Topical Agents for Premature Ejaculation: A Review.

INTRODUCTION: Premature ejaculation (PE) is among the most common sexual dysfunctions that affect men. Currently, topical medications are considered a first-line treatment option for PE, with no specific medication having market approval in the United States specifically for the treatment of PE. Topical agents for PE include eutectic mixture of local anesthetics cream, topical eutectic mixture for premature ejaculation spray, severance secret-cream, resiniferatoxin, and an assortment of over-the-counter treatments, including medicated condoms, sprays, and wipes. AIM: Given the paucity of controlled studies for these treatment modalities, the goal of this article is to review the currently available options for PE to help educate providers in appropriate treatment options. METHODS: Comprehensive review of published literature, as well as clinical experience were evaluated to determine efficacy of known treatments for PE. MAIN OUTCOME MEASURE: The topical treatment options and efficacy of these options for PE were reviewed. Eutectic mixture of local anesthetics, topical eutectic mixture for premature ejaculation, severance secret-cream, resiniferatoxin, and medicated condoms are the mainstay of treatment. Each has certain risks and benefits associated with use as described, as well as relative cost of use. RESULTS: Although data supporting the effectiveness of topical agents for PE is limited, prior clinical trials demonstrate increases in timed intravaginal ejaculatory latency time and improved patient-partner sexual satisfaction survey scores on some treatment options. CONCLUSION: More research is needed to evaluate efficacy, cost-effectiveness, potential side effects, and benefits of combined medical and psychological intervention for better ejaculatory control. Butcher MJ, Zubert T, Christiansen K, et al. Topical Agents for Premature Ejaculation: A Review. Sex Med Rev 2020;8:92-99.

A Review of the FAERS Data on 5-Alpha Reductase Inhibitors: Implications for Postfinasteride Syndrome.

OBJECTIVE: To quantify reports made to the Food and Drug Administration Adverse Event Reporting System (FAERS), create a demographic of patient reports, and examine the cluster of symptoms to correlate consistency of postfinasteride syndrome (PFS) complaints. PFS is a provisional diagnosis encompassing a cluster of sexual, physical, and psychological and/or neurologic symptoms associated with 5-alpha reductase inhibitor use that emerge or continue after discontinuation of medication. MATERIALS AND METHODS: FAERS dataset of 5-alpha reductase inhibitors from April 2011 to October 2014 was obtained. Each FAERS report had 16 categories for completion, but not every report was fully completed. Statistical analysis compared variables of interest between the 2 doses of finasteride (1 mg vs 5 mg). RESULTS: From FAERS, 2048 monotherapy cases were identified: 1581 of finasteride 1 mg, 240 of finasteride 5 mg, and 226 of unreported doses. Possibly related to labeling changes, from 2011 to 2014, there was a significant increase in adverse events (AEs) reported involving 1 mg dosing. Finasteride use was reported with many sexual AEs including diminished libido, erectile dysfunction, and ejaculatory complaints. Other common AEs included dermatologic, metabolic, and psychological and/or neurologic complaints. There were more AE reports with the 1 mg dose than the 5 mg dose. One case of dutasteride reported back pain, not generally attributed to PFS. CONCLUSION: FAERS data suggests that finasteride exposure is reported with a diverse collection of symptoms, particularly in younger men on 1 mg dosage compared to older men on 5 mg. Many of these complaints fall well out of the realm of previously established AEs from long-term controlled studies.

A Review of Pathophysiology and Management Options for Delayed Ejaculation.

