sildenafil-citrate and Sexual-Dysfunction--Physiological

Multiple sclerosis (MS) is the most common chronic inflammatory demyelinating disease of the central nervous system (CNS). The most common clinical manifestations of MS are spasticity, pain, vesico-urethral disorders, cognitive impairments, chronic fatigue and sexual dysfunction. This review aims to explore the possible therapeutic options for managing sexual dysfunction in people with MS (PwMS).. A thorough search of the PubMed Medline database was performed. Records were limited to clinical studies published between 01/01/2010 up to 01/01/2022. The results were screened by the authors in pairs.. The search identified 36 records. After screening, 9 records met the inclusion-exclusion criteria and were assessed. The pharmacological approaches investigated the effectiveness of sildenafil, tadalafil and onabotulinumtoxinA. Of the interventional studies the non-pharmacological investigated, the effectiveness of aquatic exercises, the application of pelvic floor exercises,the combination of pelvic floor exercises and mindfulness technique, the combination of pelvic floor exercises and electro muscular stimulation with electromyograph biofeedback, the application of yoga techniques and the efficacy of assistive devices like the clitoral vacuum suction device and the vibration device.. The management of sexual dysfunction in PwMS needs to be further investigated. A team of healthcare professionals should be involved in the management of SD in order to address not only the primary (MS-related) SD symptoms but the secondary and tertiary as well. The main limitations that were identified in the existing literature were related to MS disease features, sample characteristics and evaluation tools and batteries.

Topics: Exercise Therapy; Humans; Multiple Sclerosis; Pain; Sexual Dysfunction, Physiological; Sildenafil Citrate

Topics: Continuous Positive Airway Pressure; Erectile Dysfunction; Humans; Male; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sleep Apnea, Obstructive

Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective.. A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis.. Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction.. The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

Topics: Body Mass Index; Continuous Positive Airway Pressure; Female; Hormones; Humans; Inflammation; Male; Menopause; Phosphodiesterase 5 Inhibitors; Severity of Illness Index; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sleep Apnea, Obstructive

Clinical studies evaluating the effectiveness and safety of phosphodiesterase type 5 inhibitors (PDE5is) for female sexual dysfunction have reported conflicting results.. To systematically review evidence from studies comparing PDE5is with placebo in the treatment of female sexual dysfunction.. Searches of PubMed, the Cochrane Library, and Embase databases were performed using the MeSH terms "females/female/women", "sexual", and "sildenafil/tadalafil/vardenafil/PDE5/PDE5i".. All randomized controlled trials, available in English, published no later than January 28, 2015 comparing the effectiveness of PDE5is, or PDE5is in combination with other agents, with placebo in improving female sexual function were included.. The inclusion criteria were met by 14 studies, which were analyzed by two reviewers.. The randomized controlled trials included in the present study adopted different questionnaires for measuring sexual function; consequently, most of the data had to be considered separately rather than pooled. Generally, the use of PDE5is resulted in significant improvements in sexual function compared with placebo, with some studies demonstrating negative results. Pooled data regarding adverse events demonstrated significantly higher rates of headache, flushing, and changes in vision in PDE5i-treated patients.. PDE5is could be an effective treatment modality for female sexual dysfunction. Although there were significant increases in adverse events in comparison with placebo, PDE5is were still relatively safe.

Topics: Female; Flushing; Headache; Humans; Nausea; Orgasm; Phosphodiesterase 5 Inhibitors; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Treatment Outcome; Vision Disorders

'Female sexual dysfunction' (FSD) is an umbrella term comprising a range of common disorders, including hypoactive sexual desire, reduced subjective and/or physical genital arousal (poor sensation, vasocongestion, lubrication), sexual pain and inability to achieve orgasm/satisfaction, which are multidimensional by nature and often coexisting. Psychological and contextual factors have a significant influence on organic components of sexual response and behavior and a tailored medical approach to sexual symptoms is inevitably limited.. The paper reports the most recent advances in pharmacotherapy for women taking into account the biopsychosocial model. Hormone therapy, including estrogens, testosterone, tibolone and dehydroepiandrosterone, are discussed in term of efficacy and safety in postmenopausal women both for female sexual interest/arousal disorder (FSIAD) and genito-pelvic pain/penetration disorder. Ospemifene, a selective estrogen receptor modulator, approved to treat dyspareunia at menopause, is also discussed. Data on psychoactive agents for treatment of FSIAD in premenopausal women are discussed, including the potential use of on-demand combined hormonal (testosterone) and non-hormonal (buspirone or sildenafil) treatments to address possible neurophysiological profiles of women.. We are still waiting for an approved pharmacotherapy for FSD. This is not the result of gender inequality in sexual medicine, but it reflects the need of balancing benefits and risks in order to provide effective and safe treatments to women of any age.

Topics: Buspirone; Clinical Trials, Phase III as Topic; Estrogens; Female; Humans; Menopause; Norpregnenes; Piperazines; Purines; Selective Estrogen Receptor Modulators; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfonamides; Tamoxifen; Testosterone

Several treatments produce modest, but statistically significant, clinical increases in sexual desire and function in women. The testosterone transdermal patch improves hypoactive sexual desire disorder (HSDD) in postmenopausal women.

Topics: Administration, Cutaneous; Antidepressive Agents, Second-Generation; Bupropion; Female; Humans; Libido; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Testosterone; Treatment Outcome

Sexual dysfunction (including altered sexual desire, orgasmic and ejaculatory dysfunction, erectile and other problems) is a relatively common side effect of antidepressant medication. These sexual side effects may compromise a person's lifestyle and result in a lack of compliance with the prescribed antidepressant to the detriment of the person's mental health. A wide range of management strategies are possible to address this problem, including behavioural, psychological and pharmacological approaches.. 1. To determine the effectiveness of management strategies for sexual dysfunction caused by antidepressants.2. To determine the adverse effects and acceptability of the different management strategies.. We searched the Cochrane Depression, Anxiety and Neurosis Group's Specialized Register (CCDANCTR, to 1 January 2013), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). Additional searches were carried out by the author team on the same biomedical databases (using terms for 'sexual dysfunction' only) together with CINAHL (1982 to Jan 2012). The reference lists of reports of all included studies were screened.. We included randomised controlled trials that compared management strategies for antidepressant-induced sexual dysfunction versus placebo or any alternative strategy.. Two authors independently extracted data and assessed trial quality. Study authors were contacted for additional information.. We included 23 trials involving 1886 people in this updated review. Twenty-two of these trials investigated the addition of medication to treat the identified dysfunction, with most agents studied in only single studies. One study investigated switching to an alternative antidepressant.In men, data for the phosphodiesterase inhibitors sildenafil (three studies, 255 participants) and tadalafil (one study, 54 participants) indicated they led to a greater improvement in erectile function than placebo. Combined data from three sildenafil studies found benefit over placebo on International Index of Erectile Function ratings of ability to achieve (MD 1.04, 95% CI 0.65 to 1.44), and maintain erections (MD 1.18, 95% CI 0.78 to 1.59). A single point improvement on these ratings is equivalent to an improvement in frequency from 'sometimes' to 'most times'. Men receiving tadalafil were more likely to report improved erectile function (RR 11.50, 95% CI 3.03 to 43.67). For women it remains uncertain whether sildenafil is more effective than placebo. Unpublished data could reduce this uncertainty.Data from three studies in men and women of bupropion 150 mg twice daily indicate a benefit over placebo on rating scale scores (SMD 1.60, 95% CI 1.40 to 1.81), but response rates in two studies of bupropion 150 mg once daily demonstrated no statistically significant difference in effect (RR 0.62, 95% CI 0.09 to 4.41).Other augmentation strategies failed to demonstrate significant improvements in sexual dysfunction compared with placebo.One trial involving 75 people with sexual dysfunction due to sertraline assessed the effect of changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.19 to 0.60), however, nefazodone is no longer available for clinical use.There is an absence of randomised trials assessing the effects of switching to currently-available antidepressant agents with lower rates of adverse sexual effects, the role of psychological or mechanical interventions, or of techniques such as drug holidays.We identified no data for any of the strategies included in the trials assessed that indicated that they led to a worsening of psychiatric symptoms. However, the relatively small numbers assessed for many of the interventions studied means that the possibility of such an effect cannot confidently be excluded in all cases.Given the small numbers of stud. The evidence currently available is rather limited. For men with antidepressant-induced erectile dysfunction, the addition of sildenafil or tadalafil appears to be an effective strategy. For women with antidepressant-induced sexual dysfunction the addition of bupropion at higher doses appears to be the most promising approach studied so far.

Topics: Antidepressive Agents; Bupropion; Carbolines; Drug Substitution; Female; Humans; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Randomized Controlled Trials as Topic; Sex Factors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Tadalafil

There is limited evidence for the management of sexual dysfunction and/or hyperprolactinemia resulting from use of antipsychotics in patients with schizophrenia and spectrum. The aim of this study was to review and describe the strategies for the treatment of antipsychotic-induced sexual dysfunctions and/or hyperprolactinemia. The research was carried out through Medline/PubMed, Cochrane, Lilacs, Embase, and PsycINFO, and it included open labels or randomized clinical trials. The authors found 31 studies: 25 open-label noncontrolled studies and 6 randomized controlled clinical trials. The randomized, double-blind controlled studies that were conducted with adjunctive treatment that showed improvement of sexual dysfunction and/or decrease of prolactin levels were sildenafil and aripiprazole. The medication selegiline and cyproheptadine did not improve sexual function. The switch to quetiapine was demonstrated in 2 randomized controlled studies: 1 showed improvement in the primary outcome and the other did not. This reviewed data have suggested that further well-designed randomized controlled trials are needed to provide evidence for the effects of different strategies to manage sexual dysfunction and/or hyperprolactinaemia resulting from antipsychotics. These trials are necessary in order to have a better compliance and reduce the distress among patients with schizophrenia.

Topics: Adult; Antipsychotic Agents; Aripiprazole; Drug Substitution; Drug Therapy, Combination; Erectile Dysfunction; Female; Humans; Hyperprolactinemia; Male; Piperazines; Psychotic Disorders; Purines; Quinolones; Schizophrenia; Schizophrenic Psychology; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Spinal cord injured (SCI) patients have sexual disorders including erectile dysfunction (ED), impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I) such as Sildenafil (Viagra), intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM). Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy can be used to obtain sperm which can then be used for intra-uterine or in-vitro fertilization. Infertility treatment in male SCI patients involves a combination of the above treatments for erectile and anejaculatory dysfunctions. The basic approach to and management of sexual dysfunction in female SCI patients are similar as for men but do not require treatment for erectile or ejaculatory problems.

Topics: Cognitive Behavioral Therapy; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Spinal Cord Injuries; Sulfones; Testosterone

There are ongoing debates about the definition, classification and prevalence of premature ejaculation (PE). The first evidence-based definition of PE was limited to heterosexual men with lifelong PE who engage in vaginal intercourse. Unfortunately, many patients with the complaint of PE do not meet these criteria. However, these men can be diagnosed as one of the PE subtypes, namely acquired PE, natural variable PE or premature-like ejaculatory dysfunction. Nevertheless, the validity of these subtypes has not yet been supported by evidence. The absence of a universally accepted PE definition and lack of standards for data acquisition have resulted in prevalence studies that have reported conflicting rates. The very high prevalence of 20%-30% is probably due to the vague terminology used in the definitions at the time when such surveys were conducted. Although many men may complain of PE when questioned for a population-based prevalence study, only a few of them will actively seek treatment for their complaint, even though most of these patients would define symptoms congruent with PE. The complaints of acquired PE patients may be more severe, whereas complaints of patients experiencing premature-like ejaculatory dysfunction seem to be least severe among men with various forms of PE. Although numerous treatment modalities have been proposed for management of PE, only antidepressants and topical anaesthetic creams have currently been proven to be effective. However, as none of the treatment modalities have been approved by the regulatory agencies, further studies must be carried to develop a beneficial treatment strategy for PE.

