Chapter
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Ejaculation is a complex event that involves the autonomic, somatic, and central nervous systems working together with physiologic coordination of muscular contractions. With such a complex array of intricate processes, many things can go awry. Delayed ejaculation (DE) is overall a very poorly understood ejaculatory disorder with low quality data in terms of incidence, pathology, diagnosis, and treatment. In this chapter, we summarize the proper assessment of DE patients and highlight not only the medical conditions contributing to the disorder but also the psychologic ailments. Treatment is outlined based on pathology and an algorithm will be presented for treatment of ejaculatory disorders. With appropriate treatment many of those afflicted will be able to find relief. Nonetheless, ongoing DE research is still needed.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... 8,9 DE can be lifelong or acquired; it presumably has physiological/somatic, pathophysiological, and/or psychological origins. 3,[10][11][12][13][14][15] Furthermore, a sizable percentage of men experiencing DE also report comorbid erectile dysfunction (ED). [8][9][10] Whatever the etiology and complicating factors, central to the concept of DE is men's self-reported difficulty reaching orgasm/ejaculation, contributing over 50% of the variation to its diagnosis. ...
... In instances involving acquired (secondary) DE, an etiology may become apparent through a medical or psychosexual history. 3,4,15 But for men having a lifelong condition of DE, etiological pathways remain largely hypothetical. Based on recent theoretical and empirical reports, several differentiating etiological risk factors have been proposed to explain men's difficulty reaching orgasm/ejaculation, including ones related to genetic/biological predispositions, 18,19 levels of distress/anxiety, 16,[20][21][22] relationship issues, 13,23 and insufficient arousal to reach ejaculation. ...
Article
Full-text available
Background Difficulty reaching orgasm/ejaculation during partnered sex, a primary characteristic of delayed or absent ejaculation, affects about 5% to 10% of men, but the reasons underlying this problem are poorly understood. Aim The study sought to gain insight into possible etiologies of delayed ejaculation by assessing men’s self-perceptions as to why they experience difficulty reaching orgasm. Methods We drew 351 men reporting moderately severe to severe difficulty reaching orgasm during partnered sex from a sample of over 3000 respondents obtained through an online survey. As part of the 55-item survey, participants responded to 2 questions asking about their self-perceived reasons for having difficulty reaching orgasm and selected from a list of 14 options derived from the research literature, a series of men’s focus groups, and expert opinion. The first question allowed respondents to select all the reasons that they felt contributed to the problem, the second to select only the most important reason. In addition, both men with and without comorbid erectile dysfunction were investigated and compared. Outcomes Hierarchical ordering of men’s self-pereceived reasons for having difficulty reaching orgasm, including typal reasons established through principal component analysis. Results The major reasons for difficulty were related to anxiety/distress and lack of adequate stimulation, with relationship and other factors endorsed with lower frequency. Further exploration using principal components analysis identified 5 typal reasons, in descending order of frequency: anxiety/distress (41%), inadequate stimulation (23%), low arousal (18%), medical issues (9%), and partner issues (8%). Few differences emerged between men with and without comorbid ED other than ones related to erectile problems, such as higher level of endorsement of medical issues. Typal reasons showed correlations, albeit mostly weak, with a number of covariates, including sexual relationship satisfaction, frequency of partnered sex, and frequency of masturbation. Clinical Implications Until supplemental medical treatments for delayed ejaculation are developed and approved, a number of men’s purported reasons for difficult or absent ejaculation/orgasm—anxiety/distress, inadequate stimulation, low arousal, relationship issues—fall into areas that can be addressed in couples counseling by a trained sex therapist. Strengths and Limitations This study is unique in scope and robust in sample size. Drawbacks include those associated with online surveys, including possible bias in sample selection, limitation to Western-based samples, and the lack of differentiation between men with lifelong and acquired difficulty. Conclusion Men who have difficulty reaching ejaculation/orgasm identify putative reasons for their problem, ranging from anxiety/stress, inadequate stimulation, and low arousal to partner issues and medical reasons.
... [3][4][5] More recent clinical and community samples have placed the prevalence substantially higher, by some estimates closer to 7% to 15% of men. [6][7][8] For example, one recent community sample reported that the percentage of men indicating a strong "desire to ejaculate sooner" during partnered sex was around 7% to 8%, 9 nearly identical to results from the National Health and Social Life Survey in the United States. 10 Others, however, note that in the absence of clear diagnostic criteria, the rate of DE may be underreported and therefore even higher. ...
Article
Background Little is known regarding the demographic, sexual, and relationship characteristics of men with symptoms of delayed ejaculation (DE). Aim To identify differences between men with and without DE symptomology to validate face-valid diagnostic criteria and to identify various functional correlates of DE. Methods A total of 2679 men meeting inclusion criteria were partitioned into groups with and without DE symptomology on the basis of their self-reported “difficulty reaching ejaculation/orgasm during partnered sex.” Men were then compared on a broad array of demographic and relationship variables, as well as sexual response variables assessed during partnered sex and masturbation. Outcomes Outcomes included the identified differences between men with and without DE symptomology. Results Men with DE—whether having comorbid erectile dysfunction or not—differed from men without DE on 5 face-valid variables related to previously proposed diagnostic criteria for DE, including ones related to ejaculation latency (P < .001); self-efficacy related to reaching ejaculation, as assessed by the percentage of episodes reaching ejaculation during partnered sex (P < .001); and negative consequences of the impairment, including “bother/distress” and (lack of) “orgasmic pleasure/sexual satisfaction” (P < .001). All such differences were associated with medium to large effect sizes. In addition, men showed differences on a number of functional correlates of DE, including anxiety, relationship satisfaction, frequency of partnered sex and masturbation, and level of symptomology during partnered sex vs masturbation (P < .001). Clinical Implications Face-valid criteria for the diagnosis of DE were statistically verified, and functional correlates of DE relevant to guiding and focusing treatment were identified. Strengths and Limitations In this first comprehensive analysis of its kind, we have demonstrated widespread differences on sexual and relationship variables relevant to the diagnosis of DE and to its functional correlates between men with and without DE symptomology during partnered sex. Limitations include participant recruitment through social media, which likely biased the sample; the use of estimated rather than clocked ejaculation latencies; and the fact that differences between men with acquired and lifelong DE were not investigated. Conclusion This well-powered multinational study provides strong empirical support for several face-valid measures for the diagnosis of DE, with a number of explanatory and control covariates that may help shed light on the lived experiences of men with DE and suggest focus areas for treatment. Whether or not the DE men had comorbid erectile dysfunction had little impact on the differences with men having normal ejaculatory functioning.
Article
Background Social platforms such as YouTube have become sources of information about diseases as they can be easily and rapidly accessed. However, this also has the risk of ill-intentioned content and misleading information. Objective To evaluate the reliability of YouTube video content about delayed ejaculation treatment. Material and methods YouTube videos were searched using the terms “delayed ejaculation,” “retarded ejaculation,” “inhibited ejaculation,” and “anejaculation.” Videos were excluded if they were not in English, were not related to the subject, or did not have audio and visual content. In accordance with the scientifically proven accurate information, the videos were separated as reliable (Group 2, n: 112) and unreliable videos (Group 1, n: 94). The groups were compared in respect of the video characteristics, and the scores obtained in the DISCERN-5, Global Quality Scale, the Patient Education Materials Assessment Tool Audiovisual, and the Journal of the American Medical Association scales. Intraclass correlation test was used to evaluate the level of agreement between the two investigators. Results Of the 1200 videos, 994 were excluded. No significant difference was determined between the Group 1 and Group 2 in respect of the median number of views [1672 (4555) vs 1547 (28,559), p = 0.63] and likes [10 (42) vs 17 (255), p = 0.07]. There was a greater number of videos in the Group 2 (54.4%) and the points obtained on the scoring scales were significantly higher than the Group 1 ( p < 0.001). The videos originating from universities/professional organizations/non-profit physician/physician group were comprised the majority of the reliable videos (55.3%) and the unreliable videos had more content related to treatment (71.4%) ( p < 0.001). Conclusion Although there was a greater number of reliable videos related to the problem of delayed ejaculation, the content could be misleading and should be avoided by patients seeking treatment without consulting a physician.
