Disorders of orgasm and ejaculation in men

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery

OBJECTIVE

To evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery.

METHODS

We retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months.

RESULTS

All patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100-145). Median estimated blood loss was 224 ml (IQR: 190-255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up.

CONCLUSIONS

US-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.

Glans penis volume is associated with lifelong premature ejaculation

BACKGROUND

Although premature ejaculation (PE) is the most common male sexual dysfunction, the underlying mechanisms are not fully understood.

AIM

The study sought to evaluate the possible associations among glans penis volume and tissue stiffness measured using penile ultrasonography and penile shear wave elastography (SWE) with PE.

METHODS

Men 18 to 65 years of age with normal International Index of Erectile Function scores (>25) and who were diagnosed with PE between June 2021 and June 2022 were enrolled. The Premature Ejaculation Diagnostic Tool score and intravaginal ejaculation latency times were recorded. Healthy volunteers constituted the control group. The study group was divided into lifelong PE (LLPE) and acquired PE (AqPE) subgroups. In all groups, the glans penis volume was measured via penile ultrasonography and tissue stiffness of the glans penis, penile frenulum, postcircumcision mucosal cuff, and penile shaft were measured via SWE. The findings of the groups were compared using appropriate statistical methods.

OUTCOMES

The outcomes included ultrasonographic and elastographic measurements of the glans penis.

RESULTS

Data on 140 men, including 70 PE patients and 70 healthy volunteers, were evaluated. Of the patients, 20 had LLPE and 50 had AqPE. The median glans penis volume was significantly greater in the LLPE group (14.1 [range, 6.6-19] mm3) compared with the AqPE group (11.7 [range, 5.1-27] mm3) and control group (11.4 [range, 6.1-32] mm3) (P = .03). According to the Youden index, the best cutoff value for glans penis volume in LLPE compared with non-LLPE (AqPE + control) was 12.65 mm3 (area under the curve, 0.684; 95% confidence interval, 0.556-0.812; P = .009). The risk of having LLPE in those with a glans penis volume ≥12.65 mm3 was 3.326 (95% confidence interval, 1.234-8.965) times higher than the non-LLPE group (P = .014). There were no significant differences between the groups in the SWE evaluation of glans penis, penile frenulum, mucosal cuff, and penile shaft tissue stiffness.

CLINICAL IMPLICATIONS

The high incidence of PE in those with high glans penis volume may make glans penis volume a predictor for the development of LLPE.

STRENGTHS AND LIMITATIONS

This was the first study to show that PE is more common in individuals with a high glans penis volume. It was also the first to perform a penile elastographic evaluation in patients with PE. The most important limitation was that we did not evaluate glans penile nerve function with a test, but rather we made an indirect inference about the density of free nerve endings based on increased glans penile volume.

CONCLUSION

Glans penis volume was a significant predictor for LLPE. However, there are no associations between PE and the glans penis, postcircumcision mucosal cuff, penile frenulum, or penile shaft tissue stiffness and development.

Application of the sexual therapy combined with vacuum negative pressure hydropneumatic/pneumatic bubble massage in primary intravaginal anejaculation

INTRODUCTION

Primary intravaginal anejaculation (PIAJ) is a relatively uncommon male sexual dysfunction characterized by an inability to achieve intravaginal ejaculation during all sexual intercourse. Effective treatment options for this condition are lacking. We aimed to explore the clinical effect of the sexual therapy combined with vacuum negative pressure hydropneumatic/pneumatic bubble massage (VNPHP/PBM) on primary intravaginal anejaculation, and its possible mechanism.

METHODS

A total of 95 PIAJ patients were randomly divided into three groups, including group A with 32 patients treated with the sexual therapy combined with VNPHP/PBM, group B with 32 patients treated with the sexual therapy and group C with 31 patients treated with VNPHP/PBM. The efficacy of therapeutic regimes, latency of the somatosensory evoked potentials of dorsal nerve (DNSEP), glans penis (GPSEP) and penile shaft sensory threshold (PSST), measures of sexual behavior of patients, as well as the self-rating anxiety scale (SAS) sores of patients and their partners, were compared before and after treatment among three groups.

RESULTS

The total effective rate of group A (84.38%) was higher than those of groups B and C (53.13% and 41.94%), however, no differences were found between groups B and C. The ratios of patients and their partners with anxiety, frequency of observing erotic films of patients, ratios of patients with special self-masturbation and frequency of masturbation decreased significantly in the three groups after the treatment. The decrease in the ratios of patients and their partners with anxiety, frequency of observing erotic films of patients in groups A and B were higher than those of group C, however, no differences were identified between groups A and B. The decrease in the ratios of patients with special self-masturbation and frequency of masturbation in group A were higher than those of group B, however, no differences were found between groups A and C, B and C. There were no differences in the latency of DNSEP, GPSEP, and PSST among the three groups before and after treatment.

CONCLUSION

The sexual therapy combined with VNPHP/PBM has good therapeutic effects on PIAJ, which might be achieved by reducing the anxiety level of patients and their partners, improving sexual behavioral patterns, rather than increasing the sensitivity of penis including dorsal nerve and glans penis.

Antihyperglycemic and aphrodisiac effect of West African Albizia (Albizia zygia) leaves-inclusive diet in diabetes-induced erectile dysfunctional rats

ETHNOPHARMACOLOGICAL RELEVANCE

West African Albizia (Albizia zygia DC J. F. Macbr) leaves are a tropical plant that are frequently used in folkloric medicine to treat a number of illnesses, including type 2 diabetes (TY2D) and erectile dysfunction (ED), without having a complete scientific foundation.

AIM OF THE STUDY

This investigation examined the effect of action of dietary augmentation of Albizia zygia leaves (AZL) on rat sexual functioning and important enzymes related to TY2D and ED.

MATERIALS AND METHODS

Thirty matured adult Wistar rats of the weight 180-200 g were acclimatized in a lab environmental condition for two weeks prior to experiment given food and water to acclimate. Twenty-four of the rats got high fat diet (HFD) for periods of two weeks before receiving streptozotocin (STZ) intraperitoneally (i.p.), 35 mg/kg body weight single dose. Six rats got basal diets. Type 2 diabetes was identified in rats 72 h after STZ treatment. Rats were then used to evaluate the mounting number, mount delay, intromission number, and intromission latency.

RESULTS

Following that, meals supplemented with AZL (5% or 10% inclusion) were given to diabetic-ED rats for 14 days. AZL was added. Therefore, in diabetic-ED rats, AZL supplementation could significantly (p0.05) lower blood glucose levels and the activities of alpha amylase, alpha glucosidase, phosphodiesterase-5, and arginase. In the case of diabetic-ED treated rats in consideration with diabetic-ED control group, nitric oxide levels were increased along with sexual function.

CONCLUSION

Thus, experimental results of this study demonstrated rats that consumed AZL in their diets had less erectile dysfunction. In order to address ED caused by diabetes, AZL could be suggested as functional meals.

Unrecognised orgasmic phase disorders in men presenting with new-onset erectile dysfunction-Findings from a real-life, cross-sectional study

BACKGROUND

Orgasmic phase disorders in men worsen the burden of erectile dysfunction on sexual satisfaction.

OBJECTIVES

To investigate the prevalence of and predictors of unreported orgasmic phase disorder in a cohort of men looking for their first urological assessment for new-onset erectile dysfunction in a real-life setting.

MATERIALS AND METHODS

Data from 1107 heterosexual, sexually active men consecutively assessed for new-onset erectile dysfunction were analysed. Throughout a comprehensive medical and sexual history, all patients were asked to self-report any orgasmic phase disorder and to complete the International Index of Erectile Function and the Beck's Inventory for Depression (depressive symptoms scored as Beck's Inventory for Depression ≥11). Men self-reporting orgasmic phase disorder during the interview were excluded from further analyses. The median value of the International Index of Erectile Function-orgasmic function domain was arbitrarily used to categorise men with (International Index of Erectile Function-orgasmic function ≤5) and without unreported orgasmic phase disorder (International Index of Erectile Function-orgasmic function >5). Circulating hormones were measured in every patient. Descriptive statistics and logistic regression models were used to test the association between clinical variables and unreported orgasmic phase disorder.

