Prevalence of phimosis and foreskin sliding abnormalities in male adolescents and their correlation with later onset of first sexual intercourse.

INTRODUCTION AND OBJECTIVES: The aim of the study is to evaluate the prevalence of andrological abnormalities, such as phimosis and foreskin sliding abnormalities among male adolescents, and if these might interfere with sexuality, leading to a later onset of sexual experiences. MATERIAL AND METHODS: Between April and May 2015 a prevention campaign in andrology was conducted in an area surrounding Rome, Ostia and the Ladispoli area, among 15-19 year-old students. The screening consisted of a frontal lesson with the students in order to explain and raise the awareness of the most common andrological abnormalities and diseases. Among the routine anamnestic questions, three additional questions were submitted to 18-year-old boys: "Have you ever had sexual intercourse?", "How old were you when you had your first sexual intercourse?" and "Have you consulted a health professional about your genitals?" Finally a detailed clinical examination was performed and the outcome sent to the family and to the General Practitioner (GP). RESULTS: A total of 552 high school students were evaluated. Out of them 131 (23.7%) were at least 18 years old. Among these, 79 (60.3%) said that they had already had full sexual intercourse. The phimosis and foreskin sliding abnormalities had a prevalence of 12.9% within the 18-year-old students, with a significant prevalence among those who hadn't had any sexual intercourse at all, 21.1% vs 7.5% p = 0.023. The age of the complete first sexual experience in the circumcised young men was the same as those without phimosis; 89% of the boys with phimosis hadn't had an andrological examination in the previous years. CONCLUSIONS: Male adolescents with phimosis or preputial sliding abnormalities tend to have a late onset of sexual experiences compared to same aged boys without phimosis. These data support the urgent need of an andrological consultation for all boys at the beginning of, and during, their adolescent period because genital abnormalities may interfere with sexuality. Finally, in order not to confuse effects with causes, we suggest matching a routine genital physical examination in all studies dealing with sexual psychological aspects of male adolescents.

INSIST-ED: Italian Society of Andrology registry on penile prosthesis surgery. First data analysis.

OBJECTIVES: The Italian Society of Andrology, i.e. "Società Italiana di Andrologia" (S.I.A.), launched on December 2014 a prospective, multicenter, monitored and internal review board approved Registry for penile implants, the "INSIST-ED" (Italian Nationwide Systematic Inventarisation of Surgical Treatment for ED) Registry. Purpose of this first report is to present a baseline data analysis of the characteristics of penile implant surgery in Italy. MATERIAL AND METHODS: The INSIST-ED Registry is open to all surgeons implanting penile prostheses (all brands, all models) in Italy, providing anonymous patient, device, surgical procedure, outcome, follow-up data, for both first and revision surgeries. A Registry project Board overviews all the steps of the project, and a Registry Monitor interacts with the Registry implanting surgeons. RESULTS: As by April 8, 2016, 31 implanting surgeons actively joined the Registry, entering 367 surgical procedures in its database, that comprise: 310 first implants, 43 prosthesis substitutions, 14 device explants without substitution. Implanted devices account for: 288 three-component devices (81,3%), 20 two-component devices (5,4%), 45 non-hydraulic devices (12,3%). Leading primary ED etiologies in first implant surgeries resulted: former radical pelvic surgery in 111 cases (35,8%), Peyronie's disease in 66 cases (21,3%), diabetes in 39 cases (12,6%). Two intraoperative complications have been recorded. Main reasons for 57 revision surgeries were: device failure (52,6%), erosion (19,3%), infection (12,3%), patient dissatisfaction (10,5%). Surgical settings for patients undergoing a first penile implant were: public hospitals in 251 cases (81%), private environments in 59 cases (19%). CONCLUSIONS: The INSIST-ED Registry represents the first European experience of penile prosthesis Registry. This baseline data analysis shows that: three-pieces inflatable prosthesis is the most implanted device, leading etiology of erectile dysfunction (ED) in patient receiving a prosthesis is former radical pelvic surgery, primary reason for revision surgery is device failure, primary settings for first penile implant surgery are public hospitals. Evaluation of penile implant impact on recipients quality of life is presently ongoing.

Awareness and timing of pelvic floor muscle contraction, pelvic exercises and rehabilitation of pelvic floor in lifelong premature ejaculation: 5 years experience.