Article
Full-text available
The role of masturbation frequency and pornography use on sexual response during partnered sex has been controversial, the result of mixed and inconsistent findings. However, studies investigating this relationship have often suffered from methodological shortcomings. We investigated the role of masturbation frequency and pornography use on both the occurrence and severity of delayed/inhibited ejaculation (DE), an increasingly common sexual problem among men. We did so in a large (nonclinical) multinational sample of cisgender men (N = 2332; mean age = 40.3, SE = 0.31) within a multivariate context that relied on multiple (and, when possible, standardized) assessments of sexual dysfunctions while controlling for possible confounding variables. Results indicated a weak, inconsistent, and sometimes absent association between the frequency of pornography use and DE symptomology and/or severity. In contrast, both poorer erectile functioning and anxiety/depression represented consistent and strong predictors of DE and, to a lesser extent, DE severity. Other factors, including relationship satisfaction, sexual interest, and masturbation frequency, were significantly though moderately to weakly associated with DE. In conclusion, associations (or sometimes lack thereof) between masturbation frequency, pornography use, and delayed ejaculation are more clearly understood when analyzed in a multivariate context that controls for possible confounding effects.
Article
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.
Article
Full-text available
Delayed Ejaculation (DE) is probably the least studied and understood of the male sexual dysfunctions (MSD). There is still little unanimity concerning its psychological/interpersonal aetiology. Previous studies found that MSD are strongly related with alexithymia, a multifaceted personality construct that describes a disturbance in the regulation of emotions.The aim of this study was to investigate the presence of alexithymia in men with DE and correlate alexithymia levels with DE severity. According to specific features of the symptoms, we hypothesized that alexithymia would not be correlated with this specific sexual disorder. 54 outpatients with a diagnosis of DE assessed at the Institute of Clinical Sexology and the Urology Department of Sapienza, University in Rome were enrolled in the study. DE was diagnosed after a specialist examination and according to Diagnostic and Statistical Manual of Mental Disorders -IV-TR criteria. Participants were provided with the Toronto Alexithymia Scale (20 items; TAS-20), a self-measure of the Intravaginal Ejaculation Latency Time and an ad hoc questionnaire to collect anamnestic data. 9.3% of patients could be categorized as alexithymics, 9.3% of them as borderline, while 81.4% of the sample was found to be non-alexithymic. The overall average TAS-20 score was 45.46. Results show that alexithymia is correlated neither with the presence of DE nor with its severity, in contrast to other MSDs, where this condition was found in about 30% of patients. The data presented suggest that DE, although not correlated to alexithymia, is probably related to other psychogenic features such as hypercontrol configuration. This paper can contribute to the understanding of DE, by excluding one of the possible etiological factors, previously found to be important in the onset and the maintenance of the other MSDs. More studies are needed in order to better understand DE and provide recommendations about treatment.
Article
Full-text available
Introduction: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. Aim: The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method: A comprehensive literature review was performed. Results: This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion: Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years. Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG, Becher E, Dean J, Giuliano F, Hellstrom WJG, Giraldi A, Glina S, Incrocci L, Jannini E, McCabe M, Parish S, Rowland D, Segraves RT, Sharlip I, and Torres LO. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE). Sex Med 2014;2:60–90.
Article
Full-text available
Background: To retrospectively evaluate postoperative genital function, local recurrence rate and survival rate after total mesorectal excision (TME) combined with or without pelvic autonomic nerve preservation (PANP) in male patients with rectal cancer. Methods: A total of 953 male patients with rectal cancer after TME (518 patients received TME combined with PANP [PANP group] and 434patients received TME alone [TME group]) were included. Assessments of postoperative genital function, local recurrence rate, and 5 year survival rate were collected. Results: Rate of erection dysfunction in PANP group (41.9 %) was significantly lower than that in TME group (76.7 %, P < 0.05). Rate of ejaculation dysfunction in PANP group (42.5 %) was also significantly lower than that in TME group (67.3 %, P < 0.05). Local recurrence rate (P = 0.66) and survival rate (P = 0.26) did not differ between the two groups. For patients with preoperative obstruction, local recurrence rate was significantly higher (P = 0.01) and survival rate significantly lower (P = 0.03) in PANP group. Conclusions: PANP surgery has significant advantage with respect to preservation of genital function and should be recommended as surgical treatment for rectal cancer patients. However, PANP surgery should be considered with caution in patients with preoperative obstruction in view of the poorer long-term outcomes in these patients.
Article
Full-text available
Many of the prostatic cysts are asymptomatic and only 5% are symptomatic (Hamper et al., 1990; Higashi et al., 1990). These symptoms include pelvic pain, hematospermia, infertility, voiding dysfunction, prostatitis-like syndrome, and painful ejaculation. Treatment of prostatic cysts includes TRUSG guided drainage, endoscopic transurethral resection, and in some cases even open surgery. In the literature, endoscopic interventions use marsupialization of the midline prostatic cyst with transurethral resection (TUR) or transurethral incision with endoscopic urethrotomy (Dik et al., 1996; Terris, 1995). Holmium: YAG laser was employed for the marsupialization of the cyst wall in midline prostatic cyst treatment for the first time in the present study. Symptoms, treatment, and follow-up are presented in this paper.
Article
Full-text available
We have demonstrated that sexual activity produces transient sympathoadrenal activation and a pronounced, long-lasting increase in prolactin in men and women. However, by analyzing endocrine alterations at 10-min intervals, a precise assignment of these changes to the pre-, peri-and postorgasmic periods was not possible. Thus, the current study aimed to accurately differentiate the endocrine response to sexual arousal and orgasm in men using an automatic blood collection technique with 2-min sampling intervals. Blood was drawn continuously before, during and after orgasm over a total period of 40 min in 10 healthy subjects and were compared with samples obtained under a control condition. Sexual activity induced transient increases of plasma epinephrine and norepinephrine levels during orgasm with a rapid decline thereafter. In contrast, prolactin levels increased immediately after orgasm and remained elevated throughout the experiment. Although oxytocin was acutely increased after orgasm, these changes were not consistent and did not reach statistical significance. Vasopressin, LH, FSH and testosterone plasma concentrations remained unaltered during sexual arousal and orgasm. These data confirm that prolactin is secreted after orgasm and, compared with oxytocin, seems to represent a more reliable and sustained marker for orgasm in man. The results further reinforce a role for prolactin either as a neuroendocrine reproductive reflex or as a feedback mechanism modulating dopaminergic systems in the central nervous system that are responsible for appetitive behavior.
Article
Full-text available
Zinner syndrome refers to the triad of ipsilateral renal agenesis, seminal vesicle cysts and ejaculatory duct obstruction. Ipsilateral renal agenesis may be associated with seminal vesicle cysts in 70% of cases, but a remnant ureteral bud has been shown to coexist in only 27% of these cases. While some patients may remain asymptomatic and are discovered incidentally, others present with symptoms related to seminal vesicle cysts or ejaculatory duct obstruction: voiding or ejaculatory difficulty or pain. The diagnosis is made with imaging findings, and differentiation from other pelvic cysts requires a multimodality approach. In this report, we present typical imaging findings of a patient who presented with painful ejaculation where there was a congenital seminal vesicle cyst with ipsilateral renal agenesis associated with a remnant ureteral bud draining into the seminal vesicle cyst and also associated with a cyst of the prostatic utricle. We discuss the relevant embryological basis for this unusual combination of findings. 2015 BMJ Publishing Group Ltd.
Article
Full-text available
Abstract The relationship between masturbation and sexual desire has not been systematically studied. The present study assessed the association between masturbation and pornography use and the predictors and correlates of frequent masturbation (several times a week or more often) among coupled heterosexual men who reported decreased sexual desire (DSD). Analyses were carried out on a subset of 596 men with DSD (mean age = 40.2 years), who were recruited as part of a large online study on male sexual health in three European countries. A majority of the participants (67%) reported masturbating at least once a week. Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with DSD. These findings point to a pattern of pornography-related masturbation that can be dissociated from partnered sexual desire and can fulfill diverse purposes. Clinical implications include the importance of exploring specific patterns of masturbation and pornography use in the evaluation of coupled men with DSD.