RESULTS

Of 1098 patients with non-self-reporting orgasmic phase disorder, 314 (28.6%) had International Index of Erectile Function-orgasmic function ≤5. Patients with erectile dysfunction + unreported orgasmic phase disorder were older (median [interquartile range]: 58 [44-66] years vs. 51 [40-60] years), had higher body mass index [25.8 (23.7-28.1) kg/m2 vs. 25.2 (23.3-27.4) kg/m2 ], higher prevalence of type 2 diabetes (36 [11.5%] vs. 45 [5.7%]) and lower International Index of Erectile Function-erectile function scores (6 [2-10] vs. 18 [11-24]) than men with erectile dysfunction-only (all p < 0.05). Patients with erectile dysfunction + unreported orgasmic phase disorder depicted higher rates of severe erectile dysfunction (75.5% vs. 25%) and Beck's Inventory for Depression ≥11 (22.6% vs. 17.9%) (all p < 0.05). In the multivariable logistic regression analysis, older age (odds ratio: 1.02) and lower International Index of Erectile Function-erectile function scores (odds ratio: 0.83) were independently associated with unreported orgasmic phase disorder (all p < 0.05).

CONCLUSIONS

Almost one in three men seeking first medical help for erectile dysfunction depicted criteria suggestive of unreported orgasmic phase disorder. Men with unreported orgasmic phase disorder were older and had higher rates of severe erectile dysfunction and concomitant depressive symptoms. These real-life findings outline the clinical relevance of a comprehensive investigation of concomitant sexual dysfunction in men only complaining of erectile dysfunction to more effectively tailor patient management.

Pentaclethra macrophylla leaves reduce blood glucose level, improve sexual behavior and modulate critical enzymes associated with diabetes-erectile dysfunction morbidity in rats

OBJECTIVES

This research work studied the phenolic composition of Pentaclethra macrophylla (PM), the inclusion of dietary supplementation of PM leaves on sexual functions and its connection to inhibit enzymes (arginase and phosphodiesterase-5) and nitric oxide level, linked to type 2 diabetes-induced erectile dysfunction in rats.

METHODS

Gallic acid, chlorogenic and ellagic acids, Kaempferol, and epicatechin etc. was spotted with High performance liquid chromatography-diode array detector from PM extract. Twenty-five (25) rats were used for the study. Five rats were placed with basal diet; diets not supplemented with PM leaves (normal rat group) while twenty rats were made diabetic by feeding them with high fat diet for two weeks, prior to single injection with 35 mg/kg of streptozotocin (STZ). After checking with glucometer, experimental animals with blood glucose level >250 mg/dL were accepted as diabetic. The diabetic rats were subsequently divided into four groups of five rats each (n=5). The diabetic rats were placed on basal diet, or diets supplemented with PM leaves (10 % or 5 % inclusion) or sildenafil citrate (SC).

RESULTS

The result revealed that PM supplemented diets caused significant (p<0.05) reduction in blood glucose level, and augmented erectile function by inhibiting arginase and PDE5 activities as well as enhancing nitric oxide level.

CONCLUSIONS

In conclusion, dietary inclusion of PM leaves could serve as a potent nutraceutical source in hyperglycemia induced erectile dysfunction management.

Exploring the potential relationships among obstructive sleep apnea, erectile dysfunction, and gut microbiota: a narrative review

INTRODUCTION

Poor sleep quality is closely associated with comorbidities affecting a multitude of organ systems. Among the sleep disorders in the population, there has recently been an increase in the prevalence of obstructive sleep apnea (OSA), which has particularly affected men. The intermittent hypoxia and sleep fragmentation associated with OSA can result in the manifestation or aggravation of a number of pathophysiologic conditions, including the impairment of reproductive function in men and women. In this context, erectile dysfunction (ED) is of particular concern. Other consequences of OSA are changes in the gastrointestinal microbiota, with the resultant dysbiosis having potentially harmful consequences that promote downstream exacerbation of various comorbidities.

OBJECTIVES

This narrative review aims to explore the potential relationships among ED, gut microbiota, and OSA.

METHODS

A search of the relevant literature was performed in the PubMed, Embase, Medline, and Web of Science databases.

RESULTS

Sleep is important for regulating the body's functions, and sleep deprivation can negatively affect health. OSA can damage organic functions, including reproductive function, and can lead to ED. Restoring the microbiota and improving sleep can help to improve sexual function or reverse ED and enhance other associated conditions mediated through the gut-brain axis relationship. Probiotics and prebiotics can be used as supportive strategies in the prevention and treatment of OSA, as they help to reduce systemic inflammation and improve intestinal barrier function.

CONCLUSION

A good diet, a healthy lifestyle, and proper bowel function are essential in controlling depression and several other pathologies. Modulating the gut microbiota through probiotics and prebiotics can provide a viable strategy for developing new therapeutic options in treating many conditions. A better understanding of these a priori unrelated phenomena would foster our understanding of the effects of OSA on human fertility and how changes in gut microbiota may play a role.

First-time orgasm in a young man with lifelong anorgasmia after flibanserin use: a case report

Introduction

Anorgasmia is a poorly understood phenomenon defined as either a lifelong or acquired consistent inability to achieve ejaculation. Despite the prevalence of anorgasmia, there is currently no established treatment for the condition.

Aims

To report a unique case of a patient with lifelong anorgasmia who was able to achieve his first orgasm with off-label use of flibanserin.

Methods

The present case study relies on the patient's self-report and a review of the relevant literature. The patient provided written informed consent.

Results

A 28-year-old male presented to our office with complaints of lifelong anorgasmia, without any signs of erectile dysfunction. He reported good libido and energy levels and denied any urinary symptoms or history of depression. The patient failed medical management with numerous off-label medications, including bupropion and bremelanotide. Despite having received 4 or 5 sex therapy sessions over 3 months, the patient reported that this treatment approach was not effective. Off-label use of flibanserin was then initiated, and after 28 to 32 doses over 4 weeks, he achieved his first orgasm. Notably, the patient experienced nocturia and insomnia. The follow-up International Index of Erectile Function score marginally improved by 2 points without any improvement in the overall satisfaction subdomain.

Conclusion

This case highlights the challenges of managing anorgasmia and anejaculation in a young male patient. A stepwise approach involving pharmacotherapy and sex therapy was not successful. However, the off-label use of flibanserin ultimately resulted in the patient achieving his first orgasm, albeit with some side effects. Further studies are needed to evaluate the efficacy and safety of flibanserin in men for this indication.

Evaluation of sexual function after robot-assisted radical prostatectomy: A farewell to IIEF questionnaire

Longevity with localized prostate cancer (PCa) has been achieved, and the contribution of robot-assisted radical prostatectomy (RARP) to cancer control is evident. The next step to investigate in the treatment of localized PCa is improvement of the quality of life (QOL) after RARP. Erectile dysfunction has been considered a major surgical complication, and patient satisfaction after RARP has not improved despite the development of nerve preservation and penile rehabilitation. To comprehensively understand sexual dysfunction after RARP, we must investigate other complications with regard to sexual health, including low sexual desire, disturbed orgasmic function (i.e., anejaculation, orgasm intensity, painful orgasm, and climacturia), shortening of penile length, penile curvature (Peyronie's disease) and unique psychological alterations after the diagnosis of PCa, which are neglected side effects after prostatectomy. In this context, routine evaluation of erectile function by the International Index of Erectile Function only is not sufficient to understand patients' difficulties. A questionnaire is just one way of enabling patients to evaluate their pre- and postoperative concerns; listening to patients face-to-face is warranted to detect symptoms. Understanding the relationship between symptoms and preserved nerve localization can ultimately provide an individualized nerve-sparing procedure and improve patient satisfaction after RARP. In combination with psychological counseling, including the partner and medical treatment, such as testosterone replacement, it is time to reconsider ways to improve sexual dysfunction after RARP.

Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion

It is the responsibility of the clinician to assess for the presence of erectile dysfunction, ejaculatory dysfunction, or diminished libido in men presenting for evaluation of infertility. Referral to a reproductive urologist or other appropriate specialist with the requisite expertise in the evaluation and treatment of such conditions, including appropriate treatment of testosterone deficiency, is often warranted. This article replaces the article of the same name, last published in 2018.

Mechanism of Shugan Yidan fan, a Chinese herbal formula, in rat model of premature ejaculation

BACKGROUND

Premature ejaculation (PE) is one of the most common forms of sexual dysfunction in men, and multimodal therapeutic regimens should be considered to treat the condition. We developed a Chinese medicine herbal medicine, Shugan Yidan fang that had a significant clinical effect on PE patients, extending the time between penetration and ejaculation. However, the mechanism of this formula remains unclear. There is evidence that PE is associated with peripheral neuropathology, and the actions of dopamine (DA) and 5-hydroxytryptamine (5-HT). The aim of this study was to investigate the mechanism of Shugan Yidan fang's effect on PE through the relationship between sexual behavioristics and the level of neurotransmitters and dopamine receptors (DARs).

RESULTS

We showed that the male PE groups had a significant PE phenotype compared to healthy rats. Treatment with Shugan Yidan fang improved the behavioristics of the PE rats, and reduced the expression of DAR mRNA and protein while improving dopamine transporter levels.

CONCLUSIONS

Our study provided evidence for the beneficial effect of Shugan Yidan fang in PE therapy, and proposed a preliminary potential mechanism for the clinical application of the formula.

Ejaculation physiology and dysfunction after BPH surgery: the role of the new MISTs

BACKGROUND

Human ejaculation can be defined as a complex and still largely unknown function. Since decades, Benign Prostatic Hyperplasia (BPH) surgery-associated loss of antegrade ejaculation has been reported as a bother by many patients. New technologies and modified surgical techniques were developed, to reduce the impact of ejaculatory dysfunction on patients' perceived quality of life. Recently, the emerging of the new Minimally Invasive Surgical Techniques (MISTs) empowered the urological surgeons with the technological means to introduce the ejaculation-sparing principles into everyday clinical practice.

METHODS

Our paper was conceived as a state-of-the-art analysis about the anatomical and physiological premises of the human ejaculation and their clinical application in the field of ejaculation-sparing surgery for the treatment of Lower Urinary Tract Symptoms (LUTS). Moreover, we proposed an innovative physiological model for antegrade ejaculation.

RESULTS

We analysed the elements of the "ejaculatory apparatus" from an anatomical point of view. We investigated the physio-pathological models of the human ejaculation, from the classical "combustion chamber" paradigm to the new evidences by which it could be overcome. Finally, we provided a synthetic literature review about the ejaculation-sparing techniques for BPH surgery. Particularly, we distinguished them between classical techniques, modified for ejaculation-preserving purposes, and the new MISTs, characterized by the introduction of new technologies and different treatment modalities.

CONCLUSIONS

Modified surgical techniques and new technologies opened new perspectives about human ejaculation. Previously established functional paradigms were questioned and overcome by recent clinical evidence. The new MISTs gained a prominent role in the process, opening a whole new era for BPH surgery.

Diagnoses and medications associated with delayed ejaculation

Background

Delayed ejaculation (DE) is a disorder that can cause significant distress for sexually active men. The etiology of DE is largely idiopathic, with even less being known about clinical factors associated with the condition.

Aim

We sought to use data mining techniques to examine a broad group of health conditions and pharmaceutical treatments to identify factors associated with DE.

Methods

Using an insurance claims database, we evaluated all men with a diagnosis of DE and matched them to a cohort (1:1) of men with other male sexual disorders of urologic origin (ie, erectile dysfunction [ED] and Peyronie's disease [PD]). Given the low prevalence of DE, we incorporated the random forest approach for classification of DE vs controls, with a plethora of predictors and cross-validation with the least absolute shrinkage and selection operator (LASSO). We used both a high-performance generalized linear model and a multivariate logistic model. The area under the curve was reported to demonstrate classifier performance, and odds ratios were used to indicate risks of each predictor. We also evaluated for differences in the prevalence of conditions in DE by race/ethnicity.

Outcomes

Clinical factors (ie, diagnoses and medications) associated with DE were identified.

Results

In total, 11 602 men with DE were matched to a cohort of men with PD and ED. We focused on the 20 factors with the strongest association with DE across all models. The factors demonstrating positive associations with DE compared to other disorders of male sexual dysfunction (ie, ED and PD) included male infertility, testicular dysfunction, anxiety, disorders of lipid metabolism, alpha adrenergic blocker use, anemia, antidepressant use, and psychoses such as schizophrenia or schizoaffective disorder. In addition, the prevalence of several conditions varied by race/ethnicity. For example, male infertility was present in 5% of Asian men compared to <2% of men of other races.

Clinical Implications

Several medical conditions and pharmacologic treatments are associated with DE, findings that may provide insight into the etiology of DE and offer treatment options.

Strengths and Limitations

This study is to our knowledge the first to use using data mining techniques to investigate the association between medical conditions/pharmacologic agents and the development of subsequent DE. The generalizability of our findings is limited given that all men were commercially insured.

Conclusion

DE is associated with multiple medical conditions, a finding that may help identify the etiology for this disorder.

Opioid-Induced Sexual Dysfunction in Cancer Patients

Simple Summary

Sexual disorders affect up to 80% of cancer patients, depending on the type of cancer, yet they are commonly overlooked and untreated. Opioid-induced sexual dysfunction (OISD) is reported in half of opioid users. The pathophysiology of OISD—still a subject for research—may include disorders of both the endocrine and nervous systems, expressed in, among other things, erectile dysfunction and declined sexual desire, sexual arousal, orgasm, and general satisfaction with one’s sex life. The etiology of sexual dysfunction in cancer patients is usually multifactorial, so the management should be multifaceted and individualized by targeting pathophysiological factors. The treatment options for OISD are few and include testosterone replacement therapy, bupropion, opioid antagonists, phosphodiesterase type 5 inhibitors, plant-derived substances, and non-pharmacological treatments, although the evidence is insufficient. One of the treatment options may also be a choice of an opioid that is less likely to cause sexual dysfunction, yet further research is necessary.

Abstract

Sexual dysfunction is common in patients with advanced cancer, although it is frequently belittled, and thus consistently underdiagnosed and untreated. Opioid analgesics remain fundamental and are widely used in cancer pain treatment. However, they affect sexual functions primarily due to their action on the hypothalamus–pituitary–gonadal axis. Other mechanisms such as the impact on the central and peripheral nervous systems are also possible. The opioid-induced sexual dysfunction includes erectile dysfunction, lack of desire and arousal, orgasmic disorder, and lowered overall sexual satisfaction. Around half of the individuals taking opioids chronically may be affected by sexual dysfunction. The relative risk of sexual dysfunction in patients on chronic opioid therapy and opioid addicts increased two-fold in a large meta-analysis. Opioids differ in their potential to induce sexual dysfunctions. Partial agonists and short-acting opioids may likely cause sexual dysfunction to a lesser extent. Few pharmaceutical therapies proved effective: testosterone replacement therapy, PDE5 inhibitors, bupropion, trazodone, opioid antagonists, and plant-derived medicines such as Rosa damascena and ginseng. Non-pharmacological options, such as psychosexual or physical therapies, should also be considered. However, the evidence is scarce and projected primarily from non-cancer populations, including opioid addicts. Further research is necessary to explore the problem of sexuality in cancer patients and the role of opioids in inducing sexual dysfunction.

Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis

STUDY DESIGN

Retrospective cohort.