Topics: Animals; Benzylamines; Coitus; Humans; Lidocaine; Male; Naphthalenes; Piperazines; Premature Ejaculation; Prevalence; Prilocaine; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

As yet, a summary of research evidence concerning the efficacy of psychological treatment in male sexual dysfunction is lacking.. Our systematic review gives an overview of the efficacy of psychosocial interventions in all male sexual dysfunctions.. Main outcome measures included, for example, psychometrically validated scales, interviews, and clinical assessment by an independent rater. The efficacy of psychosocial interventions was measured, for example, by the frequency of and satisfaction with sexual activity and sexual functioning.. The systematic literature search included electronic database search, handsearch, contact with experts, and an ancestry approach. Studies were included if the man was given a formal diagnosis of a sexual dysfunction (International Statistical Classification of Diseases and Related Health Problems [ICD10/-9]; Diagnostic and Statistical Manual of Mental Disorders [DSM-IV/-III-R]) and when the intervention was psychosocial or psychotherapeutic. The control group included either another treatment or a waiting-list control group. The report of relevant outcomes was necessary for inclusion as well as the design of the study (randomized controlled trials [RCTs] and controlled clinical trials [CCTs]). The assessment of methodological quality comprised aspects of randomization, blinding, incomplete outcome data, selective reporting, and allegiance.. We identified 19 RCTs and one CCT that investigated the efficacy in male sexual dysfunction and two further studies that examined male and female sexual dysfunction together. Twelve out of 20 trials in men used either a concept derived from Masters and Johnson or a cognitive-behavioral treatment program. Overall, psychosocial interventions improved sexual functioning. While one study found that psychotherapy is superior to sildenafil, another study found the opposite. In men with premature ejaculation, behavioral techniques proved to be effective. A shortcoming was the rather low methodological quality of included studies.. Most of the compared interventions proved to be similarly effective. Possibly, there are underlying constructs throughout all therapies that have an effect on the outcome.

Topics: Alprostadil; Counseling; Couples Therapy; Humans; Hypnosis; Injections; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Psychotherapy; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents; Yohimbine

Psychotropic drugs are associated with sexual dysfunction. Symptoms may concern penile erection, lubrication, orgasm, libido, retrograde ejaculation, sexual arousal, or overall sexual satisfaction. These are major aspects of tolerability and can highly affect patients' compliance.. To determine the effects of different strategies (e.g. dose reduction, drug holidays, adjunctive medication, switching to another drug) for treatment of sexual dysfunction due to antipsychotic therapy.. An updated search was performed in the Cochrane Schizophrenia Group's Trials Register (3 May 2012) and the references of all identified studies for further trials.. We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction.. We extracted data independently. For dichotomous data we calculated random effects risk ratios (RR) with 95% confidence intervals (CI), for crossover trials we calculated Odds Ratios (OR) with 95% CI. For continuous data, we calculated mean differences (MD) on the basis of a random-effects model. We analysed cross-over trials under consideration of correlation of paired measures.. Currently this review includes four pioneering studies (total n = 138 , duration two weeks to four months), two of which are cross-over trials. One trial reported significantly more erections sufficient for penetration when receiving sildenafil compared with when receiving placebo (n = 32, MD 3.20 95% CI 1.83 to 4.57), a greater mean duration of erections (n = 32, MD 1.18 95% CI 0.52 to 1.84) and frequency of satisfactory intercourse (n = 32, MD 2.84 95% CI 1.61 to 4.07). The second trial found no evidence for selegiline as symptomatic treatment for antipsychotic-induced sexual dysfunction compared with placebo (n = 10, MD change on Aizenberg's sexual functioning scale -0.40 95% CI -3.95 to 3.15). No evidence was found for switching to quetiapine from risperidone to improve sexual functioning (n = 36, MD -2.02 95% CI -5.79 to 1.75). One trial reported significant improvement in sexual functioning when participants switched from risperidone or an typical antipsychotic to olanzapine (n = 54, MD -0.80 95% CI -1.55 to -0.05).. We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.

Topics: Antipsychotic Agents; Benzodiazepines; Cross-Over Studies; Drug Substitution; Erectile Dysfunction; Female; Humans; Male; Olanzapine; Piperazines; Purines; Randomized Controlled Trials as Topic; Selegiline; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Phosphodiesterase type 5 inhibitors (PDE5), such as sildenafil, tadalafil, and vardenafil, have revolutionized the treatment of erectile dysfunction. Few successes, in contrast, have been reported for the use of these agents in treatment of sexual arousal problems in women.. To review research examining efficacy of PDE5 in women, critique the methods and models employed, and integrate the findings within a broader, gender-specific understanding of female sexual response.. A conceptual and methodological review of all published studies examining PDE5 efficacy in female samples.. Study methods, populations, outcome measures, study results.. A total of 16 studies were reviewed. Studies using self-reported measures of sexual functioning showed mixed results whereas studies examining physiological effects of PDE5 on genital vasocongestion consistently report significant effects on genital sexual response.. The lack of efficacy of PDE5 treatment in women is likely attributable to gender differences in the concordance between physiological and psychological components of sexual response. Discordance between genital and subjective measures of sexual response in women may be augmented by PDE5 effects on genital vasocongestion in some populations, rendering successful treatment unlikely via pharmacological treatment alone.

Topics: Animals; Carbolines; Clitoris; Female; Humans; Imidazoles; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Purines; Sex Factors; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Vagina; Vardenafil Dihydrochloride; Women's Health

Female sexual arousal disorder (FSAD) is a common disorder encountered in clinical practice, with self-reported arousal difficulties reported in up to 26% of American women. Various oral therapies for FSAD have been studied, including sildenafil citrate, a phosphodiesterase inhibitor that is currently used to treat male erectile dysfunction. In vitro studies of sildenafil citrate have demonstrated smooth-muscle relaxation in clitoral tissue, and phosphodiesterase type-5 has been shown to be present in vaginal, clitoral and labial smooth muscle; these findings have led to theories that sildenafil citrate might be successful for treating FSAD. This Review discusses the data from clinical trials that have assessed sildenafil citrate for the treatment of FSAD; the trials show that sildenafil citrate is moderately effective. Sildenafil citrate may also be effective in women with FSAD secondary to multiple sclerosis, diabetes or antidepressant use; however, more trials in these patient populations are required to confirm these findings.

Topics: Animals; Cyclic Nucleotide Phosphodiesterases, Type 2; Female; Forecasting; Humans; Libido; Piperazines; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Female sexual dysfunction (FSD) incorporates various sexual disorders including hypoactive sexual desire disorder, sexual arousal disorder, orgasmic and sexual pain disorders. Although many strategies have been formulated for the treatment of male sexual problems, FSD remains an area that warrants further research and trial studies to identify the most efficacious treatment options. Research has highlighted numerous pharmacological interventions that have been trialled and found to exhibit positive effects. These include hormonal therapies, prostaglandins, dopaminergic agonists, phosphodiesterase type-5 (PDE-5) inhibitors and melanocortin agonists.

Topics: Dopamine Agonists; Female; Hormones; Humans; Melanocortins; Piperazines; Prostaglandins; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Psychotropic drugs are associated with sexual dysfunction. Symptoms may concern penile erection, lubrication, orgasm, libido, sexual arousal or overall sexual satisfaction.. To determine the effects of different strategies (e.g. dose reduction, drug holidays, adjunctive medication, switching to another drug) for treatment of sexual dysfunction due to antipsychotic therapy.. We searched the Cochrane Schizophrenia Group's Register (June 2006), the Cochrane Library (Issue 2, 2005), MEDLINE (1966-8/2005), PsycLIT (1974-8/2005), EMBASE (1980-8/2005) and references of all identified studies for further trials. We contacted relevant pharmaceutical companies and authors of trials.. We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction.. Working independently, we extracted data. For dichotomous data we calculated random effects odds ratios (OR) with 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data we calculated weighted mean differences on the basis of a random effects model. We analysed crossover trials under consideration of correlation of paired measures.. Currently this review includes two pioneering crossover studies (total n=42 men, duration 2-3 weeks). They reported significantly more erections sufficient for penetration when receiving sildenafil compared with when receiving placebo (n=32, WMD 3.20 CI 1.83 to 4.57), a greater mean duration of erections (n=32, WMD 1.18 CI 0.52 to 1.84) and frequency of satisfactory intercourse (n=32, WMD 2.84 CI 1.61 to 4.07). The second trial found no evidence for selegiline as symptomatic treatment for antipsychotic-induced sexual dysfunction compared with placebo (n=10, WMD change on Aizenberg's sexual functioning scale -0.40 CI -3.95 to 3.15).. We are not confident that crossover studies are appropriate for this participant group. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Further well designed, conducted and reported trials are urgently needed.

Topics: Antipsychotic Agents; Cross-Over Studies; Erectile Dysfunction; Female; Humans; Male; Piperazines; Purines; Randomized Controlled Trials as Topic; Selegiline; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Endocrine abnormalities are common in patients with chronic kidney disease (CKD) and lead to sexual dysfunction, anemia, hyperparathyroidism, and altered mineral metabolism. Common clinical problems include disturbances in menstruation in women, erectile dysfunction in men, and decreased libido and infertility in both sexes. Organic factors tend to be prominent and are related to uremia and other comorbid illnesses. Psychological factors and depression may exacerbate the primary problem. Alterations in the hypothalamic-pituitary axis are seen early in CKD and tend to worsen after patients start dialysis. Hypogonadism plays a dominant role in male sexual function, whereas changes in hypothalamic-pituitary function predominate in female sexual dysfunction. In patients on dialysis, treatment strategies include optimizing dose of dialysis, correction of anemia with erythropoietin, and correction of hyperparathyroidism. Successful kidney transplantation may restore normal sexual function, especially in younger patients.

Topics: Androgens; Chronic Disease; Erythropoietin; Female; Hormone Replacement Therapy; Humans; Hypogonadism; Kidney Diseases; Kidney Transplantation; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Recombinant Proteins; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Testosterone

To review and assess the update studies regarding selective serotonin reuptake inhibitors (SSRIs) in the treatment of premature ejaculation (PE) and then provide practical recommendations and possible mechanisms concerning state of the art knowledge for the use of SSRIs in alleviating PE.. Using the Medline, 48 articles published from January 1st, 1996 to August 1st, 2006 concerning the use of SSRIs and their possible mechanisms in alleviating PE were found and reviewed.. PE, rapid ejaculation, early ejaculation and SSRIs were employed as the keywords, and relevant articles about the use of SSRIs and their possible mechanisms in the treatment of PE were selected.. Many kinds of SSRIs, such as fluoxetine, sertraline, paroxetine and citalopram, have widely been employed to treat PE. However, their effects are moderate and there is no a universal agreement about the kind, dose, protocol and duration. Dapoxetine, as the first prescription treatment of PE, may change this bottle-neck situation. SSRIs are suggested to be used in young men with lifelong PE, and acquired PE when etiological factors are removed but PE still exists. Phosphodiesterase 5 inhibitors (PDE(5)-Is) are suggested to be employed alone or combined with SSRIs when SSRIs fail to treat PE or sexual dysfunction associated with SSRIs occurs. The protocol of taking drugs on demand based on taking them daily for a suitable period is proposed to be chosen firstly. The possible mechanisms include increasing serotonergic neurotransmission and activating 5-hydroxytryptamine 2C (5-HT(2C)) receptors, then switching the ejaculatory threshold to a higher level, decreasing the penile sensitivity and their own effect of antidepression.. The efficacies of the current SSRIs are moderate in the treatment of PE and they have not been approved by the FDA, therefore new SSRI like dapoxetine needs to be further evaluated.

