Delayed Ejaculation Research Articles

(257) Is Adderall Effective in the Treatment of Delayed Ejaculation? A Continued Retrospective Analysis

Abstract Introduction Numerous treatments have been evaluated for delayed ejaculation (DE), but many are considered sub-optimal and have limited data support. This results in significant patient distress and leads to confusion for providers on the best treatment recommendations for this difficult sexual medicine condition. Preliminary studies have shown as needed low dose Adderall (amphetamine/dextroamphetamine) to provide improvement in symptoms and orgasmic latency time in patients with delayed orgasm or anorgasmia. Objective The objective of this study is to retrospectively assess the efficacy of Adderall treatment in men with DE, as well as associated comorbidities. The first phase of this study establishes baseline characteristics of patients that were prescribed Adderall for DE. The second phase of this study includes a survey to assess optimal frequency and dosage based on patient satisfaction and any side-effect profile. Methods Patients were identified from an AllScripts query using ICD-10 codes of “Retarded Ejaculation” (N53.11) and “Other ejaculatory dysfunction” (N53.19) and retrospective record review identifying men with DE over 18 years old having been prescribed Adderall. Objective data was collected including biothesiometry results, total testosterone levels, penile prosthesis placement, previous circumcision, and presence of co-morbidities such as erectile dysfunction, diabetes, depression, prostate cancer, smoking and neurologic disorders. Success was defined as subjective reduced time to orgasm per patient report. The second phase of this study includes contacting this study group via survey (RedCAP and phone) to assess the effective dose and side effects of using Adderall for DE. Results 35 men were treated with Adderall for DE. In total, Adderall was shown to be preliminarily effective in 31% of patients (11/35) with 40% unable to be determined from retrospective review. The majority of patients were started on 5mg Adderall and titrated up to 20mg as needed taken 1-4 hours before sexual activity. Baseline patient characteristics are detailed in Table 1. The average age of patients was 59 years old with 57% of patients over the age of 70 years old. 65% (20/35) patients had abnormal biothesiometry results. There were no adverse events reported. Conclusions Low dose Adderall resulted in preliminary improvement in at least 31% of patients with DE. Further patient surveillance is planned, in part to determine if particular patient characteristics may be better for this approach. It is critical to avoid misuse of this drug and larger prospective studies are still needed. This study supports the use of Adderall as another treatment option for this difficult and poorly understood condition. Disclosure No.

Diagnoses and medications associated with delayed ejaculation.

Delayed ejaculation (DE) is a disorder that can cause significant distress for sexually active men. The etiology of DE is largely idiopathic, with even less being known about clinical factors associated with the condition. We sought to use data mining techniques to examine a broad group of health conditions and pharmaceutical treatments to identify factors associated with DE. Using an insurance claims database, we evaluated all men with a diagnosis of DE and matched them to a cohort (1:1) of men with other male sexual disorders of urologic origin (ie, erectile dysfunction [ED] and Peyronie's disease [PD]). Given the low prevalence of DE, we incorporated the random forest approach for classification of DE vs controls, with a plethora of predictors and cross-validation with the least absolute shrinkage and selection operator (LASSO). We used both a high-performance generalized linear model and a multivariate logistic model. The area under the curve was reported to demonstrate classifier performance, and odds ratios were used to indicate risks of each predictor. We also evaluated for differences in the prevalence of conditions in DE by race/ethnicity. Clinical factors (ie, diagnoses and medications) associated with DE were identified. In total, 11 602 men with DE were matched to a cohort of men with PD and ED. We focused on the 20 factors with the strongest association with DE across all models. The factors demonstrating positive associations with DE compared to other disorders of male sexual dysfunction (ie, ED and PD) included male infertility, testicular dysfunction, anxiety, disorders of lipid metabolism, alpha adrenergic blocker use, anemia, antidepressant use, and psychoses such as schizophrenia or schizoaffective disorder. In addition, the prevalence of several conditions varied by race/ethnicity. For example, male infertility was present in 5% of Asian men compared to <2% of men of other races. Several medical conditions and pharmacologic treatments are associated with DE, findings that may provide insight into the etiology of DE and offer treatment options. This study is to our knowledge the first to use using data mining techniques to investigate the association between medical conditions/pharmacologic agents and the development of subsequent DE. The generalizability of our findings is limited given that all men were commercially insured. DE is associated with multiple medical conditions, a finding that may help identify the etiology for this disorder.

