Contemporary management of ejaculatory dysfunction

Gray, Marisa C.; Zillioux, Jacqueline; Khourdaji, Iyad; Smith, Ryan P.

doi:10.21037/tau.2018.06.20

Cited by 37 publications

(32 citation statements)

References 158 publications

(227 reference statements)

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“…Although treating anejaculation or retrograde ejaculation is important, particularly to men who intend to become fathers, the prevalence of this condition was only reported in one study on European men ( Hendrickx et al, 2016 ; Mehta & Sigman, 2015 ). Secondly, for these ejaculatory problems to be reported as a disorder, the men suffering from them were required to have suffered from personal distress ( Gray et al, 2018 ). There is no gold standard for diagnosis of DE, nor is there a specifically defined time of latency, and even physicians from developed countries have an inconsistent practice pattern for diagnosing DE ( Abdel-Hamid & Saleh, 2011 ; Butcher et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Male Sexual Dysfunction in Asian and European Regions: A Systematic Review

et al. 2020

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Male sexual dysfunctions (MSDs) often remain undiagnosed and untreated in Asia compared to Europe due to conservative cultural and religious beliefs, socioeconomic conditions, and lack of awareness. There is a tendency for the use of traditional medicines and noncompliance with and reduced access to modern healthcare. The present systematic review compared the incidence and factors of MSD in European and Asian populations. English language population/community-based original articles on MSDs published in MEDLINE from 2008 to 2018 were retrieved. A total of 5392 studies were retrieved, of which 50 (25 Asian and 25 European) were finally included in this review. The prevalence of erectile dysfunction (ED) (0%–95.0% vs. 0.9%–88.8%), low satisfaction (3.2%–37.6% vs. 4.1%–28.3%), and hypoactive sexual desire disorder (HSDD) (0.7%–81.4 vs. 0%–65.5%) was higher in Asian than in European men, whereas the prevalence of anorgasmia (0.4% vs. 3%–65%) was lower in Asian than in European men. Age was an independent positive factor of MSD. In European men over 60 years old, the prevalence of premature ejaculation (PE) decreased. The prevalence of MSD was higher in questionnaires than in interviews. The significant factors were age, single status, low socioeconomic status, poor general health, less physical activity, cardiovascular diseases, diabetes, obesity, lower urinary tract symptoms, prostatitis, anxiety, depression and alcohol, tobacco, and drug use. The prevalence of MSD differed slightly in Asian and European men. There is a need to conduct large studies on the various Asian populations for the effective management of MSD.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Male Sexual Dysfunction in Asian and European Regions: A Systematic Review

et al. 2020

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“…In this study, RE was defined as the release of less or no semen fluid during sexual climax. 10,24 Therefore, RE was defined by MSHQ-EjD-SF Item 3: "How would you rate the amount or volume of semen fluid when you ejaculate" and an answer other than "As much as it always was" regarded as RE.…”

Section: Outcome Measuresmentioning

confidence: 99%

Retrograde ejaculation after holmium laser enucleation of the prostate (HoLEP)—Impact on sexual function and evaluation of patient bother using validated questionnaires

et al. 2020

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Background A vast body of literature has focused on erectile function after Holmium Laser Enucleation of the Prostate (HoLEP). Interestingly, retrograde ejaculation (RE), despite its frequency has sparsely been investigated. Objectives To study patient perception and impact of RE on sexuality following HoLEP. Materials and methods We retrospectively analyzed 2,131 patients undergoing HoLEP 2006‐2015 at our institution. Patients were followed via standardized questionnaires namely International Index of Erectile Function (IIEF) as well as Male Sexual Health Questionnaire Ejaculatory Short Form (MSHQ‐EjD‐SF). Exclusion criteria were missing/follow‐up <6 months, missing data on MSHQ‐EjD‐SF and IIEF score, resulting in 535 assessable patients. Multivariable logistic regression was employed to identify independent predictors of satisfaction with overall sex life (IIEF question 13). Results Median follow‐up was 50 months (IQR: 30‐78). Overall, 495 (92.5%) patients reported RE. Patients differed significantly with respect to age (P = .036), IPSS at follow‐up (P = .01), and erectile function (P < .001), whereas no other statistically significant differences were observed. In multivariable logistic regression analyses, presence of RE was not independently associated with satisfaction with overall sex life (OR: 2.7, 95% CI: 0.70‐10.5, P = .1). However, in the cohort of patients exhibiting RE, patients who stated “feeling bothered by RE” had lower satisfaction with overall sex life (OR: 0.23, 95% CI: 0.13‐0.38, P < .001). Bother by RE varied according to erectile function and did not impact overall satisfaction in men with superior erectile function. Conclusions RE is a very common event after HoLEP but in this retrospective analysis was not associated with overall satisfaction with sex life. Contrary, satisfaction with sex life is impaired in patients who feel bothered by RE. Proper patient selection will pose key to identify patients in which RE bother will offset the benefits of LUTS relief.