Topics: Clinical Trials as Topic; Ejaculation; Humans; Male; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Testosterone deficiency syndrome (TDS) is defined as a clinical and biochemical syndrome associated with advancing age and is characterized by typical symptoms and deficiency in serum testosterone levels. TDS is a result of the interaction of hypothalamo-pituitary and testicular factors. Now, treatment of TDS with testosterone is still controversial due to a lack of large, controlled clinical trials on efficacy. The risks of treatment with testosterone appear to be minimal, although long-term studies on the safety of testosterone therapy are lacking. The aim of the therapy is to establish a physiological concentration of serum testosterone in order to correct the androgen deficiency, relieve its symptoms and prevent long-term sequelae. All of the available products, despite their varying pharmacodynamic and pharmacokinetic profiles, are able to reach this goal. Newer testosterone patches seem not to cause severe skin irritation. Testosterone gels minimize the skin irritation while providing flexibility in dosing and a low discontinuation rate. Oral testosterone undecanoate (TU) is free of liver toxicity. Recent formulation of oral TU markedly increased shelf-live, a major drawback in the older preparation. Producing swings in testosterone levels rising rapidly to the supraphysiological range is not the case with the new injectable long-acting preparation of TU. To be able to rapidly react and stop treatment in cases where side-effects and contraindications are detected, the short-acting transdermal and oral delivery modes have certain advantages. However, there is no evidence that the use of an injectable long-acting TU in men with TDS has limitations in clinical application for this reason. The use of dehydroepiandrosterone is still controversial because of a lack of well designed long-term trials, although some recent studies suggest positive effects on various body systems. Only a few studies have been carried out to investigate the effect of hCG (human chorionic gonadotropin) in TDS with some positive results on various body systems.

Topics: Aging; Androgens; Body Composition; Drug Therapy, Combination; Hormone Replacement Therapy; Humans; Male; Muscle Strength; Osteoporosis; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Syndrome; Testosterone

The frequency of female sexual dysfunction increases with age, and the menopause has a negative influence on sexual life. Pharmacological treatment options of female sexual dysfunctions in the menopause include hormone therapy and sildenafil. Few randomised controlled studies have been done, and there is evidence suggesting that systemic hormone therapy, such as estrogen, estrogen/progesterone, estrogen/testosterone and tibolone, has a positive impact on sexual dysfunction in the menopause. There is evidence that local estrogen relieves vaginal dryness and dyspareunia. The recent discoveries of the side effects of hormone therapy necessitate careful evaluation of the indication for hormone therapy, and the duration of treatment is recommended to be as short as possible. The long-term side effects of testosterone in women have not yet been fully investigated. Sildenafil has shown a positive effect on female sexual dysfunction only in a limited group of women: those with arousal problems without desire problems. This result demands a focus on new pharmaceutical products, and at present the effect of testosterone and selective estrogen receptor modulators on female sexual dysfunction is being investigated.

Topics: Adult; Androgens; Estrogen Receptor Modulators; Estrogen Replacement Therapy; Female; Humans; Incidence; Libido; Menopause; Middle Aged; Norpregnenes; Phosphodiesterase Inhibitors; Piperazines; Postmenopause; Purines; Risk Factors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Testosterone

To date, there is no FDA-approved therapy for premature ejaculation (PE). Recently, phosphodiesterase 5 inhibitors (PDE5-Is) have been demonstrated to have encouraging results in the treatment of PE by a few studies. The aim of this review was to assess the updated manuscripts and thereafter present the practical recommendations and possible mechanisms concerning PDE5-Is for treating PE. Using MEDLINE, we searched and assessed the peer manuscripts published from 1 January 1996 to 1 September 2005 about PDE5-Is for treating PE. The results show that the number of patients in all the reports is very few and most of the studies do not employ double-blinded and placebo-controlled tests, though they are prospective and randomized. Therefore, the results and conclusions might be biased. PDE5-Is are suggested to be used in PE with old age or associated with erectile dysfunction (ED), or to be employed alone or in combination with selective-serotonin reuptake inhibitors (SSRIs) when SSRIs fail to treat PE; behavioural therapy is proposed to be used for preventing the recurrence of PE following withdrawal of PDE5-Is. In addition, for the PE patient with a definite aetiological cause, the aetiology should be cured first, if PE still exists, followed by PDE-Is prescription. Possible mechanisms that are involved include relaxing the smooth muscles of vas deferens, seminal vesicle, prostate and urethra; decreasing the central sympathetic output; inducing peripheral analgesia; prolonging the duration of erection; and increasing confidence, the perception of ejaculatory control, overall sexual satisfaction, and decreasing the post-orgasmic refractory time to achieve a second erection after ejaculation. Well-designed multicentre studies are urgently warranted to further elucidate the efficacies and safety as well as mechanisms of PDE5-Is in the treatment of PE.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Carbolines; Cyclic Nucleotide Phosphodiesterases, Type 5; Ejaculation; Humans; Imidazoles; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Vardenafil Dihydrochloride

To review the pathophysiology of female sexual dysfunction (FSD) and the literature regarding the use of sildenafil in its treatment.. Literature was accessed through MEDLINE (1966-April 2006), Iowa Drug Information Service (1966-April 2006), EMBASE (1966-April 2006), and bibliographies of pertinent articles. Search terms included female sexual dysfunction; sexual dysfunction, psychological; phosphodiesterase inhibitors; and sildenafil.. The lack of a clear understanding of FSD contributes to the limited treatment options available. Studies regarding the safety and efficacy of the phosphodiesterase 5 inhibitor sildenafil in the management of FSD were evaluated. Many trials have been of poor quality, making clinical application of their results difficult. The current literature does not show sildenafil to be an effective treatment option for FSD.. Treatment of FSD should include both physical and psychological components. Based on the limited data available, it appears that sildenafil, while well tolerated, offers little or no benefit to most patients with FSD.

Topics: Female; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

The frequency of female sexual dysfunction increases with age, and the menopausal transition has a negative effect on the sexuality. Pharmacological treatment options for female sexual dysfunction during the peri- and post-menopause include hormone therapy or sildenafil. A limited number of randomized, controlled trials have been conducted and evidence suggests that systemic hormone therapy with estrogen, estrogen/progesterone, estrogen/testosterone and tibolone have a positive impact on sexual dysfunction during the peri- and postmenopause. Further, there is evidence that treatment with local estrogen relieves vaginal dryness and dyspareunia. Recent knowledge on side effects related to hormone therapy necessitates careful evaluation of the indication for hormone therapy and the duration of postmenopausal hormone therapy should be as short as possible. Long-term side effects of testosterone have not yet been fully investigated. A positive effect of sildenafil has been observed in a limited group of women; those with arousal problems but with no desire problems. The results suggest an intensified focus on new pharmaceutical products for the treatment of female sexual dysfunction in the postmenopause. For the time being the effect of testosterone therapy and tibolone on female sexual dysfunction is being investigated. Sexual dysfunction in women (Female Sexual Dysfunction, FSD) is multi-factorial and influenced by physiological, psychological, social and emotional factors. FSD is defined in four diagnostic groups: desire-, arousal-, orgasm- and pain problems. Recently, it has been suggested that the woman herself should assess the dysfunction as distressful to be diagnosed as having a sexual dysfunction [1]. There are only a limited number of well-conducted population surveys on the prevalence of FSD. Further, relatively few randomized, controlled trials of pharmacological treatment of FSD have been carried out.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Androgen Antagonists; Estradiol; Estrogen Replacement Therapy; Estrogens; Female; Humans; Menopause; Middle Aged; Norpregnenes; Perimenopause; Piperazines; Purines; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone; Vagina

More than 30 million men are estimated to have erectile dysfunction (ED) in the United States. Worldwide, ED is estimated to affect more than 150 million men, and that number is expected to exceed 300 million men by the year 2025. The prevalence of ED ranges from 7% in men aged 18-29 years to 85% in men aged 76-85 years. In addition, a recent report showed that 68% of patients with ED aged 18 years and older have at least one comorbid diagnosis of hypertension, hyperlipidaemia, diabetes or depression, and research suggests that ED may be an early indicator of systemic vascular disease. Viagra (sildenafil citrate), the first-in-class phosphodiesterase type 5 (PDE5) inhibitor, was introduced in 1998 for the treatment of ED. In the 7 years since its market launch, more than 750,000 physicians have prescribed sildenafil to more than 23 million men, helping establish an excellent safety and efficacy record. Clinical studies have demonstrated that sildenafil successfully treats ED of varied organic, psychogenic or mixed aetiology, and is effective in men with ED and comorbidities such as hypertension, hyperlipidaemia, diabetes or depression. Sildenafil was a breakthrough medication that addressed a previously unfulfilled medical need. The impact of sildenafil has stimulated academic, clinical and industrial research to better understand the nature of sexual function and develop better treatment and management for sexual dysfunctions such as ED. With the advent of other erectogenic therapies for the treatment of ED, this 7-year update will focus on the unique history and development of sildenafil, its current use and applications and its future directions and indications. Special emphasis is placed on the impact of sildenafil on our understanding of sexual health and on the extensive safety and efficacy data that have been amassed from numerous clinical trials.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cardiovascular Diseases; Drug Interactions; Erectile Dysfunction; Female; Humans; Male; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

This review was undertaken to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication.. Electronic databases and reference lists were searched, and pharmaceutical companies and experts contacted to identify randomised controlled trials comparing management strategies for antidepressant-induced sexual dysfunction.. Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 to 0.6). Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF) (WMD 19.36, 95% CI 15.00 to 23.72). Another trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 to 1.55). In a further study the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo.. The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.

Topics: Antidepressive Agents; Depressive Disorder; Female; Humans; Male; Piperazines; Placebos; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

This systematic review includes all randomized and placebo-controlled trials (RCTs) of treatment for female sexual dysfunction (FSD) in postmenopausal women published since 1990.. Electronic database and manual bibliography searches were conducted to identify all relevant publications.. Only six RCTs have been done to assess the effects of different therapies on sexual function in postmenopausal women: one with sildenafil citrate (Viagra), three with hormone replacement therapy, and two with tibolone.. In women with FSD, many treatments that are used in practice are not supported by adequate evidence. Although an improvement of sexual function was reported with tibolone and the combination of estrogen-androgen therapy, it still remains unclear which groups of postmenopausal women with FSD would benefit most from these therapies. The adverse effects of testosterone replacement therapy should be assessed against the effects of placebo in RCTs with larger sample sizes and longer duration.

Topics: Adult; Androgens; Controlled Clinical Trials as Topic; Drug Therapy, Combination; Estrogen Replacement Therapy; Estrogens; Female; Humans; MEDLINE; Middle Aged; Norpregnenes; Piperazines; Placebos; Postmenopause; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

What is the current knowledge concerning the pharmacologic treatment of human sexual dysfunction? A number of interventions, including oral phophodiesterase inhibitors and intracorporeal agents with vasodilatory effects, are available to treat male erectile disorder. Serotonergic drugs have been shown to be effective in the treatment of rapid ejaculation. Various lines of research suggest that high dosages of androgenic agents may eventually have a role in the treatment of decreased libido in females. There may be a role for phophodiesterase inhibitors in the treatment of a subgroup of women with arousal disorders. Normal sexual function involves successful integration of biological, psychological, and interpersonal influences. Clinical psychiatry with its biopsychosocial model should incorporate the treatment of human sexual dysfunction within its purview.

Topics: Female; Humans; Male; Piperazines; Purines; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Involuntary childlessness is considered to be a chronic stressor for couples suffering from infertility. Stress itself may interfere with spermatogenesis and fertility rate. The long period of diagnostic and treatment procedures may also have a negative impact on the sex life of the infertile couple. In fact, we observed in such patients a higher frequency of male sexual disturbances expressed as erectile dysfunction, ejaculatory disorders, loss of libido and a decrease in the frequency of intercourse. We tried to partially overcome these sexual symptoms by administration of 50 mg of a type-V phosphodiesterase inhibitor (sildenafil) to two selected groups: patients collecting semen for artificial insemination and male partners of couples before post-coital testing. The results of this uncontrolled pilot study suggest that sildenafil is effective in increasing compliance of male patients facing infertile couple management procedures, and also in improving some sperm parameters, above all the number of sperm penetrating the cervical mucus.