The sextech industry and innovative devices for treating sexual dysfunction.

Since the digital revolution, there has been a notable increase in the use and popularity of sex toys and innovative sexual devices, which can be attributed to advancements in technology. The sex toys industry strives to improve sexual experience, pleasure and sexual health, and to address sexual dysfunction through devices and technology. With the growth of this industry, new products that are considered "smart sexual devices" have gradually entered the market. Smart sexual devices feature wireless connectivity to a smartphone application that allows the user to control the device's features and provide personal or sexual data about their sexual experiences. Other smart devices have sensors and are able to collect physical data during usage. With the aid of this data, individuals may be able to understand their sexual behavior and arousal better, resulting in improved sexual experience or the overcoming of sexual dysfunction. The present article aims to explore the potential applications of technology-based devices, and smart sexual devices, in the treatment of male sexual dysfunctions, including premature ejaculation (PE), and delayed ejaculation (DE), as well as female sexual dysfunction (FSD), such as sexual arousal disorder and female orgasmic disorder. Furthermore, we examine the advantages and disadvantages of these devices. Given the limited literature available on this subject and the absence of controlled studies, we conduct a narrative review of the existing scientific research on technological and smart sexual devices.

(182) The Differences in Brain Function Between Lifelong Premature Ejaculation and Delayed Ejaculation: A Study Based on High-density Electroencephalogram

Abstract Introduction Ejaculatory dysfunction is common male sexual dysfunction, which is a conceptual continuum, and premature ejaculation (PE) and delayed ejaculation (DE) anchor the opposite ends of this conceptual continuum, and normal ejaculation is in the center. The pathogenesis of PE and DE is still not fully elucidated, and the studies on the central nervous mechanisms are highly lacking, and the differences in brain function between PE and DE are unclear. Objective We try to use a high-density electroencephalogram (HDEEG) to explore the differences in brain function to compensate for the deficiency of previous studies based on functional magnetic resonance Imaging (fMRI) and provide a theoretical foundation for future studies exploring the treatment methods. Methods We included 12 lifelong premature ejaculation (LPE) patients and 11 lifelong delayed ejaculation (LDE) patients, and all of them are right-handed. We evaluated the conditions of all subjects, who reported estimated intravaginal ejaculation latency time (eIELT). We used the premature ejaculation diagnostic tool (PEDT), the abridged international index of erectile function (IIEF-6), and erection hardness score (EHS) to quantify the sexual function and sexual arousal. EEG signals were recorded in patients with LDE and LPE during two segments of resting and watching an erotic video, respectively. The duration of the recording was about five minutes and fifteen minutes, respectively. The subjects whose EEG signals were less than 30 segments were excluded from the final analysis. The power spectral density was analyzed based on fast Fourier transform (FFT). Differences in the power spectral density during resting and sexual arousal between the two groups were compared. We analyzed changes in the power spectral density of β oscillation with sexual arousal in each group. Results There were no statistical differences in the general clinical characteristics. The mean eIELT of LPE patients was 0.8 ± 0.4 minutes. The scores of EHS were not statistically different during watching an erotic video between the two groups. There were no significant differences in δ, θ, and α oscillations between the LDE group and the LPE group during resting, but the LDE group had significantly higher power of β1, β2, and β3 oscillations. The power of β1, β2, and β3 oscillations was significantly higher in the LDE group during watching an erotic video, and other oscillations were not significantly different. The power of β1, β2, and β3 oscillations significantly increased in the LDE group during sexual arousal, and β2 and β3 oscillations significantly increased in the LPE group. Conclusions Based on the previous literature and our results, we proposed a scientific hypothesis to explain the increase of β oscillation in LDE patients. The increase of β oscillation is associated with the activation of the inhibitory brain area. The over-activation of the inhibitory brain area leads to LDE and the under-activation leads to LPE. The activation of the inhibitory brain area may be associated with gamma-aminobutyric, which is an inhibitory neurotransmitter. Disclosure No

Identifying an optimal ejaculation latency for the diagnosis of men reporting orgasmic/ejaculation difficulty.

