Curr Urol Rep. 2010 Sep 7;
Keel CE, Dorsey PJ, Acker W, Hellstrom WJ

Premature ejaculation is the most common male sexual dysfunction. The International Society of Sexual Medicine recently defined premature ejaculation as ejaculation less than about 1 min after penetration, inability to control ejaculation, and resulting negative personal consequences. Evolving treatments target the modulation of the neurobiological causes of the disorder. Current pharmaceuticals focus on aerosolized topical agents, selective serotonin reuptake inhibitors, 5-hydroxytryptamine receptor modulators, and opioid agonists. These emerging medications and the ability to tailor treatments based on genetic information likely will change the paradigm of this disorder and how it will be treated by clinicians.

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Urologiia. 2010 May-Jun; 49-52

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.

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BMC Int Health Hum Rights. 2010 Aug 21; 10(1): 21
Amini R, Haghani H, Masoumi M

ABSTRACT: BACKGROUND: Quality of Life measurements are necessary tools for effectively evaluating health services. In the population of patients afflicted with war-related blindness in Iran, such measurements have yet to be documented and utilized. “The design and implementation of this study involved the determination of a baseline score for QOL in a population of Iranian blinded in the Iraq-Iran war in order to facilitate the design of interventions intended to improve the population’s QOL.” METHODS: This was a cross-sectional study of a representative population of 250 war victims blind in both eyes at a 14-day recreational conference. RESULTS: Participants had a mean age of 43.20(SD8.34) and their composition was 96.5% male and 3.5% female with a mean SF-36 QOL score of 59.20(SD22.80). An increasing level of education among the participants correlated with a higher QOL score (p = 0.006). The QOL also has a significant correlation to number of injuries (p < 0.0001). High systolic and diastolic blood pressure, hearing loss, and tinnitus had negative individual correlations to QOL (p = 0.016, 0.016, 0.005, p < 0.0001). The male sexual disorders of erectile dysfunction and premature ejaculation both had significant correlations to QOL (p = 0.026, p < 0.0001). Hypercholesterolemia showed significant correlation to QOL (p = 0.021). CONCLUSIONS: As blind war survivors' age, they will present with a greater set of burdens despite their relatively better QOL in the physical component scale when compared with lower limb amputees. Risk factors of cardiovascular attack such as high blood pressure and hypercholesterolemia were present and need future intervention.

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Beijing Da Xue Xue Bao. 2010 Aug 18; 42(4): 425-32
Wang YB, Mao Y, Wei Q, Wu TX, Dong Q

OBJECTIVE: To assesss the effectiveness of dapoxetine in the treatment of premature ejaculation. METHODS: Both English and Chinese studies involving men with prematrue ejaculation who were treated with dapoxetine from the Cochrane Library, MEDLINE, EMBASE and CNKI, CBM, VIP between 1979 and 2009.were included in the randomized controlled trials (RCTs) and the data processed by RevMan.RESULTS: Five RCTs involving 4433 patients were included in the Meta analysis, of which 3 were of grade A and 2 were of grade B according to the quality evaluation of methodology. Intravaginal ejaculatory latency time(IELT), patient-reported global impression of change(PGI), satisfaction with sexual intercourse(SWSI),perceived control over ejaculation(PCOE),personal distress related to ejaculation(PDRE) were used for assessment. Meta analysis based on included studies of patients having been treated with dapoxetine for 9-24 weeks showed that: (1) the difference of the patients’ IELT between treatment group and control group was statistically significan [P<0.001,WMD(95%CI) was 1.38(1.21,1.55)]; (2) the difference of the PGI of development in premature ejaculation between treatment group and control group was statistically significant [P<0.001,OR(95%CI) was 3.56(2.60,4.88)]; (3) the difference of the patients' SWSI between treatment group and control group was statistically significant [P<0.001, OR(95%CI) was 3.85(2.08,7.10)]; the difference of the patients' score of SWSI between treatment group and control group was statistically significant [P<0.001, WMD(95%CI) was 0.55(0.48,0.62)]; (4) the difference of the patients' change of PCOE between treatment group and control group was statistically significant [P<0.001, OR(95%CI) was 2.87(2.30,3.58)]; the difference of the patients' score of PCOE between treatment group and control group was statistically significant [P<0.001, WMD(95%CI) was 0.63(0.49,0.78)]; (5) after being treated with dapoxetine for 9-24 weeks, the difference of the patients' change of PDRE between treatment group and control group was statistically significant [P<0.001,OR(95%CI) was 2.02(1.69,2.42)]. All the RCTs reported the side effects of dapoxetine, but the results showed that there were no serious side effects of dapoxetine during the treatment period. CONCLUSION: The available evidence indicates that dapoxetine would improve the symptoms of premature ejaculation, prolong IELT over 9-24 weeks in men from a wide range of cultural backgrounds, and significantly improve all patients' reported outcomes and the patients' clinical global impressions of premature ejaculation, including more control, greater satisfaction, and less distress.