Topics: Humans; Infertility, Male; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sexuality; Sildenafil Citrate; Stress, Psychological; Sulfones; Tissue and Organ Harvesting; Tissue Donors

An essential factor for successful sex counseling by the family doctor is an atmosphere of openness and trust between physician and patient. However, few patients will begin to talk about their sexual problems of their own accord. The physician should therefore allow himself sufficient time for such counseling, be aware of his own limitations, and develop an ear attuned to involuntary remarks by the patient. During talks, only sparse use should be made of technical terms, the better to encourage the patient. The problems most commonly described in the doctor's office are functional disorders with a psychosomatic cause, and triggering factors may vary considerably (a high level of stress at the workplace, social or financial crises, monotonous leisure activities). In view of this, a somatic investigation should always be preceded by careful history-taking.

Topics: Adult; Carbolines; Erectile Dysfunction; Family Practice; Female; Humans; Male; Middle Aged; Phosphodiesterase Inhibitors; Physician-Patient Relations; Piperazines; Purines; Risk Factors; Sex Counseling; Sex Factors; Sexual Dysfunction, Physiological; Sexuality; Sildenafil Citrate; Sulfones; Tadalafil; Vasodilator Agents

Since the sexual revolution of the 1960s, medical complications of sexual activity and sexual side effects related to use of medications have become a significant part of healthcare practice. Specifically, there has been an expanding interest in the treatment of headaches and their relationship to sexual function. Most sexual side effects associated with headache treatment are benign and can be managed with reassurance or changes in medication regimens. However, sudden headache should always be investigated carefully to rule out a dangerous intracranial event.

Topics: Antidepressive Agents; Antihypertensive Agents; Coitus; Female; Headache; HIV Infections; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Dissatisfaction from sexual relationships can result in deprivation as well as problems, such as depression, anxiety, and destruction of family's mental health. One hundred twenty-five women (18 to 40 years) who suffered from hypoactive sexual desire disorder were divided into Elaeagnus angustifolia flower (4.5 g g daily for 35 days), sildenafil citrate tablet (50 mg for 4 weeks), and control groups. The study data were collected using the Female Sexual Function Index and Spielberger's questionnaire and measurement of thyroid-stimulating hormone and prolactin hormone. In the Elaeagnus angustifolia group, the mean score of state and trait anxiety decreased after the intervention. In the sildenafil citrate group also, the mean score of state anxiety decreased from 22.15 ± 4.98 to 20.1 ± 5.15 (P = .001) and that of trait anxiety decreased from 23.07 ± 4.44 to 21.55 ± 4.82 (P = .002) after the intervention. Consumption of sildenafil citrate tablet was effective in reduction of the mean score of anxiety resulting from sexual dysfunction.

Topics: Adult; Elaeagnaceae; Female; Flowers; Humans; Patient Satisfaction; Plant Extracts; Sexual Dysfunction, Physiological; Sildenafil Citrate; Tablets; Treatment Outcome; Young Adult

Antidepressant-induced sexual dysfunction affects approximately 50% of patients taking antidepressants. Previous research has explored sildenafil's effectiveness in treating various forms of erectile dysfunction, but there is no research supporting sildenafil's use for improving the quality of life for patients with sexual dysfunction linked to antidepressant use. The authors of this article aimed to assess the improvements in quality of life in patients taking sildenafil to treat antidepressant-induced sexual dysfunction.. One hundred and two out of 2,239 male and female patients in the follow-up phase of the Sequenced Treatment Alternatives to Relieve Depression antidepressant trials who complained of sexual dysfunction were given sildenafil, 50 to 100 mg, as needed. After 12 months, we measured patients' change in libido, sexual drive, family relationships, overall well-being, satisfaction with treatment, and overall contentment with items on the 17-item Hamilton Depression Rating Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, 30-item Inventory of Depressive Symptoms, and 12-item Short Form Health Survey.. There was a significant association between sildenafil use and improvement in libido and sexual drive by month 6. There was no significant improvement in the quality-of-life scores we examined, but treatment satisfaction and overall contentment increased over time.. Despite no direct association with sildenafil use and quality-of-life scores, sildenafil may be a beneficial treatment for antidepressant-induced sexual dysfunction. A double-blind, placebo-controlled study of sildenafil in antidepressant-induced sexual dysfunction is needed to further explore its potential benefits.

Topics: Adult; Antidepressive Agents; Depressive Disorder, Major; Double-Blind Method; Female; Humans; Libido; Male; Middle Aged; Patient Preference; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Quality of Life; Sexual Behavior; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

Study Type--Therapy (RCT) Level of Evidence 1b. What's known on the subject? and What does the study add? Several authors have reported their experience with PDE5 inhibitors alone or in combination with selective serotonin re-uptake inhibitors for treating premature ejaculation. However, to our knowledge, this is the first laboratory design study to evaluate the effects of three PDE5 inhibitors throughout the ejaculation process in men with lifelong premature ejaculation. In this laboratory setting study PDE5 inhibitors seem to prolong ELT but the difference from placebo is significant only in vardenafil. The quality of penile rigidity is better with PDE5 inhibitors in the post-ejaculatory period but the difference is significant only in sildenafil and vardenafil.. • To evaluate the effects of three phosphodiesterase type 5 (PDE5) inhibitors on the ejaculation process in men with lifelong premature ejaculation using a double-blind laboratory setting.. • Eighty men with lifelong premature ejaculation, 20 in each group, received placebo, vardenafil (10 mg), sildenafil (50 mg) or tadalafil (20 mg) in a double-blind study design. Placebo or PDE5 inhibitor was ingested after at least 2 h fasting and non-smoking. The subjects were placed in a silent room immediately and real-time penile rigidity and tumescence was monitored. • Subjects read some magazines or newspapers without any sexually stimulating material for 1.5 h. At the end of this period audiovisual sexual stimulation began with a video film and after the 8th minute the subject began vibratory stimulation to the frenular area. • At the beginning of ejaculation the patient stopped stimulation. When the patient began and stopped stimulation, the light near the observer turned on and off and the observer calculated the ejaculation period with a chronometer. The elapsed time was the ejaculation latency time (ELT) in seconds. • There was no interaction between subjects and observer during the test. The ELT, and the qualities of base and tip rigidities during ELT and after ejaculation were calculated.. • Median age of patients was 29 (range 22-39) years and median duration of premature ejaculation was 60 (range 7-180) months and there was no significant difference between groups. Median duration of vibratory stimulation (ELT) of subjects who received placebo was 48.5 s: 53.5 s for sildenafil, 70.0 s for tadalafil and 82.5 s for vardenafil. Compared with the placebo group, ELT was significantly longer only in subjects receiving vardenafil (P = 0.019). • In the post-ejaculatory refractory period, times to last recorded base rigidities were significantly longer than placebo in vardenafil and sildenafil groups with better erection quality (P < 0.01 for each).. • The PDE5 inhibitors seem to prolong ELT and the quality of penile rigidity is better with PDE5 inhibitors in post-ejaculatory period. • These findings suggest that PDE5 inhibitors might have some beneficial effects in men with lifelong premature ejaculation.

Topics: Administration, Oral; Adult; Carbolines; Dose-Response Relationship, Drug; Ejaculation; Follow-Up Studies; Humans; Imidazoles; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Tadalafil; Treatment Outcome; Triazines; Vardenafil Dihydrochloride; Young Adult

Post-traumatic Stress Disorder (PTSD) symptoms cause dysfunction in broad areas of patients' lives and those of their families. Sexual dysfunction (SD) is common in these patients and aggravates their distress, affecting overall sexual activity, desire, arousal, orgasm, activity and satisfaction. PTSD clinic patients are frequently referred for consultation and treatment in the SD clinic. This prospective naturalistic follow-up study of a random group of patients was intended to evaluate response to pharmacologic and psychotherapeutic interventions for SD, in terms of both sexual functioning and overall symptomatology.. Ten patients fulfilling DSM-IV diagnostic criteria for PTSD (one woman and nine men) were recruited. Treatment for the sexual symptoms was tailored individually and was administered in addition to the continuing (stable) treatment in the PTSD clinic.. After two months of treatment for the sexual symptoms, statistically significant improvements in all domains of sexual functioning were observed. In parallel, statistically significant improvements in all domains of the Impact of Events Scale scores were observed, both on the avoidance and intrusive subscales. There were no significant differences in response to treatment in terms of time elapsed since the onset of PTSD, or the pattern or severity of sexual and PTSD symptoms.. The results of this modest study demonstrate the importance of relating to the SD of PTSD patients irrespective of the duration or severity of their disorder. In this mixed group of PTSD patients with varied duration of symptoms, both SD and PTSD core symptoms improved significantly in response to individually tailored adjunctive treatment of the SD.

Topics: Adult; Chronic Disease; Combined Modality Therapy; Complementary Therapies; Female; Humans; Male; Middle Aged; Piperazines; Prospective Studies; Psychotherapy; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Stress Disorders, Post-Traumatic; Sulfones; Surveys and Questionnaires; Vasodilator Agents

To analyze the effects of sildenafil citrate on clitoral blood flow and sexual response in postmenopausal women with orgasmic dysfunction.. In this randomized, double-blind, placebo-controlled trial 22 women received a 50-mg dose of sildenafil (n=11) or placebo (n=11) daily for 15 days. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was used for subjective evaluation of the sexual-response cycle. Clitoral blood flow was measured by color and pulse Doppler at baseline, after 1 hour of taking the first dose, and after 15 days of treatment.. Blood flow was significantly more improved in the sildenafil than in the placebo group (P<0.05), and a positive correlation between Doppler values and GRISS scores was noted in the sildenafil group after only 15 days of treatment.. Sildenafil may improve clitoral blood flow and increase the GRISS scores in postmenopausal women with orgasmic dysfunction.

Topics: Blood Flow Velocity; Clitoris; Double-Blind Method; Female; Humans; Middle Aged; Personal Satisfaction; Piperazines; Postmenopause; Purines; Regional Blood Flow; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Pulsed; Vasodilator Agents

Antidepressant-associated sexual dysfunction is a common adverse effect that frequently results in premature medication treatment discontinuation and for which no treatment has demonstrated efficacy in women.. To evaluate the efficacy of sildenafil for sexual dysfunction associated with selective and nonselective serotonin reuptake inhibitors (SRIs) in women.. An 8-week prospective, parallel-group, randomized, double-blind, placebo-controlled clinical trial conducted between September 1, 2003, and January 1, 2007, at 7 US research centers that included 98 previously sexually functioning, premenopausal women (mean [SD] age 37.1 [6] years) whose major depression was remitted by SRIs but who were also experiencing sexual dysfunction.. Forty-nine patients were randomly assigned to take sildenafil or placebo at a flexible dose starting at 50 mg adjustable to 100 mg before sexual activity.. The primary outcome measure was the mean difference in change from baseline to study end (ie, lower ordinal score) on the Clinical Global Impression sexual function scale. Secondary measures included the Female Sexual Function Questionnaire, the Arizona Sexual Experience scale-female version, the University of New Mexico Sexual Function Inventory-female version, a sexual activity event log, and the Hamilton Depression Rating scale. Hormone levels were also assessed.. In an intention-to-treat analysis, women treated with sildenafil had a mean Clinical Global Impression-sexual function score of 1.9 (95% confidence interval [CI], 1.6-2.3) compared with those taking placebo (1.1; 95% CI, 0.8-1.5), with a mean end point difference of 0.8 (95% CI, 0.6-1.0; P = .001). Assigning baseline values carried forward to the 22% of patients who prematurely discontinued resulted in a mean end point in the sexual function score of 1.5 (95% CI, 1.1-1.9) among women taking sildenafil compared with 0.9 (95% CI, 0.6-1.3) among women taking placebo with a mean end point difference of 0.6 (95% CI, 0.3-0.8; P = .03). Baseline endocrine levels were within normal limits and did not differ between groups. The mean (SD) Hamilton scores for depression remained consistent with remission in both groups (4.0 [3.6]; P = .90). Headache, flushing, and dyspepsia were reported frequently during treatment, but no patients withdrew because of serious adverse effects.. In this study population, sildenafil treatment of sexual dysfunction in women taking SRIs was associated with a reduction in adverse sexual effects.. clinicaltrials.gov Identifier: NCT00375297.

