Tramadol Abuse and Sexual Function.

INTRODUCTION: Tramadol exhibits an effect profile similar to that of opioid agonists, and tramadol abuse seems to be a problem for a number of countries. The relationship between tramadol and sexual function appears to be controversial. Men with premature ejaculation (PE) may benefit from taking tramadol off label; however, these patients live "on a knife's edge" and are exquisitely sensitive to develop other sexual dysfunctions. AIM: To review the literature regarding the problem of tramadol abuse and its relationship with sexual function. METHODS: We searched electronic databases from 1977 to September 2015, including PubMed MEDLINE, EMBASE, EBCSO Academic Search Complete, Cochrane Systematic Reviews Database, and GoogleScholar using the following key words: tramadol, sexual functions, and sexual dysfunction. MAIN OUTCOME MEASURE: To define the supposed benefits and the potential risks of tramadol on different sexual functions including ejaculation, orgasm, erection, desire, and testosterone levels. RESULTS: Although tramadol is thought to have low abuse and dependence potentials worldwide, its abuse has become a serious problem in many countries, particularly in the Middle East, Africa, and West Asia. The benefit of tramadol in PE was reported in 11 clinical trials, evaluated by 6 systematic reviews, 3 of which pooled data in a meta-analysis. The evidence base on erectile dysfunction, decreased libido, hypogonadism, anorgasmia, and risky sexual behaviors in patients abusing tramadol is inadequate. CONCLUSIONS: Tramadol may offer a useful intervention for treating PE. As all primary studies had suffered from selection, allocation, performance, or assessment bias, additional rigorous well-designed controlled trials are warranted to further investigate the potential long-term risks of tramadol and to determine the safe and the effective minimum daily dose. Clinical research on drug abuse and sexual dysfunction is an emerging field. To date, small numbers of studies have been performed and further studies are warranted.

Effects of female genital cutting on the sexual function of Egyptian women. A cross-sectional study.

INTRODUCTION: The existing literature is conflicting regarding effects of female genital cutting (FGC) on sexual functions. Several studies from Africa over the past 20 years have challenged the negative effect of genital cutting on sexual function as defined by performance on the following domains: desire, arousal, lubrication, orgasm, satisfaction, and sexual pain. Other studies however indicated that sexual function of genitally cut women is adversely altered. AIM: The aim of the study was to investigate the effects of FGC on the female sexual function of Egyptian women. METHODS: This is a cross-sectional study conducted between February and May 2011 at the outpatient clinic of Cairo University Hospitals. The study included 650 Egyptian females between 16 and 55 years of age (333 genitally cut women and 317 uncut women). Participants were requested to complete the Arabic Female Sexual Function Index (ArFSFI) and were then subjected to clinical examination where the cutting status was confirmed. MAIN OUTCOME MEASURES: The total score of the ArFSFI and its individual domains. RESULTS: The mean age of cutting was 8.59 (±1.07) years. Of the cut participants, 84.98% showed signs of type I genital cutting, while 15.02% showed signs of type II genital cutting. After adjusting for age, residential area, and education level, uncut participants had significantly higher ArFSFI total score (23.99±2.21) compared with cut participants (26.81±2.26). The desire, arousal, lubrication, orgasm, and satisfaction domains were significantly higher in the uncut participants (4.02±0.78, 4.86±0.72, 4.86±0.75, 4.86±0.68, 5.04±0.71, respectively) compared with those of the cut participants (3.37±0.89, 4.13±0.71, 4.16±0.84, 4.50±0.79, 4.69±0.92, respectively). No significant difference between the two groups was found regarding the sexual pain domain. CONCLUSION: In Egyptian women, FGC is associated with reduced scores of ArFSFI on all domain scores except the sexual pain domain.

Arabic translation of Female Sexual Function Index and validation in an Egyptian population.

INTRODUCTION: Female sexual dysfunction (FSD) is a prevalent health problem that has been inadequately investigated in the Arab world. An Arabic assessment instrument for FSD is urgently needed. AIM: To validate the Arabic version of the Female Sexual Function Index (ArFSFI). METHODS: This is a cross-sectional study conducted between January and April 2010. Eight hundred and fifty-five women (16-60 years old) participated in the study. Validation was carried out on aspects of face, content, discriminant, and criterion (concurrent) validity. Construct validity was evaluated using principal component analysis. Reliability studies on test-retest and on internal consistency were conducted with Pearson correlation and Cronbach's alpha, respectively. The best cutoff point for the ArFSFI to differentiate cases and noncases was determined using a receiver operating characteristic (ROC) curve. MAIN OUTCOME MEASURE: Parameters of validity and reliability of the ArFSFI and its domains. RESULTS: ArFSFI total score and scores of various domains showed high test-retest reliability (r from 0.92 to 0.98). ArFSFI domains showed high internal consistency (α from 0.85 to 0.94). Six hundred and forty-four women (75.32%) met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for diagnosis of sexual dysfunction while 211 women (24.68%) showed normal function. The ArFSFI was found to have good discriminant validity. There were significant differences between the mean scores of women with sexual dysfunction and those of women without sexual dysfunction. A total score of 28.1 was taken as the cutoff point for the ArFSFI to distinguish between women with FSD and women with normal function (sensitivity 96.7%, specificity 93.2%). The ArFSFI showed an excellent overall performance (area under the curve [AUC] = 0.985, 95% confidence interval 0.978-0.992). CONCLUSION: The ArFSFI is a validated, reliable, and locally accepted tool for use in the assessment of FSD in the Egyptian population.

Peyronie's disease: perspectives on therapeutic targets.