INTRODUCTION: Delayed ejaculation (DE) is a poorly defined disorder that entails the delay or absence of orgasm that results in personal distress. Numerous causes of DE exist, and management must be tailored to the specific etiology to maximize treatment success. Management strategies include psychological and sexual therapy, pharmacotherapy, and penile vibratory stimulation. AIM: This article intends to review the pathophysiology and treatment options for DE discussed in the literature to date. METHODS: A review of the literature was performed to identify and evaluate the existing data on treatment success for the various forms of DE management. MAIN OUTCOME MEASURES: Each treatment option was evaluated for method of administration, data supporting its success for DE, and potential risks or side effects. RESULTS: Different psychosexual therapy strategies have been described for DE but with limited data to describe efficacy. There is no medication for DE approved by the United States Food and Drug Administration. The quality of evidence supporting the off-label use of medications for DE is low. However, there are numerous medications reported in the literature suggested to treat the condition. Cabergoline and bupropion are the two most commonly used. In addition, penile vibratory stimulation has been described as an adjunct treatment option for DE. CONCLUSION: There are different treatment options reported for DE, all with limited evidence supporting their efficacy. Identifying the etiology of the DE is important to appropriately target therapy. A multimodal approach combining psychosexual therapy with medications and/or penile vibratory stimulation will likely provide the best outcomes.

Use of Sperm Parameters to Predict Clinical Pregnancy with Intrauterine Insemination.

OBJECTIVE: To test the hypothesis that morphology is the best predictor of clinical pregnancy (CP) when employing intrauterine insemination (IUI). STUDY DESIGN: We retrospectively reviewed a registry of 527 couples who collectively underwent 1,027 IUI cycles, testing sperm parameters and other variables with univariate and multivariate analyses for association with CP. With the literature scant regarding the impact of sperm morphology on IUI outcome, we determined semen parameter threshold values in our patient population and compared them to published reference range values. A logistic regression model was used to determine predictors of CP. RESULTS: Fecundity was 12.9% per cycle and fertility was 23.3% by the third attempted cycle. Morphology was the most significant parameter predicting CP with IUI. Motility was also significant when employing our new threshold values. Using receiver operator characteristic curve analysis, values 16% morphology and 69% motility were found to be the optimal threshold values for achieving CP. CONCLUSION: Morphology was the best predictor of CP. When considering IUI, the best chance of clinical pregnancy occurs when both motility and morphology values are above normal thresholds.

Counseling on sexual side effects from TURP.

INTRODUCTION: We designed a pilot study to measure preoperative sexual dysfunction risk counseling between sexual medicine experts (SME) and general urologists between monopolar/bipolar transuretheral resection of the prostate (TURP) and laser TURP (LT). MATERIALS AND METHODS: An emailed electronic survey was distributed to members of the North Central Section (NCS) of the American Urologic Association and the Sexual Medicine Society of North America (SMSNA). Overall, 260 (12.3%) completed the survey. Counseling for ejaculatory disorder (EjD), erectile dysfunction (ED), stricture formation and incontinence was assessed. Additional subset analysis between those SME's versus general urologist was done. RESULTS: Overall, 82% (224) identified as general urologists and 18% (49) as SME. Two-thirds were in private practice versus academic. Over 90% of all practitioners 'almost always' counsel about the possibility of EjD, with varied risk rate for LT. Overall, 62%(140) for monopolar TURP (MBT) and 60% (110) for LT 'almost always' counsel about ED. There was no statistical difference between groups counseling on incontinence, strictures, EjD or ED between SME and general urologists. CONCLUSIONS: Sexual side effects of treatment for LUTS/BPH are appreciated by urologists. Most practitioners counsel about EjD, however the incidence varies between MBT and LT. Practitioners counsel their patients on ED less often than EjD. Counseling rates are not improved with those specializing in sexual medicine independent of TURP technique.

Testosterone Replacement Therapy on the Natural History of Prostate Disease.

The physiology of testosterone production and action are closely related to prostatic disease. An understanding of the natural history of testosterone and prostate growth and development is needed in order to understand this complex relationship. Lower urinary tract symptoms (LUTS), benign prostatic hyperplasia (BPH), prostate cancer, and sexual function are common disorders for which testosterone is thought to play a role. Proposed in this review are some theories as to how testosterone interacts to potentially ameliorate these conditions. Further research is needed, but we feel our proposed points are valid given the review of the literature.