Topics: Adult; Antidepressive Agents; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Double-Blind Method; Female; Hormones; Humans; Middle Aged; Piperazines; Prospective Studies; Psychiatric Status Rating Scales; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Vasodilator Agents

Recently, sildenafil has been demonstrated to be effective in treating premature ejaculation (PE). However, these studies ignored female factors and could not exclude the probability of drug interaction when combined with paroxetine. Therefore, the aim of this study was to evaluate the efficacy and safety of sildenafil alone in the treatment of primary PE, taking female factors into consideration.. One hundred and eighty potent men with primary PE were randomly divided into three groups and followed up for 6 months. Group A were treated with 50 mg sildenafil as needed, group B with 20 mg paroxetine daily and group C with squeeze technique daily. Intravaginal ejaculatory latency time (IELT), PE grade, intercourse satisfactory score (ISS), frequency of intercourse, and adverse effects of drugs were recorded before treatment, and 3 and 6 months after treatment.. Compared with pretreatment, the three groups had significant differences in all the parameters after 3 or 6 months treatment, except the frequency of intercourse in Group C (all P = 0.00). However, there were no significant differences between 3 and 6 months. Compared with paroxetine and squeeze technique, after 3 or 6 months, sildenafil had significant differences in all the parameters (all P = 0.00). After 6 months, 1.7%, 18.3% and 36.7% patients in groups A, B and C, respectively, withdrew from the study and 86.7%, 60.0% and 45.0% patients, respectively, wanted to be treated further with the original administration, and this was statistically significant (both P = 0.00).. Sildenafil is very effective and safe to treat PE, and has much higher efficacy than paroxetine and squeeze technique.

Topics: Adolescent; Adult; Coitus; Ejaculation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Personal Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Purines; Reaction Time; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

The aim of this study was to compare the efficacy of fluoxetine alone and combined with sildenafil in patients complaining of premature ejaculation.. Ninety-one married potent men, 21-43 years old, with premature ejaculation but without any obvious organic cause were enrolled. Pretreatment evaluation included history, physical examination, and self-administration of the International Index of Erectile Function questionnaire. The patients were randomly divided into two groups: group A patients (n = 48) received 20 mg fluoxetine daily for 4 weeks and then 20 mg as needed 2-3 h before sexual activity for 4 months, and group B patients (n = 43) received group A regimen plus 50 mg sildenafil as needed 1 h before sexual activity for 4 months.. Ejaculatory latency time and intercourse satisfaction significantly improved in group B as compared with group A (p < 0.05).. Fluoxetine combined with sildenafil seems to provide significantly better ejaculatory latency time and intercourse satisfaction as compared with fluoxetine alone in patients with premature ejaculation.

Topics: Adult; Drug Therapy, Combination; Ejaculation; Fluoxetine; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Single-Blind Method; Sulfones; Time Factors

To compare the efficacy of sildenafil (Viagra) only, sildenafil plus topical anesthetic cream (EMLA), and topical EMLA-cream-only to that of placebo in treating premature ejaculation.. A total of 84 patients were enrolled in this study. The duration of premature ejaculation in the patients ranged from 9 to 60 months (mean 32.5 +/- 14.6). Patients were randomized into four groups. Group 1 consisted of 20 patients who took placebo for 2 months. Groups 2 and 3 consisted of 20 and 22 patients, respectively, and they received 50 mg sildenafil 45 minutes before coitus for 2 months. In addition, patients in group 3 applied topical EMLA cream to the glans penis 15 minutes before coitus. The 22 patients in group 4 used topical EMLA-cream-only. After at least eight sexual attempts, the patients' clinical responses were assessed using the patient self-description method. Effectiveness was described as improvement plus cure.. The effectiveness was 40% in group 1, 55% in group 2, 86.4% in group 3, and 77.3% in group 4. Of the groups, a significant difference was found in the effectiveness of the treatments (Pearson chi-square= 0.00). No significant difference was found between groups 1 and 2 (P = 0.26). Efficacy was more successful in groups 3 and 4 than in the others (P = 0.00). The difference between groups 3 and 4 was not significant (Pearson chi-square = 0.42).. Sildenafil-only was not superior to placebo or combination treatment. Topical EMLA-cream-only had equal effectiveness to that of sildenafil plus topical EMLA treatment. The use of topical EMLA-cream-only seems to be an effective treatment of premature ejaculation.

Topics: Administration, Topical; Adult; Anesthetics, Local; Drug Therapy, Combination; Ejaculation; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Phosphodiesterase Inhibitors; Piperazines; Prilocaine; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Time Factors

To assess the effect of premature ejaculation (PE) and low desire on the efficacy and satisfaction rate of sildenafil in the treatment of erectile dysfunction (ED).. A total of 586 male patients with ED in association with and without PE or low desire were enrolled in this study. Patients were screened for ED using the International Index for Erectile Function. All patients were also screened for PE and low desire. We compared the responses to the erectile function domain, questions 3 and 4, before and after sildenafil in patients with and without PE or low desire. Overall satisfaction and global efficacy question responses were also assessed in all patients.. The mean age +/- SD was 58 +/- 6.4 years. Significant associations were found between the increased duration and severity of ED and the decreased rate of overall satisfaction. Before sildenafil administration, significant differences were found in the erectile function domain, Q3 and Q4 between patients with and without PE or low desire. After sildenafil administration, no significant differences were found in those assessment variables and the presence or absence of PE and low desire. No significant differences were found between the global efficacy question response and the overall satisfaction rate between patients with and without PE or low desire.. The efficacy of sildenafil was negatively affected by an increased duration and severity of ED; however, global efficacy and overall patient satisfaction were not attenuated by PE or low desire.

Topics: Ejaculation; Erectile Dysfunction; Humans; Libido; Male; Middle Aged; Patient Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Time Factors

We assessed the tolerability, safety and efficacy of sildenafil for the treatment of women with sexual dysfunction secondary to multiple sclerosis, as well as the role of somatosensory evoked potential neurophysiological testing.. We performed a double-blind, randomized, placebo controlled, crossover study investigating the effects of sildenafil in women with multiple sclerosis and sexual dysfunction. Assessments were done by validated questionnaires. Pudendal and tibial evoked potentials were also recorded.. A total of 19 women completed the 2 arms of the double-blind phase and 12 completed the optional open label extension phase. Statistically significant improvement following sildenafil was only reported in the lubrication domain of sexual function during the double-blind phase. There was no overall change in quality of life after sildenafil. There was a significant correlation between the latency of tibial and pudendal evoked potentials.. Sildenafil only appeared to produce limited benefit in certain individuals with female sexual dysfunction. Some measure of the extent of neurological deficit in these patients could be ascertained from the latency of tibial evoked potentials, which correlated with pudendal evoked potentials. However, it could not predict the extent of sexual dysfunction. Sildenafil is unlikely to help all patients with neurogenic female sexual dysfunction.

Topics: Algorithms; Cross-Over Studies; Double-Blind Method; Female; Humans; Multiple Sclerosis; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires

To determine the changes, if any, on female sexual pathways using sildenafil (primary outcome), and to verify the safety of this drug (second outcome).. Following previous research on symptomatic women, we wanted to study the effects of sildenafil on asymptomatic women. We would like to make it clear from the outset that this study is part of an ongoing line of research and this drug, and others of its type, should be used under strict medical supervision only on symptomatic patients. A randomized double-blind cross-over, placebo-controlled study was conducted at the Family Planning Centre of the Group for Sexological Research, Department of Microbiological and Gynecological Science, School of Medicine, University of Catania, Italy. Sixty-eight healthy volunteer women aged 19-38 years, asymptomatic for sexual disorders, were enrolled. The study consisted of 4 weeks sildenafil, 2 weeks washout, and 4 weeks placebo, by two possible sequences: sildenafil 50 mg, washout, placebo; or placebo, washout, sildenafil 50 mg. Efficacy of sildenafil was assessed by the Personal Experiences Questionnaire (PEQ) based on the 5-point Likert scale. The questionnaire quantified subjective sexual aspects at baseline, during washout, after treatments, and at the follow-ups. Statistical analysis was done with the Wilcoxon's rank-sum test and Student's t-test.. 50/68 women completed the study at the first follow-up, and 38 women reached the second follow-up. Six women withdrew because of adverse events. Sildenafil improved arousal (P<0.001), orgasm (P<0.05), and enjoyment (P<0.001) with respect to placebo. Significant differences were noted during sildenafil usage with respect to the baseline for arousal (P<0.01), orgasm (P<0.001), and sexual enjoyment (P<0.001). The adverse events were transient and mild or moderate.. Our study suggests that sildenafil acts on the different sexual pathways in healthy women, improving their sexual experience. This study could help to understand the physiologic and pathophysiologic aspects of female sexuality. In comparison with current psychosexual therapies, which are long-term, compliance would be improved with use of this drug. Additional studies are required to define the use of sildenafil in a clinical setting.

Topics: Adult; Cross-Over Studies; Double-Blind Method; Female; Humans; Orgasm; Piperazines; Placebos; Purines; Sexual Behavior; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires

Some postmenopausal women lose genital sexual responsivity despite preserved subjective sexual arousal from non-genital stimuli. When oestrogen replacement is without benefit, both the underlying pathophysiology and management of this acquired genital female sexual arousal disorder are unclear. We aimed to study the effect of sildenafil on sexual arousal and orgasmic functioning of such women. Secondly, we aimed to explore the concordance between a detailed historical assessment of genital response in real life, with laboratory vaginal photoplethysmographic assessment of genital vasocongestion.. Session one consisted of a semi-structured clinical interview to assess real life sexual arousal. Session two employed vaginal pulse amplitude and self-report questionnaire assessment of erotica-induced sexual arousal. Sessions three and four were a randomised, double-blind, placebo-controlled crossover administration of sildenafil on orgasm latency, intensity, perception of genital congestion and subjective arousal to erotica plus clitoral vibrostimulation.. University associated Sexual Medicine Clinic and Psychophysiology Laboratory.. Volunteer sample of 34 oestrogenised postmenopausal women with acquired genital female sexual arousal disorder and impaired orgasm.. Sildenafil (50 mg) or placebo administered over two laboratory sessions.. Orgasm latency and intensity during drug sessions; subjective and psychophysiological sexual arousal during photoplethysmography session.. The erotic video significantly increased subjective sexual arousal in all women. Vaginal pulse amplitude responses varied from robust to absent. Although across all women, sildenafil improved neither arousal nor orgasm, subsequent analyses comparing high versus low vaginal pulse amplitude responders revealed significantly reduced latency to orgasm, and increased subjective sexual arousal and perception of genital arousal in the latter group of women.. The data suggest that oestrogenised postmenopausal women with genital female sexual arousal disorder and orgasmic impairment based only on clinical assessment do not benefit from sildenafil. However, the photoplethysmograph had predictive value-those women showing low vaginal pulse amplitude response benefited from sildenafil compared with women with a higher response. Thus, oestrogenised women diagnosed with acquired genital female sexual arousal disorder may be a heterogeneous group and the photoplethysmograph might be useful in their further characterisation.