OBJECTIVES

Delayed ejaculation (DE) is a distressing condition characterized by a notable delay in ejaculation or complete inability to achieve ejaculation, and there are no existing reports of DE following lumbar spine surgery. Inspired by our institutional experience, we sought to assess national rates of DE following surgery of the lumbar spine.

METHODS

We queried the Optum De-identified Clinformatics Database for adult men undergoing surgery of the lumbar spine between 2003 and 2017. The primary outcome was the development of DE within 2 years of surgery. Multivariable logistic regression was performed to identify factors associated with the development of DE.

RESULTS

We identified 117 918 men who underwent 162 646 lumbar spine surgeries, including anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), and more. The overall incidence of DE was 0.09%, with the highest rate among ALIF surgeries at 0.13%. In multivariable analysis, the odds of developing DE did not vary between anterior/lateral lumbar interbody fusion, PLF, and other spine surgeries. A history of tobacco smoking (OR = 1.47, 95% CI 1.00-2.16, P = .05) and obesity (OR = 1.56, 95% CI 1.00-2.44, P = .05) were associated with development of DE.

CONCLUSIONS

DE is a rare but distressing complication of thoracolumbar spine surgery, and patients should be queried for relevant symptoms at postoperative visits when indicated.

Drug-Induced Sexual Dysfunction: An Analysis of Reports to a National Pharmacovigilance Database

INTRODUCTION

Sexual dysfunction (SD) is a problem that can affect any phase of the sexual response cycle (such as sexual desire, arousal and orgasm) and individuals of any age. SD can be caused by physical reasons, such as medical conditions, alcoholism or drug abuse; psychological factors, such as stress and anxiety; and different medicines, such as selective serotonin reuptake inhibitors (SSRIs), and their associated adverse effects.

AIM

The aim of this study was to characterise drugs suspected to have caused SD adverse drug reactions (ADRs) in patients, by conducting a descriptive study based on pharmacovigilance reports.

METHODS

Reports submitted to the Netherlands Pharmacovigilance Centre Lareb from January 2003 to December 2019 were used to investigate drug-induced sexual disorders. Selected reports had at least one ADR reported in the Medical Dictionary for Regulatory Activities (MedDRA^®) System Organ Class (SOC) 'Reproductive system and breast disorders' and the SOC 'Psychiatric disorders' relating to sexual disorders and corrected for drug utilisation (expenditure) for the Dutch population.

RESULTS

A total of 2815 SD ADRs were reported in the observed period. Data were divided according to three variables: pharmacotherapeutic group, the drug itself, and sex. A total of 722 different SD/pharmacotherapeutic group pairs were observed. The pharmacotherapeutic groups with the highest frequency of SD reports were SSRIs (n = 488, 17.58%), other antidepressants (n = 172, 6.20%) and HMG-CoA reductase inhibitors (n = 149, 5.37%). Distinguishing ADRs by sex, men suffered more from erectile dysfunction, decreased libido and ejaculation disorders, while among women, libido disorders, dyspareunia and SD were the most common ADRs.

CONCLUSION

Different reactions and disproportionality of reactions were detected between the sexes. Antidepressants, antihypertensives, oral contraceptives, α-blockers, and anti-androgens were the pharmacotherapeutic groups with the highest number of SD reports and corresponding high odds ratios.

Delayed ejaculation in men with depressive disorders

Delayed ejaculation belongs to the group of sexual disorders in men. The causes of delayed ejaculation or anejaculation are not exactly known. It is assumed that it can be caused by psychogenic or organic influences or their combinations. One of the causes of delayed ejaculation may be elevated prolactin levels, which may be increased by psychosocial stress, pituitary disorders or also treatment with selective serotonin reuptake inhibitors in the treatment of depression. We tested a selected group of 50 men who were diagnosed with a depressive disorder and whose antidepressant treatment lasted for at least 24 weeks. These patients reported long-term delayed ejaculation or, in some cases, anejaculation as comorbidity. The results showed significant Spearman's correlation between elevated prolactin levels and intravaginal ejaculation latency values (R = 0.45), as well as between Beck's Depression-II inventory and intravaginal ejaculation latency and latency values (R = 0.48).

Premature Ejaculation and Endocrine Disorders: A Literature Review

Premature ejaculation (PE) is the most common male sexual dysfunction, with 30% of men experiencing PE worldwide. According to the generally accepted classification, there are two types of PE: lifetime PE and acquired PE. Various biological and psychological causes are known to be involved in the etiology of PE. However, due to the incomplete definition and etiopathogenesis of PE, there is no effective treatment. Although clinical and animal studies indicate that hormones play a role in controlling the ejaculation process, the precise endocrine mechanisms are unclear. In addition, little is known about the role of endocrine disorders in PE etiology. However, there is evidence that diabetes mellitus (DM), obesity, metabolic syndrome (MetS), thyroid gland disorders, pituitary gland disorders, and vitamin D deficiency affect the prevalence of PE. Moreover, it has been reported that the prevalence of PE decreases with treatment of these endocrine disorders. In this review, the relationship between PE and DM, MetS, obesity, vitamin D deficiency, and thyroid and pituitary gland disorders is summarized.

What Is the Trigger for Sexual Climax?

A model is proposed to consider sexual climax in men, women, and animals as a unitary phenomenon. Sexual climax is a stereotyped rhythmic pattern of spinally generated neural activity in the autonomic and somatic nerves innervating pelvic organs. A column of neurons in the spinal cord of the male rat is strongly activated by ejaculation (sexual climax in the male). These neurons project to the thalamus and are therefore called lumbar spinothalamic cells (LSt cells). Comprehensive studies have demonstrated that the LSt cells constitute a central pattern generator of ejaculation. These findings have been extended to female animals. Further studies identified LSt cells in the lumbar spinal cord of men and women. Strong evidence indicates that the LSt cells mediate ejaculation in men. The climax model generalizes and extends these studies. It postulates that LSt cells in the lumbar spinal cord of humans and animals of both sexes generate climax. The LSt cells generate the neural activity driving the pelvic contractions and other responses of climax. The activity is transmitted to supraspinal sites to activate orgasm. The LSt cells receive excitatory and inhibitory projections from supraspinal sites. The descending projections reflect subjective arousal and inhibitions. Spinal sensory neurons from the genitals provide excitatory and inhibitory innervation to the LSt cells. These represent pleasurable and noxious sensations. The supraspinal and spinal excitatory and inhibitory inputs are integrated by the LSt. When the sum of the excitatory inputs, minus the sum of the inhibitory inputs reaches a threshold, the LSt cells generate sexual climax.

The upregulation of tryptophan hydroxylase-2 expression is important for premature ejaculation treatment with the selective serotonin reuptake inhibitor

BACKGROUND

Although there was some evidence to suggest that the serotonergic system in the brain played an important role in premature ejaculation (PE), tryptophan hydroxylase-2 (TPH2) is considered to be the key enzyme for the synthesis of 5-hydroxytryptamine (5-HT) and few studies have reported that brain TPH2 is involved in the regulation of ejaculation.

OBJECTIVES

This study aimed to investigate whether changes in brain TPH2 levels were associated with PE and to explore the effects of acute administration of dapoxetine on TPH2 expression in the brain of rats with rapid ejaculation.

MATERIALS AND METHODS

Based on the ejaculation frequency, the male rats were split into three groups: "rapid," "normal," and "sluggish" ejaculators. The level of 5-HT in the brain was determined by an enzyme-linked immunosorbent assay. TPH2 expression was detected by western blot analysis and immunohistochemistry.

RESULTS

The results showed that the concentration of 5-HT and the expression of TPH2 in rapid rats were the lowest, while those in sluggish rats were the highest. Correlation analysis also indicated the level of TPH2 was positively correlated with ejaculation latency (r = 0.8633, p < 0.0001) and negatively correlated with ejaculation frequency (r = -0.874, p < 0.001). In addition, dapoxetine acute administration to rapid rats resulted in upregulation of TPH2 expression in the brain.