OBJECTIVES: To assess the cure rate of patients with premature ejaculation who underwent a treatment involving: 1) awareness of the pelvic floor muscles 2) learning the timing of execution and maintenance of contraction of the pelvic floor muscles during the sensation of the pre-orgasmic phase 3) pelvic floor rehabilitation (bio feed back, pelvic exercises and electrostimulation). MATERIALS AND METHODS: We recruited 78 patients with lifelong premature ejaculation who completed the training. The patients were informed of the role of the pelvic floor. They were taught to carry out the execution and maintenance of contraction of the pelvic floor muscles during the sensation of the pre-orgasmic phase to control the ejaculatory reflex. In order to improve the awareness, the tone and the endurance of the pelvic floor muscles, patients were treated with the rehabilitation of pelvic floor (RPF) consisting mainly in biofeedback, pelvic exercises and in some cases also in electro-stimulation (ES). The training was carried out for a period of about 2-6 months with an average of 2-5 visits per cycle. RESULTS: 54% of patients who completed the training were cured of premature ejaculation and learned over time to be able to postpone the ejaculation reflex. In a subgroup of 26 patients was also measured the IELT which on the average increased from < 2 minutes to >10 minutes. The best results occurred mainly in patients aged less than 35 where the cure rate was 65%. There were no side effects. CONCLUSIONS: In this study, approximately half of patients with premature ejaculation were cured after applying the above treatment.This therapy, necessitates a fairly long period of time (2-6 months) and a great commitment on the part of the patient, nevertheless it can be a valid and effective treatment for patients with premature ejaculation. This treatment makes the patient independent in that he is not bound to specific times for taking medication. Furthermore there are no side effects and this therapy is particularly effective in young males.

Awareness of the role of the pelvic floor muscles in controlling the ejaculatory reflex: preliminary results.

The difficulty in correctly identifying the etiologic factors of premature ejaculation (PE) could be due to the fact that the role of the pelvic floor muscles (PFMs) in the voluntary control of ejaculatory reflex has not been elucidated. The aim of the present investigation was to measure the prevalence of awareness of the role and use of PFM contraction in controlling the ejaculatory reflex among PE and non-PE participants. A total of 44 men with PE and 73 men without PE were recruited. In the first part of the study, we validated a test that rendered the participants aware of the PFMs through digital rectal examination and the PFM contraction. In the second part, we posed this multiple-choice question: "Which muscles do you use to delay ejaculation?". Men not answering correctly were considered not to be using the PFMs and also to be unaware that it is necessary to contract the PFMs to control the ejaculatory reflex. Only 3 of 44 subjects (6.8%) with PE and 60 of 73 subjects (82%) without PE answered correctly and used PFMs to control the ejaculatory reflex (Fisher test p < 0.0001). This test has a sensibility of 93%, a specificity of 82%, and an accuracy of 86%. The vast majority of PE subjects were unaware that to inhibit or delay ejaculation it is necessary to contract the PFMs. This association also raises the question whether the difficulties in defining PE and finding effective PE therapies could be due to a nonhomogeneous population of PE patients with different etiopathogenetic factors. More studies are required to confirm these data and to answer this question.

The distribution of the clinical variables in a population of adult males circumcised for phimosis: A contribution to the clinical classification of phimosis.

BACKGROUND: The literature regarding the quality of the sex life in adult males after circumcision, due to phimosis, is scarce and sometimes contrasting. This could be due to comparisons of a nonhomogeneous distribution of the clinical variables of men who have undergone circumcision. OBJECTIVE: The objective of this study was to evaluate the distribution of the clinical variables in the adult male population who had circumcision for phimosis, and to propose a clinical classification of the phimosis to characterize it in adult males in more homogeneous sub-groups for the common clinical variables. MATERIALS: A population of 244 adult male patients with phimosis was evaluated retrospectively. The mean age was 50.7 years. Each patient was classified according to the most common clinical variables. The variables that make up this classification of the phimosis were: Position (P1-2) to indicate if phimosis is present when the penis is at rest (P2) or only during an erection (P1); Grade (G 0-4) in relation to the extent of glans visibility; Complexity (Co 0-4) of comorbidities; Timespan (T 1-10) of the phimosis. RESULTS: The distribution of the variables was the following: Position P1:30.73%, P2:69.26%; Grade G0:30.73%, G1:23.77%, G2:27.45%, G3:12.29%, G4:5.73%; Complexity (associated penile comorbidities): C0:48.36%, C1:4.5%, C2:0.8%, C3:43.03%, C4:3.27% Timespan: 57.78% of the patients had phimosis for less than a year; 18.03% between 1 and 2 years; 11.88% between 2 and 10 years; and 12.29% for more than 10 years. CONCLUSIONS: The distribution of the clinical variables in the adult male population who underwent circumcision due to phimosis was not homogeneous regarding the appearance, severity, comorbidity, and timespan. This non-homogeneity could explain, in some cases, the contrasting results regarding the quality of sex life after circumcision in the literature. The proposed classification can offer an objective tool for researchers and clinicians group the patients into more homogeneous subgroups.

