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Frontiers in Pharmacology 2022Selective serotonin reuptake inhibitors (SSRIs) are widely used for a variety of diseases, and their impact on semen quality is unclear. We performed a systematic search...
Selective serotonin reuptake inhibitors (SSRIs) are widely used for a variety of diseases, and their impact on semen quality is unclear. We performed a systematic search in PubMed and Embase, and after a strict screening, we included 4 studies with a total of 222 male participants. In result, SSRIs reduced normal sperm morphology (95% CI [-16.29, -3.77], = 0.002), sperm concentration (95%CI [-43.88, -4.18], = 0.02), sperm motility (95%CI [-23.46, -0.47], = 0.04) and sperm DNA fragmentation index (DFI) (95% CI [6.66,21.93], = 0.0002), without a statistically significant effect on semen volume (95%CI [-0.75,0.65], = 0.89). Moreover, the impact on both sperm morphology and sperm concentration were observed within the 3-month period of SSRIs use. In general, our meta-analysis showed that SSRIs have a negative effect on semen quality. More larger, randomized, well-controlled clinical studies should be conducted to support our conclusion.
PubMed: 36188547
DOI: 10.3389/fphar.2022.911489 -
The Cochrane Database of Systematic... May 2020Sexual dysfunction following stroke is common but often is poorly managed. As awareness of sexual dysfunction following stroke increases as an important issue, a clearer...
BACKGROUND
Sexual dysfunction following stroke is common but often is poorly managed. As awareness of sexual dysfunction following stroke increases as an important issue, a clearer evidence base for interventions for sexual dysfunction is needed to optimise management.
OBJECTIVES
To evaluate the effectiveness of interventions to reduce sexual dysfunction following stroke, and to assess adverse events associated with interventions for sexual dysfunction following stroke.
SEARCH METHODS
We conducted the search on 27 November 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; from June 2014), in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that compared pharmacological treatments, mechanical devices, or complementary medicine interventions versus placebo. We also included other non-pharmacological interventions (such as education or therapy), which were compared against usual care or different forms of intervention (such as different intensities) for treating sexual dysfunction in stroke survivors.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected eligible studies, extracted data, and assessed study quality. We determined the risk of bias for each study and performed a 'best evidence' synthesis using the GRADE approach.
MAIN RESULTS
We identified three RCTs with a total of 212 participants. We noted significant heterogeneity in interventions (one pharmacological, one physiotherapy-based, and one psycho-educational), and all RCTs were small and of 'low' or 'very low' quality. Based on these RCTs, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the use of sertraline, specific pelvic floor muscle training, or individualised sexual rehabilitation.
AUTHORS' CONCLUSIONS
Use of sertraline to treat premature ejaculation needs to be tested in further RCTs. The lack of benefit with structured sexual rehabilitation and pelvic floor physiotherapy should not be interpreted as proof of ineffectiveness. Well-designed, randomised, double-blinded, placebo-controlled trials of long-term duration are needed to determine the effectiveness of various types of interventions for sexual dysfunction. It should be noted, however, that it may not be possible to double-blind trials of complex interventions.
