Moving Toward Empirically Based Standardization in the Diagnosis of Delayed Ejaculation

BackgroundCriteria for delayed ejaculation (DE) rely on a long ejaculation latency (EL) time, lack of control/advancement regarding ejaculation, and associated bother/distress; yet, few studies have investigated these criteria in men who indicate the desire to ejaculate sooner during partnered sex.AimTo help standardize criteria for DE by better understanding characteristics of men who desire to ejaculate sooner during partnered sex in terms of their EL, reported ejaculatory control, and level of bother/distress, as well as their perceptions of typical and ideal ELs for men in general and of ELs for men with premature ejaculation (PE).MethodsA total of 572 men recruited through social media responded to an online survey regarding their EL, as well as typical, ideal, and PE ELs of men in general. They also rated (i) their ability to control and/or advance ejaculation and (ii) their level of associated bother/distress. 4 comparison groups were then established: men with probable DE (with [DE1] and without [DE2] ejaculatory control issues), a reference group with no ejaculatory disorders, and men who identified as having PE.OutcomesTo demonstrate differences in EL, ejaculatory control, and bother/distress between men with delayed ejaculation and the control and PE reference groups.ResultsELs for men with probable DE were twice as long as those with no ejaculatory disorders. When probable DE men were further subdivided into DE2 and DE1, differences were greater for the DE2 group. DE2 men also differed significantly from the reference group on ejaculatory control/advancement but not on bother/distress. Both DE and reference groups differed from the PE group.Clinical ImplicationsUsing both EL and ejaculatory control are useful in distinguishing men with delayed ejaculation from men without delayed ejaculation.Strengths & LimitationsA sizable sample drawn from a multinational population powered the study, whereas the use of social media for recruitment limited the generalizability of findings.ConclusionBoth EL and ejaculatory control differentiate men with probable DE from a control reference group having no ejaculatory disorders. Differences in bother/distress did not emerge as significant. Implications for diagnosing men with DE are presented.Rowland DL, Cote-Leger P. Moving Toward Empirically Based Standardization in the Diagnosis of Delayed Ejaculation. J Sex Med 2020;17:1896–1902.     

保留神经腹膜后淋巴结清除术治疗睾丸肿瘤

目的探讨保留神经腹膜后淋巴结清除术(RPLND)在低期睾丸肿瘤治疗中的作用和效果。方法1999年6月至2003年7月收治睾丸肿瘤患者13例,年龄24～41岁,平均29岁。肿瘤位于左侧9例,右侧4例,大小2cm×3cm×2cm～9cm×6cm×5cm。临床分期:Ⅰ期11例,均为非精原细胞瘤;ⅡA期1例,为畸胎瘤(CT示腹膜后转移灶1cm×2cm);ⅡC期1例,为精原细胞瘤(CT示腹膜后转移灶10cm×9cm)。12例非精原细胞瘤者根治性睾丸切除术后1～4周行保留神经RPLND,1例精原细胞瘤者根治性睾丸切除术后行3疗程BEP方案化疗后行保留神经RPLND。结果术后病理分期:Ⅰ期11例,ⅡA期2例,其中ⅡC期精原细胞瘤患者化疗后分期降为Ⅰ期。13例术后均无肠梗阻、淋巴瘘和体位性低血压。术后2周复查时血AFP和βHCG均降至正常范围。术后8～12周均恢复射精功能。随访18～64个月,平均39个月,无肿瘤复发或转移。结论对于青壮年患者,保留神经RPLND是治疗低期非精原细胞瘤和化疗后降期的精原细胞瘤的首选方法。     

