Prevalence, Characteristics and Implications of Premature Ejaculation/Rapid Ejaculation

Total Page:16

File Type:pdf, Size:1020Kb

Prevalence, Characteristics and Implications of Premature Ejaculation/Rapid Ejaculation Prevalence, Characteristics and Implications of Premature Ejaculation/Rapid Ejaculation Stanley E. Althof*,† From the Department of Urology, Case School of Medicine and Center for Marital and Sexual Health of South Florida, West Palm Beach, Florida Purpose: Premature ejaculation/rapid ejaculation is a common but incompletely understood male sexual dysfunction. The purposes of this review are to 1) raise awareness of the prevalence and characteristics of PE/RE, its impact on the male and his partner, and the lack of approved medications indicated for its treatment, 2) encourage dialogue about PE/RE between physicians and patients, and 3) stimulate the development of appropriate new therapies. Materials and Methods: A MEDLINE search was performed to retrieve articles relating to PE/RE pathophysiology, etiology, impact, diagnosis and treatment. Sexual medicine journals not indexed in MEDLINE, sexual medicine texts and congress abstracts were also reviewed. Results: No universally accepted definition, licensed treatment, validated screening instrument or diagnostic criteria have been established for PE/RE, and its pathophysiology and etiology are incompletely understood. Additional barriers are the reluctance of patients and physicians to talk about PE/RE and the lack of knowledge regarding available treatments. Current pharmacological treatments include off label uses of antidepressants, topical anesthetics or phosphodiesterase-5 inhibitors. All are associated with drawbacks that limit their efficacy. Psychological counseling and behavioral therapy have a valuable role, although resources for this modality are limited. Conclusions: Prevalence rates of 20% to 30% and negative effects on the quality of life of men and their partners illustrate the need for improved, standardized methods of PE/RE diagnosis, assessment and treatment. Medications indicated specif- ically for PE/RE and effective on an as needed basis are required. Behavioral therapies should emphasize pleasure, arousal, control, confidence and satisfaction, and they may have the best success when coupled with pharmacological approaches. Key Words: testis; ejaculation; sexual dysfunctions, psychological; behavioral medicine lthough PE/RE is the most common male sexual dys- The distress induced by PE/RE affects not only the male, function, much remains to be learned about this vex- but also his sexual partner, the relationship as a whole and A ing condition. There is no universally accepted other areas of his life.1,2,7 The stigma associated with having definition, there are no validated screening instruments spe- a sexual problem inhibits men from discussing it with their cific for this dysfunction, and the pathophysiology and etiol- physician and partner.2,7,8 Embarrassment, lack of knowl- ogy remain incompletely understood. The number of men edge and a tendency to dismiss sexual problems as unim- presenting for treatment of PE/RE does not align with re- portant or not within the purview of medicine inhibit ported prevalence rates. Derived from the responses of men physicians from asking their patients if they have PE/RE to survey questions regarding sexual symptoms or problems, symptoms.7,9 Further, men who desire treatment may not the prevalence rates for PE/RE in men across a broad age know which specialist to consult. Should they seek treat- range, eg 18 to 59, or 21 to 65 years or older, are approxi- ment from a urologist, primary care physician, psychiatrist 1–6 mately 20% to 30%. Because the definition of PE/RE is or sex therapist? Additional reasons for not seeking treat- not uniform across studies, a reported prevalence rate may ment are selfishness, the belief that there is no treatment be an overestimate if compared with various diagnostic cri- and a lack of motivation unless encouraged by their part- teria, or an underestimate if men are inhibited from re- ner.2 The lack of standardized, validated screening criteria sponding openly to survey questions. Unfortunately there is is a barrier to diagnosis. These issues create a gap between no large-scale, population based study using agreed upon symptoms and resolution. Men do not know to ask about diagnostic criteria that examines the influence of patient their condition and others do not know whom to ask about age, ethnicity and culture on ejaculatory disorders. their condition, while physicians and mental health clini- cians do not routinely assess patients for symptoms of Submitted for publication May 4, 2005. PE/RE despite its high prevalence. * Correspondence: Department of Psychology, Case School of Med- Historically PE/RE was thought to be primarily psycho- icine, Center for Marital and Sexual Health of South Florida, 1515 North Flagler Dr., Suite 540, West Palm Beach, Florida 33401 logical in etiology, although recent research has documented (telephone: 561-822-5454; FAX: 561-822-5456; e-mail: sxa6@ that the condition also has a physiological