DISCUSSION

There was an important link between the level of TPH2 and the change of ejaculation behaviors. Decreased expression of TPH2 in relevant brain regions will lead to rapid ejaculation. Moreover, the effect of dapoxetine on prolonging ejaculation may be due to the upregulation of TPH2 expression.

CONCLUSION

We found the correlation between the level of TPH2 in the brain and PE. The findings in this study will open up a novel way for future research in PE therapy.

Abnormal Functional Connectivity Between the Left Medial Superior Frontal Gyrus and Amygdala Underlying Abnormal Emotion and Premature Ejaculation: A Resting State fMRI Study

Introduction

Premature ejaculation (PE) is a common sexual dysfunction and is found to be associated with abnormal emotion. The amygdala plays an important role in the processing of emotion. The process of ejaculation is found to be mediated by the frontal-limbic neural circuits. However, the correlations between PE and emotion are still unclear.

Methods

Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired in 27 PE patients with stable emotion (SPE), 27 PE patients with abnormal emotion (NPE), and 30 healthy controls (HC). We used rs-fMRI to explore the underlying neural mechanisms in SPE, NPE, and HC by measuring the functional connectivity (FC). Differences of FC values among the three groups were compared when choosing bilateral amygdala as the regions of interest (ROIs). We also explored the correlations between the brain regions showing altered FC values and scores of the premature ejaculation diagnostic tool (PEDT)/Eysenck Personality Inventory about neuroticism (EPQ-N) in the PE group.

Results

When the left amygdala was chosen as the ROI, the SPE group exhibited an increased FC between the left medial superior frontal gyrus (SFGmed) and amygdala compared with the NPE or HC group. When the right amygdala was chosen as the ROI, the NPE group exhibited a decreased FC between the left SFGmed and right amygdala compared with the HC group. In addition, FC values of the left SFGmed had positive correlations with PEDT and negative correlations with EPQ-N scores in the PE group. Moreover, FC values of the left superior temporal gyrus had positive correlations with EPQ-N scores in the PE group.

Conclusion

The increased FC values between the left SFGmed and amygdala could reflect a compensatory cortical control mechanism with the effect of stabilized emotion in the limbic regions of PE patients. Abnormal FC between these brain regions could play a critical role in the physiopathology of PE and could help us in dividing PE into more subtypes.

Physiological and pharmacological impact of oxytocin on epididymal propulsion during the ejaculatory process in rodents and men

During the emission phase of ejaculation, the sperm is driven from the cauda epididymidis, where it is stored, through the vas deferens by strong contractions. These contractions are thought of as being mainly induced by the sympathetic nervous system and the neurotransmitter noradrenaline. In the present study, we investigated the effect of oxytocin (suggested to exert effects during ejaculation as well) on defined segments of the rat and human epididymis using live imaging. Our results indicate that it is the very last part of the epididymis, segment 19 (S19) in rat and likewise segment 9 in human, which responds in a uniquely strong and rapid manner to oxytocin (similar to noradrenaline). Because of the complex nature of this contractile response, we developed an imaging analysis method, which allowed us to quantify multidirectional contractions and to display them using heat maps. The reaction of S19 to oxytocin was concentration-dependent and could be inhibited by pretreatment with oxytocin antagonists (atosiban and cligosiban), but not with an arginine vasopressin 1_A antagonist (SR49059). In both rat and human tissue, pretreatment with the alpha-1 adrenoreceptor antagonist tamsulosin inhibited the response to noradrenaline, whereas the effect of oxytocin was unimpaired. Our data (from men and rodents) strongly suggest that the hormone oxytocin is involved in the ejaculatory process. Thus, oxytocin-based medications might be a promising non-adrenergic treatment option for ejaculatory disorders. Additionally, we propose that S19 could be an advantageous model (detecting very low concentrations of oxytocin) to test the bioactivity of new oxytocin agonists and oxytocin antagonists.

Ejaculatory dysfunction in men with diabetes mellitus

Diabetes mellitus (DM) is a metabolic disorder that is characterized by elevated blood glucose levels due to absolute or relative insulin deficiency, in the background of β-cell dysfunction, insulin resistance, or both. Such chronic hyperglycemia is linked to long-term damage to blood vessels, nerves, and various organs. Currently, the worldwide burden of DM and its complications is in increase. Male sexual dysfunction is one of the famous complications of DM, including abnormal orgasmic/ejaculatory functions, desire/libido, and erection. Ejaculatory dysfunction encompasses several disorders related to DM and its complications, such as premature ejaculation, anejaculation (AE), delayed ejaculation, retrograde ejaculation (RE), ejaculatory pain, anesthetic ejaculation, decreased ejaculate volume, and decreased force of ejaculation. The problems linked to ejaculatory dysfunction may extend beyond the poor quality of life in diabetics as both AE and RE are alleged to alter the fertility potential of these patients. However, although both diabetes patients and their physicians are increasingly aware of diabetic ejaculatory dysfunction, this awareness still lags behind that of other diabetes complications. Therefore, all these disorders should be looked for thoroughly during the clinical evaluation of diabetic men. Besides, introducing the suitable option and/or maneuvers to treat these disorders should be tailored according to each case. This review aimed to explore the most important findings regarding ejaculatory dysfunction in diabetes from pre-clinical and clinical perspectives.

Focusing on sexual rehabilitation besides penile rehabilitation following radical prostatectomy is important

Erectile dysfunction is commonly reported after radical prostatectomy. Besides the loss of erections, sexual life after prostatectomy is impacted by urinary incontinence, orgasmic dysfunction, and psychological stress. In this review, we describe classical medical therapies used for erectile function rehabilitation such as PDE5 inhibitors and injection therapy. A vast amount of data support the idea of focusing on restoration of sexual function on top of erectile function after prostatectomy. The important strategies described to rehabilitate sexual function include pelvic floor muscle therapy, couple therapy, appropriate preoperative counseling, and focusing on non-penetrative alternatives. A multidisciplinary approach and including the partner is important. Erectile function alone is not sufficient for satisfactory sexual experience and may not be used as a proxy for sexual quality of life. Adding full-spectrum sexual rehabilitation to a standard penile rehabilitation regimen has the highest chances of obtaining satisfactory sexual outcomes in men and their partners after radical prostatectomy.

Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment

Male sexual dysfunction, a common sequela following primary prostate cancer (PC) treatment, is likely to be more significant following salvage PC therapy. In general, these impairments in sexual domains can be divided into three groups, namely (1) sexual desire, sexuality and masculinity; (2) erectile function (EF); and (3) ejaculation and orgasm. However, there is considerable overlap between these sexual domains and male sexual response cycle, and various factors such as cancer status, mental well-being, medical conditions and social circumstances can adversely impact on the male sexual function. While several preventive and treatment strategies for the preservation and recovery of sexual function are available, there is limited consensus guidelines exist regarding the optimal rehabilitation or treatment protocol for men with sexual dysfunction following salvage therapy. While penile rehabilitation may be effective to restore erectile function and the ability to have coital sex, there is lack of effective treatments in other domains of male sexual function, thereby underscoring the importance of psychological and sexual counselling in sexual rehabilitation. Indeed, a comprehensive multidisciplinary approach is necessary to better understand and optimally assist and manage the men and their respective partners for better sexual health and activity.

Preservation of antegrade ejaculation after surgical relief of benign prostatic obstruction is a valid endpoint

PURPOSE

To review the current data on retrograde ejaculation (RE) and ejaculatory dysfunction (EjD) after endoscopic and minimally invasive surgical treatment of benign prostatic obstruction (BPO) and, their perceived impact in the quality of life (QoL) and sexual life of patients and their partners.

METHODS

Narrative review of systematic reviews (SR) assessing comparative rates of RE, EjD or erectile dysfunction (EF) was carried out. Relevant articles on the prevalence of RE, EjD or EF and on their impact in the QoL or sexual life of patients and partners were manually selected based on relevance.