Criteria for the definition and diagnosis of delayed ejaculation (DE) are yet under consideration. This study sought to determine an optimal ejaculation latency (EL) threshold for the diagnosis of men with DE by exploring the relationship between various ELs and independent characterizations of delayed ejaculation. In a multinational survey, 1660 men, with and without concomitant erectile dysfunction (ED) and meeting inclusion criteria, provided information on their estimated EL, measures of DE symptomology, and other covariates known to be associated with DE. We determined an optimal diagnostic EL threshold for men with DE. The strongest relationship between EL and orgasmic difficulty occurred when the latter was defined by a combination of items related to difficulty reaching orgasm and percent of successful episodes in reaching orgasm during partnered sex. An EL of ≥16minutes provided the greatest balance between measures of sensitivity and specificity; a latency ≥11minutes was the best threshold for tagging the highest number/percentage of men with the severest level of orgasmic difficulty, but this threshold also demonstrated lower specificity. These patterns persisted even when explanatory covariates known to affect orgasmic function/dysfunction were included in a multivariate model. Differences between samples of men with and without concomitant ED were negligible. In addition to assessing a man's difficulty reaching orgasm/ejaculation during partnered sex and the percent of episodes reaching orgasm, an algorithm for the diagnosis of DE should consider an EL threshold in order to control diagnostic errors. This study is the first to specify an empirically supported procedure for diagnosing DE. Cautions include the use of social media for participant recruitment, relying on estimated rather than clocked EL, not testing for differences between DE men with lifelong vs acquired etiologies, and the lower specificity associated with using the 11-minute criterion that could increase the probability of including false positives. In diagnosing men with DE, after establishing a man's difficulty reaching orgasm/ejaculation during partnered sex, using an EL of 10 to 11minutes will help control type 2 (false negative) diagnostic errors when used in conjunction with other diagnostic criteria. Whether or not the man has concomitant ED does not appear to affect the utility of this procedure.

