A systematic review and meta-analysis of randomized controlled trials of "on-demand" use of tramadol vs "on-demand" use of paroxetine in the management of patients with premature ejaculation

Substance abuse and male sexual dysfunction: what lies beneath?

INTRODUCTION

Substance abuse has become a worldwide health problem, leading to numerous consequences such as social problems among family members, abnormal behavior, adverse health effects, and psychological problems as well as economic consequences.

OBJECTIVES

We sought to assess the relationship between substance abuse and male sexual health.

METHODS

A search was carried out in the following databases: PubMed, MeSH (Medical Subject Headings), Science Direct, Scopus, Cochrane Library, EMBASE, CINAHL, Academic Search Complete, and the Egyptian Knowledge Bank. The following keywords were used to assess the outcomes for relevant associations: illicit drugs, addiction, substance abuse, sexual health, erectile dysfunction, ejaculatory disorders, impotence, orgasm disorders, and sexual performance.

RESULTS

The initial literature search identified a total of 148 articles in all searched databases. After removal of duplicate studies and application of inclusion/exclusion criteria, 75 reported studies were retained for review, including 38 case-control studies and 37 cross-sectional studies. These articles were classified into the following categories according to the type of abused substance addressed: cannabis/marihuana, 16 articles; opioids, 13 articles; heroin, 11 articles; cocaine, 5 articles; tramadol, 6 articles; ketamine, 2 articles; ecstasy, 4 articles; amphetamine, 2 articles; khat, 7 articles; androgen anabolic steroids, 2 articles; and polydrugs, 7 articles. Most of these recruited articles demonstrated a negative impact of the addressed substance on male sexual health, with variable levels.

CONCLUSION

Substance abuse has negative impacts on male sexual health that should be addressed. More studies conducted with proper methodological and statistical approaches, including logistic regression analysis, are needed to predict the effects of specific substances, considering the rapidly growing effects of non-substance-use disorders on male sexual health.

The Influence of Tramadol on Intravaginal Ejaculatory Latency Time and Sexual Satisfaction Score in Treating Patients With Premature Ejaculation: A Network Meta-Analysis

This network meta-analysis aimed at assessing the influence of tramadol on the intravaginal ejaculatory latency time (IELT) and sexual satisfaction score (SSS) in treating patients with premature ejaculation (PE). The PubMed, Embase, Cochrane Library databases (until July 2021), and original references of the included articles was systematically retrieved. The PRISMA checklist was followed. Finally, 14 articles including 1971 patients were included in this analysis. The results indicated that patients who were treated with tramadol (50 mg, 62 mg, 89 mg, and 100 mg) were superior to those treated with placebo in terms of IELT (p = .003, p < .00001, p < .00001, and p < .00001, respectively), but 25 mg tramadol did not show a significant advantage (p = .06). Patients who were treated with tramadol (50 mg and 100 mg) had a better efficacy than who were treated with 25 mg tramadol in the IELT (p < .00001 and p < .00001), but the effect of 50 mg tramadol and 100 mg tramadol were not significantly different (p = .17). The tramadol group had the better effect than the placebo group in the SSS (p < .0001). And 50 mg tramadol showed a significant improvement compared with 20 mg paroxetine, as assessed by the IELT (p = .03) and SSS (p = .03). Safety assessments including adverse events suggested that tramadol was well tolerated. Tramadol showed a better improvement of IELT and SSS than placebo or paroxetine, and 50 mg tramadol may be a more reasonable therapeutic dose for patients with PE.