Painful Ejaculation: a Contemporary Review Greear, Garrick M.; Nicholson, Tristan M.; Hehemann, Marah C.
Current sexual health reports,
12/2021, Volume:
13, Issue:
4
Journal Article
Painful ejaculation is a distressing condition to nearly all affected men. Despite a prevalence of up to 9.7% in the general population and up to 58% among men with chronic prostatitis, it remains ...poorly understood. There is a wide variety of genitourinary pathology associated with painful ejaculation: benign prostatic hyperplasia, chronic prostatitis, definitive prostate cancer treatment, ejaculatory duct and seminal vesicle abnormalities, medication, and post-procedural sequelae. Effective management requires an understanding of these associations and individualization of workup and treatment. Uroselective alpha blockers are the most studied intervention and appear to have efficacy in several clinical scenarios. Rigorous contemporary data are sparse, and further study is warranted.
Fertility, a social, cultural, and medical issue, has aroused public attention because of its potential to predict future health. In recent years, the incidence of male infertility has increased ...significantly, and various risk factors, such as congenital factors, acquired factors, and idiopathic factors, have led to this situation. Male infertility causes substantial psychological and social distress in patients. With the implementation of the two-child policy, male infertility has brought enormous psychological and social pressure and huge economic burden to patients and the healthcare system. This has attracted the attention of not only men of childbearing age but also many male experts. The conventional therapeutic approaches for treating male infertility, including drugs, varicocele surgery, intrauterine insemination,
fertilization, and intracytoplasmic sperm injection, can restore fertility to a certain extent, but their efficacy is far from satisfactory, not to mention some adverse events. Therefore, acupuncture has been chosen by many men to treat their infertility and produced significant effects. In the present paper, the efficacy and mechanism of acupuncture in the treatment of male infertility were analyzed from different perspectives such as regulating hormone secretion, reducing inflammation, and improving semen parameters. The existing literature shows that acupuncture can effectively treat male infertility.
•First study to examine neurodevelopmental outcomes of offspring of men using ASM.•ASM use does not alter conception time, prematurity rates or offspring birth weight.•ASM use in fathers showed a ...trend of delayed developmental milestones in offspring.
There is a paucity of data in the literature specific to men with epilepsy on anti-seizure medication (ASM). The current study investigated the time to conception as well as the gestational and the neurodevelopmental outcomes of offspring of men with epilepsy on ASM compared to controls. Additionally, the prevalence of psychiatric comorbidities, and measures of sexual performance in males with and without epilepsy were analyzed.
A total of 450 male patients with and without epilepsy at one hospital were provided questionnaires to determine demographic characteristics, epilepsy history, type of ASM at the time of conception, comorbidities and sexual health. Time to conception, fertility methods and offspring birth and developmental history born to males with and without epilepsy was recorded. Survey data was evaluated using Student’s t-test for continuous variables and Fisher’s exact test for categorical variables. Odds ratio (OR) were calculated to determine associations between the measured data.
After matching for age, we analyzed a total of 110 males with epilepsy and 110 without epilepsy. In the epilepsy group there was a higher rate of psychiatric comorbidities such as major depressive disorder, general anxiety disorder, bipolar disorder, and suicidal ideation when compared to the control group (N = 110; OR 3.39; 95% IC: 1.87–6.13, p < 0.001). Males with epilepsy also had a higher frequency of low erection scores when compared to males without epilepsy (N = 70 with epilepsy, N = 76 without epilepsy; OR 3.67; 95% IC: 1.44–9.39, p = 0.005). Of the 110 men with a diagnosis of epilepsy, 17 conceived children while using ASMs (38 total children). A total of 18.42% of children born to fathers on ASMs experienced developmental delays compared to 2.63% of controls, however this result was not statistically significant (p = 0.056). In addition, we did not find that offspring had significantly different birth weights or gestational ages in men on ASM compared to controls (p > 0.05).
The present study suggests that men with epilepsy have an increased incidence of psychiatric comorbidities, and altered sexual performance, specifically erectile dysfunction, when compared with men without epilepsy. There was no statistically significant difference in the rates of developmental disorders and birth characteristics among those men with epilepsy on ASM at the time of conception and controls.