MP45-13 CAN DELAYED EJACULATION HAVE AN IMPACT ON PSYCHOLOGICAL HEALTH? FINDINGS FROM A CROSS SECTIONAL STUDY

You have accessJournal of UrologyCME1 Apr 2023MP45-13 CAN DELAYED EJACULATION HAVE AN IMPACT ON PSYCHOLOGICAL HEALTH? FINDINGS FROM A CROSS SECTIONAL STUDY Christian Corsini, Federico Belladelli, Edoardo Pozzi, Giuseppe Fallara, Simone Cilio, Massimiliano Raffo, Alessandro Bertini, Francesco Lanzaro, Donato Cannoletta, Fausto Negri, Ludovica Cella, Margherita Fantin, Luigi Candela, Paolo Capogrosso, Luca Boeri, Alessia D'Arma, Francesco Montorsi, and Andrea Salonia Christian CorsiniChristian Corsini More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Simone CilioSimone Cilio More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Luca BoeriLuca Boeri More articles by this author , Alessia D'ArmaAlessia D'Arma More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Delayed Ejaculation (DE) is among the most challenging male sexual dysfunctions. We aimed to explore and compare the sociodemographic and clinical characteristics of men with DE with those complaining of primary premature ejaculation (PE) METHODS: Data from 555 consecutive men seeking first medical help for DE and/or primary PE between 2005 and 2022 at a single tertiary-referral center were retrospectively analyzed. Complete socio-demographic, clinical and laboratory data were collected for all patients. All patients completed the International Index of Erectile Function (IIEF) and the Beck Depression Inventory (BDI) at baseline. We excluded men with known or potential causes responsible for ejaculatory disorders (n= 52). Descriptive statistics was used to detail and compare clinical and sociodemographic characteristics between the two groups (DE vs. PE). Linear regression models tested the association between depressive symptoms (BDI) and baseline IIEF domains scores among men with DE. RESULTS: Of 555 patients, 479 (86.3%) and 76 (13.7%) primary PE and DE, respectively. Men with DE were significantly older (44 vs. 47, p=0.01) than patients with PE. Conversely, the two groups did not differ in terms of educational/relational status, BMI, comorbidities, and hormonal milieu. At psychosexual interview, men with DE report more frequently symptoms referable to anxiety and depression (9.4% and 12,7%) along with higher median baseline BDI scores (8 vs. 6), all p<0.01. DE patients reported lower median IIEF-OF, -SD domains (6 vs. 9) and (7 vs. 8) than patients with PE only, all p<0.05. At linear regression analysis, among DE patients, a higher BDI score was associated with lower IIEF-OS (coeff. -1.57 p=0.004), and IIEF-IS (coeff. -0.72 p=0.01) domains (Figure 1). No association between BDI and IIEF-OF, -EF, -SD domains was found. CONCLUSIONS: Among men complaining of ejaculatory disorders, one out of ten reports DE. These patients have higher chances to report clinically significant depression significantly impacting on their overall satisfactory sexual life. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e626 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Corsini More articles by this author Federico Belladelli More articles by this author Edoardo Pozzi More articles by this author Giuseppe Fallara More articles by this author Simone Cilio More articles by this author Massimiliano Raffo More articles by this author Alessandro Bertini More articles by this author Francesco Lanzaro More articles by this author Donato Cannoletta More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Luigi Candela More articles by this author Paolo Capogrosso More articles by this author Luca Boeri More articles by this author Alessia D'Arma More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

MP45-14 EJACULATORY DISORDERS IN THE REAL-LIFE CLINICAL PRACTICE: LANDSCAPE FORM A TERTIARY REFERRAL ACADEMIC CENTER

You have accessJournal of UrologyCME1 Apr 2023MP45-14 EJACULATORY DISORDERS IN THE REAL-LIFE CLINICAL PRACTICE: LANDSCAPE FORM A TERTIARY REFERRAL ACADEMIC CENTER Giueppe Fallara, Edoardo Pozzi, Federico Belladelli, Simone Cilio, Massimiliano Raffo, Fausto Negri, Ludovica Cella, Margherita Fantin, Alessandro Bertini, Christian Corsini, Francesco Lanzaro, Luigi Candela, Luca Boeri, Paolo Capogrosso, Alessia D'arma, Francesco Montorsi, and Andrea Salonia Giueppe FallaraGiueppe Fallara More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Simone CilioSimone Cilio More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Alessia D'armaAlessia D'arma More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The spectrum of ejaculatory disorders (DoE) includes numerous complaints often challenging to manage. We sought to describe the prevalence and the characteristics of men consecutively presenting with DoEs at a tertiary referral academic center over a 17-yr time-frame. METHODS: Data from 761 men presenting for DoE as their primary complaint between 2005-2022 were analysed. Baseline clinical and socio-demographic characteristics were collected. All patients completed the International Index of Erectile Function (IIEF) at first assessment. Men were stratified according to their DoE into: anejaculation (AE); anorgasmia (AO); retrograde ejaculation (RE); delayed ejaculation (DE); painful ejaculation (PE); premature ejaculation(PreE); and, multiple ejaculatory complaints (ME) (defined according to EAU guidelines). Descriptive statistic was used to assess differences among the groups and logistic regression analysis using year at presentation as covariate was used to assess statistical significance for the shown trends. RESULTS: Overall, 49(6.4%) men complained for AE, 18(2.4%) for AO, 11(1.4%) for RE [of these, 8(72.7%) had been submitted to surgery for BPH], 62(8.1%) for DE, 19(2.5%) for PE, and 602(79.1%) for PreE. Over time we depicted a decrease in the percentage of men presenting with PE as their primary complaint as compared with the other DoEs (OR:0.98; 95CI% 0.85-0.94; p<0.001) (Figure). Overall, BMI, sexual hormone profile and comorbidities were similar amongst groups, whilst median age was higher for those with RE (67.0 years [IQR 62.5, 70.5]) and lower for those with PE (44.0 years [34.0, 54.0]) (p<0.001). Patients with a history of AE, RE and AO more frequently had diabetes (either type I or II) and a history of cardiovascular diseases (p<0.001). The proportion of men with concomitant erectile dysfunction ranged from 31.6%(6) in men with PE to 90.9%(10) of those with RE. IIEF-orgasmic function and IIEF-overall satisfaction domains were significantly lower for those presenting with AE and AO as compared with all other DoEs. CONCLUSIONS: The rates and characteristics of the DoEs in the real-life clinical setting over the last 17-yr time frame have changed. The proportion of unusual DoEs has increased whilst the prevalence of PE has decreased throughout the analyzed period. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e626 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giueppe Fallara More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Simone Cilio More articles by this author Massimiliano Raffo More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Alessandro Bertini More articles by this author Christian Corsini More articles by this author Francesco Lanzaro More articles by this author Luigi Candela More articles by this author Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Alessia D'arma More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

