BMC Nurs. 2010 Mar 18; 9(1): 5
Omu FE, Omu AE

ABSTRACT: BACKGROUND: The unfulfilled desire of millions of infertile couples worldwide to have their own biological children results in emotional distress. This study evaluated the emotional reactions of couples attending a combined infertility clinic in Kuwait and successful clients’ perception of nurses. METHODS: Quantitative and qualitative methods were used. The first phase was by structured interview using two standardized psychological scales: the 25-item Hopkins Symptom Checklist and Modified Fertility Adjustment Scale. Data were collected from 268 couples attending the combined infertility clinic, between October 2002 and September 2007. The second phase was a semi-structured interview of 10 clients who got pregnant following treatment. The interview explored their feelings and perception of the nurses’ role. Interviews were transcribed verbatim and analyzed. RESULTS: The average duration of infertility was 4 years; 65.7% of the women and 76.1% of men suffered from primary infertility. Emotional reactions experienced were: anxiety in women (12.7%) and men (6%), depression in women (5.2%) and men (14.9%) and reduced libido in women (6.7%) and men (29.9%). Also in men, 14.9% experienced premature ejaculation, 5.2% weak ejaculation and 7.9% had impotence although 4.9% were transient. In the semi-structured interviews, the emotions expressed were similar and in addition to anger, feelings of devastation, powerlessness, sense of failure and frustration. In the survey, 12.7% of the men were found to show more anxiety than women (6%). Although all the 10 women interviewed confirmed they were anxious; only 4 of their partners were reported to be sad or anxious. Successful clients’ perception of nurses’ roles included nurses carrying out basic nursing procedures, communicating, educating about investigative and treatment procedures, providing emotional support by listening, encouraging, reassuring and being empathetic. CONCLUSIONS: This study illuminates the emotional reactions of infertile clients. Fertility nurses in Kuwait can provide emotional support through communication. The need for additional and continuous training for nurses employed in fertility settings in Kuwait is paramount.

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Ther Umsch. 2010 Mar; 67(3): 123-8
Casella R

Phosphodiasterase type 5 inhibitors (sildenafil, vardenafil, tadalafil) are the first line symptomatic therapy for patients with erectile dysfunction. The patient should receive a meticolous information on the use of these drugs and their possible side effects. These drugs are safe and can be used even in patients with stable cardiovascular disease. Patients not responding to oral drugs may be offered intraurethral or intracavernous alprostadil. Vacuum constriction devices are a second line option more acceptable to older patients. Penile prosthesis are very seldom used in Switzerland and vascular surgery is a vanishing option. Testosterone substitution is seldom needed in this setting. Treatment of premature ejaculation subdivides into behavioural therapy (”stop-start” or “squeeze” technique) and drug therapy as well. Topical therapy with lidocaine/prilocaine-containing medications to be applied before sexual intercourse and a oral daily off label use therapy with selective serotonin re-uptake inhibitors (paroxetine, fluoxetine, sertraline) can be offered. Dapoxetine, a potent selective serotonin reuptake inhibitor with short half life time, is the first officially approved medication for the treatment of premature ejaculation and should be available soon in Switzerland.

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Zhonghua Nan Ke Xue. 2009 Nov; 15(11): 1035-8
Wang HY, Huang YF

In recent years, more and more attention has been drawn to the role of phosphodiesterase 5 (PDE5) in penile erection. The cyclic nucleotide (cGMP) signaling pathway mediates the smooth-muscle relaxing effect of nitric oxide necessary for normal erectile function. Down-regulation of this pathway is the pathological pivot of many forms of erectile dysfunction (ED) and leads to the development of some chronic diseases. Therapeutic outcomes have shown that vardenafil is effective and safe in the treatment of ED associated with dyslipidemia, hypertension, depression, diabetes, radical retropubic prostatectomy, spinal cord injury, sildenafil failure, renal transplantation, chronic prostatitis and that accompanied by premature ejaculation. Vardenafil provides a reasonable therapeutic alternative for these refractory ED patients. In addition, vardenafil can prolong erectile duration of ED patients.