Sexual education and temporary total androgen blockade in the fight against heroin addiction: a new hypothesis.

Various theories have been advanced to account for heroin addiction. One of the causes, upon which little attention has, so far, been focused, concerns the relationship with testosterone and with sexual distress. In the present report, a new strategy in the fight against heroin use is proposed which is based upon the assumption that testosterone, or its metabolites, would exert on drug seeking behaviours and drug taking behaviours through a direct effect upon the rewarding circuit or indirectly eliciting the drug craving and by leading some youths with sexual distress to seek improvement in their sexual performance with the use of drugs. The new strategy proposed here is based upon sexual and affectivity education in adolescents to prevent First Drug Use and for those already addicted, upon sexual and affectivity education and temporary total androgen blockade with pharmaceutical agents that, in a reversible fashion, block both the production and the effect of testosterone and their metabolites until complete disintoxication of drug use is reached.

The role of sexual dysfunctions in inducing the use of drug in young males.

INTRODUCTION: Adolescence is one of the periods in which the risk of the initial use of drugs is high. Among the risk factors of first drug use, sexual disorders have been considered one of the possible reasons leading young males to substance abuse and addiction. AIM: To provide data supporting the "La Pera hypothesis", according to which, a very large percentage of young males begin to use drugs due to sexual problems. METHODS: A total of 86 subjects, recruited from 5 drug rehabilitation centers were invited to fill in a questionnaire with their personal data, toxicological history, sexual experiences as well as quality of performances. RESULTS: Approximately 50% of the entire sample used psychotropic drugs to improve their sexual performance with 30 subjects (34.1%) stating that their sexual disorder had influenced their decision to start taking drugs. Of these 30 subjects, 18 (60%) stated their sexual problem had influenced them a little, while in 8 (26.7%), it had influenced them a lot and in 4 (13.3%) it had been a decisive factor. The prevalence of sexual dysfunction prior to first drug use was greater among subjects whose sexual problems influenced their initial use of drugs compared to the remainder of the sample, the difference being statistically significant. CONCLUSIONS: These data are in accordance with the "La Pera hypothesis" based on the cause/effect relationship between sexual dysfunctions and initial use of drugs. It is urgent to demonstrate that sexual disorders lead to first drug use since sex education and early treatment of sexual dysfunctions could provide an effective tool for the primary prevention of substance abuse in young males.

Sexual dysfunction prior to first drug use among former drug addicts and its possible causal meaning on drug addiction: preliminary results.

INTRODUCTION: Adolescence is one of the periods in which the risk of initial use of drugs is high. Among the reasons leading to first drug use (FDU), sexual disorders have so far been poorly investigated. AIM: To evaluate the prevalence of premature ejaculation, erectile dysfunction, and low sexual desire in former drug addicts in the period prior to FDU; whether or not the former drug addicts claimed that sexual dysfunctions influenced their decision to start illicit drug taking, and whether or not the subjects had sought and used drugs aiming to improve sexual drive. METHODS: Eighty-six male former drug addicts (18-35 years old) were investigated using a questionnaire. MAIN OUTCOME MEASURES: Fisher and Armitage tests. RESULTS: Before FDU, 61 (71%) subjects reported having one or more sexual dysfunctions. Only 25 (29%) had no sexual dysfunction prior to FDU. Among those with normal sexual function, only three (3.49%) stated that sexual dysfunctions had influenced their decision, whereas in the sexual dysfunction group, 27 (31.4%) confirmed this experience. This difference is statistically significant, Fisher test, P = 0.0033. The more severe the sexual dysfunction, the higher the percentage of those who stated that sexual dysfunction influenced their decision to start taking drugs. This trend is statistically significant, P < 0.0025. About 50% of the entire sample admitted they had used drugs to improve sexual performance. CONCLUSIONS: Users of illicit drugs report a high prevalence of sexual disorders prior to FDU. A large percentage claimed that sexual dysfunction influenced their decision to start taking drugs. The higher the severity of the sexual disorders, the higher the percentage of those claiming that sexual dysfunction had influenced their decision. In our opinion, these data highlight a possible new strategy in the primary prevention of substance abuse in which sexual education and early treatment of sexual disorders, among adolescents, may prevent them from FDU.