Article
Full-text available
Oxytocin (OT) is a nonapeptide with an impressive variety of physiological functions. Among them, the 'prosocial' effects have been discussed in several recent reviews, but the direct effects on male and female sexual behavior did receive much less attention so far. As our contribution to honor the lifelong interest of Berend Olivier in the control mechanisms of sexual behavior, we decided to explore the role of OT in the present review. In the successive sections, some physiological mechanisms and the 'pair-bonding' effects of OT will be discussed, followed by sections about desire, female appetitive and copulatory behavior, including lordosis and orgasm. At the male side, the effects on erection and ejaculation are reviewed, followed by a section about 'premature ejaculation' and a possible role of OT in its treatment. In addition to OT, serotonin receives some attention as one of the main mechanisms controlling the effects of OT. In the succeeding sections, the importance of OT for 'the fruits of labor' is discussed, as it plays an important role in both maternal and paternal behavior. Finally, we pay attention to an intriguing brain area, the ventrolateral part of the ventromedial hypothalamic nucleus (VMHvl), apparently functioning in both sexual and aggressive behavior, which are at first view completely opposite behavioral systems.
Article
Full-text available
Introduction: In 2009, the International Society for Sexual Medicine (ISSM) convened a select panel of experts to develop an evidence-based set of guidelines for patients suffering from lifelong premature ejaculation (PE). That document reviewed definitions, etiology, impact on the patient and partner, assessment, and pharmacological, psychological, and combined treatments. It concluded by recognizing the continually evolving nature of clinical research and recommended a subsequent guideline review and revision every fourth year. Consistent with that recommendation, the ISSM organized a second multidisciplinary panel of experts in April 2013, which met for 2 days in Bangalore, India. This manuscript updates the previous guidelines and reports on the recommendations of the panel of experts. Aim: The aim of this study was to develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method: A comprehensive literature review was performed. Results: This article contains the report of the second ISSM PE Guidelines Committee. It offers a new unified definition of PE and updates the previous treatment recommendations. Brief assessment procedures are delineated, and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion: Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. We again recommend that these guidelines be reevaluated and updated by the ISSM in 4 years.
Article
Full-text available
La dysfonction sexuelle (DS) est un aspect fréquent chez des hommes atteints de sclérose en plaques (SEP). La DS est souvent méconnue parce tant les patients que les médecins hésitent à aborder ces types de problèmes. Des symptômes surviennent dans 50 à 90 % des cas ; parmi eux figurent la dysfonction érectile, la dysfonction éjaculatoire ; la dysfonction orgasmique et une baisse de la libido. La DS peut se manifester à n’importe quel stade de la maladie, sans nécessairement être accompagnée d’infirmités sévères. Alors que la dysfonction érectile (DE) est censée être liée à une lésion spianle, la fatigue, la spasticité et des troubles vésico-sphinctériens sont également en cause dans la DS. En outre, des questions psychosociales et culturelles, dont la dépression, l’anxiété de la performance, et une baisse de l’estime de soi sont à prendre en considération. Une évaluation complète de tous ces aspects est nécessaire. La dysfonction érectile peut être traitée efficacement avec des inhibiteurs de la phosphodiestérase ou des injections intracaverneuses. Le traitement de la dysfonction éjaculatoire comporte la stimulation vibratoire pénienne et la midodrine. En ce qui concerne les questions de fertilité, les effets des immunomodulateurs sur la qualité du sperme sont en majeure partie inconnus, alors que de nombreux traitements avec immunosuppresseurs ont un effet peut-être définitivement négatif sur la qualité du sperme. Des méthodes de procréation assistée représentent parfois la seule option conduisant à la conception. La conscience qu’ont les médecins de ce problème peut contribuer à l’arrivée de traitements appropriés et améliorer la qualité de vie de cette population.
Article
Full-text available
Masturbation is a common sexual activity among people of all ages throughout life. It has been traditionally prohibited and judged as immoral and sinful by several religions. Although it is no longer perceived as a negative behavior, masturbation is often omitted in the diagnostic inquiry of patients with sexual problems. The aims of this study are to increase the awareness of clinicians to the importance of including questions regarding masturbatory habits in the process of sexual history taking, to analyze cases of male sexual dysfunction (SD) associated with unusual masturbatory practices, and to propose a practical tool for clinicians to diagnose and manage such problems. A clinical study of four cases that include a range of unusual masturbatory practices by young males who applied for sex therapy is described. An intervention plan involving specific questions in case history taking was devised. It was based on detailed understanding of each patient's masturbatory practice and its manifestation in his SD. Effects of identifying and altering masturbatory practices on sexual function. The four men described unusual and awkward masturbatory practices, each of which was associated with different kinds of SD. The unlearning of the masturbatory practices contributed notably to improvement of their sexual function. The four cases in this study indicate that the detailed questioning of masturbatory habits is crucial for a thorough assessment and adequate treatment of sexual problems in men. We propose specific questions on masturbatory behavior as well as a diagnostic and therapeutic flowchart for physicians and sex therapists to address those problems. Bronner G and Ben-Zion IZ. Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men. J Sex Med **;**:**-**.
Article
Full-text available
Delayed Ejaculation (DE) is probably the least studied and understood of the male sexual dysfunctions (MSD). There is still little unanimity concerning its psychological/interpersonal aetiology. Previous studies found that MSD are strongly related with alexithymia, a multifaceted personality construct that describes a disturbance in the regulation of emotions.The aim of this study was to investigate the presence of alexithymia in men with DE and correlate alexithymia levels with DE severity. According to specific features of the symptoms, we hypothesized that alexithymia would not be correlated with this specific sexual disorder. 54 outpatients with a diagnosis of DE assessed at the Institute of Clinical Sexology and the Urology Department of Sapienza, University in Rome were enrolled in the study. DE was diagnosed after a specialist examination and according to Diagnostic and Statistical Manual of Mental Disorders -IV-TR criteria. Participants were provided with the Toronto Alexithymia Scale (20 items; TAS-20), a self-measure of the Intravaginal Ejaculation Latency Time and an ad hoc questionnaire to collect anamnestic data. 9.3% of patients could be categorized as alexithymics, 9.3% of them as borderline, while 81.4% of the sample was found to be non-alexithymic. The overall average TAS-20 score was 45.46. Results show that alexithymia is correlated neither with the presence of DE nor with its severity, in contrast to other MSDs, where this condition was found in about 30% of patients. The data presented suggest that DE, although not correlated to alexithymia, is probably related to other psychogenic features such as hypercontrol configuration. This paper can contribute to the understanding of DE, by excluding one of the possible etiological factors, previously found to be important in the onset and the maintenance of the other MSDs. More studies are needed in order to better understand DE and provide recommendations about treatment.
Article
Full-text available
SMSNA ABSTRACT: # 120 MASTURBATION IS A KEY VARIABLE IN THE TREATMENT OF RETARDED EJACULATION, BY THE PRACTICING UROLOGIST Michael A. Perelman, Ph.D. New York, NY Introduction and Objectives: New pharmaceuticals have increased the number of patients presenting for treatment of sexual dysfunctions, including retarded ejaculation (RE). There are no FDA approved pharmaceutical treatments for RE, a reportedly difficult-to-treat dysfunction. A study was carried out to identify variables that could improve a practicing health care practitioner’s (HCP) capacity to understand and treat RE. Methods: A 6-year retrospective chart review was conducted of the 85 men diagnosed as REs, who had been referred for sex therapy by their urologists. Key variables previously unexplored by their urologists were identified. Results: Of 85 charts, 78 were adequately legible and capable of being fully categorized. The men, both partnered and single, ranged in age from 19 to 77 years; mean age 37. 51% had tried a PDE-5 inhibitor; many of the urologists had not differentiated ED from RE. Some men with concomitant ED improved their erections, but there was no improvement in their RE. Some men experienced RE as a treatment emergent symptom secondary to PDE-5 use. 23% of the men were diagnosed with a “global,” and “life-long” RE; the remainders were “situational.” 77% of the men could masturbate to orgasm. Of those who masturbated, a significant number did so at high frequency. Notably, almost 45 % of those men reported masturbating at least every other day or more. More than 43% reported masturbating 6-14 times per month. Less than 2% of the sample that masturbated did so less than 4 times per month on average. A robust pattern emerged: high-frequency masturbation correlated highly with the presentation of RE. Further, over 59 % of these men who masturbated, did so using an idiosyncratic style. An idiosyncratic style was defined as a technique not easily duplicated by their partner’s hand, mouth, or vagina. Almost universally, these men had failed to communicate their preferences to either their doctor or their partners, because of shame, embarrassment, or ignorance. Finally, 25% of these men used a variant sexual fantasy during masturbation, which was not usually incorporated into sex with their partner. Conclusions: The data strongly suggested that high frequency; idiosyncratic masturbation and fantasy/partner disparity predispose RE. Failure to assess these factors may account for much of the perceived difficulty in treating RE. Identifying and using counseling techniques to alter these patterns could enhance the practicing HCP’s ability to improve their patient’s orgasmic capacity. Once new drugs are developed to increase the ease and speed of ejaculatory latency, combination drug and sex therapy protocols may produce the best treatment outcome. References: • Perelman M. “Retarded Ejaculation.”], In Current Sexual Health Reports 2004 [Ed: Mulhall,J.]. Current Science, Inc., Philadelphia, Pennsylvania, 2004:1:3. • Rowland D. & Perelman M. “Inhibited or Retarded Ejaculation.” In Handbook of Premature Ejaculation, [Ed. O’Leary M]. Taylor & Francis, Philadelphia, Pennsylvania, 2006. In Press. RECOMMENDATIONS: The data strongly suggested that high-frequency, idiosyncratic masturbation predisposes RE. Failure to assess these factors may account for much of the perceived difficulty in treating RE. Which for me raises the issue of Combination treatment and leads to the following recommendations: Inquire about masturbatory frequency and technique when assessing patients with RE. Sex coaching can alter dysfunctional patterns, enhancing the HCP’s ability to treat RE. Once new drugs are developed to increase the ease and speed of ejaculatory latency, a combination treatment protocol of drugs and sex therapy.
