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Sexual Medicine Reviews Jul 2020Many men experience distressing issues regarding the timing of orgasm and ejaculation, such as premature ejaculation (PE) and delayed ejaculation (DE). Despite being... (Review)
Review
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.
Topics: Ejaculation; Humans; Male; Premature Ejaculation; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological
PubMed: 31668585
DOI: 10.1016/j.sxmr.2019.09.002 -
Journal of the European Academy of... Apr 2020Vulvovaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) may affect up to 90% of menopausal women. Features include vulvovaginal atrophy, vulvovaginal... (Review)
Review
Vulvovaginal atrophy (VVA) or genitourinary syndrome of menopause (GSM) may affect up to 90% of menopausal women. Features include vulvovaginal atrophy, vulvovaginal laxity, vulvovaginal dryness and irritation, dyspareunia, anorgasmia and urinary symptoms. The vulva, vagina and bladder are oestrogen-responsive tissues, but oestrogen replacement therapy is not possible in women who have hormone-responsive cancers or normal oestrogen levels. Therefore, there is a role for alternative treatments. To date, three non-surgical energy-based therapies have been proposed: fractional microablative CO laser, erbium:YAG laser and temperature-controlled radiofrequency (RF). Our objective was to assess the available evidence for the safety and efficacy of erbium:YAG laser, microablative fractional CO laser and RF in the treatment of VVA/GSM. The authors reviewed the current published literature evaluating these therapies. All three therapies appear safe; however, all the studies were uncontrolled and used different protocols and outcome measurements. Therefore, comparison of treatments is difficult. It appears that there is more evidence in favour of the CO laser than the erbium:YAG laser. Both lasers have more evidence than RF. In conclusion, microablative CO laser, erbium:YAG laser and RF may be offered to patients suffering from VVA/GSM as an alternative or adjunct to conventional therapies. Further well-conducted controlled studies are needed.
Topics: Atrophy; Catheter Ablation; Female; Humans; Lasers, Gas; Lasers, Solid-State; Menopause; Rejuvenation; Vaginal Diseases; Vulvar Diseases
PubMed: 31714632
DOI: 10.1111/jdv.16066 -
Sexual Medicine Reviews Jun 2023Clitoral adhesions occur when the prepuce adheres to the glans. These adhesions have been found in up to 22% of women seeking evaluation for sexual dysfunction. The... (Review)
Review
INTRODUCTION
Clitoral adhesions occur when the prepuce adheres to the glans. These adhesions have been found in up to 22% of women seeking evaluation for sexual dysfunction. The etiology of clitoral adhesions remains largely unclear. Studies published to date on the presentation and management of clitoral adhesions are relatively recent and raise questions for future research.
OBJECTIVES
We sought to provide a background of existing knowledge on the prevalence, presentation, etiology, associated conditions, and management of clitoral adhesions and to identify areas for future research.
METHODS
A review of literature was performed for studies that investigate clitoral adhesions.
RESULTS
Conditions associated with chronic clitoral scarring appear to have a role in the development of clitoral adhesions. Symptoms include clitoral pain (clitorodynia), discomfort, hypersensitivity, hyposensitivity, difficulty with arousal, and muted or absent orgasm. Complications include inflammation, infection, and the development of keratin pearls and smegmatic pseudocysts. There are surgical and nonsurgical interventions to manage clitoral adhesions. Additionally, topical agents can be included in conservative and/or postprocedural management. Although many studies on clitoral adhesions are limited to patients with lichen sclerosus (LS), clitoral adhesions are not confined to this population.
CONCLUSION
Areas for future research include etiologies of clitoral adhesion; such knowledge is imperative to improve prevention and management. Also, in previous studies, patients were instructed to apply various topical agents and manually retract the prepuce for conservative management or postlysis care. However, the efficacy of these interventions has not been investigated. Surgical and nonsurgical lysis procedures have been described for the management of pain and difficulties with arousal and orgasm that are causes of the sexual dysfunction associated with clitoral adhesion. Although previous studies have assessed efficacy and patient satisfaction, many of these studies were limited to small sample sizes and focused solely on patients with LS. Future studies are needed to inform a standard of care for the management of clitoral adhesions.
