Sexual ejaculatory

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. 

Khat produces effects similar to those of other monoamine stimulants, (i.e., increases in mental stimulation, physical endurance, elevated mood) (Widler etal. 1994 Kalix 1994 Brenneisen etal. 1990). Stimulus generalization occurs between cathinone, amphetamine, and cocaine, suggesting similar subjective effects (Huang and Wilson 1986). Similar to other monoamine stimulants, cathinone causes dose-dependent reductions in eating and body weight (Islam et al. 1990 Zelger and Carlini 1980). Oral cathinone increases sexual arousal in rats, but does not affect erectile or ejaculatory responses (Taha et al. 1995). 

Sexual dysfuntion Sexual dysfuntion was markedly increased in male patients with OCD taking clomipramine (42% ejaculatory failure, 20% impotence) compared to placebo. Sexual dysfunction also occurs with other TCAs. 

Somnolence, fatigue, dry mouth, blurred vision, constipation, sexual dysfunction (42%), ejaculatory failure (20%), impotence, weight gain (18%), delayed micturition, orthostatic hypotension, diaphoresis, impaired concentration, increased appetite, urine retention Occasional... 

Sexual Anorgasmia, ejaculatory dysfunction, impotence, priapism, reduced libido Dopamine 2 Consider sexual dysfunction if poor compliance... 

In addition to the sexual side effects that can occur as a direct result of hyperprolactinemia, other sexual side effects may occur as well. These include ejaculatory difficulties, impotence, anorgastnia, priapism, and reduced libido (Hansen et ah, 1997 Arana, 2000). 

An advantage of age is that ejaculatory control is far better among older men. Because arousal is slower, the older man is likely to engage in more foreplay. During penetration, older men are liberated from the ejaculatory urgency of youth. And they have had time to overcome sexual inhibitions and have gained skill in lovemaking. 

Anabolic steroids, antidepressants and drugs of abuse affect libido, potency, and ejaculatory function. Anabolic steroids are derivatives of testosterone, and have strong genitotropic effects. There is published evidence indicating that anabolic steroids increases sexual desire however, the frequency of erectile dysfunction is also increased. Treatment with the antidepressant fluoxetine has been associated with sexual side effects including delayed or nonexistent ejaculation and hyposexuality. Mice treated in utero with the anideukemic agent 5-aza-2/-deoxycytidine exhibit abnormal reproductive behavior and low reproductive capacity. 

Blanker MH, Bosch JL, Groeneveld FP et al. Erectile and ejaculatory dysfunction in a community-based sample of men 50-78 years old prevalence, concerns and relation to sexual activity, Urology 2001 57 763-768,... 

Sexual disturbance has also been associated with sertraline (14), and a high frequency of such adverse effects has been reported in studies in which high doses were used. In a double-blind, placebo-controlled study of sertraline and amitriptyline in patients with major depression, male sexual dysfunction, mainly ejaculatory disturbance, was reported significantly more often with sertraline (in 21% of the patients) (15). Male sexual dysfunction in 15% of sertraline-treated patients has also been reported (16). 

Neuroleptic drug-induced sexual dysfunction, including erectile and ejaculatory dysfunction and changes in libido and the quality of orgasm, appear to be reversible on withdrawal. 

The frequency and course of sexual disturbances associated with clozapine have been studied in a prospective open study in 75 men and 25 women, mean age 29 years, and compared with the effects of haloperidol in 41 men and 12 women, mean age 26 years (200). There were no statistically significant differences between the patients taking haloperidol and those taking clozapine. During 1-6 weeks of treatment with clozapine, the most frequent sexual disturbances among women were diminished sexual desire (28%) and amenorrhea (12%), while among men they were diminished sexual desire (57%), erectile dysfunction (24%), orgasmic dysfunction (23%), ejaculatory dysfunction (21%), and increased sexual desire (15%). The mean daily doses were haloperidol 16 mg and clozapine 261 mg. 

A 37-year-old man with paranoid schizophrenia had ejaculatory difficulty during sexual intercourse with his wife, compatible with retrograde ejaculation, 1-2 weeks after starting to take risperidone (201). He reported complete failure to emit semen but a normal desire, erection, and sense of orgasm. Semen was seen in postcoital urine. The dosage of risperidone was reduced to 3 mg/day and anterograde ejaculation was partially restored. 

Spinal chord SE Sexual function Anorgasmia, impotence, ejaculatory delay... 

Sexual dysfunction (men decreased libido, erectile disturbance, impotence, ejaculatory dysfunction, abnormal orgasm women decreased libido, abnormal orgasm)... 

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. 

Experimental studies of men have consistently shown that, at BACs of 0.05%-0.10%, alcohol pharmacologically retards sexual arousal. When the BAG climbs to more than 0.10%, erection and ejaculatory competence are inhibited or eliminated. These results have been found repeatedly in samples of non-problem-drinker college students and in alcoholics. Alcohol docs not stimulate men s libido, especially at moderate or higher BACs. 

Dallo J, Lekka N, Knoll J (1986b) The ejaculatory behavior of sexually sluggish male rats treated with (-)deprenyl, apomorphine, bromocriptine and amphetemine. Pol J Pharmacol Pharm 38 251-255... 

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. 

Both acute and chronic alcohol use can lead to impotency in men. Increased blood alcohol concentrations lead to decreased sexual arousal, increased ejaculatory latency, and decreased orgasmic pleasure. Additionally, many chronic alcoholics develop testicular atrophy and decreased fertility the mechanisms are complex and likely involve altered hypothalamic function and a direct toxic effect of alcohol on Leydig cells. Testosterone levels may be depressed, but many men who are alcohol-dependent have normal testosterone and estrogen levels. Gynecomastia is associated with alcoholic liver disease and is related to increased cellular response to estrogen and to accelerated metabolism of testosterone. 

Male patients taking clomipramine should be informed of sexual dysfunction as a side effect associated with antidepressants having significant serotonergic activity. Sexual dysfunction in men appears as ejaculatory incompetence, ejaculatory retardation, decreased... 

Sexual function In a post hoc analysis of a Japanese trial, ejaculatory dysfunction was associated with larger symptomatic improvements in lower urinary tract symptoms with silodosin [95. The authors suggested that the pharmacological receptor target for improvement in the symptoms of benign prostatic hyperplasia may be the same target as that for ejaculatory dysfunction. 

Sexual function There was a clear association between a-adrenoceptor antagonists and ejaculatory dysfunction (pain/discom-fort) in an observational study in Spanish men with benign prostatic hyperplasia and/or lower urinary tract symptoms [106 ]. The presence and severity of symptoms were assessed using the male sexual health questionnaire there was an 83% prevalence of ejaculatory dysfunction in patients taking a-adrenoceptor antagonists. Most cases of ejaculatory dysfunction were mild and severe dysfunction occurred in only 4% of cases. Although the adverse effects on sexual function were seen with all of the a-adrenoceptor antagonists, alfuzosin was associated with better ejaculatory function than tamsulosin, terazosin, or doxazosin. 

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. 

Sexual function The effect of tamsulosin on the ejaculatory function has been studied among healthy male volunteers [36 ]. Anaejaculation occurred in all subjects after tamsulosin administration. 

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