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Acta Clinica Croatica Mar 2018The aim of the review is to establish sexual and reproductive functions in men with spinal cord lesion (SCL). Many sexual and reproductive dysfunctions may be found in... (Review)
Review
The aim of the review is to establish sexual and reproductive functions in men with spinal cord lesion (SCL). Many sexual and reproductive dysfunctions may be found in these patients including individual's low self-esteem, delay of orgasm, erectile or ejaculatory disorder and abnormalities of semen, which are characterized by lower sperm motility or viability. Owing to improvements in physical medicine and rehabilitation, the focus has been shifted from keeping patients alive towards ensuring the quality of life and improvements of sexual dysfunctions and later reproduction. Erectile dysfunction can be treated by using phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be retrieved from anejaculatory patients by medically assisted methods utilizing penile vibratory stimulation, electroejaculation, prostate mas-sage, or surgically. Although there is low chance for pregnancy in natural way in most of SCL pa-tients, fatherhood is possible through the introduction of assisted medical management. By use of various medical, technical and surgical procedures for sperm retrieval combined with assisted reproductive methods, high pregnancy rates have been reported comparable to those in able-bodied subfertile patients. Nevertheless, future studies are needed to improve semen quality and methods of assisted ejaculation in patients with SCL.
Topics: Female; Humans; Infertility, Male; Male; Pregnancy; Quality of Life; Semen Analysis; Sperm Motility; Spinal Cord Injuries
PubMed: 30256024
DOI: 10.20471/acc.2018.57.01.19 -
Sexual Medicine Reviews Jan 2019Individually, thyroid disease and sexual dysfunction are common conditions that can have a detrimental effect on quality of life. Recent reports have documented an... (Review)
Review
BACKGROUND
Individually, thyroid disease and sexual dysfunction are common conditions that can have a detrimental effect on quality of life. Recent reports have documented an increased prevalence of sexual dysfunction among patients with thyroid disorders. As such, it is important for sexual medicine physicians to be primed on the presentation of patients with overlying sexual and thyroid dysfunction to allow for proper management.
AIM
To review the available literature exploring the relationship between thyroid disease and sexual dysfunction in men and women.
METHODS
A PubMed review of existing clinical and pre-clinical studies from 1978 through 2018 was performed.
MAIN OUTCOME MEASURES
The prevalence, symptomatology, pathophysiology, diagnosis and management of patients with sexual dysfunction in the setting of thyroid disease were reviewed.
RESULTS
The prevalence of sexual dysfunction in patients with hypothyroid (59-63% and 22-46% in men and women, respectively) and hyperthyroidism (48-77% and 44-60% in men and women, respectively) has been estimated in select populations. Both hypothyroidism and hyperthyroidism were strongly associated with erectile and ejaculatory dysfunction: hypothyroidism with delayed ejaculation, hyperthyroidism with pre-mature ejaculation. Hypothyroidism and hyperthyroidism have been reported to impair libido in men and women; however, evidence of hypothyroidism's impact on male libido is mixed. Hypothyroid and hyperthyroid women demonstrated impairments in desire, arousal/lubrication, orgasm, satisfaction, and pain during intercourse. Mechanistically, hypothyroidism and hyperthyroidism exert effects on circulating sex hormone levels through peripheral and central pathways and can indirectly provoke psychiatric and autonomic dysregulation that can impair sexual function. Correction to euthyroid state was associated with dramatic resolution of sexual dysfunction in both male and female patients with hypothyroidism or hyperthyroidism.
CONCLUSION
By improving awareness of the link between thyroid disease and sexual dysfunction, sexual medicine physicians may sooner identify patients whose sexual symptoms may be remedied by treating an underlying thyroid disorder. Gabrielson AT, Sartor RA, Hellstrom WJG. The Impact of Thyroid Disease on Sexual Dysfunction in Men and Women. Sex Med Rev 2019;7:57-70.