Article
Full-text available
BACKGROUND After spinal cord injury (SCI), most men cannot ejaculate without medical assistance. A major advance in the knowledge of the spinal control of ejaculation has been achieved with the discovery of a spinal generator of ejaculation (SGE) in the rat. The aim of this report was to review studies about ejaculation after SCI in order to revisit the spinal control of ejaculation and especially to assess the existence of an SGE in man.METHODS Studies were identified from Embase, PubMed, EBSCOhost and Cochrane Library. Studies were eligible when they specify the occurrence of antegrade ejaculation as a function of the neurological characterization of SCI. Studies were excluded when ejaculation was elicited by rectal electrical stimulation or when ejaculation could not be discriminated from climax. Meta-analyses were performed to assess the reference ejaculation rates for each procedure used to elicit ejaculation, i.e. masturbation or coïtus, penile vibratory stimulation (PVS) or acetylcholine esterase (AchE) inhibitors prior to masturbation. Subgroup analyses were performed according to the procedure used to elicit ejaculation on (i) the completeness of the SCI and (ii) the upper and lower limits of the SCI. To assess the existence of an SGE, the effect of concurrent lesions of different spinal segments was assessed by means of a stratified bivariate analysis.RESULTSFrom 523 studies, 45 were selected (n = 3851). Ejaculation occurred in response to masturbation or coïtus, PVS or AchE inhibitors followed by masturbation in, respectively, 11.8% (n = 1161), 47.4% (n = 597) and 54.7% (n = 309) of patients with complete SCI and in, respectively, 33.2% (n = 343), 52.8% (n = 305) and 78.1% (n = 32) of patients with incomplete SCI. Ejaculation, in the case of complete lesion of the sympathetic centres (T12 to L2), of the parasympathetic and somatic centres (S2-S4) or of all spinal ejaculation centres (T12 to S5) occurred in response to PVS in none of the patients (respectively, n = 5, n = 4 and n = 21) and in response to AchE inhibitors followed by masturbation in 4.9% (n = 61), 30.8% (n = 26) and 0% (n = 16) of the patients, respectively. Ejaculation in response to PVS or AchE inhibitors prior to masturbation was rhythmic forceful in 97.9% (n = 48) of the patients with complete lesion strictly above Onuf's nucleus (segments S2-S4). Complete lesion of the S2-S4 segments precluded the occurrence of rhythmic forceful ejaculation (n = 5). Controlling for the number of the injured segments between T12 and L2, the ejaculation rate sharply decreased when the lesion extended to the L3 segment and below.CONCLUSIONS The results reinforce the crucial roles of the spinal sympathetic and parasympathetic centres for emission and the somatic centre for expulsion. The spinal segments between L2 and S2 is more than a pathway to connect the ejaculation centres and likely harbours an SGE in man located in the L3, L4 and L5 segments.
Article
Full-text available
Dopaminergic therapy in Parkinson's disease (PD) can improve some cognitive functions while worsening others. These opposite effects might reflect different levels of residual dopamine in distinct parts of the striatum, although the underlying mechanisms remain poorly understood. We used functional magnetic resonance imaging (fMRI) to address how apomorphine, a potent dopamine agonist, influences brain activity associated with working memory in PD patients with variable levels of nigrostriatal degeneration, as assessed via dopamine-transporter (DAT) scan. Twelve PD patients underwent two fMRI sessions (Off-, On-apomorphine) and one DAT-scan session. Twelve sex-, age-, and education-matched healthy controls underwent one fMRI session. The core fMRI analyses explored: (1) the main effect of group; (2) the main effect of treatment; and (3) linear and nonlinear interactions between treatment and DAT levels. Relative to controls, PD-Off patients showed greater activations within posterior attentional regions (e.g., precuneus). PD-On versus PD-Off patients displayed reduced left superior frontal gyrus activation and enhanced striatal activation during working-memory task. The relation between DAT levels and striatal responses to apomorphine followed an inverted-U-shaped model (i.e., the apomorphine effect on striatal activity in PD patients with intermediate DAT levels was opposite to that observed in PD patients with higher and lower DAT levels). Previous research in PD demonstrated that the nigrostriatal degeneration (tracked via DAT scan) is associated with inverted-U-shaped rearrangements of postsynaptic D2-receptors sensitivity. Hence, it can be hypothesized that individual differences in DAT levels drove striatal responses to apomorphine via D2-receptor-mediated mechanisms.
Article
Full-text available
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Book
In the last decade, much of the clinical interest in the field of infertility has focused on advancing reproductive techniques and has often under-appreciated the role that male sexuality plays in reproductive problems. Male sexual function is an integral part of reproduction, and the treatment of sexual dysfunction is an important component for any couple seeking fertility. In some cases, treatment of sexual dysfunction may obviate the need for more invasive cures through advanced reproductive techniques. Thanks to recent clinical and scientific advances in male sexual medicine, the management of men’s sexual dysfunction is often more effective and less invasive than how it was historically described. Men’s Sexual Health and Fertility is the only resource that focuses on the interplay and interconnections between male sexual dysfunction and male factor infertility, gathering insightful data from a panel of experts in male sexual medicine for clinicians who treat couples with fertility issues due to male sexual dysfunction. Chapters discuss advances in the field of men’s sexual medicine, including the latest treatment for erectile dysfunction, the most up-to-date understanding of the physiology and pathophysiology of ejaculation, and the growing body of evidence that low testosterone and male infertility are intimately related. As such, this book provides important information in order to be able to better understand the link between sexual dysfunction and infertility and, most importantly, to better treat male sexual dysfunction in the infertile couple.
Article
Introduction: Hypoactive sexual desire is defined as a persistent or recurrent deficient or absent sexual fantasies or desire for sexual activity which should not be comorbid with other medical conditions or with the use of psychoactive medications. Reduced libido is a symptom referring more to a reduction in sexual drive for sexual activity. The aim of the present study is to investigate the risk factors of primary reduced libido (i.e. not associated with conditions causing loss of libido such as hypogonadism, hyperprolactinemia, psychopathology and/or psychoactive medications) or secondary reduced libido (i.e. with aforementioned conditions) in male patients with sexual dysfunction. Methods: A consecutive series of 3714 men (mean age 53.2±12.5 years) was retrospectively studied. Patient’s reduced libido was evaluated using question #14 of SIEDY (‘Did you have more or less desire to make love in the last three months?’) Results: Reduced libido was comorbid with erectile dysfunction, premature ejaculation and delayed ejaculation in 38, 28.2 and 50% respectively, whereas it was isolated in 5.1%. Reduced libido prevalence was substantially increased by hypogonadism, almost doubled by psychopathology and universally present in subjects with hyperprolactinemia (secondary reduced libido). Subjects with primary reduced libido are characterized by higher post-school qualification, more disturbances in domestic and dyadic relationships, and an overall healthy body (lower glycaemia and triglyceride levels). Accordingly, in patients with primary reduced libido the risk of major cardiovascular events as calculated with the Progetto Cuore algorithm was lower than in the rest of the sample. Features of hypogonadism- or psychopathology-associated reduced libido essentially reflect their underlying conditions. Comorbidity with other sexual dysfunctions did not affect the main characteristics of primary or secondary reduced libido. Conclusions: Primary and secondary reduced libido have different risk factors and clinical characteristics. Recognizing primary or secondary reduced libido will help clinicians to identify comorbidities and to tailor appropriate treatments.