Topics: Adult; Aged; Aged, 80 and over; Antidepressive Agents; Female; Humans; Male; Middle Aged; Orgasm; Pelvic Floor; Premature Ejaculation; Quality of Life; Randomized Controlled Trials as Topic; Resistance Training; Sertraline; Sex Education; Sexual Dysfunction, Physiological; Sexual Partners; Stroke; Vitamin B 12; Vitamin B Complex; Young Adult
PubMed: 32356377
DOI: 10.1002/14651858.CD011189.pub2 -
Asian Journal of Andrology Sep 2013This meta-analysis was performed to assess sexual functions following adult male circumcision. We searched the Cochrane Central Register of Controlled Trials, PUBMED,... (Meta-Analysis)
Meta-Analysis Review
This meta-analysis was performed to assess sexual functions following adult male circumcision. We searched the Cochrane Central Register of Controlled Trials, PUBMED, EMBASE, the Cochrane Database of Systematic Review and Web of Science from their inception until January 2013 to identify all eligible studies that reported on men's sexual function after circumcision. The Cochrane Collaboration's RevMan 5.2 software was employed for data analysis, and the fixed or the random effect model was selected depending on the proportion of heterogeneity. We identified 10 studies, which described a total of 9317 circumcised and 9423 uncircumcised men who were evaluated for the association of circumcision with male sexual function. There were no significant differences in sexual desire (odds ratio (OR): 0.99; 95% confidence interval (CI): 0.92-1.06), dyspareunia (OR: 1.12; 95% CI: 0.52-2.44), premature ejaculation (OR: 1.13; 95% CI: 0.83-1.54), ejaculation latency time (OR: 1.33; 95% CI: 0.69-1.97), erectile dysfunctions (OR: 0.90; 95% CI: 0.65-1.25) and orgasm difficulties (OR: 0.97; 95% CI: 0.83-1.13). These findings suggest that circumcision is unlikely to adversely affect male sexual functions. However, these results should be evaluated in light of the low quality of the existing evidence and the significant heterogeneity across the various studies. Well-designed and prospective studies are required for a further understanding of this topic.
Topics: Adolescent; Adult; Case-Control Studies; Circumcision, Male; Coitus; Cross-Sectional Studies; Dyspareunia; Ejaculation; Erectile Dysfunction; Humans; Libido; Male; Middle Aged; Premature Ejaculation
PubMed: 23749001
DOI: 10.1038/aja.2013.47 -
International Journal of Clinical... Oct 2021To demonstrate evidence from available clinical studies to clarify the scientific points that have been achieved in relation to thyroid disorders and ejaculatory... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To demonstrate evidence from available clinical studies to clarify the scientific points that have been achieved in relation to thyroid disorders and ejaculatory dysfunction (EjD).
DATA SOURCES
Clinical trial articles published in English on Medline.
ELIGIBILITY CRITERIA
Clinical studies that investigated the association of thyroid disorders with the ejaculatory function of subjects and the trials evaluating the effect of thyroid dysfunction treatment on the ejaculatory function of the subjects were eligible.
SYNTHESIS METHODS
We searched Medline with "ejaculation" and different combinations of "thyroid," "serum TSH," "serum T3," "serum T4" keywords in PubMed.
RESULTS
Standardised mean serum thyroid-stimulating hormone (TSH) levels in premature ejaculation (PE) sufferers differed from non-PE control subjects (P = .05). Hyperthyroidism was associated with increased odds among PE subjects (OR = 2.0, P = .03). Delayed ejaculation was seen with increased odds in hypothyroid patients compared with hyperthyroidism patients (OR = 57, P = .0001). Serum TSH and mean intra-vaginal ejaculation latency time (IELT) of the subjects showed a correlation both before and after treatment for thyroid disorder. Treatment of thyroid disorders improved the mean IELT measures of the subjects. The overall estimate of the effect of hyperthyroidism treatment on mean IELT was .64 (P = .0001) in the random-effects model.
LIMITATIONS
The low quality and quantity of evidence from available studies limited the interpretation of our study findings.
CONCLUSIONS
The causal relationship between EjD and thyroid disorders remains to be clarified. Sufferers of delayed ejaculation acquired PE subjects, and PE sufferers who have accompanying erectile dysfunction and/or anxiety may benefit from thyroid disorder investigation.
Topics: Ejaculation; Erectile Dysfunction; Humans; Hyperthyroidism; Male; Premature Ejaculation
PubMed: 34047440
DOI: 10.1111/ijcp.14419 -
Sexual Medicine Dec 2021The counterfeit phenomenon is a largely under-reported issue, with potentially large burden for healthcare. The market for counterfeit drugs used in sexual medicine,... (Review)
Review
INTRODUCTION
The counterfeit phenomenon is a largely under-reported issue, with potentially large burden for healthcare. The market for counterfeit drugs used in sexual medicine, most notably type 5 phosphodiesterase inhibitors (PDE5i), is rapidly growing.