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“…The role of psychological distress from the diagnosis or presence of GCT may represent another risk factor for erectile dysfunction, as a study on 241 GCT survivors compared to 223 healthy controls have shown erectile dysfunction in 37.7% of patients before chemotherapy and persisting after treatment [ 24 ]. Orgasmic dysfunction may stem from several factors, including chemotherapy or radiotherapy-induced neuropathy, lower levels of testosterone or psychological issues, and possible use of selective serotonin reuptake inhibitors [ 25 – 28 ]. While retrograde ejaculation is the common adverse outcome of retroperitoneal lymph node dissection [ 29 , 30 ], the orgasmic sensation is usually retained.…”

Section: Discussionmentioning

confidence: 99%

Long-term sexual functioning in germ-cell tumor survivors

et al. 2020

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Background: Survivors of germ-cell tumors (GCT) may suffer from long-term adverse consequences. Our study was conducted to assess a long-term sexual functioning in GCT survivors. Methods: GCT survivors (N = 170) from the National Cancer Institute in Slovakia completed a Sexual Function Questionnaire that was modified from PROMIS Sexual Function and Satisfaction Questionnaire 9-year median follow up (range 5-32) as a primary exploratory aim. Study groups consisted of 17 survivors (10%) who had active surveillance (AS, controls), and 153 (90%) survivors who received treatment beyond orchiectomy (Tx), including cisplatin-based chemotherapy (CT, N = 132; 78%), radiotherapy to the retroperitoneal lymph nodes (RT, N = 12; 7%) or both (CTRT, N = 9; 5%). Results: In univariate analysis, treatment of any type resulted in difficulty to maintain erection during sexual intercourse compared to patients treated with AS (P = 0.04). Survivors who received CTRT had lower ability to achieve orgasm during sexual activities (P = 0.04) and they reported disappointment with their overall quality of sex life (P = 0.002). The number of attempts to initiate sexual intercourse did not differ. Sexual relationships caused none or mild anxiety and the desire to be sexually active was higher after CTRT (P = 0.05). Multivariable analysis confirmed that orgasmic dysfunction after ≥400 mg/m 2 of cisplatin and issues in maintaining erection after Tx were independent of retroperitoneal lymph-node dissection (P = 0.03 and P = 0.04, respectively). Survivors were disappointed with the quality of sex life and had stronger desire to be sexually active independent of age, (P = 0.01 and P = 0.05, respectively). Conclusions: This study identified an impairment in sexual function may represent an issue for long-term GCT survivors. Treatment with chemotherapy plus radiotherapy were associated with disappointment and stronger sexual desire, while a higher cumulative dose of cisplatin may be responsible for orgasmic dysfunction.

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Contemporary management of ejaculatory dysfunction

Cited by 37 publications

References 158 publications

Epidemiology of Male Sexual Dysfunction in Asian and European Regions: A Systematic Review

Epidemiology of Male Sexual Dysfunction in Asian and European Regions: A Systematic Review

Retrograde ejaculation after holmium laser enucleation of the prostate (HoLEP)—Impact on sexual function and evaluation of patient bother using validated questionnaires

Long-term sexual functioning in germ-cell tumor survivors

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