Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), also known as NIH category III prostatitis, is common and has significant impact on quality of life through pain and lower urinary tract symptoms. A high proportion of men with CP/CPPS suffer from some form of sexual dysfunction including erectile dysfunction, premature ejaculation, and painful ejaculation. While well described, the pathophysiology of these sexual symptoms has not been well studied. This review will focus on what we know regarding the incidence and potential mechanisms for sexual dysfunction in CP/CPPS and discuss diagnostic and therapeutic options.

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Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), also known as NIH category III prostatitis, is common and has significant impact on quality of life through pain and lower urinary tract symptoms. A high proportion of men with CP/CPPS suffer from some form of sexual dysfunction including erectile dysfunction, premature ejaculation, and painful ejaculation. While well described, the pathophysiology of these sexual symptoms has not been well studied. This review will focus on what we know regarding the incidence and potential mechanisms for sexual dysfunction in CP/CPPS and discuss diagnostic and therapeutic options.

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To study the clinical effects of the Chinese drug Yimusake, used alone or in combination with trazodone hydrochloride, on primary premature ejaculation (PE).Sixty-eight primary PE patients were randomized to a control (n=32) and an experimental group (n=36), the former treated with Yimusake 1 tablet (50 mg) pre day, and the latter with 1 tablet of trazodone hydrochloride (50 mg) pre day in addition, both given orally after supper and for 4 weeks, followed by observation of the therapeutic effects.Eighteen cases (56.25%) responded in the control and 25 (69.44% ) in the experimental group, with statistically significant difference between the two groups (P<0.05).Yimusake combined with trazodone hydrochloride is highly efficacious for primary PE.

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Premature ejaculation (PE), the most common sexual dysfunctions in men, is characterized by loss or absence of ejaculatory control. PE can be classified as either a lifelong or acquired condition. Although the prevalence of lifelong PE is rather low in the general male population, recent studies demonstrated that the patients who seek treatment for their rapid ejaculation mostly report lifelong PE. Although no drug for PE has been approved by regulatory bodies, chronic selective serotonin reuptake inhibitors (SSRIs) proved to be effective in treating lifelong PE. Despite the rising use and known effects of antidepressants on ejaculation, only a few reports have evaluated the impact of these drugs on the male fertility. Thus, the aim of this review is to evaluate the efficacy and adverse effects of SSRIs on semen parameters of patients with lifelong PE as well as to assess the safety of this treatment among sexually active couples who desire to have a child.International Journal of Impotence Research advance online publication, 10 May 2012; doi:10.1038/ijir.2012.12.

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Premature ejaculation (PE), the most common sexual dysfunctions in men, is characterized by loss or absence of ejaculatory control. PE can be classified as either a lifelong or acquired condition. Although the prevalence of lifelong PE is rather low in the general male population, recent studies demonstrated that the patients who seek treatment for their rapid ejaculation mostly report lifelong PE. Although no drug for PE has been approved by regulatory bodies, chronic selective serotonin reuptake inhibitors (SSRIs) proved to be effective in treating lifelong PE. Despite the rising use and known effects of antidepressants on ejaculation, only a few reports have evaluated the impact of these drugs on the male fertility. Thus, the aim of this review is to evaluate the efficacy and adverse effects of SSRIs on semen parameters of patients with lifelong PE as well as to assess the safety of this treatment among sexually active couples who desire to have a child.International Journal of Impotence Research advance online publication, 10 May 2012; doi:10.1038/ijir.2012.12.

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Premature ejaculation (PE) is defined as persistent or recurrent ejaculation with minimal sexual stimulation that occurs before the participant wishes to ejaculate and is associated with marked distress or interpersonal difficulty. Impulse control disorders (ICDs) are grouped as a heterogeneous cluster of disorders linked by a “failure to resist” impulses to engage in harmful, disturbing or distressing behaviours. I hypothesise that premature ejaculation is an impulse control disorder. ICDs share features with PE aspects of impaired control, rapid responses to stimuli and hypersensitivity. These disorders often occur with subjective and social distress for patients. In addition to these features, the neurotransmitter systems have been similarly implicated in ICDs and PE. The same treatment options further support a relationship between ICDs and PE. The behaviours likely exist on a spectrum.