AIMS
To report the health risks associated with the use of counterfeit medications, the reasons driving their use, and the strategies enacted to contain this phenomenon.
METHODS
A systematic scoping review of the literature regarding counterfeit PDE5i was carried between January and June 2021, then updated in August 2021.
MAIN OUTCOME MEASURE
We primarily aimed to clarify the main drivers for counterfeit PDE5i use, the health risks associated, and the currently available strategies to fight counterfeiters.
RESULTS
One hundred thirty-one records were considered for the present scoping review. Production of fake PDE5i is highly lucrative and the lacking awareness of the potential health risks makes it a largely exploitable market by counterfeiters. Adulteration with other drugs, microbial contamination and unreliable dosages make counterfeit medications a cause of worry also outside of the sexual medicine scope. Several laboratory techniques have been devised to identify and quantify the presence of other compounds in counterfeit medications. Strategies aimed at improving awareness, providing antitampering packaging and producing non-falsifiable products, such as the orodispersible formulations, are also described.
CLINICAL IMPLICATIONS
Improving our understanding of the PDE5i counterfeit phenomenon can be helpful to promote awareness of this issue and to improve patient care.
STRENGTHS & LIMITATIONS
Despite the systematic approach, few clinical studies were retrieved, and data concerning the prevalence of counterfeit PDE5i use is not available on a global scale.
CONCLUSION
The counterfeit phenomenon is a steadily growing issue, with PDE5i being the most counterfeited medication with potentially large harmful effects on unaware consumers. Sansone A, Cuzin B, and Jannini EA. Facing Counterfeit Medications in Sexual Medicine. A Systematic Scoping Review on Social Strategies and Technological Solutions. Sex Med 2021;9:100437.
PubMed: 34619517
DOI: 10.1016/j.esxm.2021.100437 -
BMC Urology May 2016To evaluate the efficacy and safety of silodosin as a medical expulsive therapy for ureteral stones by means of a systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To evaluate the efficacy and safety of silodosin as a medical expulsive therapy for ureteral stones by means of a systematic review and meta-analysis.
METHODS
We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register to identify randomized controlled trials (RCTs) of silodosin in the treatment of ureteral stones. The reference lists of retrieved studies were also investigated.
RESULTS
Six RCTs, including 916 participants and comparing silodosin with controls, were used in the meta-analysis. Silodosin was superior to controls in terms of stone expulsion rate, the primary efficacy end point in all six RCTs (odds ratio [OR] for expulsion 2.16, 95 % confidence interval [CI] 1.62 to 2.86, p <0.00001). Silodosin was also more effective for secondary efficacy end points; the stone expulsion time (standardized mean difference [SMD] -3.66, 95 % CI -6.61 to -0.71; p =0.01) and analgesic requirements (SMD -0.89, 95 % CI -1.19 to -0.60; p < 0.00001) were significantly reduced compared with those of controls. Other than the incidence of abnormal ejaculation, which was higher in the silodosin groups (OR 2.84, 95 % CI 1.56 to 5.16, p =0.0006), few adverse effects were observed.
CONCLUSION
This meta-analysis indicates silodosin is an effective and safe treatment option for ureteral stones with a low occurrence of side effects.
Topics: Drug-Related Side Effects and Adverse Reactions; Female; Humans; Indoles; Male; Premature Ejaculation; Prevalence; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome; Ureterolithiasis; Urological Agents
PubMed: 27233621
DOI: 10.1186/s12894-016-0141-y -
The Journal of Sexual Medicine Jan 2021The field of study addressing the relationship between FSD and male sexual dysfunction (MSD) represents a pivotal worldwide health issue as interrelationship between FSD... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The field of study addressing the relationship between FSD and male sexual dysfunction (MSD) represents a pivotal worldwide health issue as interrelationship between FSD and MSD studies are still inconclusive.