Topics: Female; Humans; Libido; Male; Prevalence; Quality of Life; Sexual Dysfunction, Physiological; Sexual Health; Thyroid Diseases; Thyroid Function Tests; Thyroid Hormones
PubMed: 30057137
DOI: 10.1016/j.sxmr.2018.05.002 -
Urologia Dec 2017Premature ejaculation (PE) is a common complaint of male sexual dysfunction affecting men and their partners and consequently causing significant personal and... (Review)
Review
Premature ejaculation (PE) is a common complaint of male sexual dysfunction affecting men and their partners and consequently causing significant personal and interpersonal distress. Increased sensitivity of the glans penis and abnormalities of the afferent-efferent reflex pathway within the ejaculatory process are involved in the occurrence of PE. Drugs that either selectively reduce penile sensitization or modify the afferent-efferent reflex are well established therapeutic options for PE. Fortacin™ is the first topical treatment to be officially approved for the treatment of primary PE in adult men, and is mentioned as an experimental aerosol (as TEMPE) in the current European Association of Urology guidelines. It was approved for use in the European Union and launched in the United Kingdom in November 2016. Fortacin™ is a eutectic-like mixture of lidocaine 150 mg/mL and prilocaine 50 mg/mL that meets the requirements of an ideal treatment for PE because it is fast acting (within 5 minutes), has durable effects, can be easily used "on-demand", and shows minimal side-effects. The metered-dose spray delivery system allows the desensitizing agents to be deposited in a dose-controlled, concentrated film onto the glans penis consequently reducing its sensitivity. This is translated into a delaying of the ejaculatory latency time without adversely affecting the sensation of ejaculation and orgasmic pleasure. The efficacy and safety of Fortacin™ have been proven by means of increased ejaculatory latency, control, and sexual satisfaction in large scale studies demonstrating the significant benefits for both patients and their partners.
Topics: Anesthetics, Local; Humans; Lidocaine, Prilocaine Drug Combination; Premature Ejaculation; Treatment Outcome
PubMed: 30047847
DOI: 10.5301/uj.5000275 -
Psychiatry Journal 2018This study aimed to evaluate the relationship between sleep quality and sexual function among Iranian women.
PURPOSE
This study aimed to evaluate the relationship between sleep quality and sexual function among Iranian women.
METHODS
This study was conducted on 277 married women of reproductive age. The inclusion criteria were as follows: married women aged 18-45 years, with at least basic literacy, and women married monogamously for at least one year. The following tools were used for gathering data: a demographic questionnaire; Pittsburgh Sleep Quality Index (PSQI); Insomnia Severity Index (ISI); Epworth Sleepiness Scale (ESS); and Female Sexual Function Index (FSFI). Pearson correlation coefficients, independent -tests, chi-square tests, and linear regression analyses were used to analyze the data.
RESULTS
There was a significant inverse relation between poor sleep quality ( = -0.13, = 0.02), daytime sleepiness ( = -0.39, < 0.001), insomnia ( = -0.35, < 0.001), and sexual function. Sexual desire was significantly related to sleep quality and insomnia ( < 0.001). Sexual arousal ( = -0.18, = -0.29, < 0.001), lubrication ( = -0.21, = -0.3, -0.12, < 0.001), orgasms ( = 0.17, = -0.15, < 0.001), and sexual satisfaction ( = -0.02, - = 0.3, = -0.15, < 0.001) were significantly related to all types of sleep disorders (poor sleep quality, insomnia, and sleepiness). Pain during intercourse was significantly associated with poor sleep quality and insomnia. With each unit decrease in sleep quality, sexual function decreased by 0.49 ( < 0.001), and with each unit increase in the delay of sleep onset, sexual function decreased by 1.58 ( = 0.04).
CONCLUSION
Results of this study showed that there was a significant relationship between sleep quality and sexual function in Iranian women of reproductive age. The quality of sleep among reproductive-aged women merits the attention of health care providers and policy makers.
PubMed: 29850469
DOI: 10.1155/2018/1045738 -
Maturitas Jun 2018Testosterone (T) is deeply involved in every step of the male sexual response. However, the occurrence of sexual disorders cannot be automatically related to a decline... (Review)
Review
Testosterone (T) is deeply involved in every step of the male sexual response. However, the occurrence of sexual disorders cannot be automatically related to a decline in T levels. In fact, this relationship is complicated by organic, relational and psychological factors, which can independently impair sexual function. For example, it is recognized that erectile dysfunction (ED) can result from vascular damage as well as from low levels of T. T therapy (TTh) can improve sexual function but meta-analyses show that it improves erectile function only in men with ED and overt hypogonadism. Similarly, impaired sexual desire can result from a wide range of organic, relational and psychological factors, although it is recognized as one of the most specific symptoms of hypogonadism. Accordingly, low desire is improved by TTh in men with overt hypogonadism. The association between low T levels and delayed ejaculation has not been well studied and needs further confirmation, as does the role of TTh in such cases. Meta-analyses have found that TTh can improve orgasmic function in hypogonadal men. Clinicians should bear in mind that sexual dysfunctions have multifactorial causes and hypogonadism represents only one of these. Only hypogonadal men are likely to improve their sexual symptoms when treated with TTh. The assessment of serum T levels is mandatory before patients are prescribed TTh, as are the assessment and possible treatment of other concomitant conditions.