Anejaculation: Relevance to Sexual Enjoyment in Men and Women

IntroductionEjaculation and orgasm are important components of sexual response in men. Our understanding of both phenomena is limited. Anejaculation can be a source of substantial distress, even when procreation (ostensibly the only purpose of ejaculation itself) is not a priority.AimTo present an opinion on male perceptions of ejaculation disorders (specifically anejaculation) based on a variety of data sources, including peer-reviewed literature.MethodsA non-systematic review of literature on anejaculation and other impairments of ejaculatory and orgasmic response was conducted. Relevant articles were critically analyzed and reportedMain Outcome MeasureAn opinion is presented, based on existing data sources, on how and why ejaculation is deemed important to men and their sexual partners.ResultsThe peer-reviewed literature on disorders of ejaculation is scant; existing reports oftentimes do not adequately distinguish between orgasm and ejaculation in assessment. Men’s perceptions of ejaculation quality appear to be positively associated with satisfaction with sexual response, particularly regarding orgasm. Based on very limited data, female sexual partners of men appear to often (but not always) value the orgasmic experience of their partner; only a minority prioritize actual ejaculation. There is evidence that disorders of ejaculation may be particularly troublesome for men who have sex with men.Clinical ImplicationsThe influence of medical conditions and treatments on ejaculation should be considered in the clinical context. Psychological adaptations and interventions may be of value in some cases.Strengths & LimitationsData on the clinical relevance of anejaculation outside the context of concomitant orgasmic dysfunction are sparse. Men’s experience of orgasm is at least partially associated with ejaculation-specific variables; whether this association is mediated by psychological, physical, or a combination of factors remains unclear.ConclusionsEjaculation, orgasm, and sexual satisfaction are closely intertwined but distinct phenomena.Shindel AW. Anejaculation: Relevance to Sexual Enjoyment in Men and Women. J Sex Med 2019;16:1324–1327.     

Genetic polymorphism in the serotonin transporter gene-linked polymorphic region and response to serotonin reuptake inhibitors in patients with premature ejaculation

OBJECTIVES:

Serotonin plays a central role in ejaculation and selective serotonin reuptake inhibitors have been successfully used to treat premature ejaculation. Here, we evaluated the relationship between a polymorphism in the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and the response of patients with premature ejaculation to SSRI medication.

METHODS:

Sixty-nine premature ejaculation patients were treated with 20 mg/d paroxetine for three months. The Intravaginal Ejaculatory Latency Time and International Index of Erectile Function scores were compared with baseline values. The patients were scored as having responded to therapy when a 2-fold or greater increase was observed in Intravaginal Ejaculatory Latency Time compared with baseline values after three months. Three genotypes of 5-HTTLPR were studied: LL, LS and SS. The appropriateness of the allele frequencies in 5-HTTLPR were analyzed according to Hardy-Weinberg equilibrium using the χ²-test.

RESULTS:

The short (S) allele of 5-HTTLPR was significantly more frequent in responders than in nonresponders (p<0.05). Out of the 69 total PE patients, 41 patients (59%) responded to therapy. There was no significant difference in the International Index of Erectile Function score at the end of therapy between the responder and nonresponder groups. The frequencies of the L allele and S allele were 20% and 39%, respectively, in the responder group (p<0.05).

CONCLUSION:

We conclude that premature ejaculation patients with the SS genotype respond well to selective serotonin reuptake inhibitor therapy. Further studies with large patient groups are necessary to confirm this conclusion.     

经直肠超声实时引导在精囊镜手术中的应用研究

目的:探讨经直肠超声实时引导在射精管梗阻性无精子症或少弱精子症患者精囊镜手术中的应用价值。方法:回顾性分析2011年9月至2015年12月北京大学第三医院经直肠超声实时引导行精囊镜手术治疗的25例射精管梗阻性无精子症或少弱精子症患者的临床资料。患者年龄(29.4±4.5)岁;精液量0.4(0～2.8)ml,精液pH值6...     

Erectile Dysfunction and Premature Ejaculation in Homosexual and Heterosexual Men: A Systematic Review and Meta-Analysis of Comparative Studies

Introduction

Comparative studies on differences in sexual function outcomes between homosexual and heterosexual men are sparse and inconclusive.