Characteristics of men who report symptoms of delayed ejaculation: providing support for empirically derived diagnostic criteria.

Little is known regarding the demographic, sexual, and relationship characteristics of men with symptoms of delayed ejaculation (DE). To identify differences between men with and without DE symptomology to validate face-valid diagnostic criteria and to identify various functional correlates of DE. A total of 2679 men meeting inclusion criteria were partitioned into groups with and without DE symptomology on the basis of their self-reported "difficulty reaching ejaculation/orgasm during partnered sex." Men were then compared on a broad array of demographic and relationship variables, as well as sexual response variables assessed during partnered sex and masturbation. Outcomes included the identified differences between men with and without DE symptomology. Men with DE-whether having comorbid erectile dysfunction or not-differed from men without DE on 5 face-valid variables related to previously proposed diagnostic criteria for DE, including ones related to ejaculation latency (P < .001); self-efficacy related to reaching ejaculation, as assessed by the percentage of episodes reaching ejaculation during partnered sex (P < .001); and negative consequences of the impairment, including "bother/distress" and (lack of) "orgasmic pleasure/sexual satisfaction" (P < .001). All such differences were associated with medium to large effect sizes. In addition, men showed differences on a number of functional correlates of DE, including anxiety, relationship satisfaction, frequency of partnered sex and masturbation, and level of symptomology during partnered sex vs masturbation (P < .001). Face-valid criteria for the diagnosis of DE were statistically verified, and functional correlates of DE relevant to guiding and focusing treatment were identified. In this first comprehensive analysis of its kind, we have demonstrated widespread differences on sexual and relationship variables relevant to the diagnosis of DE and to its functional correlates between men with and without DE symptomology during partnered sex. Limitations include participant recruitment through social media, which likely biased the sample; the use of estimated rather than clocked ejaculation latencies; and the fact that differences between men with acquired and lifelong DE were not investigated. This well-powered multinational study provides strong empirical support for several face-valid measures for the diagnosis of DE, with a number of explanatory and control covariates that may help shed light on the lived experiences of men with DE and suggest focus areas for treatment. Whether or not the DE men had comorbid erectile dysfunction had little impact on the differences with men having normal ejaculatory functioning.

