Prevalence Of Male Sexual Dysfunction Research Articles

Trends, safety, and efficacy of wearable male sexual devices.

The prevalence of male sexual dysfunction (MSD) increases with age, with >50% of men aged >40years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been increasingly utilized by patients and recommended by sexual medicine clinicians. This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were based on patient reviews, cost, and specific features. Investigatory evidence and Food and Drug Administration status were also reviewed. Additionally, Google Trends was used to determine the popularity of devices over time. Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the RigiScan, the Adam sensor provides feedback on erectile quality while monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices such as the Morari Patch and vPatch/in2 Patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Overall, this review describes the available investigatory evidence for a range of WMSDs and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients.

High-intensity interval training (HIIT) and slow breathing interventions alleviate premature ejaculation (PE) symptoms

BackgroundPhysical exercise may alleviate premature ejaculation symptoms, a prevalent male sexual dysfunction linked to a series of negative outcomes for men and their partners. ObjectiveWe investigated the effectiveness of high-intensity interval training (HIIT) and slow breathing interventions on premature ejaculation symptoms and their relation to autonomic activity and attention regulation. MethodChinese adult men (N = 76, M = 21.89, SD = 3.32) with premature ejaculation completed one of the two-week interventions in their homes or as participants in a normal breathing control group; they reported their age, height, weight, physical activity level, premature ejaculation symptoms, and attention regulation. In the HIIT group, 26 participants engaged in a 7-minute HIIT each day. In the slow breathing group, 25 participants performed 7-minute slow breathing exercises per day while the 25 participants in the normal breathing group similarly performed normal breathing exercises. All participants measured their heart rate once before and five times (with one-minute intervals) after the intervention. When participants had penile-vaginal sex with their partners, they measured their heart rate once after ejaculation. ResultsTime × Intervention interaction was significant with lower levels of premature ejaculation symptoms on Days 12, 13, and 14 in the HIIT group (M ± SD = 16.19 ± 3.45, 15.96 ± 3.43, and 15.15 ± 3.62) compared to the normal breathing group (M ± SD = 17.68 ± 3.06, 17.68 ± 3.15, and 17.44 ± 3.25). Higher levels of attention regulation were associated with fewer premature ejaculation symptoms. We also found that a larger increase in heart rate from resting to after sex was associated with fewer premature ejaculation symptoms. ConclusionCompared to the control group, the efficacy of two weeks of HIIT exercise in mitigating PE symptoms suggests its potential as a novel treatment for PE.

(251) Exploring Trends, Safety, and Efficacy of Wearable Male Sexual Devices: Revolutionizing Intimacy

Abstract Introduction The prevalence of male sexual dysfunction (MSD) increases with age, with greater than 50% of men aged over 40 years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been both increasingly utilized by patients and recommended by sexual medicine clinicians. Objective This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Methods Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were made based on patient reviews, cost, and specific features of each device. Investigatory evidence and FDA status were also reviewed (Figure 1). Additionally, Google Trends was used to determine the popularity of different devices over time (Figure 2). Results Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were found to be the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the Rigiscan, the ADAM sensor provides feedback on erectile quality while also monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices like Morari Patch and vPatch/in2 patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Conclusions Overall, this review describes the available investigatory evidence for a range of WMSDs and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Charles A Loeb, MD - None relevant Muhammad A M Hammad, MBBCh - None relevant David W Barham, MD - None relevant Jake Miller MD - None relevant Kirsten Young, MS - None relevant Rainey Horwitz, MD – Paid collaboration with FirmTech on Instagram Eliad Amini, BS - None relevant Mai Xuan Nguyen, BS - None relevant Nitish Nag, MD, PhD - None relevant Lawrence Jenkins, MD – None relevant Amy M Pearlman, MD – Consultant for/received grant funding from Boston Scientific; consultant for Endo Pharmaceuticals; consultant for FirmTech; investor in ByteMD; influencer in Urology Times Faysal A Yafi, MD – Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(076) Hyaluronic Acid Injection of Penis for Management of Premature Ejaculation: A Systematic Review with Single-Arm Meta-Analysis