basis, involving po.cwru.edu). primarily serotonergic but also dopaminergic and adrenergic † Financial interest and/or other relationship with Auxilium, Eli 10,11 Lilly/ICOS, Johnson and Johnson, Pfizer, Sanofi-Synthelabo and neurotransmission. Psychological and cognitive aspects Solvay. contribute but are difficult to characterize.12,13 There is 0022-5347/06/1753-0842/0 842 Vol. 175, 842-848, March 2006 THE JOURNAL OF UROLOGY® Printed in U.S.A. Copyright © 2006 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/S0022-5347(05)00341-1 PREVALENCE OF PREMATURE EJACULATION/RAPID EJACULATION 843 likely a mixed etiology or spectrum of PE/RE etiologies, ulation sufficiently but in whom the dysfunction later devel- involving psychological and physiological influences (Appen- oped.17 dix 1).11,13–15 PE/RE should not be confused with ED. They are different Men with PE/RE may not be aware of these physiological disorders. ED is defined as the inability to achieve or main- and psychological factors or that anything can be done to tain erection sufficient for satisfactory sexual perfor- remedy them. In contrast to ED, no regulatory authority has mance.21 PE/RE and ED can coexist but different approved a medication for PE/RE. This may also contribute pathological mechanisms underlie each disorder.3,11 A sub- to under treatment because men may assume that no pre- set of men have PE/RE after the onset of ED. They recognize scription treatment is available and, therefore, they do not that erection is time limited and they adaptively learn to discuss it with their physician.7 In a survey of men 40 years ejaculate prior to erectile softening. Thus, a detailed sexual or older 1% stated that they had received treatment for history is necessary in men who present with ejaculatory PE/RE, although 18% responded that they “always/almost complaints. always” or “usually” ejaculated prematurely, highlighting The most frequently used primary end point for PE/RE in 16 the problem of under treatment. A 2004 multicountry sur- clinical research is IELT, defined as the time from vaginal vey of more than 11,500 men in the United States, Italy and penetration to the start of intravaginal ejaculation.8 How- Germany found an overall PE/RE prevalence of 25% and less ever, the use of IELT alone is not likely to be the best method than 12% of the men who self-reported PE/RE had sought of diagnosis or treatment evaluation since it does not con- 2 treatment. sider individual perceptions of control over ejaculation, sat- Pharmacological treatments in use but not approved by isfaction with sexual intercourse and associated distress. the United States FDA or EMEA for PE/RE include antide- Supporting this point, in a recent study in which 1,587 men pressants, topical anesthetics and PDE-5 inhibitors. Psycho- were divided into PE/RE and nonPE/RE groups based on logical counseling and behavioral therapy are also used but DSM-IV-TR criteria results showed considerable overlap in they require time, money, commitment and the availability IELT between the groups.22 Furthermore, there is currently of a well trained sex therapist. Each of these approaches is no uniform method of measuring IELT. Many studies have associated with drawbacks that limit its usefulness. The incorporated a stopwatch to measure IELT, while others AUA has published consensus guidelines for the pharmaco- relied on IELT estimated by the individual. Self-estimated logical management of PE,3 which recognize that a univer- IELT and IELT measured by a stopwatch may vary. Al- sally accepted definition and improved, standardized though further study in this area is needed, reports suggest methods of diagnosis, assessment and treatment are needed. that discrepancies may exist.8,11,23 In addition, there is lack Pharmacological treatments developed specifically for PE/ of consensus on the IELT cutoff defining PE/RE due to the RE, and better psychological and behavioral interventions paucity of normative data. Some investigators suggest that along with algorithms for combined psychotherapy and it should be 1 minute based on the distribution of IELTs in pharmacotherapy are research goals. The aims of this article PE/RE populations that they have studied,8 while others are to 1) raise awareness of the characteristics and preva- suggest 2 minutes based on a review and summary of pub- lence of PE/RE, its impact on the male and his partner, and lished IELT data in men with PE/RE.11 Despite these con- the lack of approved prescription medications indicated for flicting opinions it is acknowledged that IELT is less its treatment, 2) encourage dialogue about the condition meaningful than the perception of control and satisfaction between physicians and patients, and 3) stimulate the de- 3 velopment of new pharmacological, psychological and com- with sexual intercourse by a man. Finally, the frequency of bined forms of therapy. sexual interactions in which IELT is below a specified cutoff is also a consideration, eg greater than 90%, greater than 75% or greater than 50% of the time, as is the period in MATERIALS AND METHODS question, eg the previous month, 6 months or year.