Article
The clinical effect of laparoscopic rectal cancer curative excision with pelvic autonomic nerve preservation (PANP) was investigated. This study evaluated the frequency of urinary and sexual dysfunction of 149 male patients with middle and low rectal cancer who underwent laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation (PANP) from March 2011 to March 2013. Eighty-four patients were subjected to laparoscopic surgery, and 65 to open surgery respectively. The patients were followed up for 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. In the laparoscopic group, 13 patients (18.37%) presented transitory postoperative urinary dysfunction, and were medically treated. So did 12 patients (21.82%) in open group. Sexual desire was maintained by 52.86%, un-ability to engage in intercourse by 47.15%, and un-ability to achieve orgasm and ejaculation by 34.29% of the patients in the laparoscopic group. Sexual desire was maintained by 56.36%, un-ability to engage in intercourse by 43.63%, and un-ability to achieve orgasm and ejaculation by 33.73% of the patients in the open group. No significant differences in urinary and sexual dysfunction between the laparoscopic and open rectal resection groups were observed (P>0.05). It was concluded that laparoscopic rectal cancer radical excision with PANP did not aggravate or improve sexual and urinary dysfunction. © 2016, Huazhong University of Science and Technology and Springer-Verlag Berlin Heidelberg.
Article
Introduction: Delayed ejaculation (DE) is a poorly defined disorder that entails the delay or absence of orgasm that results in personal distress. Numerous causes of DE exist, and management must be tailored to the specific etiology to maximize treatment success. Management strategies include psychological and sexual therapy, pharmacotherapy, and penile vibratory stimulation. Aim: This article intends to review the pathophysiology and treatment options for DE discussed in the literature to date. Methods: A review of the literature was performed to identify and evaluate the existing data on treatment success for the various forms of DE management. Main outcome measures: Each treatment option was evaluated for method of administration, data supporting its success for DE, and potential risks or side effects. Results: Different psychosexual therapy strategies have been described for DE but with limited data to describe efficacy. There is no medication for DE approved by the United States Food and Drug Administration. The quality of evidence supporting the off-label use of medications for DE is low. However, there are numerous medications reported in the literature suggested to treat the condition. Cabergoline and bupropion are the two most commonly used. In addition, penile vibratory stimulation has been described as an adjunct treatment option for DE. Conclusion: There are different treatment options reported for DE, all with limited evidence supporting their efficacy. Identifying the etiology of the DE is important to appropriately target therapy. A multimodal approach combining psychosexual therapy with medications and/or penile vibratory stimulation will likely provide the best outcomes.
Book
The new international standard reference work for sexual medicine. Written under the auspices of the International Society for Sexual Medicine, (www.issm.info), the leading professional society in sexual medicine and founder of the most influential journal in the field, The Journal of Sexual Medicine,published by Blackwell Publishing. Comprehensive coverage of the full range of diagnostic and treatment options in all aspects of male and female sexual dysfunctions. Provides information on recent progress in pharmacologic approaches, including the highly successful drug treatments for ED. Useful for any part of the patient-clinician consultation, from gathering symptoms to diagnosis to treatment to reports on potential and developing treatments.
Article
Objectives: To assess sexual behaviour, prevalence of ICD-10 diagnosed sexual dysfunction, associations between sexual and psychological problems, and help seeking for sexual problems in people attending general practice; to assess predictors of ICD-10 diagnosis of sexual dysfunction. Design: Cross sectional study. Setting: 13 general practices in London. Participants: 1065 women and 447 men attending general practices. Main outcome measure: Prevalence and predictors of ICD-10 diagnoses of sexual dysfunction. Results: 97 (22%, 95% confidence interval 18% to 25%) men and 422 (40%, 37% to 43%) women received at least one ICD-10 diagnosis, but only 3-4% had an entry relating to sexual problems in their general practice notes. The most common problems were erectile failure and lack or loss of sexual desire in men and lack or loss of sexual desire and failure of orgasmic response in women. Increasing age and being unemployed predicted sexual problems in women, and bisexual orientation, being non-white, and being unemployed were demographic predictors in men. No practice note factors predicted sexual problems in women, but high consulting rate predicted problems in men. The main clinical predictors were poor physical function and dissatisfaction with current sex life in both sexes and higher psychological morbidity in women. When all factors were considered, increasing age (odds ratio 1.01, 1.00 to 1.02), physical subscale score on the SF-12 (0.98, 0.97 to 0.99), sexual dissatisfaction (1.9, 1.5 to 2.4), and scoring over a 3/ 4 threshold score on the general health questionnaire (1.5, 1.1 to 1.9) independently predicted an ICD-10 sexual dysfunction diagnosis in women. Being bisexual (4.1, 1.3 to 12.8) was the only independent predictor of an ICD-10 diagnosis in men. Conclusions: Sexual difficulties are common in people attending general practitioners, and many people are prepared to talk about them with their doctors.
Article
Ejaculatory disorders are one of the most frequent sexual dysfunction. To study this problem in different climatic regions, we made a population-based trial with participation of 543 Russian men (149 from the south of Russia, 394 from Siberia). Correlation of ejaculatory disorders with IELT duration, a testosterone level, comorbid chronic prostatitis was estimated. We found that 59.2% of young men had normal ejaculation but only 20% of men over 50 years of age. In the latter group of patients delayed ejaculation predominated. 43.6% of the southerners and 33.5% of the Siberians had premature ejaculation, and 6.1 and 16.9%--delayed ejaculation, respectively; 26.7 and 31.2% were hypogonadal, respectively. Ejaculation was normal in 74.6% men with a normal testosterone level. Hypogonadal patients had premature ejaculation in 48.2% cases, delayed ejaculation in 28.3%. Of the total 543 men, 67.2% had chronic prostatitis. Only 46% of patients with chronic prostatitis had normal ejaculation, 43.3% had premature ejaculation and 10.7% had delayed ejaculation. Thus, in cold climate delayed ejaculation occurs more often, in the South premature ejaculation predominates. A low testosterone level as well as chronic prostatitis resulted in ejaculatory disorders. There are significant differences in ejaculation between young and old men, whose living in the South and Siberia, eugonadal and hypogonadal. Therefore, when characterizing a copulative act as "normal" it is necessary to take into account age, comorbidity, region of living and other factors.
Article
IntroductionEjaculatory dysfunctions other than premature ejaculation are commonly encountered in specialized clinics; however, their characterization in community-dwelling men is lacking. AimThe aim of this study was to evaluate the prevalence, severity, and associated distress of four ejaculatory dysfunctions: delayed ejaculation (DE), anejaculation (AE), perceived ejaculate volume reduction (PEVR) and/or decreased force of ejaculation (DFE) as a function of demographic and clinical characteristics in men. Methods Observational analysis of 988 subjects presenting with one or more types of ejaculatory dysfunctions other than premature ejaculation who screened for a randomized clinical trial assessing the efficacy of testosterone replacement on ejaculatory dysfunction. Demographic and clinical characteristics were assessed as potential risk factors using regression analysis. Main Outcome MeasuresThe main outcome measures used were ejaculatory dysfunction prevalence and scores (3-item Men's Sexual Health Questionnaire Ejaculatory Dysfunction-Short Form [MSHQ-EjD-SF]), and bother (MSHQ-EjD-SF Bother item) and sexual satisfaction/enjoyment (International Index of Erectile Function Questionnaire Q7, Q8) as a function of subject's age, race, body mass index (BMI) and serum testosterone levels (measured by liquid chromatography tandem mass spectrometry). ResultsMean (standard deviation [SD]) age of the participants was 52 years (11). Eighty-eightpercent of the men experienced more than one type of ejaculatory dysfunction and 68% considered their symptoms to be bothersome. Prevalence of the ejaculatory dysfunctions was substantial across a range of age, race, BMI, and serum testosterone categories. Prevalence of PEVR and DFE were positively associated with age (<40 years vs. 60-70 years: PEVR: odds ratio [OR], 3.05; 95% confidence interval [CI], 1.32-7.06; DFE: OR, 2.78; 95% CI, 1.46-5.28) while DFE was associated with BMI (30kg/m(2) vs.<25kg/m(2): OR, 1.80; 95% CI, 1.062-3.05). All ejaculatory dysfunctions were more prevalent in black men. Conclusion The majority of the participants experienced multiple ejaculatory dysfunctions and found them to be highly bothersome. Ejaculatory dysfunctions were prevalent across a wide range of demographic and clinical characteristics. Paduch DA, Polzer P, Morgentaler A, Althof S, Donatucci C, Ni X, Patel AB, and Basaria S. Clinical and Demographic Correlates of Ejaculatory Dysfunctions Other Than Premature Ejaculation: a Prospective, Observational Study. J Sex Med 2015;12:2276-2286.