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Introduction.  Besides hypogonadism, other endocrine disorders have been associated with male sexual dysfunction (MSD). Aim.  To review the role of the pituitary hormone prolactin (PRL), growth hormone (GH), thyroid hormones, and adrenal androgens in MSD. Methods.  A systematic search of published evidence was performed using Medline (1969 to September 2011). Oxford Centre for Evidence-Based Medicine-Levels of Evidence (March 2009) was applied when possible. Main Outcome Measures.  The most important evidence regarding the role played by PRL, GH, thyroid, and adrenal hormone was reviewed and discussed. Results.  Only severe hyperprolactinemia (>35 ng/mL or 735 mU/L), often related to a pituitary tumor, has a negative impact on sexual function, impairing sexual desire, testosterone production, and, through the latter, erectile function due to a dual effect: mass effect and PRL-induced suppression on gonadotropin secretion. The latter is PRL-level dependent. Emerging evidence indicates that hyperthyroidism is associated with an increased risk of premature ejaculation and might also be associated with erectile dysfunction (ED), whereas hypothyroidism mainly affects sexual desire and impairs the ejaculatory reflex. However, the real incidence of thyroid dysfunction in subjects with sexual problems needs to be evaluated. Prevalence of ED and decreased libido increase in acromegalic patients; however, it is still a matter of debate whether GH excess (acromegaly) may create effects due to a direct overproduction of GH/insulin-like growth factor 1 or because of the pituitary mass effects on gonadotropic cells, resulting in hypogonadism. Finally, although dehydroepiandrosterone (DHEA) and its sulfate have been implicated in a broad range of biological derangements, controlled trials have shown that DHEA administration is not useful for improving male sexual function. Conclusions.  While the association between hyperprolactinemia and hypoactive sexual desire is well defined, more studies are needed to completely understand the role of other hormones in regulating male sexual functioning. Maggi M, Buvat J, Corona G, Guay A, and Torres LO. Hormonal causes of male sexual dysfunctions and their management (hyperprolactinemia, thyroid disorders, GH disorders, and DHEA). J Sex Med **;**:**-**.

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Introduction.  Premature ejaculation (PE) is defined as the inability of men to control ejaculation and it is the most prevalent male sexual dysfunction. The neurobiogenesis of ejaculation is very complex and involves the serotoninergic (5-hydroxytryptamine [5-HT]) system. A genetic etiology of PE in humans was stated accounting for around 30%. Recently, genetic polymorphisms located on SLC6A4 gene codifying for 5-HT transporter (5-HTT or serotonin transporter [SERT]), the major regulator of serotonergic neurotransmission, have been linked with the pathogenesis of PE and associated with the clinical response to therapy with contrasting results. Aim.  In order to establish a possible pathogenetic link between PE and SLC6A4 polymorphisms, we analyzed the 5-HTT-linked polymorphic region (5-HTTLPR), rs25531, and STin2 polymorphisms in 121 patients affected by lifelong and acquired PE. Methods.  Polymerase chain reaction (PCR)-based technology followed by restriction fragment length polymorphism (RFLP) analysis. Main Outcome Measures.  Intravaginal ejaculatory latency time was measured by stopwatch in order to diagnose PE, and the results of the SLC6A4 polymorphisms analysis in PE patients was compared with the control group. Results.  Genotype frequencies for 5-HTTLPR, rs25531, and STin2 for both patients and controls showed no significant deviation from Hardy-Weinberg equilibrium. No statistically significant differences were found in the frequency of SLC6A4 gene polymorphisms in PE patients vs. controls, or in lifelong PE patients vs. controls, or acquired PE patients vs. controls, or lifelong PE vs. acquired PE patients. The obtained data were contrasting with three out of four previously published reports. Conclusions.  The present results indicate that no difference exists in SLC6A4 polymorphisms frequency between PE patients and controls. A comparison with the previously published reports on this field is reported. Zuccarello D, Ghezzi M, Pengo M, Forzan M, Frigo AC, Ferlin A, and Foresta C. No difference in 5-HTTLPR and Stin2 polymorphisms frequency between premature ejaculation patients and controls. J Sex Med **;**:**-**.