Abstract Introduction Premature ejaculation (PE) is the most prevalent male sexual dysfunction globally. Pharmacological treatments as the primary mainstay for PE therapy have drawbacks in systemic effect and possible recurrence after drug cessation. In the last few years, there has been a progressive use of hyaluronic acid (HA) injection in Andrology, including its use to prolong ejaculation latency time by increasing penile glans sensitivity. However, no meta-analysis on its efficacy and safety exists. Objective The study aimed to conduct a comprehensive systematic review and single-arm meta-analysis to identify the efficacy and safety of HA injection in the penis for treating PE. Methods A systematic search on PubMed, Scopus, and Embase databases were searched from inception to May 31, 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Risk of bias of included study were carried out based on Cochrane ROB2 and ROBINS-I tools. Intravaginal ejaculatory latency time (IELT) was considered the primary outcome, whereas satisfaction and complication rate were the secondary outcomes. Pooled rate and mean difference with matching 95% confidence level intervals (CIs) in the random effect model were applied in analysis using STATA 18.0 and RevMan 5.4. To ensure the impact of each study, a leave-one-out sensitivity analysis was performed. Results Of the 60 studies identified, three clinical trials and six observational studies with low and moderate risk of bias met the inclusion criteria. A total of 616 participants were eligible for meta-analysis. The results found that HA injection, with different techniques, can significantly increase IELT by 239.78 (95% CI 147.14 – 332.43), 202.76 (95% CI 121.86 – 283.66), 164.62 (95% CI 112.19 – 217.06), and 189.01 (95% CI 71.74 – 306.28) seconds at 1, 3, 6, and ≥12 months follow-up. Despite significant heterogeneity among the studies, the sensitivity analysis results were unaffected by the removal of any of the articles. As for safety, the most commonly reported complications were pain, ecchymosis, and papule formation with pooled incidence of 19% (95% CI: 15% – 24%), 8% (95% CI: 5% – 13%), and 5% (95% CI: 3% – 8%), respectively. The majority of adverse events were mild, temporary, and self-limited, although a single case of skin necrosis and vascular emboli had been reported. In addition, patients and their partners also reported increased satisfaction after HA injection. Conclusions HA injection in the penile can effectively prolong the ejaculation time by at least a year with tolerable adverse events. Nevertheless, the optimal injection technique, ideal patient candidate, and long-term outcome still need to be determined through additional well-designed trials. Disclosure No.

(354) Revolutionizing Intimacy: Exploring Trends, Safety, and Efficacy of Wearable Male Sexual Devices

Abstract Introduction The prevalence of male sexual dysfunction (MSD) increases with age, with greater than 50% of men aged over 40 years reporting erectile dysfunction (ED). In recent years, wearable male sex devices (WMSDs) have been both increasingly utilized by patients and recommended by sexual medicine clinicians. Objective This study seeks to investigate the safety and efficacy of products currently marketed for the treatment of MSD. Methods Available products for WMSDs were reviewed by analyzing product websites, forums, advertisements, and clinical recommendations. Qualitative comparisons were made based on patient reviews, cost, and specific features of each device. Investigatory evidence and FDA status were also reviewed (Figure 1). Additionally, Google Trends was used to determine the popularity of different devices over time (Figure 2). Results Eight WMSDs for the treatment of MSD and enhancement of sexual pleasure were reviewed. Constriction bands, such as the Maintain Ring Loop, Eddie by Giddy, and Xialla, have shown significant benefits in clinical trials and were found to be the most popular devices among patients. Smart devices can provide real-time feedback on erectile quality and/or sexual performance. Similar to the Rigiscan, the ADAM sensor provides feedback on erectile quality while also monitoring changes in penile tumescence during sleep with additional analysis available through a mobile application. Neuromodulation devices like Morari Patch and vPatch / in2 patch use electrical stimulation to delay ejaculation and improve sexual function. The FirmTech Performance Ring uses sensors to track the vital signs of erectile fitness with clinical trials ongoing. Conclusions Overall, this review describes the available investigatory evidence for a range of WMSDs, and highlights the potential benefits and limitations of these devices in treating MSD and enhancing sexual pleasure. Further research is needed to evaluate the effectiveness of these devices and to determine which ones may be the most suitable for individual patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Charles A Loeb, MD - None relevant Muhammad A M Hammad, MBBCh - None relevant David W Barham, MD - None relevant Jake Miller MD - None relevant Kirsten Young, MS - None relevant Rainey Horwitz, MD – Paid collaboration with FirmTech on Instagram Eliad Amini, BS - None relevant Mai Xuan Nguyen, BS - None relevant Nitish Nag, MD, PhD - None relevant Lawrence Jenkins, MD – None relevant Amy M Pearlman, MD – Consultant for/received grant funding from Boston Scientific; consultant for Endo Pharmaceuticals; consultant for FirmTech; investor in ByteMD; influencer in Urology Times Faysal A Yafi, MD – Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

