pélvico es beneficioso en la recuperación de la función eréctil después de prostatectomía radical.
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Transcutaneous neuromuscular electrical stimulation may be beneficial in the treatment of premature ejaculation. Med Hypotheses 2017; 109:181-183. [PMID: 29150283 DOI: 10.1016/j.mehy.2017.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/29/2017] [Accepted: 10/07/2017] [Indexed: 11/20/2022]
Abstract
Approximately 20-30% of sexually active men suffer from Premature Ejaculation (PE), but the pathophysiology still remains unclear and the current available treatments for PE are unsatisfying. Considering the role of rhythmic bulbospongiosus and ischiocavernosus Muscles contractions on the ejaculatory reflex, we hypothesize that weakening this muscles via inhibiting it's contractions by Application of Neuromuscular Electrical Stimulation prior to the planned sexual activity, may have a beneficial effect in the treatment of PE. Using miniaturized perineal on-demand stimulation device, in a home setting during sexual intercourse may become the first line of treatment for PE.
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Hackett G, Krychman M, Baldwin D, Bennett N, El-Zawahry A, Graziottin A, Lukasiewicz M, McVary K, Sato Y, Incrocci L. Coronary Heart Disease, Diabetes, and Sexuality in Men. J Sex Med 2017; 13:887-904. [PMID: 27215685 DOI: 10.1016/j.jsxm.2016.01.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 12/30/2022]
Abstract
Erectile dysfunction (ED) has been well recognized as a marker of increased cardiovascular risk for more than 15 years, especially in younger men. Early detection of ED represents an opportunity to intervene to decrease the risk of future cardiovascular events and limit the progression of ED severity. Evidence suggests there is a window of opportunity of 3 to 5 years from the onset of ED to subsequent cardiovascular events. This opportunity is usually missed if the onus is placed on the patient to seek care for his sexual problems. Unfortunately, these clear messages have not been incorporated into routine cardiovascular care. The reasons for these disparities within specialties are discussed in this article, in addition to management algorithms. Lifestyle modification is usually recommended as the first-line treatment to correct ED and lessen cardiovascular risk, but evidence suggests that this might be effective only in men without established cardiovascular comorbidities. In men with type 2 diabetes mellitus and established cardiovascular disease, lifestyle modification alone is unlikely to be effective. Cardiovascular medications are often associated with sexual dysfunction but changes in medication are more likely to be beneficial in men with milder recent-onset ED. A balanced view must be taken related to medication adverse events, taking into account optimal management of established cardiovascular disease. Testosterone deficiency has been associated with different metabolic disorders, especially metabolic syndrome and type 2 diabetes mellitus. Testosterone deficiency syndrome has been associated with an independent burden on sexual function globally and increased cardiovascular and all-cause mortality. Testosterone replacement therapy has been shown to improve multiple aspects of sexual function and, in some studies, has been associated with a decrease in mortality, especially in men with type 2 diabetes mellitus. Recent studies have suggested that phosphodiesterase type 5 inhibitors, the first-line medications to treat ED, could decrease cardiovascular and all-cause mortality, through multiple mechanisms, predominantly related to improved endothelial function.
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Affiliation(s)
| | - Michael Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, USA
| | - David Baldwin
- Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nelson Bennett
- Department of Urology, Lahey Hospital, Burlington, MA, USA
| | - Ahmed El-Zawahry
- Division of Urology, SIU School of Medicine, Springfield, IL, USA
| | | | | | - Kevin McVary
- Division of Urology, SIU School of Medicine, Springfield, IL, USA
| | - Yoshikazu Sato
- Department of Urology, Sanjukai Hospital, Sapporo, Japan
| | - Luca Incrocci
- Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, The Netherlands
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Rudolph E, Boffard C, Raath C. Pelvic Floor Physical Therapy for Erectile Dysfunction-Fact or Fallacy? J Sex Med 2017; 14:765-766. [PMID: 28583337 DOI: 10.1016/j.jsxm.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Elna Rudolph
- My Sexual Health, National Multidisciplinary Sexual Health Team, Johannesburg, South Africa.
| | - Catriona Boffard
- My Sexual Health, National Multidisciplinary Sexual Health Team, Johannesburg, South Africa
| | - Cecilia Raath
- My Sexual Health, National Multidisciplinary Sexual Health Team, Pretoria, South Africa
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Martin C, Nolen H, Podolnick J, Wang R. Current and emerging therapies in premature ejaculation: Where we are coming from, where we are going. Int J Urol 2016; 24:40-50. [DOI: 10.1111/iju.13202] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/09/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Christopher Martin
- Department of Urology; McGovern Medical School; The University of Texas Health Science Center at Houston; Houston Texas USA
| | - Hunter Nolen
- Department of Urology; McGovern Medical School; The University of Texas Health Science Center at Houston; Houston Texas USA
| | - Jason Podolnick
- Department of Urology; McGovern Medical School; The University of Texas Health Science Center at Houston; Houston Texas USA
| | - Run Wang
- Department of Urology; McGovern Medical School; The University of Texas Health Science Center at Houston; Houston Texas USA
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The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain. Sex Med Rev 2016; 4:53-62. [DOI: 10.1016/j.sxmr.2015.10.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/02/2015] [Indexed: 12/22/2022]
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Abstract
INTRODUCTION Erectile dysfunction (ED) has been significantly associated with many chronic conditions including obesity, the metabolic syndrome, hypogonadism, diabetes mellitus, cardiovascular disease (CVD), lower urinary tract symptoms, and psychiatric/psychological disorders. ED is also a well-established predictor of CVD. AIM This review will focus on the association of ED with cardiovascular, metabolic, and cognitive conditions and discuss the effects of managing lifestyle factors in order to reduce the burden of ED and consequently outcomes in patients with chronic conditions. METHODS A literature search using Medline, PubMed (U.S. National Library of Medicine and the National Institutes of Health), and abstracts from scientific meetings was performed from 1990. MAIN OUTCOME MEASURES Main outcome measures were improvements in sexual function. RESULTS A total of 59 reviews on the topic were evaluated. CONCLUSIONS Targeting several lifestyle factors associated with CVD/metabolic/cognitive disorders, e.g., smoking, alcohol consumption, obesity, and physical activity, can have significant benefits, leading to an improvement in ED as well as testosterone levels and consequently CVD. Kirby M. The circle of lifestyle and erectile dysfunction. Sex Med Rev 2015;3:169-182.
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Affiliation(s)
- Michael Kirby
- The Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, Herts, UK; The Prostate Centre, London, UK.
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