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Beijing Da Xue Xue Bao. 2010 Aug 18; 42(4): 425-32
Wang YB, Mao Y, Wei Q, Wu TX, Dong Q

OBJECTIVE: To assesss the effectiveness of dapoxetine in the treatment of premature ejaculation. METHODS: Both English and Chinese studies involving men with prematrue ejaculation who were treated with dapoxetine from the Cochrane Library, MEDLINE, EMBASE and CNKI, CBM, VIP between 1979 and 2009.were included in the randomized controlled trials (RCTs) and the data processed by RevMan.RESULTS: Five RCTs involving 4433 patients were included in the Meta analysis, of which 3 were of grade A and 2 were of grade B according to the quality evaluation of methodology. Intravaginal ejaculatory latency time(IELT), patient-reported global impression of change(PGI), satisfaction with sexual intercourse(SWSI),perceived control over ejaculation(PCOE),personal distress related to ejaculation(PDRE) were used for assessment. Meta analysis based on included studies of patients having been treated with dapoxetine for 9-24 weeks showed that: (1) the difference of the patients’ IELT between treatment group and control group was statistically significan [P<0.001,WMD(95%CI) was 1.38(1.21,1.55)]; (2) the difference of the PGI of development in premature ejaculation between treatment group and control group was statistically significant [P<0.001,OR(95%CI) was 3.56(2.60,4.88)]; (3) the difference of the patients' SWSI between treatment group and control group was statistically significant [P<0.001, OR(95%CI) was 3.85(2.08,7.10)]; the difference of the patients' score of SWSI between treatment group and control group was statistically significant [P<0.001, WMD(95%CI) was 0.55(0.48,0.62)]; (4) the difference of the patients' change of PCOE between treatment group and control group was statistically significant [P<0.001, OR(95%CI) was 2.87(2.30,3.58)]; the difference of the patients' score of PCOE between treatment group and control group was statistically significant [P<0.001, WMD(95%CI) was 0.63(0.49,0.78)]; (5) after being treated with dapoxetine for 9-24 weeks, the difference of the patients' change of PDRE between treatment group and control group was statistically significant [P<0.001,OR(95%CI) was 2.02(1.69,2.42)]. All the RCTs reported the side effects of dapoxetine, but the results showed that there were no serious side effects of dapoxetine during the treatment period. CONCLUSION: The available evidence indicates that dapoxetine would improve the symptoms of premature ejaculation, prolong IELT over 9-24 weeks in men from a wide range of cultural backgrounds, and significantly improve all patients' reported outcomes and the patients' clinical global impressions of premature ejaculation, including more control, greater satisfaction, and less distress.