Recommended publications
  • THE PHYSIOLOGY and ECOPHYSIOLOGY of EJACULATION Tropical and Subtropical Agroecosystems, Vol
    Tropical and Subtropical Agroecosystems E-ISSN: 1870-0462 [email protected] Universidad Autónoma de Yucatán México Lucio, R. A.; Cruz, Y.; Pichardo, A. I.; Fuentes-Morales, M. R.; Fuentes-Farias, A.L.; Molina-Cerón, M. L.; Gutiérrez-Ospina, G. THE PHYSIOLOGY AND ECOPHYSIOLOGY OF EJACULATION Tropical and Subtropical Agroecosystems, vol. 15, núm. 1, 2012, pp. S113-S127 Universidad Autónoma de Yucatán Mérida, Yucatán, México Available in: http://www.redalyc.org/articulo.oa?id=93924484010 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Tropical and Subtropical Agroecosystems, 15 (2012) SUP 1: S113 – S127 REVIEW [REVISIÓN] THE PHYSIOLOGY AND ECOPHYSIOLOGY OF EJACULATION [FISIOLOGÍA Y ECOFISIOLOGÍA DE LA EYACULACIÓN] R. A. Lucio1*, Y. Cruz1, A. I. Pichardo2, M. R. Fuentes-Morales1, A.L. Fuentes-Farias3, M. L. Molina-Cerón2 and G. Gutiérrez-Ospina2 1Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Tlaxcala-Puebla km 1.5 s/n, Loma Xicotencatl, 90062, Tlaxcala, Tlax., México. 2Depto. Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad Universitaria, 04510, México, D.F., México. 3Laboratorio de Ecofisiologia Animal, Departamento de Fisiologia, Instituto de Investigaciones sobre los Recursos Naturales, Universidad Michoacana de San Nicolás de Hidalgo, Av. San Juanito Itzicuaro s/n, Colonia Nueva Esperanza 58337, Morelia, Mich., México * Corresponding author ABSTRACT RESUMEN Different studies dealing with ejaculation view this Diferentes estudios enfocados en la eyaculación, process as a part of the male copulatory behavior.
