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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 -
The Urologic Clinics of North America May 2022Ejaculation and orgasm are complex phenomena within the male sexual response cycle. Disordered ejaculation commonly presents as premature or delayed ejaculation,... (Review)
Review
Ejaculation and orgasm are complex phenomena within the male sexual response cycle. Disordered ejaculation commonly presents as premature or delayed ejaculation, although issues with painful ejaculation, retrograde ejaculation, or postorgasmic illness syndrome are also seen. This article will review the pathophysiology of these conditions as well as the current pharmacologic treatments available.
Topics: Ejaculation; Humans; Male; Orgasm; Sexual Dysfunctions, Psychological
PubMed: 35428428
DOI: 10.1016/j.ucl.2021.12.001 -
The Journal of Urology Mar 2022Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with premature...
PURPOSE
Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with premature ejaculation (PE), while men who experience difficulty achieving sexual climax may be diagnosed with delayed ejaculation (DE). The experience of many clinicians suggest that these problems are not rare and can be a source of considerable embarrassment and dissatisfaction for patients. The role of the clinician in managing PE and DE is to conduct appropriate investigation, to provide education, and to offer available treatments that are rational and based on sound scientific data.
MATERIALS AND METHODS
The systematic review utilized to inform this guideline was conducted by a methodology team at the Pacific Northwest Evidence-based Practice Center. A research librarian conducted searches in Ovid MEDLINE (1946 to March 1, 2019), the Cochrane Central Register of Controlled Trials (through January 2019) and the Cochrane Database of Systematic Reviews (through March 1, 2019). An update search was conducted on September 5, 2019. Database searches resulted in 1,851 potentially relevant articles. After dual review of abstracts and titles, 223 systematic reviews and individual studies were selected for full-text dual review, and 8 systematic reviews and 59 individual studies were determined to meet inclusion criteria and were included in the review.
RESULTS
Several psychological health, behavioral, and pharmacotherapy options exist for both PE and DE; however, none of these pharmacotherapy options have achieved approval from the United States Food and Drug Administration and their use in the treatment of PE and DE is considered off-label.
CONCLUSION
Disturbances of the timing of ejaculation can pose a substantial impediment to sexual enjoyment for men and their partners. The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes.
Topics: Decision Making; Erectile Dysfunction; Humans; Male; Premature Ejaculation; Sexual Partners
PubMed: 34961344
DOI: 10.1097/JU.0000000000002392 -
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 -
Urology Aug 2020To describe our experience with amphetamine/dextroamphetamine salts (AMP) as a treatment for delayed orgasm/anorgasmia (DO/AO).
OBJECTIVE
To describe our experience with amphetamine/dextroamphetamine salts (AMP) as a treatment for delayed orgasm/anorgasmia (DO/AO).
METHODS
We identified patients with DO/AO from September 2017 to September 2019. Baseline characteristics and patient-reported orgasmic latency time (OLT) were recorded. After extensive screening, patients were treated with AMP. Validated questionnaires were administered including International Index of Erectile Function, quantitative Androgen Deficiency in the Aging Male and Adult ADHD Self-Report Scale. OLT change, adverse effects, and patient satisfaction were assessed. Baseline characteristics were compared using chi-squared test. OLT changes were compared with one-way ANOVA. Multivariable logistic regression was performed to identify predictors of treatment success. P < 0.05 was statistically significant.
RESULTS
Seventeen men received AMP - 6 of 17 (35.3%) for AO and 11 of 17 (64.7%) for DO, with median follow-up 1.0 year (interquartile range [IQR] 1.0 year). Amongst responders, AMP improved subjective experience of sex in 8 of 17 (47.1%) patients (2/6 with AO). Of those, 6 of 17 (35.3%; 1/6 with AO) experienced reduced OLT or increased frequency of orgasm. Non-responders were older than responders, with median age 69.5 (IQR 4.3) vs 61.0 years (IQR 12.3; P = 0.024). There were no other significant differences in baseline characteristics among responders. Of note, 6 of 8 (75%) responders and 8 of 9 (88.9%) non-responders failed other treatment modalities prior to AMP. Among responders with DO and improved OLT, mean OLT decreased by 72.3% (40.7 to 11.1 minutes, P = 0.049) during intercourse. Minimal side effects were noted including insomnia and jitters, each in one patient respectively.
