Ejaculatory disorder

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse. The definition is very subjective due to differences in desired or needed rigidity in patients of different ages and in different types of relationships. Patients may refer to their dysfunction as impotence, but the National Institutes of Health Consensus Development Conference recommends that the term erectile dysfunction replace the term impotence due to confusion with other forms of sexual dysfunction and the negative connotation associated with the term impotence.1 Patients may also develop libido or ejaculatory disorders, but these are not considered erectile dysfunction. 

Unlabeled Uses Treatment of bulimia nervosa, cataplexy associated with narcolepsy, depression, neurogenic pain, panic disorder, ejaculatory disorders, pervasive developmental disorder... 

The benefit of combining an alpha-adrenoceptor antagonist with a 5-alpha-reductase inhibitor has been assessed in men with benign prostatic hyperplasia (23). Modified-release alfuzosin was more effective than finasteride, with no additional benefit in combining the drugs. The adverse effects of alpha-blockade were postural hypotension, hypotension, headache, dizziness, and malaise the adverse effects of finasteride were ejaculatory disorders and impotence. 

Erectile dysfunction must be distinguished from disorders of libido, ejaculatory disorders, or infertility, which are caused by different pathophysiologic mechanisms and are treated with alternative agents (Table 81-1). A patient may suffer from one or more disorders of sexual dysfunction. For example, an elderly man with primary hypogonadism may suffer from decreased libido and erectile dysfunction. Diagnosis of the type of sexual disorder that a patient has is a key to initiating the most appropriate treatment. 

Rosen R, O Leary M, Altwein J, et al. Ejaculatory disorders are frequent and bofiiersome in aging males wifii LUTS A worldwide survey (MS AM-7). J Urol 2003 169(Suppl 1) 365 (abstract). 

Kamischke A, Nieschlag E. Update on medical treatment of ejaculatory disorders. Int j Androl 2002 25 333-344. 

Nausea, dry mouth, postural hypotension, sweating, somnolence, dizziness, insomnia, tremor, ejaculatory disorders... 

Sexual function While ejaculatory disorders have been attributed to a-adrenoceptor antagonists it is less clear whether they affect semen. In a randomized, doubleblind, placebo-controlled 3-way crossover study of sperm in 48 healthy men after exposure to tamsulosin, alfuzosin, and placebo for 5 days each tamsulosin was associated with negative effects on ejaculate volume, sperm concentration, total sperm count, semen viscosity, and sperm motility compared with placebo alfuzosin was comparable to placebo [115 ]. Post-ejaculate urine sperm concentrations were comparatively normal between all agents, suggesting that retrograde ejaculation is not responsible for the ejaculatory dysfunction. There was complete absence of ejaculation in 17 of the 48 men (35%) during treatment with tamsulosin compared with none in the other groups. 

Amano T, Imao T, Takemae K, Yamauchi K. Ejaculatory disorder caused by doxazosin administration for blood pressure control in patient with pheochromo-cytoma. Hinyokika Kiyo 2009 55(6) 377-80. 

Assess the patient s specific symptoms to determine the type of dysfunction. Does the patient have ED or an ejaculatory or libido disorder ... 

Sexual function in men can be compromised by cisplatin + vinblastine + bleomycin chemotherapy. Of 54 patients, 29 had disorders of sexual function 2 years after completion of treatment (234). Ejaculatory dysfunction was tentatively linked to chemotherapy in 30% of those affected. There was reduced libido, usually reversible, in 40 at the time of chemotherapy. 

The effects of all-trara-retinoic acid on the male reproductive system include gynecomastia, discomfort, potency disorders, reduced fertility, and ejaculatory failure (61). The incidence is reported to be very high, but exact figures do not seem to be available. 

The adverse events profile for escitalopram is similar to that observed with Ri-citalopram in both major depression and anxiety disorders. Discontinuation rates due to adverse events were similar in patients receiving escitalopram or placebo in several trials. Nausea and ejaculatory problems were reported in both fully published trials in patients with major depression. In addition, diarrhea, insomnia, dry mouth, headache, and upper respiratory tract infections were experienced by patients receiving escitalopram, although the incidence of these events was not significantly higher than in patients receiving placebo. The recommended dose of escitalopram for the treatment of major depression is 10 mg/day, which, depending on the individual patient response, may be titrated up to 20 mg/day. 

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