    [Show full text]
  • Andrology User Handbook
    Document code: AY.P001 Version number: 7 Date of issue: 29/06/2020 USER HANDBOOK FOR ANDROLOGY SERVICES Diagnostic Semen Analysis Post Vasectomy Semen Analysis Retrograde Ejaculation Analysis Page 1 of 24 Document code: AY.P001 Version number: 7 Date of issue: 29/06/2020 Contents: 1. Introduction .................................................................................................................... 3 2. Location and Opening Times .......................................................................................... 4 3. Useful contacts ............................................................................................................... 4 4. Services provided by the laboratory ............................................................................... 5 5. Requesting semen analysis ............................................................................................ 5 6. Analysis test types .......................................................................................................... 8 6.1 Diagnostic semen analysis (DSA) test for fertility ......................................................... 8 6.1a Instructions for collection of a semen sample for DSA (fertility)............................... 9 6.1b How Diagnostic Semen Analysis assessments are reported .................................10 6.2 Retrograde Analysis ....................................................................................................11 6.2a Instructions for collection of urine for retrograde ejaculation
    [Show full text]
  • Erectile Dysfunction and Premature Ejaculation
    GUIDELINES ON MALE SEXUAL DYSFUNCTION: Erectile Dysfunction and Premature Ejaculation (Text update April 2014) K. Hatzimouratidis (chair), I. Eardley, F. Giuliano, D. Hatzichristou, I. Moncada, A. Salonia, Y. Vardi, E. Wespes Eur Urol 2006 May;49(5):806-15 Eur Urol 2010 May;57(5):804-14 Eur Urol 2012 Sep;62(3):543-52 ERECTILE DYSFUNCTION Definition, epidemiology and risk factors Erectile dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sex- ual performance. Although ED is a benign disorder, it affects physical and psychosocial health and has a significant impact on the quality of life (QoL) of sufferers and their partners. There is increasing evidence that ED can be an early mani- festation of coronary artery and peripheral vascular disease; thus, ED should not be regarded only as a QoL issue but also as a potential warning sign of cardiovascular disease includ- ing lack of exercise, obesity, smoking, hypercholesterolaemia, and the metabolic syndrome. The risk of ED may be reduced by modifying these risk factors, particularly taking exercise or losing weight. Another risk factor for ED is radical prostatec- tomy (RP) in any form (open, laparoscopic, or robotic) because of the risk of cavernosal nerve injury, poor oxygenation of the corpora cavernosa, and vascular insufficiency. 130 Male Sexual Dysfunction Diagnosis and work-up Basic work-up The basic work-up (minimal diagnostic evaluation) outlined in Fig. 1 must be performed in every patient with ED. Due to the potential cardiac risks associated with sexual activity, the three Princeton Consensus Conference stratified patients with ED wanting to initiate, or resume, sexual activity into three risk categories.
    [Show full text]
  • Premature Ejaculation: Practice Essentials, Background, Pathophysiology
    2017­6­17 Premature Ejaculation: Practice Essentials, Background, Pathophysiology This site is intended for healthcare professionals Premature Ejaculation Updated: Mar 15, 2016 Author: Samuel G Deem, DO; Chief Editor: Edward David Kim, MD, FACS more... OVERVIEW Practice Essentials Premature (early) ejaculation is the most common sexual disorder in men younger than 40 years, with 30­70% of males in the United States affected to some degree at one time or another. It has historically been considered a psychological disease with no identified organic cause. Signs and symptoms Premature ejaculation can be lifelong or acquired. With lifelong premature ejaculation, the patient has experienced premature ejaculation since first beginning coitus. With acquired premature ejaculation, the patient previously had successful coital relationships and only now has developed premature ejaculation. Patient characteristics in lifelong premature ejaculation can include the following: Psychological difficulties Deep anxiety about sex that relates to 1 or more traumatic experiences encountered during development In patients with lifelong premature ejaculation, inquire about the following: Previous psychological difficulties Early sexual experiences Family relationships during childhood and adolescence Peer relationships Work or school General attitude toward sex Context of the event (eg, marital versus nonmarital) Sexual attitude and response of the female partner Nonsexual aspects of the current relationship level of involvement of the sexual partner in treatment
    [Show full text]
  • Sexually Transmitted Infections Treatment Guidelines, 2021
    Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 70 / No. 4 July 23, 2021 Sexually Transmitted Infections Treatment Guidelines, 2021 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Recommendations and Reports CONTENTS Introduction ............................................................................................................1 Methods ....................................................................................................................1 Clinical Prevention Guidance ............................................................................2 STI Detection Among Special Populations ............................................... 11 HIV Infection ......................................................................................................... 24 Diseases Characterized by Genital, Anal, or Perianal Ulcers ............... 27 Syphilis ................................................................................................................... 39 Management of Persons Who Have a History of Penicillin Allergy .. 56 Diseases Characterized by Urethritis and Cervicitis ............................... 60 Chlamydial Infections ....................................................................................... 65 Gonococcal Infections ...................................................................................... 71 Mycoplasma genitalium .................................................................................... 80 Diseases Characterized
    [Show full text]
  • Therapy for Premature Ejaculation
    pISSN: 2287-4208 / eISSN: 2287-4690 World J Mens Health 2016 December 34(3): 173-178 https://doi.org/10.5534/wjmh.2016.34.3.173 Review Article Ancient Chinese Fangzhongshu (Sexual Skills and Methods) Therapy for Premature Ejaculation Yong Zhu1, Qiang Chen2, Yuexing Gu1, Jin Yue1, Qingqi Zeng3 1Department of Andrology, Traditional Chinese Medicine Hospital of Yancheng City Affiliated with the Nanjing University of Chinese Medicine, Yancheng, 2Institute of Andrology, Nanjing University of Chinese Medicine, 3Department of Integrative Medicine, Jiangsu Jiankang Vocational College, Nanjing, China Premature ejaculation (PE) is a common male sexual dysfunction that can have significant effects on a couple’s relationship. Behavioral therapy and psychotherapy are both safe and effective methods of treating PE. Ancient Chinese fangzhongshu (sexual skills and methods), which reflects a summary of expert experiences in sexology, contains many therapies for sexual dysfunction that are similar to those used in behavioral therapy or psychotherapy. A brief introduction dealing with the latest definitions of PE and treatment strategies drawn from behavioral therapy and psychotherapy is provided. Typical therapies for PE from ancient Chinese fangzhongshu are listed and briefly analyzed in order to define their domain of applicability and instructions for use. Ancient Chinese fangzhongshu contains many effective and safe therapies for PE. It should be incorporated into modern medical practice after critical analysis, and its scientific aspects should be promoted as a way of improving reproductive health, both to benefit individuals affected by PE and to promote traditional Chinese culture. Based on an analysis of the condition of the individual patient, one or multiple therapies guided by fangzhongshu can be expected to have an effect on the patient.
    [Show full text]
  • Fact Sheet from Reproductivefacts.Org
    Fact Sheet From ReproductiveFacts.org The Patient Education Website of the American Society for Reproductive Medicine Intrauterine insemination (IUI) When a woman conceives naturally, sperm travel from the vagina is provided by the doctor’s office or andrology laboratory, a laboratory through the cervix (narrow, lower part of the womb), into the uterus that specializes in dealing with male health issues. Sperm can also be (womb), and up into one of the fallopian tubes. If sperm arrive in a tube collected during sex in a special condom that the doctor provides. If soon after the release of the egg from the ovary (ovulation); the sperm a man has retrograde ejaculation, the sperm can be retrieved in the and egg can meet and unite (fertilization) in the tube. laboratory from urine he has collected. The cervix naturally limits the number of sperm that enter the Men who have a difficult time with erection or ejaculation despite using uterus. This means that only a small percentage of the sperm in the medications, as well as men with a spinal cord injury, may be able ejaculate actually make their way into the fallopian tubes. Intrauterine to produce a sperm sample with the help of vibratory stimulation or insemination (IUI) is a procedure that places sperm past the cervix electroejaculation. Vibratory stimulation commonly takes place in an and in a woman’s uterus around the time of ovulation. This makes office and uses a handheld vibratory device. Electroejaculation uses the passage to the fallopian tubes much shorter, and there is a better electrical stimulation in order to produce a sperm specimen.