Peyronie’s disease (PD) is a superficial fibrosing disorder of the penis resulting in plaque formation and penile deformity. Once considered rare, PD has more recently been found in up to 13 % of ...men, and can negatively affect sexual and psychosocial function of both patients and their partners. While the etiology of PD is unclear, it is thought to result from an inciting traumatic event followed by aberrant fibrosis or dysregulated wound healing. The evaluation of men presenting with PD includes a detailed history and physical examination, focusing on the penis in both the flaccid and erect states. PD is often associated with erectile dysfunction (ED), as well as several other comorbidities. Laboratory testing is not needed to diagnose PD, although given the associations between PD and systemic diseases including hypogonadism, diabetes, and cardiovascular disease, screening and workup for these conditions in men with PD may be warranted. Treatment modalities for PD are diverse and include oral, topical, intralesional, mechanical, and surgical therapies. Oral, topical, and mechanical therapies generally have little evidence supporting their efficacy. Several intralesional therapies, including interferon α2b and collagenase
Clostridium histolyticum
, have demonstrated efficacy in the treatment of PD. Surgical treatment, indicated in men with significant, stable deformity, includes plication of the tunica albuginea, plaque incision/excision and grafting, and placement of inflatable penile prosthesis (IPP) with or without additional maneuvers to achieve desired results, and has high success rates.
Purpose of Review
Peyronie’s disease (PD) is a scarring condition of the tunica albuginea. Various graft materials are used to fill defects following plaque incision (PIG) or partial excision (PEG), ...but the optimal graft material remains unknown. This systematic review compares outcomes of different grafts, performed with or without concurrent penile prosthesis implantation (PPI).
Recent Findings
Studies reported quantitative curvature assessment, with adequate follow-up to assess straightening, change in penile length, postoperative erectile dysfunction (ED), and patient satisfaction. From a total of 41 study arms, 1732 patients underwent PEG/PIG without and 302 with PPI. For PIG/PEG without PPI, the most frequently used grafts are cadaveric human pericardium (38.3%), autologous saphenous vein (21.2%), and porcine small intestinal submucosa (13.5%) with reported mean preoperative curvature of 69.3° and curvature recurrence ≥ 30° in 6.6%, 5.4%, and 15.4%, respectively. Grafts used most commonly with PPI include hemostatic patches (36.4%), bovine pericardium (34.8%), with similar mean preoperative curvature of 70.0° (
p
< 0.01). Satisfaction rates for PIG/PEG without PPI ranged from 70 to 100% with lowest satisfaction rates associated with dermis (70%) and human pericardium (73.4%). In the prosthesis cohort, satisfaction rates exceeded 88% with all grafts.
Summary
Human pericardium seems to be the most commonly used graft when PPI is not indicated, with low rates of curvature recurrence, an acceptable rate of ED and satisfaction. Hemostatic patches are the most favorable graft choice with concurrent PPI. In general, the PD treatment literature is limited to low evidence grade retrospective studies, and further prospective investigation is warranted.
Treatment of Delayed Ejaculation Piche, Kristen; Mann, Uday; Patel, Premal
Current sexual health reports,
12/2020, Volume:
12, Issue:
4
Journal Article
Purpose of Review
Delayed ejaculation (DE), although relatively rare, can be a disconcerting and challenging disorder for patients to live with and physicians to treat. In this review, we sought to ...summarize what is currently known about the treatment for DE and aimed to summarize the findings using a holistic approach. We reviewed the most current medical literature to gather an understanding of the interventions currently available for DE and attempted to find a potential solution for patients struggling with DE.
Recent Findings
A number of articles are cited from 2016, 2018, and 2020, three of which are review articles. In this review, the psychosocial and infertility factors related to DE are covered briefly, and the current pharmacologic agents used to treat DE are reviewed. More recently, the anti-obesity drug, lorcaserin (a 5-HT2C receptor agonist), was explored for the first time in the context of treating DE. This study produced promising results that were published in 2020. There is still much that is unknown pertaining to the treatment of DE.
Summary
Some drug treatments for DE have potential, although many require further research. A holistic approach is necessary for the patient with DE, including careful consideration of the psychosocial factors related to DE. Many of the reviewed drugs for DE have been used for the treatment of DE arising from various potential etiologies (such as antidepressant-induced DE, hypogonadism, hyperprolactinemia, etc.). Ultimately, the etiology of DE in each patient must be carefully considered and treatment must be individualized.