(327) The Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT): A Novel Psychometric Tool to Evaluate Premature Ejaculation During Masturbation

Abstract Introduction Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. Its current definition, together with the most used diagnostic tools, does not include non-vaginal sexual intercourse such as anal sex, self-masturbation and/or partnered-masturbation, and other forms of sexual stimulation. However, diagnostic psychometry currently available is exclusively evaluating PE in the vaginal coitus. Objective To validate a new tool, the Masturbatory Premature Ejaculation Diagnostic Tool (MPEDT), by assessing the control over ejaculation and its psychological effects during self-masturbation, rather than heterosexual vaginal intercourse. Methods We studied 135 male patients aging from 18 to 40 years seeking medical care for PE in the Infertility and Sexual Medicine Department from June to September 2020. All the participants were asked to fill the PEDT and MPEDT questionnaires to estimate the PE symptoms during, respectively, intercourse and self-masturbation. The reliability/validity, the factor analysis of the tool, and the diagnostic sensitivity/specificity of MPEDT were calculated. Results The overall Cronbach alpha was 0.884. In our adjusted model, both RMSEA (Root Mean Square Error of Approximation) and SRMR (Standardized Root Mean Square Residual) were lower than 0.08, while Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Non-Normed Fit Index (NNFI), and Comparative Fit Index (CFI) were higher than 0.9. The area under the ROC curve (AUC) is 0.943±0.015. The results suggest MPEDT points being ≤5 as “normal”, ≥7 as “PE during self-masturbation” and 6 as “suspected PE”, with the sensitivity of 91.9% and specificity of 88.1%. Conclusions An efficient diagnostic psychometric tool is needed for the individuals who, based on the impaired control over ejaculation during self-masturbation, may also suffer from PE during partnered intercourse. MPEDT is able to evaluate the existence of PE symptoms not necessarily during heterosexual intercourse but rather during self-masturbation, possibly aiding to the diagnosis, as well as planning and follow-up of a prompt therapeutical strategy. MPEDT could be considered a new, objective and reliable diagnostic tool for the evaluation of the existence of PE symptoms. Disclosure No

Current and emerging treatment options for premature ejaculation.

Premature ejaculation (PE) is a prevalent male sexual dysfunction. Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine and other selective serotonin reuptake inhibitors (SSRIs). Most of the pharmacotherapeutic options target neurotransmitters (such as serotonin and oxytocin) that have a role in the ejaculation mechanism. However, these treatments are mildly effective and only provide a temporary delay in the ejaculation latency time, and PE recurs when the treatment is stopped. Thus, a treatment for PE is urgently needed and research is ongoing to find the ideal PE therapy. The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials. Both preclinical and clinical studies on new-generation SSRIs are ongoing. Moreover, promising results came from clinical trials in which the efficacy of on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, was assessed. Surgical intervention and neuromodulation have been proposed as potential treatment options for PE; however, current PE guidelines do not recommend these treatments owing to safety concerns.