INTRODUCTION: Peyronie's disease (PD) is an acquired benign connective tissue disorder of the penis, characterized by the development of fibrotic plaques, that can cause different degrees of bending, narrowing or shortening. Medical treatment for PD remains a major challenge. Impressive progress in our understanding of the molecular mechanisms of PD pathogenesis has uncovered several promising molecular targets for antifibrotic treatments. AREAS COVERED: This review covers the literature pertaining to the exploration of therapeutic targets for PD. The search included: i) a MEDLINE search from 1941 to January 2011, limited to English-language medical literature, ii) relevant abstracts from 2009 and 2010, iii) relevant textbooks and iv) a pipeline search for therapeutics in development. EXPERT OPINION: Rapid translational research depends on our ability to develop rational therapies targeted to penile tunical fibrosis, which necessitate a sound knowledge of the biology, biochemistry and the physiological role of fibroblasts, myofibroblasts and stem cells in PD. Much remains to be learned about the pathogenesis of PD. Although there are many interesting therapeutic targets, we are confronted with some questions when identifying new targets, or when validating potential therapeutic options.

Cardiovascular aspects of sexual medicine.

INTRODUCTION: Erectile dysfunction (ED) is common and considered to be predominantly of vascular origin. AIM: To evaluate the link between ED and coronary artery disease (CAD) and provide a consensus report regarding evaluation and management. METHODS: A committee of eight experts from six countries was convened to review the worldwide literature concerning ED and CAD and provide a guideline for management. MAIN OUTCOME MEASURE: Expert opinion was based on grading the evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS: ED and CAD frequently coexist. Between 50-70% of men with CAD have ED. ED can arise before CAD is symptomatic with a time window of 3-5 years. ED and CAD share the same risk factors, and endothelial dysfunction is the common denominator. Treating ED in cardiac patients is safe, provided that their risks are properly evaluated. CONCLUSION: ED is a marker for silent CAD that needs to be excluded. Men with CAD frequently have ED that can be treated safely following guidelines.

Chronic lead exposure may be associated with erectile dysfunction.

INTRODUCTION: Heavy metals constitute significant potential threats to human health in both occupational and environmental settings. Research examining the etiology of lead toxicity-induced hypertension reveals that the free radical production and lowering of inherent antioxidant reserves resulting from lead toxicity are directly related to vasoconstriction underlying lead-induced hypertension. A similar mechanism would affect smooth muscle relaxation in the cavernous tissue leading to erectile dysfunction (ED). AIM: Is to study the possible hazardous effect of chronic lead exposure on the erectile function, and to document the deposition of lead in the cavernous tissue. METHODS: The study group consisted of 34 men with ED, consecutively scheduled for penile implant insertion at Cairo University Hospital, as well as 15 controls. We determined the blood lead level for the two groups by the use of atomic absorption spectrophotometry. Sixteen of the 34 patients, and none of the 15 controls, had elevated lead serum levels (above 25 [g/dL]). MAIN OUTCOME MEASURES: We estimated the levels of two reactive oxygen species (ROS) and four antioxidants in peripheral blood for the two groups. At the time of penile implant insertion, we prepared cavernous tissue paraffin sections stained with Mallory-Parker stain to study lead deposition. We also prepared ultrathin sections for electron microscopy. We estimated cavernous tissue lead level. RESULTS: The ED group had significantly higher blood lead level when compared with the control group. A significant positive correlation was found between the blood lead level and cavernous tissue lead level of the ED group. Individuals with high blood lead had significantly higher levels of serum ROS and significantly lower levels of serum antioxidants, compared with those having low blood lead. Histological sections from patients with high blood lead showed deposition of grayish lead granules in the cavernous tissue. CONCLUSIONS: Chronic lead exposure may be associated with ED.

Reactive oxygen species and antioxidants relationship in the internal spermatic vein blood of infertile men with varicocele.

AIM: To assess the relation of reactive oxygen species (ROS) and antioxidants in the internal spermatic vein blood compared to the peripheral venous blood. METHODS: Sixty-eight infertile oligoasthenozoospemic patients associated with varicocele were investigated. During inguinal varicocelectomy, blood samples of internal spermatic as well as median cubital veins were withdrawn. Three ROS factors (malondialdehyde [MDA], hydrogen peroxide H(2)O(2), nitric oxide [NO]) and four antioxidants (superoxide dismutase [SOD], catalase [Cat], glutathione peroxidase [GPx] and vitamin C) were estimated in these blood samples. RESULTS: Mean levels of tested ROS factors were significantly higher in the internal spermatic venous blood compared to those in the peripheral one (mean+/-SD) (MDA 18.7+/-1.4 nmol/mL vs. 15.4+/-1.4 nmol/mL, H(2)O(2) 43.6+/-8.0 micromol/mL vs. 30.8+/-8.1 micromol/mL, NO 2.3+/-0.5 nmol/L vs. 1.6+/-0.4 nmol/L, P<0.01). Mean levels of tested antioxidants were significantly lower in the internal spermatic venous blood compared to those in the peripheral one (superoxide dismutase 1 690.7+/-130.0 U/mL vs. 1 818.5+/-143.0 U/mL, catalase 38.9+/-6.1 mol/L vs. 47.9+/-10.2 mol/L, GPx 20.4+/-8.1 U/mL vs. 23.0+/-8.4 U/mL, vitamin C 0.3+/-0.1 vs. 0.4+/-0.1 mg/dL, P<0.05). CONCLUSION: Internal spermatic venous blood of infertile male cases associated with varicocele demonstrated elevated levels of ROS and decreased levels of antioxidants compared to peripheral venous circulation.