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J Assoc Physicians India. 2009 Aug; 57: 604
Viswanathan V, Agarwal S, Kumpatla S

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Urol J. 2010; 7(1): 40-44
Dadfar MR, Baghinia MR

Introduction: A wide variety of therapeutic modalities have been tried for treatment of premature ejaculation. Selective serotonin reuptake inhibitors are from the latest and most effective medical agents. Among these drugs, fluoxetine hydrochloride has been used for some years in our institutions with considerable drug untoward effects and significant failure rates. We tried to salvage treatment process by using citalopram in fluoxetine-resistant patients. Materials and Methods: In a prospective clinical trial, we used citalopram hydrobromide as a salvage agent in 16 newly married men with premature ejaculation who experienced a history of unsuccessful treatment with fluoxetine hydrochloride. Intravaginal ejaculation latency time (IVELT) was recorded by a stopwatch before and after the treatment, and a 5-stage visual scale was designed and used to compare patients’ sexual satisfaction levels during the 1-month treatment period. Results: The IVELT and sexual satisfaction levels both significantly improved after citalopram prescription. The mean measured IVELT was 0.388 +/- 0.212 minutes before the treatment, which increased to 4.313 +/- 2.886 minutes after the treatment. The reported drug untoward effects were mild. Citalopram was ineffective only in 1 patient, which was discontinued after 4 weeks. Conclusion: Our study showed that citalopram is effective and safe in the treatment of premature ejaculation in newly married men after failed treatment with fluoxetine.

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Urol J. 2010; 7(1): 40-44
Dadfar MR, Baghinia MR

Introduction: A wide variety of therapeutic modalities have been tried for treatment of premature ejaculation. Selective serotonin reuptake inhibitors are from the latest and most effective medical agents. Among these drugs, fluoxetine hydrochloride has been used for some years in our institutions with considerable drug untoward effects and significant failure rates. We tried to salvage treatment process by using citalopram in fluoxetine-resistant patients. Materials and Methods: In a prospective clinical trial, we used citalopram hydrobromide as a salvage agent in 16 newly married men with premature ejaculation who experienced a history of unsuccessful treatment with fluoxetine hydrochloride. Intravaginal ejaculation latency time (IVELT) was recorded by a stopwatch before and after the treatment, and a 5-stage visual scale was designed and used to compare patients’ sexual satisfaction levels during the 1-month treatment period. Results: The IVELT and sexual satisfaction levels both significantly improved after citalopram prescription. The mean measured IVELT was 0.388 +/- 0.212 minutes before the treatment, which increased to 4.313 +/- 2.886 minutes after the treatment. The reported drug untoward effects were mild. Citalopram was ineffective only in 1 patient, which was discontinued after 4 weeks. Conclusion: Our study showed that citalopram is effective and safe in the treatment of premature ejaculation in newly married men after failed treatment with fluoxetine.

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Zhonghua Yi Xue Za Zhi. 2009 Dec 15; 89(46): 3249-52
Jiang XZ, Zhou CK, Guo LH, Chen J, Wang HQ, Zhang DQ, Shi BK, Xu ZS

OBJECTIVE: Primary premature ejaculation (PPE) is a prevalent sexual dysfunction among men while its precise pathologic mechanism has remained poorly understood. In current study the correlation between excitability of bulbocavernosus reflex (BCR) to stimulation of prostatic urethra and primary premature ejaculation was studied. METHODS: Forty-two patients with PPE and 20 normal potent male volunteers were studied by inserting a specially designed Foley catheter with two electrodes mounted on its distal surface (intraurethral catheter electrode) into bladder to evoke the BCR to stimulation of prostatic urethra to record the sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR and latencies of BCR. Also the sensitivity of glans penis to electrical stimulation was detected by two surface electrodes. RESULTS: The mean sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR, latencies of BCR and sensory thresholds of glans penis were (18.2 +/- 2.7) mA (0.2 ms in duration, 1 Hz), (34.8 +/- 4.2) mA (0.2 ms, 1 Hz), (71.2 +/- 5.8) ms and (14.2 +/- 1.9) mA (0.04 ms in duration, 3 Hz) in normal potent men respectively and were (12.4 +/- 3.7) mA (0.2 ms, 1 Hz), (23.8 +/- 5.6) mA (0.2 ms, 1 Hz), (70.5 +/- 6.3) ms and (11.9 +/- 2.3) mA (0.04 ms, 3 Hz) in patients with PPE respectively. Statistically significant differences were seen regarding the sensory thresholds of BCR to stimulation of prostatic urethra, the thresholds to evoke stable BCR and the sensory thresholds of glans penis between two groups (all P 0.05). CONCLUSION: Patients with PPE have hyperexcitable BCR to stimulation of prostatic urethra. It is probably one of the important etiological factors. Moreover the findings may provide new therapeutic modalities of PPE.