Male Sexual Dysfunction

Male sexual dysfunction is a series of conditions, most notably including erectile dysfunction (ED), Peyronie’s disease (PD), and premature ejaculation (PE), defined by impaired sexual functioning. The prevalence of male sexual dysfunction increases with age and is relatively high with greater than 50% of men aged 40 to 70 describing some degree of erectile dysfunction. Risk factors for male sexual dysfunction include age, diabetes mellitus (DM), cancer, stroke, hypertension, penile trauma, depression, anxiety, and disturbance in central serotonin neurotransmission and 5-HT postsynaptic receptor functioning. Sexual questionnaires including the International Index of Erectile Dysfunction, Sexual Health Inventory for Men, and the Premature Ejaculation Diagnostic Tool are useful in screening for these disorders. Focused history and physical can establish diagnoses. For a condition to be diagnosed as male sexual dysfunction, the patient or their partner must view their sexual functioning as impaired. Treatment of male sexual dysfunction is etiology dependent. For ED, first-line therapy is a phosphodiesterase-5 inhibitor or mental health care for psychogenic ED. More complicated cases may be treated with injections, surgery, or shockwave therapy. PD is either treated with medications for pain management, collagenase clostridium histolyticum injection, corpoplasty, plication, or shockwave therapy. PE may be treated behaviorally or with SSRIs as first line medication.

Sexual dysfunction among men with diabetes; a cross-sectional study at a specialised diabetes clinic in Sri Lanka

BackgroundMale sexual dysfunction in diabetes is often an unrevealed clinical issue. Though many publications report the prevalence, there is limited data on its associations, impact, and health-seeking behaviour. The objectives were to assess the prevalence of male sexual dysfunction, its associations, impact and treatment-seeking among men with diabetes in a selected tertiary care Diabetes Clinic.MethodsA cross-sectional study was conducted at the Diabetes Clinic, National Hospital of Sri Lanka, from January to September 2020. Men with diabetes aged 18 to 70 years undergoing annual assessment were recruited consecutively. Socio-demographic and clinical information were collected using an interviewer-administered questionnaire. Erectile dysfunction (ED), premature ejaculation, mental health and quality of life were assessed using validated self-administered questionnaires. Cardiovascular autonomic reflex tests and total testosterone levels were performed. Penile colour Doppler ultrasonography was performed on consenting participants with erectile dysfunction. Associations were assessed using the chi-square test or Fisher’s exact for dichotomous variables and independent sample t-test for continuous variables.ResultsTwo hundred and twelve participants were recruited with a mean age of 54.1 (SD = 10.1) years. Erectile dysfunction was present in 168 (79.2%), (mild: 45, mild-moderate: 56, moderate: 26, severe: 41). Premature ejaculation was present in 26 (18.7%). Libido was low among 16%. Sexual dysfunction was not revealed to a health provider by 85.6% despite 60.5% experiencing psychological and/or relationship effects. Out of 18 who sought treatment, only 4 achieved a good response. Mean age (55.4 ± 9.5 vs 48.7 ± 10.6 years, p < 0.001) and duration of diabetes (10.9 ± 7.6 vs 5.8 ± 4.6 years, p < 0.001) were higher while eGFR was lower (73.9 ± 27.7 vs 100.51 ± 28.08 years, p < 0.008) among those with ED compared to those without. Diabetic retinopathy (4% vs 42%, p < 0.001), peripheral neuropathy (17.9% vs 38.4%, p = 0.041) and lower limb arterial disease (0% vs 12.2%, p = 0.04) were associated with ED. Arterial insufficiency was seen among 50% of the participants who underwent penile colour Doppler ultrasonography.ConclusionsMale sexual dysfunction is a pervasive yet underappreciated problem in diabetes care despite its effect on the individual. Patient and disease characteristics would guide the identification of high-risk individuals for targeted screening in clinical practice.

The masturbatory premature ejaculation diagnostic tool (MPEDT): A novel psychometric tool to evaluate premature ejaculation during masturbation.