Article
Normal fertility is dependent on intravaginal delivery of semen through ejaculation. This process is highly dependent on an intact ejaculatory reflex arc, which can be disrupted through any type of trauma or disease causing damage to the CNS and/or peripheral nerves. Neurogenic anejaculation is most commonly associated with spinal cord injury. This aetiology is especially relevant because most men with spinal cord injuries are injured at reproductive age. Assisted ejaculation in the form of penile vibratory stimulation is the first choice for sperm retrieval in such patients because it is noninvasive and inexpensive. In patients in whom vibratory stimulation fails, electroejaculation is almost always successful. When both methods of assisted ejaculation are unsuccessful, sperm retrieval by aspiration from either the vas deferens or the epididymis, or by testicular biopsy or surgery are reasonable options. In such cases the most inexpensive and least invasive methods should be considered first. The obtained semen can be used for intravaginal or intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection.
Article
Delayed orgasm/anorgasmia defined as the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress. Delayed orgasm and anorgasmia are associated with significant sexual dissatisfaction. A focused medical history can shed light on the potential etiologies, which include medications, penile sensation loss, endocrinopathies, penile hyperstimulation, and psychological etiologies. Unfortunately, there are no excellent pharmacotherapies for delayed orgasm/anorgasmia, and treatment revolves largely around addressing potential causative factors and psychotherapy.
Article
The research which has assessed the incidence and prevalence of sexual dysfunctions is reviewed. Twenty-three studies are evaluated. Studies completed with community samples indicate a current prevalence of 5-10% for inhibited female orgasm, 4-9% for male erectile disorder, 4-10% for inhibited male orgasm, and 36-38% for premature ejaculation. Stable community estimates with regard to the current prevalence of female sexual arousal disorder, vaginismus, and dyspareunia are not available. Recent studies completed with clinical samples suggest an increase in the frequency of orgasmic and erectile dysfunction and a decrease in premature ejaculation as presenting problems. Desire disorders have increased as presenting problems in sex clinics, with recent data indicating that males outnumber females. Methodological limitations of these studies are identified and suggestions for future research are offered.
Article
The research which has assessed the incidence and prevalence of sexual dysfunctions is reviewed. Twenty-three studies are evaluated. Studies completed with community samples indicate a current prevalence of 5-10% for inhibited female orgasm, 4-9% for male erectile disorder, 4-10% for inhibited male orgasm, and 36-38% for premature ejaculation. Stable community estimates with regard to the current prevalence of female sexual arousal disorder, vaginismus, and dyspareunia are not available. Recent studies completed with clinical samples suggest an increase in the frequency of orgasmic and erectile dysfunction and a decrease in premature ejaculation as presenting problems. Desire disorders have increased as presenting problems in sex clinics, with recent data indicating that males outnumber females. Methodological limitations of these studies are identified and suggestions for future research are offered.
Article
Delayed ejaculation (DE) is a challenging disorder to treat. Many clinicians are not comfortable dealing with DE due to a lack of treatment approaches supported by evidence-based medicine. In this review, we discuss the most common treatments and the latest studies that support each DE treatment. The goal of our review is to help clinicians identify and treat patients who present with this disorder. An integrative approach using medications, penile vibratory stimulation, and sexual counseling is important for successful treatment of DE. We propose an algorithm for DE treatment to help guide clinicians. However, an individualized treatment plan should be developed for each unique case due to the multifactorial etiology of DE.
Article
Although ejaculatory dysfunction is common for patients undergoing benign prostatic hyperplasia surgery, no clear evidence is present to counsel men seeking to preserve ejaculation. Our aim was to evaluate ejaculatory dysfunction in relation to benign prostatic hyperplasia surgery. We carried out a web and manual search using MEDLINE and Embase including randomized controlled trials reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery: 42 randomized controlled trials comprising a total of 3857 patients were included. Only one study had ejaculatory dysfunction as a primary outcome, and just 10 evaluated ejaculatory dysfunction before and after surgery. The definition of ejaculatory dysfunction was not standardized. Similarly, just seven studies used internationally validated questionnaires to address ejaculatory dysfunction. The reported rates of ejaculatory dysfunction after resectional elecrosurgery, laser procedures, coagulation, ablation and implant techniques were assessed and compared. Transurethral resection of the prostate and recent laser procedures including holmium, thulium and GreenLight cause similar rates of ejaculatory dysfunction, occurring in almost three out of four to five men. Although providing less symptomatic benefit compared with transurethral resection of the prostate, transurethral incision of the prostate, transurethral needle ablation and transurethral microwave thermotherapy should be considered for men aiming to maintain normal ejaculation. UroLift is also a recent promising option for this category of patients. The vast majority of studies reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery used poor methodology to investigate this complication. Future studies able to address clear hypothesis and considering ejaculatory dysfunction anatomical and pathophysiological features are required to develop ejaculation preserving techniques and to increase the evidence to counsel men aiming to preserve ejaculation. © 2015 The Japanese Urological Association.
Article
Many aspects of sexuality can be disrupted following a spinal cord lesion (SCL). It can alter an individual's self-esteem and body image, interfere with positioning and mobility, introduce unexpected problems with incontinence and spasticity, decrease pleasure, and delay orgasm. Sexual concerns in men can involve erectile function, essential for intercourse, ejaculation function, necessary for fertility, and the ability to reach orgasm. In women they can involve concerns with vaginal lubrication, genital congestion, and vaginal infections, which can all go unnoticed, and orgasm, which may be lost. All of these concerns must be addressed during rehabilitation as individuals with SCL continue to live an active sexual life, and consider sexuality among their top priority for quality of life. This chapter describes the impact of SCL on various phases of men's and women's sexual responses and on various aspects of sexuality. Treatments are described in terms of what is currently available and what is specific to the SCL population. New approaches in particular for women are described, along with tips from sexual counseling which consider an overall approach, taking into account the primary, secondary, and tertiary consequences of the SCL on the individual's sexuality. Throughout the chapter, attempts are made to integrate neurophysiologic knowledge, findings from the literature on SCL, and clinical experience in sexual rehabilitation. © 2015 Elsevier B.V. All rights reserved.
Article
Low T levels have been associated with ejaculatory dysfunction (EjD) in cross-sectional studies; however, the efficacy of T replacement in improving EjD has not been studied in a randomized controlled trial. To evaluate the efficacy of T replacement in androgen-deficient men with EjD. A multicenter, double-blind, randomized, placebo-controlled, 16-week trial with T solution 2% versus placebo. Medical centers in the United States, Canada, and Mexico. Seventy-six men with one or more EjD symptoms, including delayed ejaculation, anejaculation, reduced ejaculate volume, and/or reduced force of ejaculation, and two total T levels <300 ng/dL (<10.41 nmol/L) measured with liquid chromatography tandem mass spectrometry. Sixty milligrams of T solution 2% or placebo applied to the axillae for 16 weeks. The primary outcome was a change in the score of the three-item Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form (MSHQ-EjD-SF); secondary outcomes included measured ejaculate volume, scores of the bother/satisfaction item of the MSHQ-EjD-SF, the orgasmic function domain of the International Index of Erectile Function Questionnaire, and the sexual activity log. Seventy-six participants were randomized; 66 completed the study. Baseline demographic and clinical characteristics were comparable between the treatment arms. T replacement improved the MSHQ-EjD-SF score (mean score change, +3.1); however, this effect was not statistically different from placebo (mean score change, +2.5; P = .596). No differences were seen in any of the secondary outcomes or frequency of adverse events. T replacement was not associated with significant improvement in EjD in androgen-deficient men.