    [Show full text]
  • Male Fertility Following Spinal Cord Injury: a Guide for Patients Second Edition
    Male Fertility Following Spinal Cord Injury: A Guide For Patients Second Edition By Nancy L. Brackett, Ph.D., HCLD Emad Ibrahim, M.D. Charles M. Lynne, M.D. 1 2 This is the second edition of our booklet. The first was published in 2000 to respond to a need in the spinal cord injured (SCI) community for a source of information about male infertility. At that time, we were getting phone calls almost daily on the subject. Today, we continue to get numerous requests for information, although these requests now arrive more by internet than phone. These requests, combined with numerous hits on our website, attest to the continuing need for dissemination of this information to the SCI community as well as to the medical community. “The more things change, the more they stay the same.” This quote certainly holds true for the second edition of our booklet. In the current age of advanced reproductive technologies, numerous avenues for help are available to couples with male partners with SCI. Although the help is available, we have learned from our patients as well as our professional colleagues that not all reproductive medicine specialists are trained in managing infertility in couples with SCI male partners. In some cases, treatments are offered that may be unnecessary. It is our hope that the information contained in this updated edition of our booklet can be used as a talking point for patients and their medical professionals. The Male Fertility Research Program of the Miami Project to Cure Paralysis is known around the world for research and clinical efforts in the field of male infertility in the SCI population.
    [Show full text]
  • A Man's Guide to Overcoming Premature Ejaculation
    A man’s guide to overcoming Premature Ejaculation Premature ejaculation affects up to 30% of men at some time in their lives yet remains an embarrassing condition which men are uncomfortable talking about. Our guide to premature ejaculation will give you the lowdown on what causes the condition, the impact it can have and advice on a variety of treatments. THE CAUSES of Premature Ejaculation How the condition can occur Premature ejaculation is a common male medical condition yet the precise causes are still not fully understood. Despite its prevalence among men, the subject is largely taboo but failure to talk about or confront the issue often serves to exacerbate the problem for sufferers. Defining what exactly constitutes premature ejaculation can be difficult as different men come at different times – but if it’s a serious concern for both partners then that’s a good working definition of premature ejaculation. This guide talks through the types, causes and impact of premature ejaculation, separates the facts from the fiction, and finally offers advice on the variety of treatments available to help sufferers manage the condition. Let’s start by looking at the two broad types of premature ejaculation: Primary/Lifelong Premature Ejaculation This is where a man has suffered from premature ejaculation since becoming sexually active. It occurs from the first sexual encounter and continues throughout life, and can be attributed to physical or psychological factors or may be hereditary. Primary premature ejaculation is often triggered by psychological impulses, such as conditioning, upbringing, or a traumatic sexual experience. www.doctorfox.co.uk Secondary/Acquired Premature Ejaculation This is when a man goes years without suffering any ejaculation problems but then either gradually or suddenly begins to experience premature ejaculation.
    [Show full text]
  • Investigation of Retrograde Ejaculation Sept 13
    Car Parking Hospital District Yeovil main carparkat Department and Pathology Location of There are visitor pay and display car parks at both Taunton and Yeovil Hospitals. Somerset Pathology Service Andrology Investigation of Retrograde Ejaculation Appointments for Taunton & Yeovil 01823 343903 Hospital, Taunton Musgrove Park car parksat Department and Pathology Location of To help us improve our service we do run occasional patient satisfaction surveys, so you may be asked to complete a questionnaire for us when you attend the laboratory. Leaflet No 71009013 Q.pulse ARE_M001 09/13 Version 1.2 Author: P Hancock Please read and follow these Can my partner bring in my sample? First wash your hands and genitals with soap instructions thoroughly Provided she can let the laboratory know the and water, ensure complete removal of all soap Testing your sample entire sample has been collected, or if part was residues and dry thoroughly lost which part (first, middle or last part), and she Collect your semen sample by masturbation Please contact the Andrology secretary to knows your general health record, that is not a directly into the container. (Do NOT use a arrange an appointment for bringing in a problem. sheath/condom for collection as they will kill semen sample for testing. There will be a wait Is there anything that may affect my results? sperm. Other forms of sample collection are for an appointment, however, if you have a also not acceptable). Collect the entire sample. fertility clinic appointment do let the secretary Failure to follow the collection guidance can Once the semen sample is collected, empty your know the date when you telephone for an seriously alter semen analysis results.