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. Its current definition, together with the most used diagnostic tools, does not include nonvaginal sexual intercourse such as anal sex, self-masturbation and/or partnered-masturbation, and other forms of sexual stimulation. However, diagnostic psychometry currently available is exclusively evaluating PE in the vaginal coitus. To validate a new tool, the masturbatory premature ejaculation diagnostic tool (MPEDT), by assessing the control over ejaculation and its psychological effects during self-masturbation, rather than heterosexual vaginal intercourse. We studied 135 male patients aging from 18 to 40 years seeking medical care for PE in the Infertility and Sexual Medicine Department from June to September 2020. All the participants were asked to fill the premature ejaculation diagnostic tool PEDT and MPEDT questionnaires to estimate the PE symptoms during, respectively, intercourse and self-masturbation. The reliability/validity, the factor analysis of the tool, and the diagnostic sensitivity/specificity of MPEDT were calculated. The overall Cronbach alpha was 0.884. In our adjusted model, both root mean square error of approximation (RMSEA) and standardized root mean square residual (SRMR) were lower than 0.08, while goodness of fit index, adjusted goodness of fit index, non-normed fit index (NNFI), and comparative fit index (CFI) were higher than 0.9. The area under the ROC curve (AUC) is 0.943 ± 0.015. The results suggest MPEDT points being ≤5 as "normal," ≥7 as "PE during self-masturbation," and 6 as "suspected PE," with the sensitivity of 91.9% and specificity of 88.1%. An efficient diagnostic psychometric tool is needed for the individuals who, based on the impaired control over ejaculation during self-masturbation, may also suffer from PE during partnered intercourse. MPEDT is able to evaluate the existence of PE symptoms not necessarily during heterosexual intercourse but rather during self-masturbation, possibly aiding to the diagnosis, as well as planning and follow-up of a prompt therapeutical strategy. MPEDT could be considered a new, objective, and reliable diagnostic tool for the evaluation of the existence of PE symptoms.

New approach to patients with premature ejaculation: Do social cognition and attachment profiles play a role in premature ejaculation?

Premature ejaculation is the most prevalent male sexual dysfunction and causes significant individual and relational distress in subjects. This study aimed to investigate the underlying psychopathologies of premature ejaculation using theory of mind, empathy and attachment parameters and included 91 participants: 46 with lifelong premature ejaculation and 45 without any ejaculatory complaints. Arabic index of premature ejaculation and stopwatch intravaginal ejaculatory latency times were recorded from all subjects in order to evaluate ejaculatory function. We used reading mind in the eyes, empathy quotient and experiences in close relationships-revised tasks to evaluate social cognitive and attachment profiles of the participants. We compared differences between groups in terms of task performances and symptom severity. Premature ejaculation patients showed significantly low levels of theory of mind abilities as well as empathic skills compared to controls. Although groups did not differ significantly in means of attachment avoidance parameters, premature ejaculation patients had significantly higher levels of attachment anxiety parameters. There was no correlation between symptom severity and social cognition and attachment scores in premature ejaculation patients. These results suggest that patients with premature ejaculations may suffer from significant social cognitive deficits and have anxious but not avoidant pattern of attachment. These results may implicate insights in terms of pharmacological and psychotherapeutic treatments of premature ejaculation.

Management of premature ejaculation: a clinical guideline from the Italian Society of Andrology and Sexual Medicine (SIAMS).

Premature ejaculation (PE) is the most prevalent male sexual dysfunction, and the most recently defined. PE is often mistakenly considered a purely psychosexological symptom by patients: the lacking awareness in regards to the pathophysiology and treatments often lead to resignation from the patients' side, making PE the most underdiagnosed sexual complaint. However, an ever-growing body of evidence supporting several organic factors has been developed in the last decades and several definitions have been suggested to encompass all defining features of PE. In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), we propose 33 recommendations concerning the definition, pathophysiology, treatment and management of PE aimed to improve patient care. These evidence-based clinical guidelines provide the necessary up-to-date guidance in the context of PE secondary to organic and psychosexological conditions, such as prostate inflammation, endocrine disorders, and other sexual dysfunctions, and suggest how to associate pharmacotherapies and cognitive-behavioral therapy in a couple-centered approach. New therapeutic options, as well as combination and off-label treatments, are also described.

Male Sexual Health and Reproduction in Cutaneous Immune-Mediated Diseases: A Systematic Review.