Premature ejaculation: results from a five-country European observational study.

OBJECTIVES: To characterize premature ejaculation (PE) in five European countries using intravaginal ejaculatory latency time (IELT) and the Premature Ejaculation Profile (PEP). METHODS: This 8-wk, multicenter, observational study enrolled men >or=18 yr of age and their female partners. Clinicians diagnosed PE using the DSM-IV-TR criteria and at least moderate, subject-reported, ejaculation-related personal distress or interpersonal difficulty. The PEP was administered at baseline and weeks 4 and 8. Partners measured IELT; the average stopwatch-measured IELT for each 4-wk period was calculated and compared with the man's screening-estimated IELT. Relationships between individual PEP measures and IELT were assessed with path analysis. RESULTS: PE was diagnosed in 201 of 1115 men. Findings were similar to those in a similarly conducted US study. Mean IELT was lower in the PE versus the non-PE group (3.3 vs. 10.0min, respectively), but substantial overlap was observed. Men with PE and their partners reported significantly worse control over ejaculation, ejaculation-related personal distress, satisfaction with sexual intercourse, and ejaculation-related interpersonal difficulty than men without PE and their partners. Path analysis showed that perceived control over ejaculation had a significant effect on ejaculation-related personal distress and satisfaction with sexual intercourse; IELT had an effect on control over ejaculation, no direct effect on satisfaction with sexual intercourse, and a small direct effect on ejaculation-related personal distress. CONCLUSIONS: No major cultural differences existed between EU and US men with and without PE and their female partners. These results emphasize the importance of the PEP measures, especially perceived control over ejaculation, in characterizing PE.

Post-traumatic high flow priapism percutaneously treated with transcatheter embolisation.

PURPOSE: The aim of this paper is to present our experience in the percutaneous management of high-flow priapism with transcatheter embolisation and gelfoam. MATERIALS AND METHODS: We present three clinical cases in which an acute trauma caused the development of high-flow priapism. After differing initial management, all cases underwent arteriography, followed by demonstration of the arterial-lacunar fistula and embolisation with gelfoam. RESULTS: Near immediate detumescence after the procedure confirmed the success of embolisation, which was supported by clinical and instrumental follow-up. DISCUSSION: In high-flow priapism, the best therapeutic solution remains transcatheter arterial embolisation, with ultra-selective catheterisation by microcatheter and embolisation of the pudendal artery only, which is responsible for the post-traumatic arterial-lacunar fistula. This manoeuvre is not always technically easy, and requires experience and remarkable dexterity. Technical failure is always possible owing to the spasm of a peripheral arteriole that cannot be resolved with papaverine, and to the possible rehabilitation by the downstream contralateral circulation. Furthermore, the apprehension of the operator carrying out the procedure in this anatomical context may make the immediate result seem satisfactory, even if it is not optimal. All these considerations stress the need for a rigorous clinical and instrumental follow-up to guide later diagnostic and therapeutic choices.

Prevalence of sexual disorders in those young males who later become drug abusers.

The purpose of this study was to learn about the frequency of sexual disorders in young males who later become substance abusers. We interviewed 228 men treated in 10 drug centers for substance abuse. The questionnaire that we used was designed to assess the onset of erectile dysfunction (ED) or of premature ejaculation (PE). Only those subjects who became substance users between the ages of 17 to 29 were taken into consideration. Of the 228 subjects recruited, only 130 met the inclusion criteria (mean age 33). These male patients had a prevalence of ED of 20.3% (cl 99% 12.3-31.2), whereas the prevalence of ED of age-matched males in the general population is 2.1% (cl 99% 0.36-5.46; p < 0.000001). The prevalence of PE in the sample prior to drug use was 37.5%. Sexual desire was in the normal range in nearly all subjects. The prevalence of ED in the men of our sample is higher than in age-matched individuals of the general population. These data suggest a new hypothesis: sexual disorders or the conviction that one has a sexual problem is a possible risk factor among men for drug abuse and addiction.