Topics: Humans; Female; Clitoris; Orgasm; Patient Satisfaction; Pain; Sexual Dysfunction, Physiological
PubMed: 36973166
DOI: 10.1093/sxmrev/qead004 -
International Journal of Impotence... May 2021In this narrative review we summarize neglected side effects of curative intended treatment for prostate cancer. They include climacturia, arousal incontinence (AI),... (Review)
Review
In this narrative review we summarize neglected side effects of curative intended treatment for prostate cancer. They include climacturia, arousal incontinence (AI), orgasmic disturbances such as altered orgasmic sensation, anorgasmia, and orgasm-associated pain (dysorgasmia), ejaculatory dysfunction, and morphological penile alterations in the form of shortening and deformity. Even though they have not received as much interest as erectile dysfunction (ED) or urinary incontinence, these side effects have been shown to negatively impact patient's quality of life. They are common and rates of climacturia after radical prostatectomy (RP) range from 20% and 45%, less after external beam radiation therapy (EBRT). Decreased orgasmic sensation ranges from 3.9% to 60% after RP and between 36-57% after EBRT. Dysorgasmia ranges from 9.5-15% for both RP and EBRT. Anejculation after EBRT ranges from 11-71% and rates of penile shortening are reported between 0 and 100%. There are no internationally validated questionnaires that adequately asses these side effects. This is necessary if we are to align patient and partner expectations properly and consequently manage them optimally. Neglected side effects should be discussed with patients and their partners preoperatively, as they are associated with bother and may lead to patient's avoiding sexual activity.
Topics: Erectile Dysfunction; Humans; Male; Orgasm; Prostatectomy; Prostatic Neoplasms; Quality of Life
PubMed: 33318637
DOI: 10.1038/s41443-020-00386-4 -
Sexual Medicine Reviews Jan 2022The "lost penis syndrome" (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings... (Review)
Review
INTRODUCTION
The "lost penis syndrome" (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection.
OBJECTIVES
To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners.
METHODS
Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations.
RESULTS
Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity.
CONCLUSION
We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice. Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2022;10:113-129.
Topics: Ejaculation; Female; Humans; Male; Penile Erection; Penis; Sexual Behavior; Sexual Dysfunction, Physiological
PubMed: 34620562
DOI: 10.1016/j.sxmr.2021.08.001 -
International Journal of Impotence... May 2024Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. Anorgasmia (AO) is characterized as the absence of orgasm.... (Review)
Review
Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. Anorgasmia (AO) is characterized as the absence of orgasm. Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. Given the multifactorial complex nature of this disorder, a thorough history and physical examination represent the most critical components of patient evaluation in the clinical setting. Treating DO/AO can be challenging due to the lack of standardized FDA-approved pharmacotherapies. There is no standardized treatment plan for DO/AO, though common treatments plans are often multidisciplinary and may include adjustment of offending medications and sex therapy. In this review, we summarize the etiology, diagnosis, and treatment of DO/AO.
PubMed: 37061617
DOI: 10.1038/s41443-023-00692-7 -
Plastic and Reconstructive Surgery Aug 2023International migration from high-prevalence regions has increasingly confronted non-endemic countries with female genital mutilation/cutting (FGM/C). Correspondingly,...
BACKGROUND
International migration from high-prevalence regions has increasingly confronted non-endemic countries with female genital mutilation/cutting (FGM/C). Correspondingly, Western-based health care providers have seen a greater demand for surgical reconstruction of female anatomical units. We introduce novel surgical techniques developed by the first author for clitoral and vulvovestibular reconstruction and examine operative outcomes.
METHODS
We performed a retrospective cohort study of operative outcomes of the Omega-Domed (OD) flap, Neurotizing and Molding of the Clitoral Stump (NMCS procedure) and anterior Obturator Artery Perforator (aOAP) flap for preputial, clitoral and vulvovestibular reconstruction respectively. Between 2014 and 2021 we treated patients with all types of FGM/C and analyzed various data, including demographics, clitoral sensation, and symptoms such as dysmenorrhea, dysuria, dyspareunia, and anorgasmia. We aimed to examine the efficacy and safety of these techniques in improving clitoral sensation and reducing symptoms.
RESULTS
A total of 119 women (mean age of 31.0 ± 10.4) were included. We performed the OD-flap (85%), the NMCS procedure (82%) and the aOAP-flap (36%) and had a 1-year follow-up period which was attended by 94.1% of patients. Patients significantly reported post-operative reduction of dysmenorrhea, dysuria, and dyspareunia as well as significant improvement of clitoral sensation and ability to achieve orgasm (p<0.001). There was one major complication (loss of flap) to report. Secondary ambulatory interventions were performed in 10 patients (8.4%).
CONCLUSIONS
By allowing for safe and effective anatomical reconstruction of the female genitalia, the described surgical techniques represent a new stage of treatment possibilities for women affected by FGM/C.
PubMed: 37647530
DOI: 10.1097/PRS.0000000000011026 -
Medical Sciences (Basel, Switzerland) Dec 2019The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side... (Review)
Review
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.
PubMed: 31835522
DOI: 10.3390/medsci7120109