Information about the possible effects of cutaneous immune-mediated diseases (cIMDs) on male sexual function and reproduction is scarce. Factors known to impair sexual health and reproduction, such as inflammation, medication use, and hypogonadism, can be present in a significant proportion of male patients with cIMD. To systematically review the literature for the influence of paternal cIMD on many aspects of male sexual and reproductive health, such as sexual function, reproductive hormones, fertility, and pregnancy and offspring outcomes. A systematic literature search was performed. The searches combined keywords regarding male sexual function and fertility, pregnancy outcomes, and offspring's health with a list of cIMDs. The majority of the identified studies included patients with psoriasis (22 of 27), and sexual function was the most common outcome of interest (20 of 27). For patients diagnosed with psoriasis, the prevalence of male sexual dysfunction reported in these studies ranged from 34 to 81%. Hypogonadism in patients with psoriasis was reported in 2 of 3 studies. Sperm analysis abnormalities in patients with psoriasis were reported in 3 of 4 studies. No information about the effect of paternal disease on pregnancy and offspring outcomes was identified. Disease activity in psoriasis might play an important role in the development of sexual dysfunction, hypogonadism, and abnormal sperm quality. For the other cIMD included in this review, there is insufficient information regarding male sexual and reproductive health to draw firm conclusions. More research is needed to understand the association between cIMD and impaired male sexual and reproductive health. Perez-Garcia LF, Dolhain R, te Winkel B, etal. Male Sexual Health and Reproduction in Cutaneous Immune-Mediated Diseases: A Systematic Review. Sex Med Rev 2021;9:423-433.

Majoon-E-Piyaz: A Potent Unani Formulation for Premature Ejaculation

Surʻat-e-Inzāl (Premature Ejaculation) is the most prevalent male sexual dysfunction affecting 25 - 40% global population of men. It is a universal disorder and is independent of age, social or marital status. It has a significant impact on both- patients and their partners, causing distress, anxiety and relationship difficulties affecting the quality of life. Several aetiologies have been proposed by various researchers which are not evidence-based but speculative. Accordingly the International Society for Sexual Medicine (ISSM) issued treatment guidelines for Premature Ejaculation (PE) recommending Serotonergic Antidepressants (SSRIs) and Local Anaesthetics (LA) for its management in modern medicine. However, these treatments were not actually developed for PE, and have limitations associated with their off-label use. Furthermore, nearly all the recommended drugs have a wider spectrum of adverse effects and serious drug interactions which sometimes could be fatal. On the other hand, centuries old Unani medicine offers a complete line of treatment for Surʻat-e-Inzāl based on traditional knowledge and experience. Unani physicians devised a large number of poly-herbal recipes which are still in vogue. Majoon-e-Piyaz (MP) is one of the compound Unani formulations which are in use for the treatment of premature ejaculation since centuries. This article is an attempt to summarize scientific investigations in support of the claim made by Unani physicians regarding Majoon-e-Piyaz (MP). &#x0D; Keywords: Surʻat-e-Inzāl, Premature Ejaculation, Majoon-e-Piyaz, Unani Medicine

High Prevalence of Male Sexual Dysfunction in a Prospective Multicenter VA Inflammatory Bowel Disease Population.

Aims of this study were to assess the prevalence of and risk factors for sexual dysfunction (SD) in male veterans with inflammatory bowel disease (IBD). We collected IBD history, quality of life (QOL), and sexual function surveys. One hundred seventy-one men enrolled, mean age 50 years, 85% had SD, 92% had erectile dysfunction (ED). More severe ED (P = 0.0001), decreased sexual desire (P = 0.004), and decreased satisfaction (P = 0.001) were associated with poorer QOL. Biologic use was associated with increased SD; hypertension with a decrease in sexual desire. SD and ED are highly prevalent and associated with poorer QOL.