Topics: Adult; Aged; Analysis of Variance; Arousal; Double-Blind Method; Erotica; Estrogen Replacement Therapy; Female; Humans; Libido; Middle Aged; Orgasm; Phosphodiesterase Inhibitors; Piperazines; Postmenopause; Pulse; Purines; Reaction Time; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vagina

Sildenafil citrate (Viagra Pfizer, New York, NY) is indicated for the treatment of erectile dysfunction in men. The nitric oxide-cyclic guanosine monophosphate pathway (NO-cGMP) involved in penile erection and enhanced by sildenafil may also play a role in some components of the female sexual arousal response. The efficacy and safety of sildenafil were evaluated in estrogenized and estrogen-deficient women with sexual dysfunction that included female sexual arousal disorder (FSAD).. Patients were randomized to receive 10-100 mg sildenafil or matching placebo. To assess efficacy, patients completed two global efficacy questions (GEQ), the Life Satisfaction Checklist (LSC), an event log of sexual activity, and a 31-item sexual function questionnaire (SFQ). To assess safety, adverse event (AE) data were recorded.. A total of 577 estrogenized and 204 estrogen-deficient women were randomized to treatment. All were diagnosed with FSAD, but it was the primary presenting symptom in only 46% and 50% of women, respectively. Differences in efficacy between sildenafil and placebo were not significant for any patient or partner end points (e.g., the two GEQ, the sexual event logs, the LSC, and the SFQ). The main AE were headache, flushing, rhinitis, nausea, visual disturbances, and dyspepsia, which were generally mild to moderate in nature.. Any genital physiological effect of sildenafil was not perceived as improving the sexual response in estrogenized or estrogen-deficient women with a broad spectrum of sexual dysfunction that included FSAD. Whether more specific subgroups of women with FSAD could potentially benefit from treatment with sildenafil is an area for future research.

Topics: Adult; Analysis of Variance; Dose-Response Relationship, Drug; Double-Blind Method; Dyspepsia; Estradiol; Estrogen Replacement Therapy; Female; Flushing; Headache; Humans; Middle Aged; Nausea; Piperazines; Purines; Rhinitis; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Statistics as Topic; Sulfones; Surveys and Questionnaires; Treatment Outcome; Vasodilator Agents; Vision Disorders

The objective was to compare the efficacy and safety of the as needed use of clomipramine, sertraline, paroxetine, sildenafil and the pause-squeeze technique in treatment of primary premature ejaculation. A prospective double blind randomized crossover study involving 31 patients was performed. Treatment phases comprised five 4-week consecutive treatment periods, each separated by a two-week washout period. Patients were randomly assigned to receive each of the 4 drugs and use pause-squeeze on an as needed basis. Drugs were administered 3 to 5 hours before anticipated coitus. Anxiety score and ejaculation latency time were measured before treatment, after each treatment, and during washout periods. Sexual satisfaction score was measured after each treatment. The median ejaculation latency time was significantly increased from the pretreatment median of 1 minute to 4 minutes, 3 minutes, 4 minutes, 15 minutes and 3 minutes during treatment with clomipramine, sertraline, paroxetine, sildenafil and pause-squeeze technique, respectively (all P 0.0001). Sildenafil was superior to other modalities in terms of ejaculation latency and satisfaction (P = 0.0001). The three antidepressants were comparable to each other in terms of efficacy (P > 0.05). Paroxetine was superior to the pause-squeeze technique in terms of efficacy (P < 0.05). In conclusion, sildenafil appears to be superior to other modalities and a valid alternative in treatment of premature ejaculation. The 3 antidepressants were equivalent to each other in terms of efficacy and safety. Paroxetine was superior to pause-squeeze technique in terms of efficacy.

Topics: Adult; Antidepressive Agents; Clomipramine; Double-Blind Method; Ejaculation; Humans; Male; Middle Aged; Paroxetine; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Purines; Sertraline; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Time Factors

Sexual dysfunction is common in women with spinal cord injuries (SCIs) and other neurologic conditions. Sildenafil has previously been shown to be safe and effective in the treatment of erectile dysfunction due to SCI. This study is the first to evaluate the sexual and cardiovascular effects of sildenafil in women with SCIs in a controlled, laboratory setting.. Nineteen premenopausal women with SCIs were randomly assigned to receive either sildenafil (50 mg) or placebo in a double-blind, crossover design study. Physiologic and subjective measures of sexual response, heart rate, and blood pressure were recorded during baseline and sexual stimulation conditions. Adverse events were also recorded.. Significant increases in subjective arousal (SA) were observed with both drug (P <0.01) and sexual stimulation conditions (P <0.001), and a borderline significant (P <0.07) effect of drug administration on vaginal pulse amplitude (VPA) was noted. Maximal responses occurred when sildenafil was combined with visual and manual sexual stimulation. Cardiovascular data showed modest increases in heart rate (+/-5 bpm) and mild decreases in blood pressure (+/-4 mm Hg) across all stimulation conditions, consistent with the peripheral vasodilatory mechanism of the drug. Sildenafil was well tolerated with no evidence of significant adverse events.. Findings suggest that sildenafil may partially reverse the sexual dysfunction commonly associated with SCI in women. Consistent with previous findings in men, the sexual effects of the drug were most evident under conditions of optimal stimulation. Mild, clinically insignificant cardiovascular effects were also noted. Further large-scale studies of sildenafil's effects in women with neurogenic sexual dysfunction are strongly indicated.

Topics: Adult; Blood Pressure; Cross-Over Studies; Double-Blind Method; Female; Heart Rate; Humans; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Behavior; Sexual Dysfunction, Physiological; Sildenafil Citrate; Spinal Cord Injuries; Sulfones

Sildenafil has been demonstrated to be safe and effective in the treatment of men with erectile dysfunction. The role of sildenafil in treating women with sexual dysfunction has heretofore not been reported. The purpose of this preliminary study was to ascertain the response of postmenopausal women with self-described sexual dysfunction treated with sildenafil for 3 months.. Thirty-three consecutive postmenopausal women with sexual dysfunction based on history were entered in this open-label, nonrandomized study. All patients received 50 mg of sildenafil. Efficacy was assessed at weeks 4, 8, and 12 using a newly developed 9-item, self-administered Index of Female Sexual Function (IFSF) and a global efficacy question ([GEQ] Did treatment improve your sexual function?). The IFSF quantifies the domains of desire, quality of sexual intercourse, overall satisfaction with sexual function, orgasm, lubrication, and clitoral sensation.. Of the group, 30 women (91 %) completed the study and were available for follow-up at 3 months. Mean baseline IFSF score before therapy was 24.8+/-9.8. Mean usage of sildenafil was 3.1+/-1.4 times per week for the duration of the study. The IFSF score improved to 29.5+/-7.6, 30.3+/-8.5, and 31.4+/-10.4 at 4, 8, and 12 weeks, respectively (P = 0.25). Mean scores for questions 2 (lubrication), 8 (orgasm), and 9 (clitoral sensation) improved by 23.2%, 7.4%, and 31.3%, respectively, at 12 weeks. Seven women (21%) noted improvement on the GEQ. Overall, only 6 (18.1%) of 33 patients had a significant (more than 60% improvement in IFSF score) therapeutic response. Clitoral discomfort and "hypersensitivity" occurred in 7 women (21%), 3 of whom withdrew from the study. Other side effects, which did not result in withdrawal from the study, included headache (n = 5), dizziness (n = 4) and dyspepsia (n = 3).. The data suggest that sildenafil is well tolerated in postmenopausal women with sexual dysfunction. Overall sexual function did not improve significantly, although there were changes in vaginal lubrication and clitoral sensitivity. The role of sildenafil in treating sexual dysfunction in various cohorts of women remains to be determined.

Topics: Adult; Aged; Female; Humans; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Postmenopause; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires

Sexual dysfunction is a side effect of the antidepressant drug paroxetine. Anogeissus leiocarpus is a medicinal plant with a wide range of biological activities which include antioxidant and antiulcer properties. With these in mind, we investigated the effect of Anogeissus leiocarpus stem bark extract on paroxetine-induced sexual dysfunction in male Wistar rats. Forty-two adult male Wistar rats were divided into seven experimental groups: normal control, PAR (10 mg/kg), PAR + sildenafil (5 mg/kg), ALE (50 and 100 mg/kg) and PAR + ALE (50 and 100 mg/kg). The experiment lasted for 21 days, after which the rats were subjected to sexual behavioral test. Various biochemical assays (phosphodiesterase-5, arginase, acetylcholinesterase, nitric oxide and MDA) were carried out on the penile tissue homogenate. From our findings, paroxetine significantly altered sexual behavior in male rats and increased phosphodiesterase-5, arginase and acetylcholinesterase activities with a concomitant decrease in nitric oxide level. Furthermore, paroxetine altered antioxidant status which revealed by increased MDA level and reduced thiol level. However, treatment with Anogeissus leiocarpus stem bark extract reversed the altered sexual behavior in male rats and boosted antioxidant status. In addition, administration of Anogeissus leiocarpus stem bark extract resulted in a significant attenuation of phosphodiesterase-5, arginase and acetylcholinesterase activities in paroxetine-induced rats. In view of the aforementioned findings, Anogeissus leiocarpus could be considered a promising natural agent in erectile dysfunction management.

Topics: Animals; Antioxidants; Arginase; Combretaceae; Cyclic Nucleotide Phosphodiesterases, Type 5; Erectile Dysfunction; Male; Malondialdehyde; Nitric Oxide; Paroxetine; Penis; Plant Extracts; Plants, Medicinal; Rats; Rats, Wistar; Sexual Behavior; Sexual Dysfunction, Physiological; Sildenafil Citrate

Auricularia polytricha is a popular mushroom found all over the world. In this study we considered the effect of an aqueous extract of A. polytricha (AEAP) on restoring sexual performance parameters to normal, evaluated by considering observations of sexual behavior. At 0, 6, 12, 18, and 24 days, the following parameters of sexual performance were identified before and throughout the observations: mount latency, intromission latency, ejaculation latency, mounting frequency, intromission frequency, ejaculation frequency, and postejaculatory interval. Treatment of rats under stress with AEAP showed promising effects on overcoming stress-induced sexual dysfunction, on sexual performance, and on accessory sexual organs and body weight. Mounting latency, intromission latency, ejaculation latency, and postejaculatory interval parameters were significantly decreased by AEAP, whereas mounting frequency, intromission frequency, and ejaculation frequency were significantly increased by AEAP. These properties were identified in sexually dynamic and indolent male rats. We conclude that AEAP has a potent aphrodisiac activity.

Topics: Agaricales; Animals; Aphrodisiacs; Female; Male; Rats; Rats, Wistar; Sexual Behavior, Animal; Sexual Dysfunction, Physiological; Sildenafil Citrate; Stress, Physiological; Water

Diabetes-associated male sexual dysfunction and fertility impairments are both common clinical complications with limited therapeutic options; hence it seriously affects the quality of life of the patients, in particular, the patients of reproductive age. Lycium barbarum polysaccharide (LBP) has long being believed to maintain and to promote reproductive functions in the traditional medical practice in China. The current study was to investigate if LBP may contribute to recovery of male sexual dysfunction and fertility impairments in diabetic individuals. The effects of LBP on sexual behaviors and histological changes of testis were studied in the type-1 diabetes male mice induced by intra-peritoneal (i.p.) injection of streptozotocin (STZ). After oral administration of LBP (10, 20 or 40 mg/kg), sildenafil citrate (SC, 5 mg/kg) or saline for 62 consecutive days, the typical abnormal changes in the sperm parameters, in relative weight of reproductive organs and in morphology of testis were observed in diabetic mice. LBP treatment of the diabetic mice considerably reversed those changes and Johnsen's testicular score, serum testosterone (T), follicular stimulating hormone (FSH) and luteinizing hormone (LH) level were also increased to different degrees. Moreover, our data have also shown that a marked improvement in sexual behavior and fertility level after administration of LBP (40 mg/kg) compared to the diabetic group. These results suggested that LBP can exert functional recovery of male sexual dysfunction and fertility damages induced by diabetes in male mice, which is likely to be mediated through regulating the hypothalamus- pituitary-gonadal axis endocrine activity.