Description of and Relationships among Potential Variables Supported for the Diagnosis of Delayed Ejaculation

The lack of empirically based diagnostic criteria for delayed ejaculation (DE) not only undermines confidence in the reported prevalence rates for this sexual dysfunction, but it has also resulted in a lack of validated patient reported outcomes (PROs) for assessing this condition. The current study was designed to describe and evaluate six face-valid variables previously shown to discriminate between men with and without DE for their utility as diagnostic measures for DE. A sample of 1285 men (mean age = 37.8, SD = 12.7) free of erectile problems and premature ejaculation completed an online sexual health survey that included potential questions intended for use in the diagnosis of DE. Questionnaire items included ones reflective of previously proposed diagnostic constructs related to DE: ejaculation timing/latency, ejaculation efficacy/control, and negative effects of DE. Results indicated that five of the six proposed items showed moderate intercorrelations, suggesting that each constituted a distinct (i.e., non-redundant) though relevant criterion related to the diagnosis of DE. Based on the level of interrelatedness, the better items representing each construct were included in commonality analysis to assess their unique contributions to the diagnosis of DE. Perceived lack of ejaculatory efficacy/control contributed the largest portion of the variance to the diagnosis of DE (58%), with bother/distress (an index of the negative effects of DE) contributing the second largest portion (25%), and ejaculation timing/latency contributing only a small portion of the variance (6%) to the diagnosis of DE. The relevance of these findings to developing a patient report outcome (PRO) for diagnosing DE that considers both empirically supported questions/items and an appropriate balance of items regarding the three constructs was discussed.

Neurons for Ejaculation and Factors Affecting Ejaculation.

Ejaculation is a reflex and the last stage of intercourse in male mammals. It consists of two coordinated phases, emission and expulsion. The emission phase consists of secretions from the vas deferens, seminal vesicle, prostate, and Cowper's gland. Once these contents reach the posterior urethra, movement of the contents becomes inevitable, followed by the expulsion phase. The urogenital organs are synchronized during this complete event. The L3-L4 (lumbar) segment, the spinal cord region responsible for ejaculation, nerve cell bodies, also called lumbar spinothalamic (LSt) cells, which are denoted as spinal ejaculation generators or lumbar spinothalamic cells [Lst]. Lst cells activation causes ejaculation. These Lst cells coordinate with [autonomic] parasympathetic and sympathetic assistance in ejaculation. The presence of a spinal ejaculatory generator has recently been confirmed in humans. Different types of ejaculatory dysfunction in humans include premature ejaculation (PE), retrograde ejaculation (RE), delayed ejaculation (DE), and anejaculation (AE). The most common form of ejaculatory dysfunction studied is premature ejaculation. The least common forms of ejaculation studied are delayed ejaculation and anejaculation. Despite the confirmation of Lst in humans, there is insufficient research on animals mimicking human ejaculatory dysfunction.

Disorders of Ejaculation: An AUA/SMSNA Guideline

Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with premature ejaculation (PE), while men who experience difficulty achieving sexual climax may be diagnosed with delayed ejaculation (DE). The experience of many clinicians suggest that these problems are not rare and can be a source of considerable embarrassment and dissatisfaction for patients. The role of the clinician in managing PE and DE is to conduct appropriate investigation, to provide education, and to offer available treatments that are rational and based on sound scientific data. The systematic review utilized to inform this guideline was conducted by a methodology team at the Pacific Northwest Evidence-based Practice Center. A research librarian conducted searches in Ovid MEDLINE (1946 to March 1, 2019), the Cochrane Central Register of Controlled Trials (through January 2019) and the Cochrane Database of Systematic Reviews (through March 1, 2019). An update search was conducted on September 5, 2019. Database searches resulted in 1,851 potentially relevant articles. After dual review of abstracts and titles, 223 systematic reviews and individual studies were selected for full-text dual review, and 8 systematic reviews and 59 individual studies were determined to meet inclusion criteria and were included in the review. Several psychological health, behavioral, and pharmacotherapy options exist for both PE and DE; however, none of these pharmacotherapy options have achieved approval from the United States Food and Drug Administration and their use in the treatment of PE and DE is considered off-label. Disturbances of the timing of ejaculation can pose a substantial impediment to sexual enjoyment for men and their partners. The Panel recommends shared decision-making as fundamental in the management of disorders of ejaculation; involvement of sexual partner(s) in decision making, when possible, may allow for optimization of outcomes.

Comorbidities Among Sexual Problems in Men: Results From an Internet Convenience Sample.