Variation in Brain Subcortical Network Topology Between Men With and Without PE: A Diffusion Tensor Imaging Study

IntroductionPremature ejaculation (PE) is a highly prevalent male sexual dysfunction. Previous studies have found abnormal activity in the sympathetic nervous system and penile sensory pathway of PE. Few studies have investigated the neural mechanisms underlying PE. AimThe aim of this study was to examine whether the altered cortico-subcortical network topological properties of the brain white matter structural network could be used to differentiate patients with PE from healthy control (HC) subjects. MethodsDiffusion tensor images data were collected from 32 patients with PE and 35 HC participants. Then, brain white matter structural networks were reconstructed from image acquisition. Main Outcome MeasureFurthermore, nodal measures were calculated and hub regions were identified using the graph-theoretical methods. ResultsFor cortical brain regions, increased strength, global efficiency, and decreased shortest path length were found in the right superior frontal gyrus (medial), and superior frontal gyrus (medial orbital) were found in patients with PE. In addition, patients with PE also showed decreased strength in the right rolandic operculum and decreased shortest path length, and increased global efficiency in the right inferior frontal gyrus (triangular part). For subcortical brain structures, patients with PE were associated with decreased shortest path length and increased global efficiency in the left insula and right caudate nucleus. Finally, the results showed that 9 PE-specific hub regions were identified in patients compared with HCs, including 7 cortical regions and 2 subcortical regions. Clinical ImplicationsOur results provide new understanding about the pathology of PE and enhances the understanding of PE pathology. Strength & LimitationsOur results offer biological markers for understanding the physiopathology of PE. However, our study is a cross-sectional design, longitudinal design studies need to explore the causal relationships between aberrant topological characteristics and PE. ConclusionOur results provide new insights into the neural mechanism of PE involving cortico-subcortical network changes, which could serve as a potential biomarker to differentiate individuals with PE from HCs.Chen J, Yang J, Huang X, et al. Variation in Brain Subcortical Network Topology Between Men With and Without PE: A Diffusion Tensor Imaging Study. J Sex Med 2020;17:48–59.

Premature Ejaculation: Aetiology and Treatment Strategies.

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that is often neglected, presenting a currently unmet therapeutic need. The classification of PE has historically been varied and at times ambiguous, contributing to inaccurate prevalence estimates. This review uses the International Society for Sexual Medicine (ISSM) definition of PE, which includes reduced ejaculatory latency, lack of control and associated negative personal consequences. Patient assessment and management options differ depending on the classification of PE and it is the role of the clinician to appropriately classify patients and be aware of the correct management strategies. This review provides an overall background of PE in terms of classification and underlying physiology, patient assessment and management strategies along with the scientific rationale for treatment. Patients with lifelong and acquired PE are most likely to benefit from combination therapy of pharmacological treatment in the form of selective serotonin re-uptake inhibitor dapoxetine, psychosexual behavioural therapy and psychological therapy.

Male Sexual Dysfunction Among Egyptian Patients with Chronic Hepatitis C Virus Infection Before and After Direct-Acting Antiviral Drugs

BackgroundChronic hepatitis C virus (HCV) infection is a global health burden that affects quality of life, with a negative impact on sexual functioning (SF). AimTo study male sexual dysfunction (MSD) among Egyptian men with chronic HCV infection and the impact of therapy with direct-acting antiviral drugs (DAAs) on their sexual health. MethodsThe self-administered International Index of Erectile Function (IIEF) questionnaire was completed by 400 sexually active male patients with chronic HCV infection without liver cirrhosis before the initiation of therapy with DAAs and then again at the completion of therapy. We compared these baseline questionnaires with those completed by a similar number of age-matched and socioeconomic status–matched controls. In the patients with HCV infection, we also compared IIEF questionnaires completed before and after DAA therapy. Main Outcome MeasureWe determined the proportions of patients and controls who were dissatisfied with their sexual life and the impact of clearing HCV infection on MSD and evaluated the impact of DAA therapy on the total IIEF score and scores in all IIEF domains. ResultsMen with chronic HCV infection before DAA treatment had significantly higher erectile dysfunction (ED) scores compared with controls, and scores increased with age (P < .0001). The average scores in all IIEF domains was significantly lower in the patients compared with controls in all age groups. Men with chronic HCV infection had significantly higher ED scores before cure than after cure (P < .0001). Clinical ImplicationsGiven the high prevalence of MSD in patients with chronic HCV infection, and given that curing the HCV virus can improve the MSD associated with HCV infection, it is recommended that sexual quality of life in men with HCV be addressed as part of the evaluation protocol before initiation of DAA treatment and again after cure in an effort to improve this particular aspect of quality of life. Strengths & LimitationsThis is the first study to report on MSD in the era of DAA therapy in Egyptian men with chronic HCV infection before the development of cirrhosis, with a relatively large study population. The use of a detailed version of the IIEF questionnaire reinforces the validity of our study. ConclusionChronic HCV infection negatively impacts MSD, affecting all domains of the IIEF, and effects increase with age. The MSD associated with HCV infection is significantly improved in patients who are cleared of the virus. These findings require further confirmation and need to be addressed as part of a comprehensive therapeutic plan to improve patients’ quality of life.Elshimi E, Morad W, Mohamad NE. Male Sexual Dysfunction Among Egyptian Patients with Chronic Hepatitis C Virus Infection Before and After Direct-Acting Antiviral Drugs. J Sex Rev 2019;16:402–409.