Topics: Erectile Dysfunction; Humans; Hypogonadism; Libido; Male; Sexual Behavior; Testosterone
PubMed: 29704917
DOI: 10.1016/j.maturitas.2018.04.004 -
CJEM Jan 2019Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is...
Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.
Topics: Adult; Emergency Service, Hospital; Exercise Therapy; Humans; Male; Penile Erection; Priapism
PubMed: 29547365
DOI: 10.1017/cem.2018.3 -
Sexual Medicine Reviews Jul 2018Ejaculation consists of the emission of semen from seminal vesicles and prostate, followed by expulsion. Ejaculatory dysfunction may take several forms including... (Review)
Review
BACKGROUND
Ejaculation consists of the emission of semen from seminal vesicles and prostate, followed by expulsion. Ejaculatory dysfunction may take several forms including premature ejaculation, delayed or anejaculation, retrograde ejaculation, and painful ejaculation. Ejaculation is what we can see whereas orgasm is what we feel. The presence of ejaculate does not indicate the ability to experience orgasm. Hence, for the purpose of this work we consider orgasm and ejaculation as 2 separate neurobiological phenomena.
AIM
To review the role of advanced investigative techniques such as perineal ultrasound in the diagnosis and management of ejaculation and ejaculatory dysfunction.
METHODS
We performed a PubMed search for key words individually and in combination: "ejaculation," "ejaculatory dysfunction," "delayed ejaculation," "painful ejaculation," "retrograde ejaculation," "perineal ultrasound," and "transrectal ultrasound." We also share our local experience using perineal ultrasound in assessing ejaculation.
OUTCOMES
Perineal ultrasound can be used as an aid in the investigation of ejaculatory dysfunction.
RESULTS
Evaluation of ejaculatory function hinges on a detailed psychosexual history and appropriate physical examination. Function of the ejaculatory center in the spine is androgen dependent; thus, hormonal evaluation is an important aspect of the workup. Disorders of ejaculation and orgasm require evaluation of neuromuscular reflexes activated during sexual activity. Dynamic ultrasonographic (US) ejaculatory-orgasmic studies allow for reproducible and detailed descriptions of the sexual response. Transrectal ejaculatory studies are useful in uncovering reasons for lack of antegrade semen emission, especially in men with poor sperm production or after vasectomy. Dynamic US studies contribute clinical utility in its non-invasive nature and can provide insight to the dynamic processes surrounding pelvic floor functioning in men.
CONCLUSIONS
Perineal US for men with delayed ejaculation or anejaculation, painful ejaculation, or retrograde ejaculation may be helpful in select cases. Further research using this modality may help advance our understanding of ejaculatory dysfunction. Forbes CM, Flannigan R, Paduch DA. Perineal Ultrasound: a Review in the Context of Ejaculatory Dysfunction. Sex Med Rev 2018;6:419-428.
Topics: Adult; Aged; Ejaculation; Humans; Male; Middle Aged; Perineum; Premature Ejaculation; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Ultrasonography
PubMed: 29463441
DOI: 10.1016/j.sxmr.2017.12.005 -
World Psychiatry : Official Journal of... Feb 2018Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual...
Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.
PubMed: 29352532
DOI: 10.1002/wps.20509 -
Sexual Medicine Reviews Apr 2018Priapism is defined as a full or partial erection lasting longer than 4 hours after sexual stimulation and orgasm or unrelated to sexual stimulation. The main goal of... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Priapism is defined as a full or partial erection lasting longer than 4 hours after sexual stimulation and orgasm or unrelated to sexual stimulation. The main goal of priapism management is to resolve the episode immediately to preserve erectile function and penile length. Corporal smooth muscle necrosis is likely to have already occurred, and medically refractory erectile dysfunction is expected in patients with a protracted episode. Penile prosthesis implantation (PPI) in the early or late phase of priapism can restore erectile function.
AIM
To review the literature on PPI in priapism.