Topics: Animals; Diabetes Mellitus, Experimental; Drugs, Chinese Herbal; Follicle Stimulating Hormone; Hypothalamo-Hypophyseal System; Infertility, Male; Luteinizing Hormone; Male; Mice; Phosphodiesterase 5 Inhibitors; Protective Agents; Sexual Behavior, Animal; Sexual Dysfunction, Physiological; Sildenafil Citrate; Testis; Testosterone

Sexual dysfunction is common after traumatic brain injury (TBI) but evaluation of treatment interventions have been sparse.. To report on the treatment of sexual dysfunction for two males with severe TBI.. Case one was treated for erectile dysfunction (ED). After a medical examination which found no underlying physiological problems, Sildenafil was prescribed. Scores on the Golombok Rust Inventory of Sexual Satisfaction Impotence subscale found that scores had improved from the dysfunction range at baseline to the functional range at 6 weeks follow-up. There was some reduction in this improvement at 3 months follow-up, maybe associated with a co-morbid deterioration of emotional state. Case two was treated for idiopathic delayed ejaculation (DE). A standard sex therapy intervention was employed that resulted in the resolution of the problem, documented on the Sex Behavior sub-scale of the Derogatis Inventory for Sexual Functioning-Self Report (comparing baseline to post intervention and follow-up scores).. The case reports show promise for the treatment of sexual dysfunction after severe TBI using standard medical and sex therapy treatments. In the future, controlled evaluations are required to demonstrate the efficacy of such interventions.

Topics: Adult; Behavior Therapy; Brain Injuries, Traumatic; Erectile Dysfunction; Humans; Male; Middle Aged; Sexual Dysfunction, Physiological; Sildenafil Citrate; Urological Agents; Young Adult

An advantage of sexuality after 60 years of age is the increased need for couple involvement to promote desire, pleasure, eroticism, and satisfaction inherent to the healthy aging process. This case study clinically explores the complex psychobiosocial interactions for understanding, assessing, and treating sexual problems for couples age 60 years and older, emphasizing the Good Enough Sex approach of variable, flexible, and shared sexual pleasure. Aging couples are discouraged from appraising their sexual experiences within the parameters of the pass/fail binary of the traditional individual performance model and are instead encouraged to embrace the evolving elasticity of their sexual experiences. The Good Enough Sex model espouses an approachable and satisfying alternative for the promotion of sexual function and satisfaction throughout the life span, with particular interest in late adulthood sexual health.

Topics: Age Factors; Aged; Combined Modality Therapy; Erectile Dysfunction; Female; Humans; Libido; Male; Medication Adherence; Qualitative Research; Quality of Life; Recurrence; Self Concept; Sex Counseling; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate

Topics: Benzimidazoles; Drug Approval; Female; Humans; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfonamides; United States; United States Food and Drug Administration

This exploratory study examines the experience of three gay couples managing sexual dysfunction as a result of undergoing a radical prostatectomy. Semi-structured interviews were conducted as part of a larger study at an urban hospital in Toronto, Ontario, Canada. Interview transcripts were transcribed verbatim, and analyzed using interpretative phenomenological analysis. The authors clustered 18 subordinate themes under 3 superordinate themes: (a) acknowledging change in sexual experience (libido, erectile function, sexual activity, orgasmic function); (b) accommodating change in sexual experience (strategies: emphasizing intimacy, embracing plan B, focus on the other; barriers: side-effect concerns, loss of naturalness, communication breakdown, failure to initiate, trial and failure, partner confounds); and (c) accepting change in sexual experience (indicators: emphasizing health, age attributions, finding a new normal; barriers: uncertain outcomes, treatment regrets). Although gay couples and heterosexual couples share many similar challenges, we discovered that gay men have particular sexual roles and can engage in novel accommodation practices, such as open relationships, that have not been noted in heterosexual couples. All couples, regardless of their level of sexual functioning, highlighted the need for more extensive programming related to sexual rehabilitation. Equitable rehabilitative support is critical to assist homosexual couples manage distress associated with prostatectomy-related sexual dysfunction.

Topics: Adaptation, Psychological; Adult; Communication; Erectile Dysfunction; Gender Identity; Homosexuality, Male; Humans; Interpersonal Relations; Interview, Psychological; Libido; Male; Middle Aged; Orgasm; Penile Prosthesis; Piperazines; Postoperative Complications; Prostatectomy; Purines; Sexual Behavior; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Urinary Incontinence

Topics: Antidepressive Agents, Second-Generation; Bupropion; Depressive Disorder, Major; Humans; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Pedalium murex Linn. has been used as Vajikaran Rasayana (aphrodisiac) in traditional Indian medicine to treat male sexual dysfunction and impotency.. The aim of this study was to investigate effects of P. murex fruits extract on sexual behaviors and testosterone level of male rats during and past withdrawal of treatment.. The extract (50, 100,150mg/kg body weight/day) and sildenafil citrate (5mg/kg body weight/day) were administered orally by gavages for 28 days to male Wistar albino rats. Penile erection index (PEI), mount latency (ML), intromission latency (IL), ejaculation latency (EL), mounting frequency (MF), intromission frequency (IF), post ejaculatory interval (PEjI) and serum testosterone levels were studied at day 0, 15, 28 during treatment. They were further evaluated after day 7 and 15 past discontinuation of the treatment. In-vitro nitric oxide release activity was also investigated in human corpus cavernosal cell line.. The ethanolic extract significantly reduced the ML, IL, EL and PEjI (p<0.05). There was a significant increase in the PEI, MF and IF and serum testosterone level (p<0.05) throughout the period of study. Ethanolic extract produced a significant effect on sexual behavior and serum testosterone level past withdrawal of the treatment. In-vitro nitric oxide release was significantly higher in extract and sildenafil citrate compared to the control group.. Present findings provide experimental in-vivo and in-vitro evidence that the ethanolic extract of P. murex fruits possesses aphrodisiac property. Study lends growing support for the traditional use of P. murex as a sexual stimulating agent and offers a significant potential for studying the effect on male sexual response and its dysfunctions. The findings justify the concept of Rasayana as rejuvenative tonics and support their role in prevention or delay of the aging process.

Topics: Animals; Aphrodisiacs; Copulation; Ejaculation; Erectile Dysfunction; Female; Fruit; Male; Medicine, Ayurvedic; Nitric Oxide; Pedaliaceae; Penile Erection; Phytotherapy; Piperazines; Plant Extracts; Purines; Rats; Rats, Inbred Strains; Sexual Behavior, Animal; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Testosterone; Vasodilator Agents

Abstract While historically sex has been seen primarily as the prerogative of the young, more recently, the emphasis has been on the maintenance of active sexuality as a marker of successful ageing. A new cultural consensus appears to have emerged which not only emphasises the importance of continued sexual activity across the lifespan, but links sexual function with overall health and encourages increased self-surveillance of, and medical attention to, late-life sexuality. Drawing on historical accounts, clinical research, popular science reporting and health promotion literatures, I explore several key shifts in models of sexual ageing, culminating in the contemporary model of gender, sexuality and ageing that has made ageing populations a key market for biotechnologies aimed at enhancing sexual function. Two central concepts frame my analysis: 'virility surveillance', where age-related changes in sexual function are taken as indicative of decline, and the 'pharmaceutical imagination', where sexual lifecourses are reconstructed as drug effects revise standards of sexual function. After consideration of how narratives emerging from qualitative research with older adults challenge the narrow depiction of sexual functionality promoted by pharmaculture, conclusions call for continued critical inquiry into the biomedical construction of sex and age.

Topics: Age Factors; Aged; Aging; Biotechnology; Erectile Dysfunction; Health Status; Humans; Life Style; Male; Phosphodiesterase Inhibitors; Piperazines; Prejudice; Purines; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sexuality; Sildenafil Citrate; Social Perception; Sulfones

Topics: Antidepressive Agents, Second-Generation; Female; Humans; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones

Topics: 5-alpha Reductase Inhibitors; Adrenergic alpha-1 Receptor Antagonists; Drug Synergism; Enzyme Inhibitors; Finasteride; Humans; Imidazoles; Male; Piperazines; Prostatic Hyperplasia; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Triazines; Vardenafil Dihydrochloride; Vasodilator Agents

Topics: Congresses as Topic; Dyspareunia; Erectile Dysfunction; Female; Humans; Male; Periodicals as Topic; Phosphodiesterase Inhibitors; Piperazines; Purines; Sex Counseling; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Societies, Medical; Sulfones; Vasodilator Agents

Topics: Adult; Antidepressive Agents; Depressive Disorder; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: Antidepressive Agents; Depressive Disorder, Major; Female; Humans; Piperazines; Purines; Risk Assessment; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Antidepressive Agents; Confounding Factors, Epidemiologic; Depressive Disorder, Major; Female; Humans; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Antidepressive Agents; Depression; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Women's Health

The aim of this study was to analyze the sexual dysfunction in patients affected by multiple sclerosis.. From January 2005 to December 2007, 221 consecutive patients, 97 women and 124 men, were included in the study. Age range was 20+/-65 years (average 38.77). Fifty-two patients, 14 women (26.9%) and 38 men (73%), among those who have had sexual dysfunctions, showed their will to tackle their problem, and were thus taken into consideration by the Department of Andrology. Sexual activity of these patients has been estimated by self-administered questionnaire, through the International Index of Erectile Function (IIEF) for men and Index of Female Sexual Arousal (IFSA) for women. All 64 patients started a domiciliary therapy with sildenafil 50 mg, and in case of failure, sildenafil 100 mg. Results have been estimated for men according to the IIEF questionnaire and to the answers to the third and fourth question, concerning the capacity to have and keep an adequate erection during a sexual intercourse, and for women according to the IFSA questionnaire and to the answers given to questions number 1, 5, 6, and 10.. Among the 124 male patients, 25 (20.1%) had a serious deficiency of the erectile function (score IIEF<10), 11 (8.8%) had a moderate deficiency (score from 11 to 16), and 20 (16.12%) had a light deficiency (score from 17 to 25). Twenty-five patients affected with serious erectile deficiency, also reported a contemporaneous decrease of libido. Among the 97 female patients, 22 (28.86%) of them reported a serious decrease of the genital sensitivity and of the sexual desire; 22 (22.68%) of them reported instead a serious decrease of the vaginal lubrication; 9 (9.2%) reported a moderate decrease of the sensitivity, and 10 (10.30%) reported a moderate decrease of the vaginal lubrication. According to Disability Scale Expanded Score 52 male patients showed a 2.6 mean score (range 1.5-7); 14 female patients showed a 2.9 mean score (range 3-6). The answers to IIEF questions number three and four, and to the IFSA questions number 1, 5, 6 and 10 reported the achievement and keeping of an adequate erection after a follow-up of 4 sexual intercourse, and lubrication and sensitivity during a sexual intercourse in all the cases analysed.. Sildenafil has been effective and safe in the treatment of sexual dysfunctions for both sexes. In all analysed patients sexual deficiency was due to the neurological and central nervous system on which depend different dysfunctions correlated with the extension and the gravity of the multiple sclerosis. IIEF questions number 13 and 14 and IFSA questions number 21 and 22 showed a clear improvement of the sexual life quality of these patients, after sildenafil therapy.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Multiple Sclerosis; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Female sexual dysfunction can be founded by disorders of sexual desire, arousal, orgasm, and sexual pain. Physiologic sexual dysfunction can, in many cases, be the result of impaired neurovascular tone to the clitoris and vagina. The vagina and clitoris both contain erectile tissue and phosphodiesterase type 5 (PDE5). Accordingly, the use of sildenafil, a PDE5 inhibitor, has been studied in relation to neurogenic female sexual dysfunction. The present case report addresses neurogenic female sexual dysfunction from the result of a ruptured L5-S1 intervertebral disk. The patient was treated with sildenafil, and her symptoms were recorded using a Female Sexual Function Index score. Discussion of the use of sildenafil in women, with an emphasis on female neurovascular sexual physiology and function, is reviewed.