Oral Testosterone Sadiq, Sabika; Towe, Maxwell; Masterson, Thomas A
Current sexual health reports,
12/2021, Volume:
13, Issue:
4
Journal Article
Testosterone is the primary sex hormone and anabolic steroid in males and serves a crucial role in the development of male reproductive tissues (testes, prostate). It also exerts its effects on ...various organs including brain, liver, muscle, bone, skin, and penis and as a result, maintains physical and emotional wellbeing in men. Thus, testosterone deficiency disrupts the normal homeostatic effects of testosterone and manifests as metabolic dysfunction, cognitive impairment, osteopenia/osteoporosis, anemia, and sexual dysfunction. Therefore, men on testosterone replacement therapy may experience a significant improvement in their mood, energy, sexual function, and increase in bone and muscle mass. Testosterone is available in a variety of preparations including transdermal patches and gels, intramuscular injections, and subcutaneous pellets. Each of these delivery systems is associated with unique challenges and adverse effects rendering them unsuitable for certain patients. For years, oral formulations were elusive due to poor efficacy and hepatoxicity. However, Jatenzo (oral testosterone undecanoate) obtained FDA approval in 2019. Oral testosterone is an appealing option due to its convenience and ease of administration when compared to alternate formulations. In this review we will discuss the history of oral testosterone, the distinct formulations and compare the benefits and risks of oral testosterone to alternate routes of administration.
Couples undergoing assisted reproductive technologies (ART) are prone to sexual dysfunction and lower quality of life (QoL), but whether the incidence of these problems differs with the type of ART ...is unknown. As such, we conducted this cross-sectional survey to compare the sexual function and QoL of 75 couples undergoing intrauterine insemination (IUI), and 160 couples undergoing in vitro fertilization (IVF). They completed an anonymous questionnaire which included: (i) demographic characteristics; (ii) female sexual function index (FSFI) or (iii) international index of erectile function-5 (IIEF-5); and (iv) fertility QoL questionnaire (FertiQoL). Overall, 22.6% of wives and 39.1% of husbands were at risk for sexual dysfunction, and the risk was similar in IUI and IVF groups. Mean core/treatment/total FertiQoL scores of husbands were higher than wives: 74.98 vs. 68.24/70.02 vs. 65.87/73.52 vs. 67.54 (all p < 0.001). FertiQoL scores were similar in IUI and IVF groups except wives' treatment FertiQoL score was significantly higher in the IUI group (68.93 vs. 64.44; p = 0.009). This study confirms that risks for sexual dysfunction were similar in IUI and IVF couples. Wives undergoing IVF had significantly lower treatment FertiQoL score. In both IUI and IVF groups, husbands' QoL was better than wives' QoL.
Purpose of Review
Up to 20–30% of patients with Peyronie’s disease (PD) suffer from some degree of erectile dysfunction (ED). When medical management fails, the surgical approach towards those with ...PD and ED relies on the penile prosthesis.
Recent Findings
Graft material has advanced in recent years, and hemostatic patch material has emerged as a promising, easy to use, and cost-effective approach. Intracorporal techniques that obviate the need for neurovascular bundle mobilization have recently been described, and can be considered a frontier for further investigation.
Summary
A thorough literature review was performed using the PubMed online database with query: “Penile Prosthesis” and “Peyronie’s disease” with “Plaque excision,” “Plaque incision,” “Tunica albuginea plication,” “Modeling,” and “Excision and grafting.” While the three-piece inflatable penile prosthesis (IPP) is commonly used, malleable implants may also achieve success where three-pieces are unavailable or not appropriate for use. When implant alone does not correct the deformity, manual modeling is a mainstay in treating residual curvature. Tunica plication, incision, and excision/graft techniques are required in patients with more severe/complicated plaques.
Unintended pregnancy is popular all over the world, accounting for 40% to 50% of all pregnancies. The condition not only exerts pressure on the relationship of couples and severely impacts the ...quality of life, but also imposes a heavy burden on the health of women and child. Recently, more than 220 million couples have chosen to be sterilized to obtain contraception, 47.3% of married couples select sterilization, of which vasectomy accounts for 17.1%. Vasectomy is currently the most convenient and effective method of male contraception. We will perform the systematic review and meta-analysis to assess the correlation between vasectomy and male sex dysfunction and provide evidence-based evidence for the couple METHODS:: The electronic databases of MEDLINE, PubMed, Web of Science, EMBASE, Clinicaltrials.org., China National Knowledge Infrastructure Database (CNKI), Wan fang Database, China Biology Medicine Database (CBM), VIP Science Technology Periodical Database, Chinese Clinical Trial Registry, and Cochrane Library will be retrieved before November 20, 2021. We will search English literature and Chinese literature with proper Medical Subject Heading or text key words. RevMan 5.3 and Stata 14.0 will be used for Systematic review and Meta-analysis. This protocol reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement.
The aim of this study was to evaluate the effect of vasectomy on the sexual function of patients after operation. The results will be published in a public issue journal to provide evidence-based medical evidence for urologists and andrologists to make clinical decisions.
INPLASY202080014.
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