CONCLUSION
AMP as a treatment for AO/DO merits further investigation. Measurable improvements in OLT or frequency of orgasm occurred in more than a third of patients. Larger prospective multicenter studies with strict inclusion and exclusion criteria are warranted.
Topics: Aged; Amphetamine; Central Nervous System Stimulants; Ejaculation; Humans; Male; Middle Aged; Orgasm; Pilot Projects; Prospective Studies; Sleep Initiation and Maintenance Disorders; Time Factors
PubMed: 32360625
DOI: 10.1016/j.urology.2020.04.081 -
Sexual Medicine Reviews Apr 2021Female orgasmic disorder (FOD) is defined as the absence, delay, infrequency, or marked diminishment in intensity of orgasm in at least 75% of sexual experiences,... (Review)
Review
INTRODUCTION
Female orgasmic disorder (FOD) is defined as the absence, delay, infrequency, or marked diminishment in intensity of orgasm in at least 75% of sexual experiences, persisting for at least 6 months and causing distress, has specified subtypes, and affects up to 28% of women in the United States and up to 46% in countries across Asia. Orgasmic difficulties are relatively common and create distress for a substantial number of women, though efficacious treatments exist.
OBJECTIVE
This article provides a review of psychological treatment of FOD.
METHODS
A literature search was conducted using PsycINFO to identify research reporting methods and outcomes of psychological treatment of FOD in peer-reviewed journals and textbooks. Search terms were female orgasmic disorder, anorgasmia, female sexual dysfunction, and orgasm. This search was supplemented with hand-searching references of review articles and journal articles.
RESULTS
Psychological treatment has been shown to be effective in helping women with FOD to gain or regain the ability to have orgasms, with higher success rates overall of treating lifelong or generalized vs acquired or situational FOD. Of the variety of treatment approaches that have been tested, the most consistent support emerges for directed masturbation, sensate focus, and psychotherapy. Approaches with little evidence for efficacy as a primary mode of treatment include systematic desensitization, bibliotherapy, and coital alignment technique training.
CONCLUSION
While existing research provides a solid foundation of knowledge, treatment of FOD has seen little innovation since the 1980s. Future research should aim for broader understanding of etiologies of all types of FOD, understanding reasons for lack of treatment success for women who have not improved with treatment, and identifying ways of tailoring FOD treatment and success rates for multicultural and community populations. Erica Marchand. Psychological and Behavioral Treatment of Female Orgasmic Disorder. Sex Med Rev 2021;9:194-211.
Topics: Coitus; Female; Humans; Masturbation; Orgasm; Sexual Behavior; Sexual Dysfunctions, Psychological; United States
PubMed: 33069622
DOI: 10.1016/j.sxmr.2020.07.007 -
World Journal of Diabetes Jul 2021Diabetes mellitus (DM) is a metabolic disorder that is characterized by elevated blood glucose levels due to absolute or relative insulin deficiency, in the background... (Review)
Review
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.
PubMed: 34326948
DOI: 10.4239/wjd.v12.i7.954 -
The Urologic Clinics of North America Nov 2021Premature ejaculation (PE) and delayed/inhibited ejaculation (DE) are 2 ejaculatory problems that may negatively affect the sexual relationship and cause distress.... (Review)
Review
Premature ejaculation (PE) and delayed/inhibited ejaculation (DE) are 2 ejaculatory problems that may negatively affect the sexual relationship and cause distress. Although no specific cause explains these problems when they have been lifelong conditions, understanding both biological and psychological factors may be relevant to treatment choices, with options ranging from pharmacologic to psychobehavioral. Integrating treatment modalities may lead to better outcomes but may also require greater psychological and resource investment from the patient or couple.
Topics: Humans; Male; Orgasm; Premature Ejaculation
PubMed: 34602177
DOI: 10.1016/j.ucl.2021.06.012