Psychological treatment strategies for rapid ejaculation: rationale, practical aspects, and outcome

The landscape has dramatically changed for patients seeking treatment for rapid ejaculation. Previously, psychotherapy or behavioral treatment was considered to be the treatment of choice for this troubling sexual dysfunction. Since the early 1990s, an efficacious alternative treatment has emerged—the off-label administration of SSRI medications. Currently, several short-acting SSRI compounds are in phase III clinical trials and are likely to receive approval as the first medical treatment for rapid ejaculation. Given the presumed efficacy of these new compounds and the off-label use of the current SSRIs, one might conclude that psychotherapy\behavior therapy for rapid ejaculation is an obsolete and antiquated intervention. On the contrary, psychotherapy is now more relevant than ever. The two aims of this paper are to review psychological/behavioral therapies for rapid ejaculation and to discuss the important role of combined psychological and medical treatment. In the new age of SSRI treatment for rapid ejaculation, some form of psychological/behavioral intervention is essential to help patients/couples make better use of medical therapies, to learn skills to delay ejaculation once off medication, to bolster sexual confidence, and to enhance patient and partner sexual satisfaction.     

H-reflex and physiologic measures of ejaculation in men with spinal cord injury

OBJECTIVE: To investigate the various physiologic parameters characterizing and predicting ejaculation. DESIGN: Single case-control study. SETTING: A referred care center and university setting. PARTICIPANTS: Two men with spinal cord injury (SCI) and 2 control subjects. INTERVENTION: Subjects were asked to self-stimulate with a Ferticare vibrator to induce ejaculation over 5 to 8 independent sessions. MAIN OUTCOME MEASURES: Penile tumescence, blood pressure, heart rate, electromyographic activity of the bulbocavernosus muscles, abdominal muscles, soleus H-reflex, and occurrence of ejaculation. RESULTS: Changes on all measures were observed, with penile tumescence being more stable in control subjects. Blood pressure increased in both groups, whereas tachycardia was observed in controls and bradycardia in subjects with SCI. H-reflex dropped slightly in controls but increased in subjects with SCI. Muscular patterns differed on ejaculatory success or failure. CONCLUSIONS: Physiologic changes on all measures can be observed in men with SCI as a function of ejaculation. Changes include hypertension and bradycardia, characteristic of hyperreflexia, and tachycardia in controls. The neural mechanisms underlying these patterns are discussed. H-reflex showed increased spinal cord excitability in subjects with SCI after ejaculation, which suggests spasticity. The results support investigation of the H-reflex to predict ejaculatory success or failure in men with SCI, along with specific analysis of muscular patterns.     

Serum Leptin Levels in Patients with Premature Ejaculation

Leptin is a fat cell-derived hormone signaling the hypothalamus about food intake, the regulation of weight, and sexual behavior. The inhibitory effect of serotonin on libido, ejaculation, and orgasm is well documented. There is an interaction between leptinergic and serotonergic systems in the central nervous system. This study was conducted to evaluate serum leptin levels of the patients with premature ejaculation. The study group consisted of 15 patients with premature ejaculation according to Diagnostic and Statistical Manual of Mental Disorders, Third Revised Version ( DSM -III-R) and 15 healthy controls. The fasting serum leptin levels were measured. Significantly high serum leptin levels in the patients were found after body mass index or age adjustment. The intravaginal ejaculation latency time negatively correlated with leptin levels in both patient and control groups. In addition, there was a positive correlation between leptin levels and the duration of illness. It would appear that leptin may be associated with premature ejaculation.     

The Role of the Levator Ani Muscle in Evacuation, Sexual Performance and Pelvic Floor Disorders

This paper reviews the role of the levator ani muscle (LAM) in evacuation, sexual performance and pelvic floor disorders. The LAM fixes the vesical neck, anorectal junction and vaginal fornices to the side wall of the pelvis by means of the suspensory sling and hiatal ligament. On contraction it shares in the mechanism of evacuation (urination, defecation). During the sexual act vaginal distension by the erect penis evokes the vaginolevator and vaginopuborectalis reflexes, with a resulting LAM contraction. The LAM also contracts upon stimulation of the clitoris or cervix uteri, an action mediated through clitoromotor and cervicomotor reflexes. LAM contraction leads to upper vagina ballooning, which acts as receptacle for semen collection, to uterine elevation and straightening and to elongation and narrowing of the vagina. These actions enhance the sexual response and prepare the uterus and vagina for the reproductive process. During ejaculation LAM contraction facilitates semen ejection. Levator subluxation and sagging leads to levator dysfunction syndrome, which may present as pudendal canal syndrome.