Efficacy and safety of behavioral therapy for premature ejaculation: Protocol for a systematic review.

Background:Premature ejaculation (PE) is the one of the most prevalent male sexual dysfunction, there has not been specific medicine or therapy for the disease. As an effective treatment for premature ejaculation is a behavioral therapy and is widely used worldwide. The purpose of this study is to evaluate the efficacy and safety of behavioral therapy in patients who suffer from PE.Method:We will search all randomized controlled trials (RCTs) from the following electronic databases, by September 30, 2018, such as PubMed, EMBASE, the Cochrane Library, Web of Science database, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal database (VIP), and Wanfang Database. We will also collect clinical trial registries, dissertations, grey literature, reference lists of studies, systematic reviews, and conference abstracts. The primary outcomes include the Intravaginal Ejaculatory Latency Time (IELT). Besides, Premature Ejaculation Diagnostic Tool (PEDT), Arabic index of Premature Ejaculation (AIPE), Index of Premature Ejaculation (IPE) will be the secondary outcomes. Two people will review these articles, extract the data information, and assess the quality of studies separately. RevMan (version 5.3) and EndNote X7 will be used for meta-analysis.Results:This study will generate a comprehensive review of current evidence of behavioral therapy for premature ejaculation.Conclusion:The study will provide updated evidence to evaluate the efficacy and safety of behavioral therapy for premature ejaculation.Ethics and dissemination:It is not necessary for this systematic review to acquire an ethical approval. This review will be reported in a peer-reviewed journal.PROSPERO registration number:PROSPERO CRD42018111339.

The Measures of the Persian Medicine Vis-à-vis the Treatment of Premature Ejaculation

Premature ejaculation is a male sexual dysfunction characterized by ejaculation which occurs within about one minute of vaginal penetration and inability to delay ejaculation on the vaginal penetrations. The individuals suffering from the premature ejaculation will reach orgasm before even the minimal penile or sexual stimulation, prior to or immediately after penetration. Premature ejaculation is the most prevalent male sexual dysfunction. It has detrimental effects on the relationship of the partners; it may cause mental distress, anxiety, and depression. Its prevalence rates run the gamut from 20% to 30%. The etiology of this problem is unknown, yet again there are some hypotheses in this regard including anxiety, penile hypersensitivity, and serotonin receptor dysfunction. The use of the Persian Medicine and herbal remedies for the treatment of diseases has a long historical background. Nutrition is the principal stepping stone of the treatment in the Persian Medicine; it proffers various food and remedy options for treating premature ejaculation. Therefore, the authors of the present paper aimed at taking into account the nutritional advice and suggestions of the Persian Medicine to ameliorate the aforementioned issue. In this review article, the seminal and original books of the Persian Medicine on the male sexual dysfunction have been thoroughly reviewed. A list of available, inexpensive and effective foods and medications which has been experienced for centuries was elicited. Due to the prevalence and the effects of the premature ejaculation on both marital relationships and subsequently fertility, constructing treatments like this list can be efficacious for to solving this problem.