RESULTS

Twelve SRs reporting on comparisons of different endoscopic/minimally invasive treatments of BPO were found. Data on outcomes varied widely. Overall, after conventional TURP or laser techniques 42-75% of patients present RE. Prostatic incision and ablative procedures present lowest rates of de novo RE or EjD whereas laser adenomectomy and ejaculation preservation procedures preserve antegrade ejaculation in 46-68% of patients. EjDs is associated to LUTS and present in 10% of sexualy active men before intervention. It modulates the QoL and sexual life of the couple. In spite of the scarce literature assessing patient's and partner's perception of postoperative EjD, it strongly suggests that both parties value the maintenance of the ejaculatory function.

CONCLUSION

Ejaculation-preserving techniques and minimally invasive techniques successfully prevent BPO treatment-induced RE or EjD in 70-100% of the cases. While this is appealing to patients and spouses, technique selection and treatment durability are issues to be discussed with the couple.

Sexual function and rehabilitation after radiation therapy for prostate cancer: a review

The treatment of prostate cancer is partly guided by patient preferences. Radical prostatectomy and radiation therapy are the standard radical therapies for localized disease and render comparable oncologic outcomes. Considering that survival is high regardless of the chosen treatment, factors such as treatment-related toxicities affecting the patients' quality of life play an important role in their decision. Notably, post-treatment sexual dysfunction, which includes decreased libido, erectile dysfunction, and ejaculatory dysfunction has been shown to be an important and prevalent concern of prostate cancer survivors. In this literature review, we sought to characterize the sexual complications associated with radiation therapy and map the available sexual rehabilitation options for prostate cancer survivors experiencing sexual dysfunction as a result of radiation therapy. We identified medical, non-biomedical, counseling, and lifestyle modification options for prostate cancer survivors seeking sexual rehabilitation. Future research in this area should address the standardization of sexual side-effect reporting and investigate sexual outcomes and rehabilitation in more diverse groups and of transgender and nonheterosexual prostate cancer survivors.

Urethral-sparing Robot-assisted Simple Prostatectomy: An Innovative Technique to Preserve Ejaculatory Function Overcoming the Limitation of the Standard Millin Approach

BACKGROUND

Despite recent technical innovations in the treatment of benign prostatic hyperplasia (BPH), retrograde ejaculation is still one of the most frequent adverse effects, with a major impact on patients' quality of life.

OBJECTIVE

To evaluate the efficacy of our technique of urethral-sparing robotic-assisted simple prostatectomy (usRASP) in obtaining effective deobstruction and maintaining anterograde ejaculation, and secondarily, to compare these outcomes with those of a control group of patients who underwent standard robotic adenomectomy according to the Millin technique.

DESIGN, SETTING, AND PARTICIPANTS

We prospectively enrolled patients between August 2017 and July 2019 with large BPH (prostate volume >80 ml) affected by significant BPH-related lower urinary tract symptoms (LUTS) who underwent usRASP. Then, a retrospective control group treated with standard Millin robotic-assisted simple prostatectomy (RASP) was selected.

SURGICAL PROCEDURE

The innovative aspect of our technique is the pivotal role of enucleation of the adenoma from all the anatomical structures, especially from the urethra. On the basis of the final results, the patients were divided into three groups (full, partial, or failed urethral sparing). Control group patients underwent standard Millin.

MEASUREMENTS

All perioperative and follow-up data were collected, and descriptive, univariate, and multivariate analyses were performed.

RESULTS AND LIMITATIONS

Ninety-two patients were enrolled. Full urethral-sparing adenomectomy was performed in 56 cases (60.86%). Urethral-sparing adenomectomy with minimal urethral infraction occurred in 21 cases (22.82%). In 15 patients (16.48%), the procedure was converted to standard RASP. Clavien grade ≥3 complications occurred in two patients (2%). Among the 70 patients with preoperative ejaculation, 57 (81%) maintained anterograde ejaculation at the 12th postoperative month. The maximum flow rate increased (17 m/s from baseline, p =  0.034), and International Prostate Symptom Score decreased rapidly (from 20 to 5 points; p <  0.001). With respect to the technique of the control group patients, usRASP allows the same perioperative and urinary functional outcomes, but with an improvement in terms of sexual function, especially for the ejaculation (p <  0.001 at every time point). A small sample size and short follow-up time are the major limitations of this study.

CONCLUSIONS

Urethral-sparing RASP has been found to be a safe and effective procedure that allows resolution of LUTS in large BPH and maintaining of ejaculatory function in a high percentage of patients.

PATIENT SUMMARY

Based on our findings, this technique should be considered as an option when counseling patients with large benign prostatic hyperplasia who are motivated to preserve antegrade ejaculation.

Premature ejaculation: an update on definition and pathophysiology

Premature ejaculation (PE) is the most common male sexual dysfunction, which represents a diagnostic as well as a therapeutic challenge for physicians. However, no universally accepted definition is currently available for PE. As a result, physicians continue to diagnose patients with PE according to major guidelines set by the professional societies. These guidelines either recommend the use of validated questionnaires or patient-reported outcomes. Recent efforts directed toward classifying PE may help provide a better understanding of the prevalence and risk factors of this disorder. While the exact etiology of PE has not been clearly elucidated, several risk factors have been strongly reported in the literature. Clearly, to understand the revised definition of PE, its etiology and pathophysiology is necessary to improve the clinical management of this medical condition and form the basis of future research in this regard. In this review, we highlight the past and current definitions of PE and present an appraisal on the classifications and theories suggested for the etiopathogenesis of PE.

Male genital sensation after spinal cord injury: a review

Genital sensation (GS) is an essential component of male sexual function. Genital sensory disturbance (GSD) caused by spinal cord injury (SCI) has a severe impact on the patients' sexual function but has garnered little research focus. Under normal conditions, GS encompasses the erection, ejaculation, sexual arousal, and orgasm courses associated with physiological and psychological responses in male sexual activity. However, in SCI patients, the deficiency of GS makes the tactile stimulation of the penis unable to cause sexual arousal, disturbs the normal processes of erection and ejaculation, and decreases sexual desire and satisfaction. To provide an overview of the contemporary conception and management of male GS after SCI, we review the innervation and sexual function of male GS in this article, discuss the effects of GSD following SCI, and summarize the current diagnosis and treatment of GSD in male SCI patients.

Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study

Introduction

Prevalence and bother of ejaculatory dysfunction (EjD) has yet to be evaluated in a men's health referral population.

Aim

To evaluate the prevalence and associated risk factors of EjD in men presenting to a men's health clinic.

Methods

A retrospective review examined patients presenting to an outpatient men's health clinic who completed the Sexual Health Inventory for Men and the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD) Short Form. Patient factors including demographics, comorbidities, and medication were examined. Descriptive statistics and multivariable logistic regression were used.

Main Outcome Measures

The main outcomes of this study are Sexual Health Inventory for Men and MSHQ-EjD scores.

Results

A total of 63 (24%) of patients presenting to the urology clinic were characterized as having EjD based on questionnaire responses. The mean age for men with EjD was 53.8 years, while those without was 42.6 years (P < .001). Of men with EjD, 74.6% were at least moderately bothered (MSHQ-EjD ≥3). Men with EjD were more likely to have erectile dysfunction (77.8%) compared with those without (21%, P < .001) as well as a history of a pelvic cancer (20.6% vs 6%, P = .001). On multivariable regression, erectile dysfunction (odds ratio: 15.04, 95% confidence interval: 6.76–35.92, P < .0001) and alpha inhibitor prescription (odds ratio: 6.82, 95% confidence interval: 1.57–30.16, P = .01) were associated with a higher odds of EjD. ED was found to be a mediator of the relationship between EjD and age, as the age association was lost in the ED population on multivariable regression compared with the non-ED population where it remained significant.