METHODS
A PubMed search of all English-language articles published before 2017 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using the following search terms: penile prosthesis implantation, priapism, and corporal fibrosis. All publications reporting on PPI during or after priapism episodes were included for review.
MAIN OUTCOME MEASURES
Three types of priapism were reviewed for management using PPI. Surgical techniques, outcomes, and patient satisfaction were reported.
RESULTS
Early implantation (during the episode) is technically easier and has lower complication rates compared with delayed (electively, after the erectile dysfunction is observed) surgery. Immediate PPI also allows preservation of penile length, which is related to higher satisfaction rates.
CONCLUSIONS
The paradigm is shifting toward immediate PPI in the management of ischemic priapism. Patients with non-ischemic priapism or recurrent priapism, even without a major ischemic episode, are at high risk for erectile dysfunction and are candidates for PPI. Yücel ÖB, Pazır Y, Kadıoğlu A. Penile Prosthesis Implantation in Priapism. Sex Med Rev 2018;6:310-318.
Topics: Adult; Aged; Erectile Dysfunction; Fibrosis; Humans; Male; Middle Aged; Penile Implantation; Penile Prosthesis; Priapism; Young Adult
PubMed: 28916463
DOI: 10.1016/j.sxmr.2017.08.002 -
The Journal of Sexual Medicine Sep 2017Although delayed ejaculation (DE) is typically characterized as a persistently longer than anticipated or desired time to ejaculation (or orgasm) during sexual activity,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Although delayed ejaculation (DE) is typically characterized as a persistently longer than anticipated or desired time to ejaculation (or orgasm) during sexual activity, a timing-based definition of DE and its association with serum testosterone has not been established in a large cohort.
AIM
To examine in an observational study estimated intravaginal ejaculatory latency time (IELT) and masturbatory ejaculation latency time (MELT) in men self-reporting DE, assess the association of IELT and MELT with serum testosterone levels, and determine whether correlation with demographic and sexual parameters exist.
METHODS
Men who resided in the United States, Canada, and Mexico were enrolled from 2011 to 2013. Self-estimated IELT and MELT were captured using an Ejaculatory Function Screening Questionnaire in a sample of 988 men screened for possible inclusion in a randomized clinical trial assessing testosterone replacement therapy for ejaculatory dysfunction (EjD) and who self-reported the presence or absence of DE and symptoms of hypogonadism. Additional comorbid EjDs (ie, anejaculation, perceived decrease in ejaculate volume, and decreased force of ejaculation) were recorded. Men with premature ejaculation were excluded from this analysis. IELT and MELT were compared between men self-reporting DE and men without DE. The associations of IELT and MELT with serum testosterone were measured.
OUTCOMES
IELT, MELT, and total testosterone levels.
RESULTS
Sixty-two percent of screened men self-reported DE with or without comorbid EjDs; 38% did not report DE but did report at least one of the other EjDs. Estimated median IELTs were 20.0 minutes for DE vs 15 minutes for no DE (P < .001). Estimated median MELTs were 15.0 minutes for DE vs 8.0 minutes for no DE (P < .001). Ejaculation time was not associated with serum testosterone levels. Younger men and those with less severe erectile dysfunction had longer IELTs and MELTs.
CLINICAL IMPLICATIONS
Estimated ejaculation times during vaginal intercourse and/or masturbation were not associated with serum testosterone levels in this study; thus, routine androgen evaluation is not indicated in these men.
STRENGTHS AND LIMITATIONS
This large systematic analysis attempted to objectively assess the ejaculation latency in men with self-reported DE. Limitations were that ejaculation time estimates were self-reported and were queried only once; the questionnaire did not distinguish between failure to achieve orgasm and ejaculation; and assessment of DE was limited to heterosexual vaginal intercourse and masturbation.
CONCLUSION
IELT and MELT were longer in men with DE, and there was no association of ejaculation times with serum testosterone levels in this study population. Morgentaler A, Polzer P, Althof S, et al. Delayed Ejaculation and Associated Complaints: Relationship to Ejaculation Times and Serum Testosterone Levels. J Sex Med 2017;14:1116-1124.
Topics: Adult; Canada; Erectile Dysfunction; Hormone Replacement Therapy; Humans; Male; Mexico; Middle Aged; Orgasm; Penile Erection; Self Report; Surveys and Questionnaires; Testosterone; Time Factors
PubMed: 28807505
DOI: 10.1016/j.jsxm.2017.06.013