AIM
To review the interrelationship between FSD and MSD and to conclude whether there is a definitive risk of men developing sexual dysfunction when his partner is suffering from FSD.
METHODS
The investigation was conducted following the standard practice for conducting and reporting the findings of systematic reviews and meta-analyses comprising of 4 electronic databases, that is, Embase, PsycInfo, Cochrane Library and Ovid (Medline) from inception to December 2019. Search strategies were developed based on relevant keywords with appropriate truncation and Boolean operators' approach. The quality of studies was employed using the McMaster Critical Review Form for Quantitative Studies and were assessed by independent reviewers. The levels of evidence of the included studies were also determined.
OUTCOMES
MSD who had been exposed to FSD.
RESULTS
From more than 8,000 studies searched, 26 studies were finally included, and most included studies have reasonable quality. Meta-analysis found a significant sexual dysfunction in men who are partnered with women with FSD. It found a consistent correlation between FDS and sexual dysfunction in men with a significant 3-fold increase in MSD who are partnered with women with FSD (odds ratio = 3.011, 95% confidence interval: 1.856-4.885, P = <.001, I² = 42.26%). Among subtypes of MSD, likelihood increased 4-fold for erectile dysfunction and that of premature ejaculation doubled. The data for several other domains on their components were mixed.
CLINICAL TRANSLATION
These findings support the notion that clinicians should evaluate sexual function pertaining to both partners and encompassing several dimensions and needing an interdisciplinary approach.
STRENGTH & LIMITATIONS
This review exhaustively examines data search from vast electronic databases and as the comparison of studies is extracted from English journal publications, not all regions worldwide are represented.
CONCLUSION
This meta-analysis and systematic review found an association between sexual dysfunction in men partnered with women with FSD, especially in the domains of erectile and ejaculatory function. Chew PY, Choy CL, Sidi Hb,et al. The Association Between Female Sexual Dysfunction and Sexual Dysfunction intheMale Partner: A Systematic Review and Meta-analysis. J Sex Med 2021;18:99-112.
Topics: Ejaculation; Erectile Dysfunction; Female; Humans; Male; Premature Ejaculation; Sexual Partners
PubMed: 33303390
DOI: 10.1016/j.jsxm.2020.10.001 -
Expert Opinion on Investigational Drugs Jul 2018The prevalence of sexual dysfunctions has increased over the last decades; despite a number of available treatments for erectile dysfunction (ED), premature ejaculation... (Review)
Review
INTRODUCTION
The prevalence of sexual dysfunctions has increased over the last decades; despite a number of available treatments for erectile dysfunction (ED), premature ejaculation (PE), and Peyronie's disease (PD), still several unmet therapeutic needs deserve to be fulfilled. The aim of this review is to detail on phase I and II clinical trials investigating novel medical treatments for ED, PE, and PD.
AREAS COVERED
We conducted a systematic review of the literature including both published and ongoing phase I and II registered trials focused on medical treatment of ED, PE, and PD during the last 5 years. A total of 35 trials have been identified. Most studies (63%) investigated ED treatments and 26% were still ongoing. Stem cells (SCs) therapy was assessed in 28% of trials.
EXPERT OPINION
SCs therapy represent a promising treatment for ED although only few patients have been treated to date. Likewise, the oral selective oxytocin receptor antagonists for treating PE showed excellent safety profile and deserve further investigations in phase III trials. Preliminary results of novel topical treatments for PD with fibrinolytic and antiinflammatory drugs are encouraging, but urgently need to be confirmed in large placebo-controlled trials.