Conclusions

EjD is common among patients presenting to a men's health clinic and may present at varying ages, though it is more common in those aged 50 years or older; it is independent of age and race. EjD is associated with erectile dysfunction, pelvic cancer history, and use of alpha inhibitors, presenting a population that could be considered for screening.

Kasman AM, Bhambhvani HP, Eisenberg ML. Ejaculatory Dysfunction in Patients Presenting to a Men's Health Clinic: A Retrospective Cohort Study. J Sex Med 2020;8:454–460.

A bibliometric analysis of international publication trends in premature ejaculation research (2008-2018)

The incidence of premature ejaculation (PE) has been on the rise over the years. Thus, significant research efforts have been directed toward understanding the pathogenesis and hence treatment of PE. Here, we performed a comprehensive analysis of the worldwide trends in research outputs in the field of PE. This study investigated the universal findings of previous PE studies and the trending issues surrounding the condition. We employed the Web of Science Core Collection for data collection. The Excel (2016) and CiteSpace IV were used for information analysis. The information was categorized using journal names, institutions, research frontiers, citation reports, regions/countries, and authors. A sum of 886 publications concerning PE between 2008 and 2018 were identified as of July 6, 2019. The highest number of publications was identified in the Journal of Sexual Medicine published. The United States of America (USA) had the highest number of publications and H-index value. The highest co-citations were from Waldinger MD. The most common keyword was 'drug treatment'. A steady pattern was observed for PE publications done between the period of 2008-2018. Thus, the USA is at the forefront of research on PE research. The interesting advanced research frontiers were drug treatment, circumcision, and sertraline.

Almond-supplemented diet improves sexual functions beyond Phosphodiesterase-5 inhibition in diabetic male rats

Hyperglycemia, an important feature of diabetes, can cause oxidative stress, which is associated with varieties of diabetic complications including erectile dysfunction. Therefore, this study sought to investigate the effect of almond-supplemented diet on some biochemical indices relevant to erection in diabetic male rats. Forty-two male rats were divided into two groups: A (n = 6) and B (n = 36). Diabetes was induced in Group B via injection of a single dose of STZ (50 mg/kg) intraperitoneally and confirmed 72 h after induction. Diabetic rats (blood glucose ≥250 mg/dL) were subsequently divided into six groups (n = 6). Fourteen days after confirmation of diabetes, rats were fed with diets containing almond drupe and seeds (10 and 20% inclusion) for fourteen days. The effects of the diets on blood glucose, sexual behavior, sexual hormones, phosphodiesterase-5 activity, nitric oxide, H₂S, and AGEs levels were evaluated. Significant increase in blood glucose level, phosphodiesterase-5 activity, and glycated hemoglobin was observed in diabetic rats. Furthermore, diabetes caused a significant decrease in nitric oxide, H₂S, sexual hormones (testosterone, follicle-stimulating hormone and luteinizing hormone) levels, and sexual behavioral indices. However, treatment with diets supplemented with almond drupe and seeds significantly reversed these effects in diabetic rats. Findings in this study revealed that almond-supplemented diets enhance some important biomarkers relevant to erection in diabetic rats. Thus, dietary inclusion of almond (drupe and seeds) could serve as a cheap and readily available nutraceutical in the management of erectile dysfunction associated with diabetes.

Ejaculatory and Orgasmic Dysfunction Following Prostate Cancer Therapy: Clinical Management

The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side effects following the treatment of prostate cancer. Orgasmic dysfunction covers a range of issues including premature ejaculation, anorgasmia, dysorgasmia, and climacturia. This review provides an overview of prevalence and management options to deal with orgasmic dysfunction. A Medline Pubmed search was used to identify articles relating to these problems. We found that orgasmic dysfunction has a very large impact on patients’ lives following prostate cancer treatment and there are ways for physicians to treat it. Management of patients’ sexual health should be focused not only on erectile dysfunction, but on orgasmic dysfunction as well in order to ensure a healthy sexual life for patients and their partners.

Network Pharmacology of Yougui Pill Combined with Buzhong Yiqi Decoction for the Treatment of Sexual Dysfunction

Purpose

We aimed to find the possible key targets of Yougui pill and Buzhong Yiqi decoction for the treatment of sexual dysfunction.

Materials and Methods

The composition of Yougui pill combined with Buzhong Yiqi decoction was obtained, and its effective components of medicine were screened using ADME; the component target proteins were predicted and screened based on the TCMSP and BATMAN databases. Target proteins were cross-validated using the CTD database. We performed gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses for target proteins using the Cytoscape plugin ClueGO + CluePedia and the R package clusterProfiler, respectively. Subsequently, protein-protein interaction (PPI) analyses were conducted using the STRING database. Finally, a pharmacological network was constructed.

Results

The pharmacological network contained 89 nodes and 176 relation pairs. Among these nodes, there were 12 for herbal medicines (orange peel, licorice, Eucommia, Aconite, Astragalus, Chinese wolfberry, yam, dodder seed, ginseng, Cornus officinalis, Rehmannia, and Angelica), 9 for chemical components (18-beta-glycyrrhetinic acid, carvacrol, glycyrrhetinic acid, higenamine, nobilin, quercetin, stigmasterol, synephrine, and thymol), 62 for target proteins (e.g., NR3C1, ESR1, PTGS2, CAT, TNF, INS, and TP53), and 6 for pathways (MAPK signaling pathway, proteoglycans in cancer, dopaminergic synapse, thyroid hormone signaling pathway, cAMP signaling pathway, and neuroactive ligand-receptor interaction).

Conclusion

NR3C1, ESR1, PTGS2, CAT, TNF, INS, and TP53 may be important targets for the key active elements in the decoction combining Yougui pill and Buzhong Yiqi. Furthermore, these target proteins are relevant to the treatment of sexual dysfunction, probably via pathways associated with cancer and signal transduction.

Premature Ejaculation and Erectile Dysfunction in Male Partners of Infertile Couples: Prevalence and Correlation

Objectives: The frequency of, and relationship between, the various manifestations of male sexual dysfunction in infertile couples have been poorly investigated, especially in Vietnam. Our study aims to assess the prevalence of premature ejaculation and erectile dysfunction in infertile couples using validated instruments, and the relationship between these disorders.

Method: Cross-sectional descriptive study, using validated questionnaires including the Premature Ejaculation Diagnostic Tool (PEDT) and the International Index of Erectile Function-15 (IIEF-15), to measure the incidence of these problems in 255 male partners of infertile couples who were examined from January through December 2017, at the Center for Reproductive Endocrinology & Infertility, Hue University Hospital.

Results: The prevalence of overt premature ejaculation was 4.7%, probable premature ejaculation was 7.1%, and erectile dysfunction was 26.3% (mild: 19.3%, mild-to-moderate: 3.9%, moderate: 2.7%, and severe: 0.4%). The PEDT total score was negatively correlated to IIEF-15-EFD and IIEF-15 total scores (r [Formula: see text]0.322 and r [Formula: see text]0.348, respectively).

Conclusions:In light of the identified prevalence of premature ejaculation and erectile dysfunction in the studied population, screening for these conditions should be included in the evaluation of infertile couples. These two disorders could negatively reciprocal effect on each other.

Comparing the Effects of Methadone, Buprenorphine, and Opium Tincture Maintenance Therapy on Sexual Function

Background

Opioid use disorder is a major concern to public health, and opioid maintenance treatment on methadone or buprenorphine is a widely used approach. On the other hand, in recent years, there has been more regards for the use of opium tincture for detoxification and maintenance treatment of opioid dependence in certain parts of the world. The purpose of our research was to compare sexual impairments of methadone maintenance treatment (MMT), buprenorphine maintenance treatment (BMT), and opium tincture maintenance treatment (OMT) in patients.

Methods

The study sample consisted of opium-addicted men candidates for maintenance treatment in an addiction quitting clinic in Tehran, Iran, from November 2017 to February 2018. Participants (n = 84) were randomly assigned to three groups (of the equal number), receiving either methadone tablet, buprenorphine sublingual tablet, and opium tincture. The average score for sexual function was evaluated using the Arizona Sexual Experiences Scale (ASEX) at the beginning and after 3 months after treatment.