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J Androl. 2010 Aug 12;
Corona G, Boddi V, Gacci M, Sforza A, Forti G, Mannucci E, Maggi M

The disorders of orgasm/ejaculation encompass a heterogeneous group of dysfunctions including premature ejaculation, delayed ejaculation and perceived ejaculate volume reduction (PEVR). The aim of this study is exploring specific associations of PEVR in a consecutive series of 3141 subjects (mean age 51.6+/-13.1 years old) consulting for ED. Among these, 71 have been excluded because they underwent prostate surgery. Different clinical and biochemical factors were evaluated along with parameters derived from SIEDY structured interview evaluating the contribution of organic, relational and intrapsychic factors to ED. After adjustment for confounders, PEVR was specifically associated with the use of androgen deprivation therapy as well as with different other medicaments including alpha-blockers, serotonergic reuptake inhibitor antidepressants and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. A higher prevalence of diabetes mellitus and hypogonadism was observed in subjects with PEVR when compared to the rest of the sample (23.0 vs. 14.1% and 9.1 vs. 5.3% respectively; both p<0.05). In addition, different sexual parameters such as severe ED (HR=1.25[1.11-1.41]; p<0.0001) patient's (HR=1.53[1.38-1.70]; p<0.0001) and partner's (HR=1.21[1.07-1.36]; p<0.005) hypoactive sexual desire (HSD) were also significantly related to PEVR. Furthermore, PEVR was associated with an impairment of both the relational and intrapsychic components of ED. In a multivariate model, adjusting for age, BMI, smoking habit and medicaments, both hypogonadism, diabetes mellitus, and severe ED as well as patient's and partner's HSD were all independently associated with PEVR. Our results indicate that PEVR is important not only for couple reproductive purposes, but it also appears to have a distinct role in the couple's sexual performance.

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Drugs Today (Barc). 2010 Jul; 46(7): 507-21
Hellstrom WJ

Premature ejaculation (PE), the most common male sexual dysfunction, impacts the quality of life of not only the affected male but also his partner. Despite its prevalence, there are currently no United States Food and Drug Administration-approved therapies for PE. In 2004, the American Urological Association published treatment guidelines for PE that recommended the serotonergic antidepressants paroxetine, sertraline, clomipramine and fluoxetine, as well as topical lidocaine-prilocaine cream. None of these treatments were developed for PE, and all have limitations associated with their use. Therapies in development may have advantages over the currently available treatments. These include PSD-502, a metered-dose aerosol of lidocaine and prilocaine used as an on-demand local treatment, and dapoxetine, an on-demand short-acting selective serotonin reuptake inhibitor. Together with a recent, evidence-based definition of PE, these novel therapies should improve sexual function and quality of life in men suffering from PE.

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Int Urol Nephrol. 2010 Aug 1;
Sönmez NC, Kiremit MC, Güney S, Arisan S, Akça O, Dalkılıç A

AIM: Chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is a common disabling condition that is primarily associated with pain in the urogenital region and disturbances in urinary and sexual function. Chronic pelvic pain symptoms are the most common presentation, especially perineal, lower abdominal, testicular, penile as well as ejaculatory pain. Other genitourinary tract complaints include voiding disorders and sexual dysfunction. We aimed in the study at examining the prevalence rates of premature ejaculation and erectile dysfunction in patients with chronic pelvic pain syndrome and comparing these rates with those of healthy control subjects. MATERIALS AND METHODS: Between November 2006 and January 2008, 85 patients with the diagnosis of CP/CPPS were chosen for the study; 30 patients without regular sexual activity and 12 patients without inclusion criteria were excluded from the study. A total of 43 patients were included in the study. Twenty healthy volunteers without prostatitis-like syndromes were used as a control group. The sexual function of the patients and the healthy volunteers were evaluated using Arizona Sexual Function Questionary Form and International Index of Erectile Function (IIEF). Erectile dysfunction (ED), ejaculatio precox (EP) and pain on ejaculation (PEP) were investigated as sexual dysfunction. RESULTS: The mean age of the patients was 33.7 (22-48) years; the mean symptom period was 37.7 (6-120) months, while the mean age of the control group was 32.4 (24-48) years. The mean NIH-CPSI score of the patient group was 26.1 (16-34). Patient group was classified as CPPS type IIIa and CPPS type IIIb. Mild and moderate erectile dysfunction (ED) was found in [9] 23.2% patients at the patient group and [2] 10% at the control group (P: 0.185). Severe erectile dysfunction was not found in both groups. Ejaculatio Precox (EP) was found at (29) 67.4% of the patient group and [7] 40% of the control group. Pain on ejaculation (PEP) was detected in [15] 37.2% of the patient group, while none of the control group had pain on ejaculation. More than one sexual dysfunction was found in [17] 41.8% of the patient group and none of the control group. Comparing patient group versus control group, ejaculation disorders (EP and PEP) and more than one sexual dysfunction disorder were statistically significant. According to ED, there is no statistical difference between the groups (P > 0.05). CONCLUSION: Sexual function disorders, especially ejaculation disorders (EP and PEP), are frequently seen in CP/CPPS patients versus normal population. Age, symptoms period, symptom score and CP/CPPS subgroups are not risk factors for sexual function disorders. Patients with the diagnosis of CP/CPPS should be evaluated for sexual function disorders.