IntroductionMen suffering from one sexual problem sometimes report having another sexual problem, but few studies have determined concordance rates among dysfunctions in non-clinical samples.AimThis study determined comorbidities among sexual dysfunctions based on an internet convenience sample of 4432 men from Hungary, the USA, and other world regions that visit social media fora.MethodParticipants completed an online 55-item questionnaire that included questions assessing erectile dysfunction (ED), premature ejaculation (PE), delayed ejaculation (DE), and lack of sexual interest (LSI).Main Outcome MeasuresConcordance rates and odds ratios among sexual dysfunctions.ResultsApproximately 8% of men suffered from two or more sexual problems; men with a severe sexual problem were significantly more likely to suffer from a second sexual problem; concordance between PE and erectile dysfunction ranged from 23–29%, with subtypes of lifelong vs acquired PE showing patterns similar to one another; and most men with delayed ejaculation reported minimal problems with LSI, although LSI was generally key to understanding all other dysfunctions.ConclusionThe percentage of men with one sexual problem having a second sexual problem was substantial, ranging from 23–40%. These findings will help clinicians better understand the intertwined nature of sexual problems and assist them in developing management protocols that address concomitant inadequacies in sexual response. Rowland DL, Oosterhouse LB, Kneusel JA, et al. Comorbidities Among Sexual Problems in Men: Results From an Internet Convenience Sample. Sex Med 2021;9:100416.

When Ejaculation Becomes the Goal in Itself: A Psychodynamic Approach to Delayed Ejaculation.

There are a group of men with delayed ejaculation (DE) where the etiology as well as the consequences of the dysfunction are unclear. The aim of the present study was to explore, from a psychodynamic perspective, personality traits among men seeking treatment due to DE. During a 2.5-year period, a consecutive series of 14 men with DE were seeking help at Karolinska University hospital, Sweden. Full medical history and physical examination, sexological case-history and psychological assessments were performed by physicians and a psychotherapist. The results found all patients to be healthy. Mean age was 34 years (range 20–43 years). No other sexual dysfunction occurred. With one exception, they were sexually active. The psychological assessment (The Karolinska Psychodynamic Profile; KAPP) found patients to have difficulties in areas of dependency and separation, control and impulse control, regression in the service of the ego, coping with aggressive affects, alexithymic traits, sexual function, and satisfaction. The results add a deeper understanding of personality traits among healthy patients with DE, which may be a tool for the case history, and offer new treatment strategies. We suggest that DE can be the physical manifestation of some specific personality difficulties, and thus, ejaculation becomes the goal in itself and not the climax of an enjoyable adventure.

Treatment of Delayed Ejaculation

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. 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. 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.

Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis.

Study Design:Retrospective cohort.Objectives:Delayed ejaculation (DE) is a distressing condition characterized by a notable delay in ejaculation or complete inability to achieve ejaculation, and there are no existing reports of DE following lumbar spine surgery. Inspired by our institutional experience, we sought to assess national rates of DE following surgery of the lumbar spine.Methods:We queried the Optum De-identified Clinformatics Database for adult men undergoing surgery of the lumbar spine between 2003 and 2017. The primary outcome was the development of DE within 2 years of surgery. Multivariable logistic regression was performed to identify factors associated with the development of DE.Results:We identified 117 918 men who underwent 162 646 lumbar spine surgeries, including anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), and more. The overall incidence of DE was 0.09%, with the highest rate among ALIF surgeries at 0.13%. In multivariable analysis, the odds of developing DE did not vary between anterior/lateral lumbar interbody fusion, PLF, and other spine surgeries. A history of tobacco smoking (OR = 1.47, 95% CI 1.00-2.16, P = .05) and obesity (OR = 1.56, 95% CI 1.00-2.44, P = .05) were associated with development of DE.Conclusions:DE is a rare but distressing complication of thoracolumbar spine surgery, and patients should be queried for relevant symptoms at postoperative visits when indicated.

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.