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Eur Urol. 2010 Feb 20;
Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, Vardi Y, Wespes E

CONTEXT: Erectile dysfunction (ED) and premature ejaculation (PE) are the two most prevalent male sexual dysfunctions. OBJECTIVE: To present the updated version of 2009 European Association of Urology (EAU) guidelines on ED and PE. EVIDENCE ACQUISITION: A systematic review of the recent literature on the epidemiology, diagnosis, and treatment of ED and PE was performed. Levels of evidence and grades of recommendation were assigned. EVIDENCE SYNTHESIS: ED is highly prevalent, and 5-20% of men have moderate to severe ED. ED shares common risk factors with cardiovascular disease. Diagnosis is based on medical and sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to the patient’s complaints and risk factors. Treatment is based on phosphodiesterase type 5 inhibitors (PDE5-Is), including sildenafil, tadalafil, and vardenafil. PDE5-Is have high efficacy and safety rates, even in difficult-to-treat populations such as patients with diabetes mellitus. Treatment options for patients who do not respond to PDE5-Is or for whom PDE5-Is are contraindicated include intracavernous injections, intraurethral alprostadil, vacuum constriction devices, or implantation of a penile prosthesis. PE has prevalence rates of 20-30%. PE may be classified as lifelong (primary) or acquired (secondary). Diagnosis is based on medical and sexual history assessing intravaginal ejaculatory latency time, perceived control, distress, and interpersonal difficulty related to the ejaculatory dysfunction. Physical examination and laboratory testing may be needed in selected patients only. Pharmacotherapy is the basis of treatment in lifelong PE, including daily dosing of selective serotonin reuptake inhibitors and topical anaesthetics. Dapoxetine is the only drug approved for the on-demand treatment of PE in Europe. Behavioural techniques may be efficacious as a monotherapy or in combination with pharmacotherapy. Recurrence is likely to occur after treatment withdrawal. CONCLUSIONS: These EAU guidelines summarise the present information on ED and PE. The extended version of the guidelines is available at the EAU Web site (http://www.uroweb.org/nc/professional-resources/guidelines/online/).

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Int Urol Nephrol. 2010 Feb 20;
Gökçe A, Demirtas A, Halis F, Ekmekcioglu O

OBJECTIVE: The aim of this study is to measure the ejaculation latency time (ELT) and to evaluate the effects of vardenafil on ELT and rigidity parameters of patients with lifelong premature ejaculation (PE) in a laboratory setting. MATERIALS AND METHODS: Double-blind, placebo-controlled, cross-over laboratory study was performed with 40 males with lifelong PE. As the subject ingested the placebo or vardenafil, real-time penile tumescence and rigidity monitoring began. Audiovisual sexual stimulation (AVSS) was performed 45 min later. The patient began vibratory stimulation to the frenular area at 8th minute of AVSS till ejaculation. A button has been placed under the cover where the patient presses to operate the vibrator. ELT was calculated in seconds with a chronometer. Following ejaculation, AVSS was stopped. The test was repeated with second medication in 7-15 days. RESULTS: Among 40 patients, the results of 17 could be evaluated. When the patient took placebo and vardenafil, mean ELTs were 62.7 and 189.5 s, respectively. When compared with placebo, vardenafil improved ELT significantly (P = 0.04). After the beginning of AVSS, time to first recorded base or tip rigidities was shorter and time to last recorded tip or base rigidities following ejaculation was longer than placebo; however, these differences were not significant (P > 0.05 for each). CONCLUSIONS: This laboratory design might be used to evaluate the effects of drugs on patients with ejaculation disorders. In this laboratory setting study, vardenafil exerted a threefold increase in ejaculation delay outside the vagina in patients with lifelong PE.

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Arch Sex Behav. 2010 Feb 19;
Christensen BS, Grønbæk M, Osler M, Pedersen BV, Graugaard C, Frisch M

Sexual dysfunctions and difficulties are common experiences that may impact importantly on the perceived quality of life, but prevalence estimates are highly sensitive to the definitions used. We used questionnaire data for 4415 sexually active Danes aged 16-95 years who participated in a national health and morbidity survey in 2005 to estimate the prevalence of sexual dysfunctions and difficulties and to identify associated sociodemographic factors. Overall, 11% (95% CI, 10-13%) of men and 11% (10-13%) of women reported at least one sexual dysfunction (i.e., a frequent sexual difficulty that was perceived as a problem) in the last year, while another 68% (66-70%) of men and 69% (67-71%) of women reported infrequent or less severe sexual difficulties. Estimated overall frequencies of sexual dysfunctions among men were: premature ejaculation (7%), erectile dysfunction (5%), anorgasmia (2%), and dyspareunia (0.1%); among women: lubrication insufficiency (7%), anorgasmia (6%), dyspareunia (3%), and vaginismus (0.4%). Highest frequencies of sexual dysfunction were seen in men above age 60 years and women below age 30 years or above age 50 years. In logistic regression analysis, indicators of economic hardship in the family were positively associated with sexual dysfunctions, notably among women. In conclusion, while a majority of sexually active adults in Denmark experience sexual difficulties with their partner once in a while, approximately one in nine suffer from frequent sexual difficulties that constitute a threat to their well-being. Sexual dysfunctions seem to be more common among persons who experience economic hardship in the family.

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