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Premature ejaculation (PE) is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patients with premature PE, as a cause or as a consequence, research on the effects of psychological approaches for PE has in general not been controlled or randomised and is lacking in long-term follow up.To assess the efficacy of psychosocial interventions for PE. CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW: Trials were searched in computerized general and specialized databases, such as: MEDLINE by PubMed (1966 to 2010); PsycINFO (1974 to 2010); EMBASE (1980 to 2010); LILACS (1982 to 2010); the Cochrane Central Register of Controlled Trials (Cochrane Library, 2010); and by checking bibliographies, and contacting manufacturers and researchers.Randomised or quasi-randomised controlled trials evaluating psychosocial interventions compared with different psychosocial interventions, pharmacological interventions, waiting list, or no treatment for PE.Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The primary outcome measure for comparing the effects of psychosocial interventions to waiting list and standard medications was improvement in IELT (i.e., time from vaginal penetration to ejaculation). The secondary outcome was change in validated PE questionnaires.In one study behavioral therapy (BT) was significantly better than waiting list for duration of intercourse (MD (mean difference) 407.90 seconds, 95% CI 302.42 to 513.38), and couples’ sexual satisfaction (MD -26.10, CI -50.48 to -1.72). BT was also significantly better for a new functional-sexological treatment (FS) (MD 412.00 seconds, 95% CI 305.88 to 518.12), change over time in subjective perception of duration of intercourse (Women: MD 2.88, 95% CI 2.06 to 3.70; Men: MD 2.52, CI 1.65 to 3.39) and couples’ sexual satisfaction (MD -25.10, 95% CI -47.95 to -2.25), versus waiting list.Overall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation. Three of the four included randomised controlled studies of psychotherapy for PE reported our primary outcome (Improvement in IELT), and the majority have a small sample size. The early success reports (97.8%) of Masters and Johnson could not be replicated. One study found a significant improvement from baseline in the duration of intercourse, sexual satisfaction and sexual function with a new functional-sexological treatment and behavior therapy compared to waiting list. One study showed that the combination of chlorpromazine and BT was superior to chlorpromazine alone. Randomised trials with larger group samples are still needed to further confirm or deny the current available evidence for psychological interventions for treating PE.

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Premature ejaculation (PE) is a very common sexual dysfunction among patients, and with varying prevalence estimates ranging from 3% to 20%. Although psychological issues are present in most patients with premature PE, as a cause or as a consequence, research on the effects of psychological approaches for PE has in general not been controlled or randomised and is lacking in long-term follow up.To assess the efficacy of psychosocial interventions for PE. CRITERIA FOR CONSIDERING STUDIES FOR THIS REVIEW: Trials were searched in computerized general and specialized databases, such as: MEDLINE by PubMed (1966 to 2010); PsycINFO (1974 to 2010); EMBASE (1980 to 2010); LILACS (1982 to 2010); the Cochrane Central Register of Controlled Trials (Cochrane Library, 2010); and by checking bibliographies, and contacting manufacturers and researchers.Randomised or quasi-randomised controlled trials evaluating psychosocial interventions compared with different psychosocial interventions, pharmacological interventions, waiting list, or no treatment for PE.Information on patients, interventions, and outcomes was extracted by at least two independent reviewers using a standard form. The primary outcome measure for comparing the effects of psychosocial interventions to waiting list and standard medications was improvement in IELT (i.e., time from vaginal penetration to ejaculation). The secondary outcome was change in validated PE questionnaires.In one study behavioral therapy (BT) was significantly better than waiting list for duration of intercourse (MD (mean difference) 407.90 seconds, 95% CI 302.42 to 513.38), and couples’ sexual satisfaction (MD -26.10, CI -50.48 to -1.72). BT was also significantly better for a new functional-sexological treatment (FS) (MD 412.00 seconds, 95% CI 305.88 to 518.12), change over time in subjective perception of duration of intercourse (Women: MD 2.88, 95% CI 2.06 to 3.70; Men: MD 2.52, CI 1.65 to 3.39) and couples’ sexual satisfaction (MD -25.10, 95% CI -47.95 to -2.25), versus waiting list.Overall, there is weak and inconsistent evidence regarding the effectiveness of psychological interventions for the treatment of premature ejaculation. Three of the four included randomised controlled studies of psychotherapy for PE reported our primary outcome (Improvement in IELT), and the majority have a small sample size. The early success reports (97.8%) of Masters and Johnson could not be replicated. One study found a significant improvement from baseline in the duration of intercourse, sexual satisfaction and sexual function with a new functional-sexological treatment and behavior therapy compared to waiting list. One study showed that the combination of chlorpromazine and BT was superior to chlorpromazine alone. Randomised trials with larger group samples are still needed to further confirm or deny the current available evidence for psychological interventions for treating PE.

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