    [Show full text]
  • Male Sexual Dysfunction
    Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation K. Hatzimouratidis (Chair), I. Eardley, F. Giuliano, I. Moncada, A. Salonia © European Association of Urology 2015 TABLE OF CONTENTS PAGE 1. INTRODUCTION 4 1.1 Aim 4 1.2 Publication history 4 1.3 Panel composition 4 2. METHODS 4 3. THE GUIDELINE 5 3A ERECTILE DYSFUNCTION 5 3A.1 Epidemiology/aetiology/pathophysiology 5 3A.1.1 Epidemiology 5 3A.1.2 Risk factors 5 3A.1.3 Pathophysiology 5 3A.1.4 Post-radical prostatectomy ED, post-radiotherapy ED & post-brachytherapy ED 6 3A.1.5 Conclusions on the epidemiology/aetiology/pathophysiology of ED 7 3A.2 Classification 7 3A.3 Diagnostic evaluation 7 3A.3.1 Basic work-up 7 3A.3.2 Sexual history 7 3A.3.3 Physical examination 8 3A.3.4 Laboratory testing 8 3A.3.5 Cardiovascular system and sexual activity: the patient at risk 8 3A.3.5.1 Low-risk category 10 3A.3.5.2 Intermediate- or indeterminate-risk category 10 3A.3.5.3 High-risk category 10 3A.3.6 Specialised diagnostic tests 10 3A.3.6.1 Nocturnal penile tumescence and rigidity test 10 3A.3.6.2 Intracavernous injection test 10 3A.3.6.3 Duplex ultrasound of the penis 10 3A.3.6.4 Arteriography and dynamic infusion cavernosometry or cavernosography 10 3A.3.6.5 Psychiatric assessment 10 3A.3.6.6 Penile abnormalities 10 3A.3.7 Patient education - consultation and referrals 10 3A.3.8 Recommendations for the diagnostic evaluation of ED 11 3A.4.
    [Show full text]
  • Developmental Status of Topical Therapies for Erectile and Ejaculatory Dysfunction
    International Journal of Impotence Research (2000) 12, Suppl 4, S80±S85 ß 2000 Macmillan Publishers Ltd All rights reserved 0955-9930/00 $15.00 www.nature.com/ijir Developmental status of topical therapies for erectile and ejaculatory dysfunction A Morales1* 1Queen's University, Department of Urology, Kingston General Hospital, Kingston, Ontario, Canada The most common of the sexual dysfunctions in men are premature ejaculation and impotence. Large strides have been made in the treatment of erectile disturbances but only limited and temporary successes have been achieved in the therapy of ejaculatory abnormalities. This manuscript examines the realm of topical therapy, its current limitations and the challenges that must be addressed if topical therapy is ever to have a niche in the urologist's treatment armamentarium. Topical agents for the treatment of premature ejaculation include anesthetics and herbal medications. The limited nature of the studies reported to date does not yet permit a reliable assessment of their ef®cacy. For the treatment of erectile dysfunction, some of the drugs administered by various other systemic routes appear to have some ef®cacy when delivered transdermally. Again, the studies and results are too limited for the urologist to develop a clear opinion about their ef®cacy. Further investigation of these drugs with the use of absorption enhancers is needed. International Journal of Impotence Research (2000) 12, Suppl 4, S80±S85. Keywords: erectile dysfunction; premature ejaculation; topical therapy; review Introduction Oral,1 intraurethral2 and sublingual3 administration of drugs have opened new and more acceptable avenues of therapy for ED. In the case of PE, the The most common sexual complaints in men are picture is different.
    [Show full text]