Findings

Although there was no significant different in ASEX scores between the groups at the beginning and end of the study (P > 0.05), but the difference was significant in each group in comparing by themselves.

Conclusion

These results showed that sexual dysfunction became better after opioid substitution therapies, and no differences were observed on sexual dysfunction between the three groups.

A Schematic Overview of the Current Status of Male Infertility Practice

The practice of male infertility has dramatically evolved over the past few decades. This has been achieved after the realization of the important contribution the male counterpart holds in the couple's infertility. It is also supported by a number of breakthroughs in the diagnosis and treatment of this medical condition. Several tests to investigate sperm quality and function were introduced along with refinements and/or institution of novel surgical techniques that can correct several causes of infertility. This manuscript is aimed at highlighting the current state of male infertility practice in a robust, schematic method addressing a broader audience involved in the treatment of male infertility.

Patient-reported ejaculatory function and satisfaction in men with lower urinary tract symptoms/benign prostatic hyperplasia

This study aimed to investigate perceived ejaculatory function/satisfaction before treatment for lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and to identify associations between specific categories of ejaculatory dysfunctions (EjDs) and LUTS. A total of 1574 treatment-naïve men with LUTS/BPH were included in this study. All patients underwent routine evaluation for LUTS/BPH including the International Index of Erectile Function and a 5-item questionnaire developed to assess ejaculatory volume/force/pain/satisfaction/latency time. Patients who had sexual intercourse over the past 4 weeks were classified as sexually active group. A total of 783 patients were categorized as sexually active group. Decreased ejaculatory volume and force were reported by 53.4% and 55.7% of 783 sexually active men, respectively. There was a strong correlation between ejaculatory volume and force. Ejaculatory pain/discomfort, premature ejaculation (PE), and delayed ejaculation (DE) were reported in 41.0%, 16.3%, and 41.4% of the patients, respectively. Over 40.0% of men without decreased ejaculation volume/force were satisfied with ejaculatory function, whereas approximately 6.0% of men with decreased volume/force were satisfied with ejaculatory function. About 30.0% of men with decreased volume/force had orgasmic dysfunction, while approximately 10.0% of men without decreased volume/force did. Decreased ejaculatory volume or force was associated with LUTS severity after adjusting for other influential factors including testosterone level, erectile function, and prostate size on ultrasonography, but PE or DE or ejaculatory pain/discomfort was not. In conclusion, a considerable portion of men with LUTS/BPH appear to have a variety of EjDs. Ejaculatory volume/force and satisfaction/orgasm do not always appear to be concordant. Ejaculatory volume or force is independently associated with LUTS severity, whereas PE or DE or ejaculatory pain/discomfort is not.

Validity of premature ejaculation diagnostic tool and its association with International Index of Erectile Function-15 in Chinese men with evidence-based-defined premature ejaculation

The premature ejaculation diagnostic tool (PEDT) is a brief diagnostic measure to assess premature ejaculation (PE). However, there is insufficient evidence regarding its validity in the new evidence-based-defined PE. This study was performed to evaluate the validity of PEDT and its association with IIEF-15 in different types of evidence-based-defined PE. From June 2015 to January 2016, a total of 260 men complaining of PE and defined as lifelong PE (LPE)/acquired PE (APE) according to the evidence-based definition from Andrology Clinic of the First Affiliated Hospital of Anhui Medical University, along with 104 male healthy controls without PE from a medical examination center, were enrolled in this study. All individuals completed questionnaires including demographics, medical and sexual history, as well as PEDT and IIEF-15. After statistical analysis, it was found that men with PE reported higher PEDT scores (14.28 ± 3.05) and lower IIEF-15 (41.26 ± 8.20) than men without PE (PEDT: 5.32 ± 3.42, IIEF-15: 52.66 ± 6.86, P < 0.001 for both). It was suggested that a score of ≥9 indicated PE in both LPE and APE by sensitivity and specificity analyses (sensitivity: 0.875, 0.913; specificity: 0.865, 0.865, respectively). In addition, IIEF-15 were higher in men with LPE (42.64 ± 8.11) than APE (39.43 ± 7.84, P < 0.001). After adjusting for age, IIEF-15 was negatively related to PEDT in men with LPE (adjust r = -0.225, P < 0.001) and APE (adjust r = -0.378, P < 0.001). In this study, we concluded that PEDT was valid in the diagnosis of evidenced-based-defined PE. Furthermore, IIEF-15 was negatively related to PEDT in men with different types of PE.

Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder

Background: The problems in sexual functioning among patients with post-traumatic stress disorder (PTSD) are often overlooked, although scientific research confirms high rates of sexual dysfunctions (SD) particularly among veterans with PTSD. The main objective of this study was to systematically identify predictors of SD among veterans with PTSD. Methods: Three hundred veterans with PTSD were included in the cross-sectional study. The subjects were assessed by the Mini-International Neuropsychiatric Interview (MINI) and self-report questionnaires: PCL-5, i.e., PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with Criterion A, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT), and Relationship Assessment Scale (RAS). Several hierarchical multiple regressions were performed to test for the best prediction models for outcome variables of different types of SD. Results: 65% of participants received a provisional diagnosis of SD. All tested prediction models showed a good model fit. The significant individual predictors were cluster D (Trauma-Related Negative Alterations in Cognition and Mood) symptoms (for all types of SD) and in a relationship status/relationship satisfaction (all, except for premature ejaculation (PE)). Conclusions: The most salient implication of this study is the importance of sexual health assessment in veterans with PTSD. Therapeutic interventions should be focused on D symptoms and intended to improve relationship functioning with the aim to lessen the rates of SD. Psychotropic treatment with fewer adverse sexual effects is of utmost importance if pharmacotherapy is applied. Appropriate prevention, screening, and treatment of medical conditions could improve sexual functioning in veterans with PTSD.

Psychological Impacts of Male Sexual Dysfunction in Pelvic Cancer Survivorship

INTRODUCTION

A common negative sequela of cancer treatment in men is sexual dysfunction, which can have a significant psychological impact and can contribute to feelings of depression, anxiety, and other mental health issues. Management of cancer survivors' psychological and mental well-being plays an important role in the treatment and recovery process.

AIM

To identify how sexual dysfunction impacts the lives of male cancer survivors and to provide clinicians with treatment recommendations specific to this patient population.

METHODS

A total of 51 peer-reviewed publications related to sexual dysfunction in male cancer survivors were selected for analysis. Sources were chosen based on relevance to current cancer therapies, causes and psychological impacts of sexual dysfunction, and treatment recommendations for clinicians caring for cancer survivors. PubMed search terms included "sexual dysfunction," "cancer survivorship," and "male cancer survivors."

MAIN OUTCOME MEASURES

Measures of sexual dysfunction were based on cancer survivors reporting inadequate erectile capacity for penetrative sexual intercourse, decreased sensitivity of the genitalia, or inability to enjoy sex.

RESULTS AND CONCLUSIONS

Sexual dysfunction was present in male cancer survivors from diverse ages, cancer diagnoses, and treatments of cancer. Many of the men surveyed presented with psychological distress resulting from their posttreatment sexual dysfunction. This had a significant negative impact on their sexual self-esteem, body image, and mental health. Sexual and social development was delayed in survivors of childhood cancer. Healthcare practitioners should initiate conversations with patients regarding the potential for sexual dysfunction at the time of cancer diagnosis and throughout treatment and follow-up. Physical symptoms of sexual dysfunction should be treated, whenever possible, using phosphodiesterase 5 inhibitors or other interventions, and all cancer survivors presenting with psychological distress related to sexual dysfunction should be offered professional counseling. Twitchell DK, Wittmann DA, Hotaling JM, et al. Psychological Impacts of Male Sexual Dysfunction in Pelvic Cancer Survivorship. Sex Med Rev 2019;7:614-626.