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Asian J Androl. 2010 Aug 2;
Park HJ, Park JK, Park K, Lee SW, Kim SW, Yang DY, Moon DG, Min KS, Moon KH, Yang SK, Hyun JS, Park NC

In this study, we aimed to investigate the prevalence and perception of premature ejaculation (PE) in young and middle-aged Korean men. The study was conducted using an Internet-assisted questionnaire. A total of 2 037 Korean male adults, aged 20 years or older, were randomly sampled based on age and residency. The questionnaire developed by the PE Study Group of the Korean Andrological Society includes four categories (overall sexual function, symptoms, distress and treatment) with a total of 16 questions. For each question, symptoms were evaluated by a scale ranging from 0 to 10. Intravaginal ejaculation latency time was ‘5-10 min’ in 38.6%, followed by ‘longer than 10 min’ in 29.9%, ‘2-5 min’ in 23.6%, ‘1-2 min’ in 5.4% and ’shorter than 1 min’ in 2.5%. In our series, 27.5% of respondents reported having PE. Control over ejaculation within a recent 3-month period was 6.2 points on average. Respondent complaints of PE-related stress averaged 7.1 points and stress-related complaints from sexual partners averaged 7.1 points. The effect of PE on sexual life was 6.8 points. Of the respondents determined as having PE, 42.6% responded that they were inclined to receive treatment. Results from this study suggest that the prevalence of PE diagnosed by the respondent on his own was approximately 27.5% in young and middle-aged men in Korea. PE-related stress had a significant effect on the stress, sexual activity and quality of life, of the respondent and his sexual partner.

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Acad Med. 2010 Aug; 85(8): 1321-1330
Shindel AW, Ando KA, Nelson CJ, Breyer BN, Lue TF, Smith JF

PURPOSE: To determine factors associated with students’ comfort in addressing patients’ sexuality in the clinical context. METHOD: The authors invited students enrolled in MD-degree-granting and osteopathic medical schools in the United States and Canada to participate in an anonymous Internet survey between February and July 2008. The survey assessed ethnodemographic factors and sexual history. Respondents also completed the Center for Epidemiologic Studies Depression Scale. Male respondents completed the International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool. Female respondents completed the Female Sexual Function Index and the Index of Sex Life. The authors used descriptive statistics, ANOVA, and multivariable logistic regression to analyze responses. RESULTS: The authors’ analyses included 2,261 completed survey responses: 910 from men, 1,343 from women, and 8 from individuals who self-identified as “other” gendered. Over 53% of respondents (n = 1,206) stated that they felt they had not received sufficient training in medical school to address sexual concerns clinically. Despite this, 81% of students (n = 1,827) reported feeling comfortable dealing with their patients’ sexuality issues. Students with limited sexual experience, students at risk for sexual problems, and students who felt that they had not been trained adequately were less likely to report being comfortable talking to patients about sexual health issues. CONCLUSIONS: Perception of inadequate sexuality training in medical school and personal issues pertaining to sex may be associated with students’ difficulty in addressing patients’ sexuality. Adequate training is preeminently associated with feeling comfortable addressing patients’ sexuality and should be a priority for medical education.

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