Article
Delayed ejaculation (DE) is an uncommon disorder that is difficult to treat because it is poorly understood. The aim was to evaluate the current opinion and clinical management of DE by practitioners in sexual medicine. Members of the Sexual Medicine Society of North America (SMSNA) were invited by email to participate in a web-based survey. The questionnaire consisted of eight questions pertaining to DE. Questions addressed patient volume, qualification of patient bother, ranking of etiologies, perceived success, treatments used, quantification of symptom resolution, and broad characterization of practitioner type. A total of 94 respondents completed the survey with 73% of those being urologists. Fifty-nine percent of the respondents saw ≤ 2 patients a month with DE and 89% of practitioners felt that DE was moderately or severely bothersome to the patients. Etiology was felt to be from medications and psychological factors primarily. Despite treatment modality, 'seldom' success was obtained for 49% of the time and 'never' for 11%. Carbergoline was the most common selected medication for DE. Academic and private urologists reported 'never' or 'seldom' success with sexual counseling compared to other practitioners, respectively (p = 0.008 and p = 0.001). Respondents who saw ≤ 2 patients per month often reported normalization of hypogonadism 'never' or 'seldom' corrected DE (p = 0.047). Delayed ejaculation is still a poorly understood disorder with inconsistent practice patterns seen among members of the SMSNA. A better understanding of this vexing disorder is needed with efforts placed on research and practitioner education. © 2015 American Society of Andrology and European Academy of Andrology.
Article
The sexually sluggish (SLG) male rat has been proposed as an animal model for the study of lifelong delayed ejaculation, a sexual dysfunction for which no treatment is available. Low endocannabinoid anandamide (AEA) doses facilitate sexual behavior display in normal sexually active and in noncopulating male rats through the activation of CB1 receptors. To establish whether low AEA doses reduced the ejaculatory threshold of SLG male rats by acting at CB1 receptors. SLG male rats were intraperitoneally injected with different doses of AEA (0.1-3.0 mg/kg), the CB1 receptor antagonist AM251 (0.1-3.0 mg/kg), or their vehicles and tested for copulatory behavior during 60 minutes. Animals receiving AEA effective doses were subjected to a second sexual behavior test, 7 days later under drug-free conditions. To determine the participation of CB1 receptors in AEA-induced actions, SLG rats were pretreated with AM251 prior to AEA. The sexual parameters, intromission latency, number of mounts and intromissions, ejaculation latency, and interintromission interval. All sexual behavior parameters of SLG rats were significantly increased when compared with normal sexually experienced animals. Low AEA doses (0.3 and 1 mg/kg) significantly lowered the ejaculatory threshold of SLG rats, reducing the number of pre-ejaculatory intromissions and ejaculation latency. IL, M number, and locomotor activity were unaffected by AEA. Facilitation of the ejaculatory response of SLG rats disappeared 7 days after AEA injection. AM251 lacked an effect on copulation of SLG rats but blocked the AEA-induced lowering of the ejaculatory threshold. AEA appears to specifically target the ejaculatory threshold of SLG rats through the activation of CB1 receptors. This specificity along with the fact that AEA's effects are exerted acutely and at low doses makes this drug emerge as a promising treatment for the improvement of the ejaculatory response in men with primary delayed ejaculation. Rodríguez-Manzo G and Canseco-Alba A. Anandamide reduces the ejaculatory threshold of sexually sluggish male rats: Possible relevance for human lifelong delayed ejaculation disorder. J Sex Med **;**:**-**. © 2015 International Society for Sexual Medicine.
Article
Introduction: Several data have emphasized the importance of early diagnosis of erectile dysfunction (ED) and meticulous cardiovascular investigation in the type 2 diabetic mellitus (T2DM) patients. Aim: To estimate the prevalence of ED and its associated determinants in a sample of male patients with new or recently diagnosed T2DM. Methods: The SUBITO-DE study is an observational, multicenter, prospective study involving 27 Italian diabetes centers. Male patients recently diagnosed with T2DM were consecutively interviewed by their attending physician at the diabetes care centers and asked whether they had experienced a change in their sexual function or found it unsatisfactory. Those responding positively were then invited to participate in the study. Main outcome measure: Several hormonal and biochemical parameters were studied. Results: A nonselected series of 1,503 patients was interviewed, 499 of which (mean age, 58.8 ± 8.8 years) entered the study, yielding a final enrolment rate of 33.3%. ED was classified as mild in 19.4%, mild-to-moderate in 15.4%, moderate in 10.4%, and severe in 21.6% of patients, respectively. In addition, premature ejaculation, delayed ejaculation, and hypoactive sexual desire (HSD) were comorbid in 28.3%, 32.9%, and 58.4%, respectively. Finally, hypogonadism, showed an estimated prevalence of almost 20%. Both organic (at least one chronic DM-associated complication) and psychological factors (severe depressive symptoms) increased the risk of ED. Severe depressive symptoms were also associated with ejaculatory problems, HSD, and hypogonadism. Conclusions: A high prevalence of sexual dysfunction in men with recently diagnosed T2DM was detected. Early diagnosis of ED could help prevent emotional and physical discomfort in men and aid in identifying reversible cardiovascular risk factors. Screening of sexual dysfunction should become a part of routine care in the management of T2DM patients.
Article
Introduction: Delayed ejaculation is a small but important subsection of ejaculatory dysfunction, with prevalence estimated at 1-4%. It is most commonly defined by DSM-IV-TR criteria, as "a persistent delay in, or absence of, orgasm in a male following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration." The pathophysiology of delayed ejaculation is related to disruptions in ejaculatory apparatus, nervous transmission, hormonal or neurochemical ejaculatory control, or psychosocial factors. Aim: To update the clinician on the evaluation and treatment of delayed ejaculation. Methods: The keywords "delayed ejaculation" and "retarded ejaculation" were utilized to search Pubmed for relevant publications. Main outcome measures: 319 results were generated from the search, and those publications judged relevant to the pathophysiology, epidemiology, evaluation, and treatment of delayed ejaculation were included in the review. Result: 110 articles were ultimately selected for inclusion in this review. Conclusion: The evaluation of this condition requires a focused history and physical, which includes a detailed sexual history, examination of the genitalia, and inquiry into the status of the partner. Laboratory tests are aimed at the detection of abnormalities in the blood count, glucose level, hormone levels, or kidney function. If a correctable etiology is discovered, treatment is directed towards the reversal of this condition. In some cases, the delayed ejaculation may be a lifelong problem. Also, in some cases the etiology of the delayed ejaculation may be irreversible, such as in the case of age-related sensation loss or diabetes-related neuropathy. In these instances treatment may require a combination of behavioral modification, sexual therapy, or perhaps pharmaceutical drugs. Participation of the partner in therapy may sometimes be necessary. Future investigations will continue to elucidate the complex biological and psychosocial factors which contribute to delayed ejaculation, leading to more effective treatments. Shin DH and Spitz A. The evaluation and treatment of delayed ejaculation. Sex Med Rev 2014;2:121-133.
Article
Multiple sclerosis (MS) is one of the most frequent diseases of the central nervous system and usually occurs at the age when people would be expected to be in the prime of their sexual lives. Clinicians working in this field commonly concentrate on the classical neurological deficits and often overlook symptoms that seriously affect the quality of life, such as sexual dysfunction (SD). Sexual functioning of MS patients remains poorly understood. The aim of this study was to assess the prevalence of SDs, their relationship with demographic factors, and sexual quality of life in men with multiple sclerosis (MS). Sixty-seven patients from the National Multiple Sclerosis Center were interviewed, completed the questionnaires, and underwent neurological assessment. Primary outcome measures included the International Index of Erectile Function (IIEF), the Sexual Quality of Life Questionnaire (SQoL), and the Expanded Disability Status Scale (EDSS). The most common complaints were erectile dysfunction (52.9%), decreased sexual desire (26.8%), and difficulties in reaching orgasm (23.1%) or ejaculation (17.9%). The severity of SD had a clear impact on sexual quality of life, especially in the domains of erectile function and intercourse satisfaction. However, neither IIEF nor SQoL scores were correlated with age, time since onset of MS symptoms, or EDSS scores. Only 6% of the patients had ever discussed their concerns with a medical professional or undergone sexual therapy. SD is highly prevalent but commonly overlooked in MS patients and has a significant impact on their sexual quality of life. The data support a multifactorial etiology of SD in MS. More focus on SD and use of appropriate screening tools in clinical practice with MS patients are recommended. Lew-Starowicz M and Rola R. Sexual dysfunctions and sexual quality of life in men with multiple sclerosis. J Sex Med **;**:**-**.