Topics: Animals; Clinical Trials, Phase I as Topic; Clinical Trials, Phase II as Topic; Drug Design; Erectile Dysfunction; Humans; Male; Penile Induration; Premature Ejaculation; Prevalence; Stem Cell Transplantation
PubMed: 29969332
DOI: 10.1080/13543784.2018.1495707 -
International Journal of STD & AIDS Oct 2005Premature ejaculation is a common sexual problem which presents to genitourinary (GU) medicine services. Five main treatment approaches have been used in clinical... (Review)
Review
Premature ejaculation is a common sexual problem which presents to genitourinary (GU) medicine services. Five main treatment approaches have been used in clinical trials: behavioural therapy, antidepressants, phosphodiesterase-5 (PDE5) inhibitors, topical anaesthetic agents and alpha-blockers. We have carried out a systematic review of published pharmacological trials. All antidepressants appeared to delay ejaculation to some extent at all doses. Anaesthetic creams appeared to be as successful in slowing ejaculation as antidepressants without systemic side-effects, although some patients did experience erectile problems or unpleasant local symptoms. Anecdotally, behavioural therapy is effective and appears to have long-lasting efficacy. There is a need for quality comparative trial of behavioural therapy, topical anaesthetic agents and antidepressants, including appropriate measures of relapse, follow-up and acceptability of continuing long-term treatment.
Topics: Adrenergic alpha-Antagonists; Antidepressive Agents, Tricyclic; Controlled Clinical Trials as Topic; Drugs, Chinese Herbal; Ejaculation; Erectile Dysfunction; Humans; Male
PubMed: 16212710
DOI: 10.1258/095646205774357299 -
The Journal of Sexual Medicine Dec 2012As yet, a summary of research evidence concerning the efficacy of psychological treatment in male sexual dysfunction is lacking. (Review)
Review
Efficacy of psychosocial interventions in men and women with sexual dysfunctions--a systematic review of controlled clinical trials: part 1-the efficacy of psychosocial interventions for male sexual dysfunction.
INTRODUCTION
As yet, a summary of research evidence concerning the efficacy of psychological treatment in male sexual dysfunction is lacking.
AIM
Our systematic review gives an overview of the efficacy of psychosocial interventions in all male sexual dysfunctions.
MAIN OUTCOME MEASURES
Main outcome measures included, for example, psychometrically validated scales, interviews, and clinical assessment by an independent rater. The efficacy of psychosocial interventions was measured, for example, by the frequency of and satisfaction with sexual activity and sexual functioning.
METHODS
The systematic literature search included electronic database search, handsearch, contact with experts, and an ancestry approach. Studies were included if the man was given a formal diagnosis of a sexual dysfunction (International Statistical Classification of Diseases and Related Health Problems [ICD10/-9]; Diagnostic and Statistical Manual of Mental Disorders [DSM-IV/-III-R]) and when the intervention was psychosocial or psychotherapeutic. The control group included either another treatment or a waiting-list control group. The report of relevant outcomes was necessary for inclusion as well as the design of the study (randomized controlled trials [RCTs] and controlled clinical trials [CCTs]). The assessment of methodological quality comprised aspects of randomization, blinding, incomplete outcome data, selective reporting, and allegiance.
RESULTS
We identified 19 RCTs and one CCT that investigated the efficacy in male sexual dysfunction and two further studies that examined male and female sexual dysfunction together. Twelve out of 20 trials in men used either a concept derived from Masters and Johnson or a cognitive-behavioral treatment program. Overall, psychosocial interventions improved sexual functioning. While one study found that psychotherapy is superior to sildenafil, another study found the opposite. In men with premature ejaculation, behavioral techniques proved to be effective. A shortcoming was the rather low methodological quality of included studies.
CONCLUSIONS
Most of the compared interventions proved to be similarly effective. Possibly, there are underlying constructs throughout all therapies that have an effect on the outcome.
Topics: Alprostadil; Counseling; Couples Therapy; Humans; Hypnosis; Injections; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Psychotherapy; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents; Yohimbine
PubMed: 23088533
DOI: 10.1111/j.1743-6109.2012.02970.x