Different levels of estradiol are correlated with sexual dysfunction in adult men

Ejaculatory dysfunction, including premature ejaculation (PE) and delayed ejaculation (DE), as well as erectile dysfunction (ED), constitute the majority of male sexual dysfunction. Despite a fair amount of data on the role of hormones and erection and ejaculation, it is inconclusive due to controversy in the current literature. To explore the correlation of male sexual dysfunction with hormonal profile, 1,076 men between the ages of 19–60 years (mean: 32.12 years) were included in this retrospective case–control study; 507 were categorized as ED, PE and DE groups. Five hundred and sixty-nine men without sexual dysfunction were enrolled in the control group. The background characteristics and clinical features of the four groups were collected and analyzed. The estradiol value was significantly elevated in the ED group than the control group (109.44 ± 47.14 pmol/L vs. 91.88 ± 27.68 pmol/L; P < 0.001). Conversely, the DE group had significantly lower level of estradiol than control did (70.76 ± 27.20 pmol/L vs. 91.88 ± 27.68 pmol/L; P < 0.001). The PE group had similar level of estradiol (91.73 ± 31.57 pmol/L vs. 91.88 ± 27.68 pmol/L; P = 0.960) but significantly higher level of testosterone (17.23 ± 5.72 nmol/L vs. 15.31 ± 4.31 nmol/L; P < 0.001) compared with the control group. In conclusion, elevated serum testosterone concentration was an independent risk factor for PE. Besides, there was a progressively increasing graded-distribution of estradiol values from DE to PE and ED groups.

The Role of Hormones in Male Sexual Function

Male sexual dysfunction has many different causes and is often multifactorial in nature. We aim to review the effects that testosterone (T), estrogen, thyroid hormone, prolactin (PRL), and cortisol have on male sexual function. T deficiency can cause decreased libido and diminished erectile function. Estrogen is necessary for sexual drive but is postulated to inhibit erectile function when elevated. Hyperthyroidism is associated with premature ejaculation (PE), hypothyroidism is associated with delayed ejaculation (DE), and both are associated with erectile dysfunction (ED). Hyperprolactinemia is associated with ED and can cause fertility issues. The role of corticosteroids is largely unknown. While hormonal disorders can largely influence male sexual health, resolution of sexual dysfunction is achieved in most cases by normalization of hormone levels.

PD28-10 PREVALENCE AND RISK FACTORS OF DELAYED EJACULATION AT AN OUTPATIENT UROLOGY CLINIC

INTRODUCTION AND OBJECTIVE:Delayed ejaculation (DE), defined as a delay in intravaginal ejaculation latency time, is an understudied conditioned with an estimated prevalence of 5%. However, literat...

Management Options for Premature Ejaculation and Delayed Ejaculation in Men.

Many men experience distressing issues regarding the timing of orgasm and ejaculation, such as premature ejaculation (PE) and delayed ejaculation (DE). Despite being highly prevalent, both PE and DE are poorly understood and present a management challenge for sexual medicine specialists. To summarize existing data on the medical management of PE and DE. A comprehensive literature review pertaining to the management of PE and DE was conducted using PubMed and clinicaltrials.gov for data published up until May 2019. Our focus was on double-blind, placebo-controlled trials and meta-analyses of such studies. Peer-reviewed studies on treatment options for PE and DE were critically analyzed for results and methodological rigor. The peer-reviewed data on PE management continue to evolve. Psychotherapy, pharmacotherapy, and procedural interventions have all been associated with some degree of efficacy. A strong evidence base supports the off-label use of selective serotonin reuptake inhibitors and local anesthetics in PE given consistent increases in ejaculation latency time. Education and mental health assessments remain important components of PE management despite a dearth of peer-reviewed data on these interventions. Numerous treatment strategies have been evaluated for DE; limited data support psychotherapy, pharmacotherapy, and/or penile vibratory stimulation as management options. A number of management options for PE or DE exist but none has been formally approved by the US Food and Drug Administration. New and novel treatments would be of great value in managing issues regarding the timing of ejaculation/orgasm. Martin-Tuite P, Shindel AW. Management Options for Premature Ejaculation and Delayed Ejaculation in Men. Sex Med Rev 2020; 8:473-485.