Article
Antidepressant-induced sexual dysfunction adversely affects the quality of life of antidepressant users and reduces compliance with treatment. Animal models provide an instructive approach for examining potential sexual side effects of novel drugs. This review discusses the stability and reproducability of our standardized test procedure that assesses the acute, subchronic and chronic effects of psychoactive compounds in a 30minute mating test. In addition, we present an overview of the effects of several different (putative) antidepressants on male rat sexual behavior, as tested in our standardized test procedure. By comparing the effects of these mechanistically distinct antidepressants (paroxetine, venlafaxine, bupropion, buspirone, DOV 216,303 and S32006), this review discusses the putative mechanism underlying sexual side effects of antidepressants and their normalisation. This review shows that sexual behavior is mainly inhibited by antidepressants that increase serotonin neurotransmission via blockade of serotonin transporters, while those that mainly increase levels of dopamine and noradrenaline are devoid of sexual side effects. Those sexual disturbances can not be normalized by simultaneously increasing noradrenaline neurotransmission, but are normalized by increasing both noradrenaline and dopamine neurotransmission. Therefore, it is hypothesized that the sexual side effects of selective serotonin reuptake inhibitors may be mediated by their inhibitory effects on dopamine signalling in sex brain circuits. Clinical development of novel antidepressants should therefore focus on compunds that simultaneously increase both serotonin and dopamine signalling.
Article
Primary delayed ejaculation (DE) is a relatively uncommon condition and has not been studied broadly. In this study, we aimed to investigate the clinical characteristics and penile afferent neuronal function using somatosensory evoked potentials in patients with primary DE. Twenty-four patients with primary DE and 24 age-matched normally potent men were enrolled in this study. Results indicated that patients with primary DE had remarkably higher frequency of masturbatory activity (especially, some with idiosyncratic styles), lower night emissions, longer intravaginal ejaculation latency time (IELT), higher anxiety and depression states (p = 0.010, p = 0.017, p < 0.001, p < 0.001, p < 0.001 respectively). In addition, the mean penile shaft sensory threshold values in the patients were considerably higher than those in the healthy men (p < 0.001). Mean latencies of dorsal nerve somatosensory evoked potential DNSEP were 4.32 ms longer in the DE group than those in the control group (p < 0.001). However, the latencies of glans penis somatosensory evoked potential (GPSEP) between the two group showed no significant difference (p = 0.985). At the same time, in comparison with the control group, the amplitudes of DNSEP were considerably lower in the DE group (p = 0.016), but not in the amplitudes of GPSEP (p = 0.934). This study indicates that the patients with primary DE appear to have penile shaft rather than glans hyposensitivity and hypoexcitability, and adaptation to a certain masturbatory technique (higher and idiosyncratic) may be related to the causes of primary DE, which is also associated with lower night emissions, longer IELT, higher anxiety and depression states.
Article
The role of medical conditions, childhood experiences, and psychological and relationship factors in the development and maintenance of male sexual difficulties is not well understood. Using self-report questionnaires, the current study examined how these factors are associated with male sexual difficulties overall, as well as for each of four separate problems (low sexual desire, erectile difficulties, premature ejaculation, delayed ejaculation). The participants for the study were 331 Australian men from the general population, all of whom were in cohabiting heterosexual relationships and had experienced one or more of the aforementioned sexual problems. Data were collected via an online survey between January 2010 and April 2011. The results demonstrated that medical factors as well as current psychological factors (e.g., performance anxiety) were most likely associated with each male sexual difficulty. These findings are in contrast to those obtained with women, where relationship factors are strongly related to female sexual problems. They would suggest that the targets for sex therapy may be different for men and women, with medical problems and performance anxiety being the primary targets for men.
Article
Objective: Men with premature ejaculation (PE) exhibit diminished control over and short latency to ejaculation. The present study attempted to delineate further characteristics of men with PE and to address a number of presumed hypotheses regarding the etiology of this disorder. Methods: Twenty-six men with PE were compared with an age-matched group of 13 sexually functional men on multiple indices of erectile and ejaculatory response during coital and masturbatory activities. These data were collected through retrospective, prospective, and laboratory methods. Results: Psychophysiological testing indicated greater ejaculatory vulnerability to penile stimulation, although not visual erotic stimulation, in PE men than functional controls. PE men also showed subtle anomalies in the way they perceived their somatic response. The correlation between measures of ejaculatory latency and control was positive and high for intercourse, but low or even negative for masturbation. Whereas functional men showed consistency in ejaculatory latency over coital and masturbatory activities, PE men exhibited much shorter latencies during coitus than masturbation. Data collected under various methodologies (retrospective, prospective, and laboratory) showed greater consistency among sexually functional subjects; and preliminary analysis of laboratory data suggests psychophysiological methodology is as effective in differentiating dysfunctional from functional men as prospective and retrospective methodologies. Conclusion: Although ejaculatory latency and control tend to be related, these measures are not always stable over different kinds of sexual activity or using different methods of data collection. Psychophysiological methodology is effective in differentiating group membership (PE vs. control), but does not predict individual ejaculatory responses measured prospectively.
Article
The Global Online Sexuality Survey (GOSS) is a worldwide epidemiologic study of sexuality and sexual disorders. In 2010, the first report of GOSS came from the Middle East. This report studies the prevalence rate of premature ejaculation (PE) in the U.S. as of 2011–2012 and evaluates risk factors for PE. GOSS was randomly deployed to English-speaking male web surfers in the USA via paid advertising on Facebook®, comprising 146 questions. Prevalence of PE as per the International Society of Sexual Medicine's (ISSM) definition. With a mean age of 52.38 years ± 14.5, 1,133 participants reported on sexual function. As per the ISSM definition of PE, the prevalence rate of PE in the USA as of 2011 was 6.3%. This is in contrast to 49.6% as per the Premature Ejaculation Diagnostic Tool (PEDT), 77.6% as per unfiltered subjective reports, and 14.4% as per subjective reporting on more consistent basis. 56.3% of the latter reported lifelong PE. 63.2% could be classified as having natural variable PE. Erectile dysfunction is a possible predisposing factor for acquired PE, while genital size concerns may predispose to lifelong PE. Age, irregular coitus, circumcision, and the practice of masturbation did not pose a risk for PE, among other risk factors. Oral treatment for PE was more frequently used and reported to be more effective than local anesthetics, particularly in those with lifelong PE. Applying the ISSM definition, prevalence of PE is far less than diagnosed by other methods, 6.3% among Internet users in USA as of the year 2011. PEDT measures both lifelong and acquired PE, in addition to 35% men with premature-like ejaculatory dysfunction, making it inaccurate for isolating lifelong and acquired PE cases. Shaeer O. The Global Online Sexuality Survey (GOSS): The United States of America in 2011 chapter III—Premature ejaculation among English-speaking male Internet users. J Sex Med **;**:**–**.
Article
We aimed to evaluate possible associations of circumcision with several sexual dysfunctions and to identify predictors for the development of these outcomes post-operatively. Telephone surveys about sexual habits and dysfunctions before and after intervention were conducted post-operatively to patients that underwent circumcision in Centro Hospitalar Vila Nova de Gaia/Espinho during 2011. McNemar test was used for a matched-pairs analysis of pre- and post-operative data. Odds ratios, adjusted in a multivariate analysis, explored predictors of de novo sexual dysfunctions after circumcision. With intervention, there was an increase in frequency of erectile dysfunction (9.7% versus 25.8%, P = 0.002) and delayed orgasm (11.3% versus 48.4%, P < 0.001), and a significant symptomatic improvement in patients with pain with intercourse (50.0% versus 6.5%, P < 0.001). Significant predictors for de novo erectile dysfunction were diabetes mellitus (OR 9.81, P = 0.048) and lack of sexual desire (OR 8.76, P = 0.028). Less than three sex partners (OR 7.04, P = 0.007) and low sexual desire (OR 7.49, P = 0.029) were significant predictors for de novo delayed orgasm.