Topics: Adult; Clitoris; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Piperazines; Purines; Rupture; Sacrum; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vagina; Vasodilator Agents

To verify whether sildenafil is effective in modifying clitoral blood flow in premenopausal women affected by type 1 diabetes.. The setting was a diabetes outpatient clinic in which 30 premenopausal women affected by type 1 diabetes treated with insulin therapy and 39 healthy premenopausal women participated in our prospective open-label clinical study. Each diabetic woman received a single oral dose of 100 mg sildenafil. Translabial color Doppler ultrasonography was used to measure the resistance index, pulsatility index, peak systolic velocity, and end-diastolic velocity of the clitoral arteries 1 and 4 hours after sildenafil intake.. One hour after the administration of sildenafil, the mean resistance index was significantly lower and the mean pulsatility index, mean peak systolic velocity, and mean end-diastolic velocity of the clitoral arteries were significantly greater compared with baseline and 4 hours after sildenafil (P <0.05). The baseline clitoral blood flow of the diabetic women was lower compared with that of the control group (P <0.001).. Sildenafil seems to improve the clitoral blood flow of premenopausal women with type 1 diabetes.

Topics: Administration, Oral; Adult; Blood Flow Velocity; Clitoris; Diabetes Mellitus, Type 1; Female; Humans; Phosphodiesterase Inhibitors; Piperazines; Premenopause; Purines; Sexual Behavior; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Ultrasonography, Doppler; Vascular Resistance; Vasodilator Agents

Topics: Drug Design; Drug Industry; Drug Prescriptions; Female; Humans; Marketing; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Congresses as Topic; Enzyme Inhibitors; Heart Diseases; Humans; Male; Piperazines; Purines; Risk Factors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

The history of sexual medicine in the United Kingdom since the 19th century is reviewed, with particular reference to masturbation, homosexuality, contraception, and in the past four decades, the treatment of sexual dysfunction. The medical profession's tendency to deal with sexual issues according to the sociopolitical and moral issues of the time is emphasized, and whereas "sex negativism" has prevailed within the medical profession for most of this historical period, there has been a succession of individuals within the profession who have presented a more positive approach to defining and promoting sexual health. Four tracks within sexual medicine over the past 30 years are described: the psychoanalytic approach of the Institute of Psychosexual Medicine, modern "sex therapy," psychophysiological sex research, and the involvement of andrology in the assessment and treatment of erectile dysfunction. The impact of Viagra is seen as the most recent chapter in this history.

Topics: History, 19th Century; History, 20th Century; History, 21st Century; Humans; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexology; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; United Kingdom

Topics: Drug Administration Schedule; Erectile Dysfunction; Female; Humans; Male; Middle Aged; Piperazines; Postmenopause; Purines; Sex Factors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Treatment Failure; Vasodilator Agents

Data on female partners' satisfaction are scarce, although there have been many articles on patient satisfaction after sildenafil citrate treatment. The aim of this study was to evaluate the satisfaction of female partners of patients receiving sildenafil citrate for their erectile dysfunction (ED) and to assess the female partners' sexual function.. Ninety-eight patients with ED were treated. Their female partners were asked to answer a questionnaire we have prepared to evaluate the efficacy of treatment, sexual satisfaction and changes in quality of life. It also included a question about female sexual function. From the results, the relationship between their female partner's satisfaction and efficacy of treatment, as well as female sexual function, were assessed.. Thirty (31%) questionnaires were returned to us for analysis. Effectiveness of the treatment was acknowledged by 90% of the partners. An improvement in their partner's quality of life was noticed by 60% of the women. The majority (66.7%) of the female partners were satisfied with sildenafil citrate treatment and 20% were disappointed. Moreover, 20% of the female partners were concerned about adverse events. Regarding female sexual function, some form of sexual dysfunction affected 46.7% of the women. Furthermore, a significant number (P = 0.0230) of the female partners disappointed with the treatment had some kind of sexual dysfunction.. The results indicated that female partners reported relatively high levels of treatment satisfaction. Female partners' sexual function and anxiety regarding adverse events should be evaluated when their satisfaction with sildenafil citrate treatment is poor despite an improvement of erectile function.

Topics: Adult; Aged; Coitus; Erectile Dysfunction; Female; Humans; Male; Middle Aged; Personal Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Purines; Quality of Life; Sexual Dysfunction, Physiological; Sexual Partners; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome

To evaluate the efficacy of sildenafil and selective serotonin reuptake inhibitor in alleviating premature ejaculation (PE) in patients in whom other treatments had failed.. Healthy men evaluated for primary PE graded their ejaculation on a scale of 0 to 8 (0 = almost never, 8 = almost always). The intravaginal ejaculatory latency time (IVELT) was graded on a scale of 0 to 3 (0 = longer than 5 minutes, 3 = shorter than 1 minute). The 138 men who scored their PE as 4 or greater and IVELT as 2 or greater comprised the study group. Psychological and behavioral counseling was provided during the study. PE was graded using the same scales 3 months after the initiation of each treatment. Topical 5% lidocaine ointment comprised the initial treatment: dissatisfied patients (PE grade 4 or greater, IVELT 2 or greater), took one tablet of paroxetine 20 mg for 30 days and then one tablet 7 hours before intercourse. Sildenafil was added to the treatment of patients dissatisfied with paroxetine alone.. The mean initial PE grade was 5.67 +/- 0.13 and that for IVELT was 2.9 +/- 0.19 for all participants (mean age 28.7 years). Thirty-eight reported improvement (PE grade 2.0 +/- 0.8, P <0.01; IVELT 0.13 +/- 0.34, P <0.001) after local lidocaine application. Of the 100 treated with paroxetine, 42 reported improvement (PE grade 2.5 +/- 0.1, P <0.01; IVELT 0.28 +/- 0.46, P <0.001), and 56 of the remaining 58 who were treated with a combination of paroxetine and sildenafil reported improvement (PE grade 1.78 +/- 0.23, P <0.001; IVELT 0.16 +/- 0.37, P <0.001). Two patients remained dissatisfied with all treatment modalities.. Sildenafil combined with paroxetine and psychological and behavioral counseling alleviated PE in patients in whom other treatments failed.

Topics: Administration, Topical; Adolescent; Adult; Drug Therapy, Combination; Ejaculation; Humans; Lidocaine; Male; Paroxetine; Penis; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sex Counseling; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Treatment Outcome

Topics: Antidepressive Agents; Female; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sex Factors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: Dopamine Agonists; Humans; Libido; Life Style; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

To evaluate the efficacy and safety of sildenafil citrate in the treatment of premature ejaculation (PE) complicated by erectile dysfunction (ED).. Forty-five patients of PE complicated by ED received flexible doses of sildenafil from 50 to 100 mg for 1 to 3 months. Intravaginal ejaculatory latency time (IELT) and sexual satisfaction ratio (SSR) of partner were recorded to evaluate the effect of PE treatment, as well as the general efficacy and satisfaction of ED treatment. And the difference of IIEF-5 before and after the treatment were compared.. Twenty-seven patients had their PE improved and the effective rate was 60%. Forty patients reported the improvement in erection and the percentage of erectile improvement was 88.88%. All the 27 patients with improvement of PE achieved effective erection through the administration of 50 mg sildenafil and the satisfaction rate reached 81.48%. On the other hand, only 1 case (5.56%) reported satisfaction over the treatment in the 18 patients who did not obtain improvement of PE. Between the PE improvement group and non-improvement group, there were significant differences (P < 0.001) shown in IIEF-5 scores before and after the treatment. Mild or moderate side effects were reported in 9 patients(20%), who recovered without any treatment.. To premature ejaculation patients with ED, sildenafil can safely and effectively improve their erectile function, the satisfaction over the ED treatment outcome means that their PE symptoms could be alleviated.

Topics: Adult; Aged; Aged, 80 and over; Ejaculation; Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Clinical Trials as Topic; Cyclic Nucleotide Phosphodiesterases, Type 5; Female; Humans; Male; Phosphodiesterase Inhibitors; Phosphoric Diester Hydrolases; Piperazines; Purines; Sex Factors; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

Topics: Female; Humans; Piperazines; Purines; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Vasodilator Agents

We compared the efficacy of paroxetine alone and combined with sildenafil in patients complaining of premature ejaculation.. Enrolled in this study were 80 consecutive potent men 19 to 47 years old (mean age 34) with premature ejaculation but without any obvious organic cause. Pretreatment evaluation included a history, self-administration of the International Index of Erectile Function (IIEF) questionnaire, physical examination and the Meares-Stamey test to exclude genital tract infection. The initial 40 patients received 10 mg. paroxetine daily for 21 days and then 20 mg. as needed, that is 3 to 4 hours before planned sexual activity, for 6 months (group 1). The other group of 40 men received 10 mg. paroxetine daily for 21 days and then 20 mg. as needed plus 50 mg. sildenafil as needed, that is 1 hour before planned sexual activity, for 6 months (group 2). Patients were followed 3 and 6 months after beginning therapy and were evaluated using several general assessment questions, IIEF and ejaculatory latency time.. Mean ejaculatory latency time +/- SE in group 1 was 0.33 +/- 0.04, 3.7 +/- 0.10 (p <0.01) and 4.2 +/- 0.03 (p <0.01) minutes at baseline, 3 and 6-month followup, while in group 2 it was 0.35 +/- 0.03, 4.5 +/- 0.07 (p <0.01) and 5.3 +/- 0.02 (p <0.001) minutes, respectively. When improvement in ejaculatory latency time was compared in the 2 groups, group 2 results proved to be significantly greater (p <0.05). Baseline, and 3 and 6-month mean intercourse satisfaction domain values of the IIEF were 9, 11 and 11 (p = 0.09, not significant), and 9, 11 and 14 (p <0.05) in groups 1 and 2, respectively. Group 2 patients reported significantly greater intercourse satisfaction than those in group 1 (p <0.05). At baseline, 3 and 6 months there was a mean of 0.9 +/- 0.1, 1.7 +/- 0.3 (not significant) and 2.5 +/- 0.3 (p <0.01) coitus episodes weekly in group 1, and 1 +/- 0.2, 2.3 +/- 0.3 (p <0.01) and 3.2 +/- 0.1 (p <0.001) in group 2, respectively. Group 2 patients reported a significantly higher number of coitus episodes weekly (p <0.05). Side effects in the 40 group 1 cases included anejaculation in 1 (2.5%), gastrointestinal upset and/or nausea in 5 (12.5%), headache in 4 (10%) and decreased libido in 2 (5%). Side effects in the 40 group 2 cases included anejaculation in 1 (2.5%), headache in 8 (20%), gastrointestinal upset and/or nausea in 6 (15%) and flushing in 6 (15%). Group 2 patients reported significantly more headaches (p <0.01) and flushing episodes (p <0.001) than those in group 1. After 6 months of treatment 33 men (82.5%) in group 1 and 36 (90%) in group 2 were willing to continue therapy (not significant).. Paroxetine combined with sildenafil appears to provide significantly better results in terms of ejaculatory latency time and intercourse satisfaction versus paroxetine alone in potent patients with premature ejaculation. However, combined treatment is associated with a mild increase in drug related side effects.

Topics: Adult; Drug Therapy, Combination; Ejaculation; Humans; Male; Middle Aged; Paroxetine; Phosphodiesterase Inhibitors; Piperazines; Prospective Studies; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: Biomedical Research; Female; Humans; Male; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

To assess the effectiveness of a progressive local treatment protocol for erectile dysfunction (ED) in patients after undergoing radical retropubic prostatectomy (RRP) for prostate cancer.. The study included 85 patients (mean age 59.5 years, range 50--75) with ED after RRP. Treatment was offered in four progressive phases, with patients passing to the next phase only if they failed the previous one: in phase I patients used a vacuum erection device; in phase II, sildenafil; in phase III, intracorporal injection; and in phase IV, intracorporal injection plus the vacuum erection device. The patients were followed for 1 year.. Of the 85 patients, 78 (92%) responded to the vacuum erection device (with an erection sufficient for vaginal penetration), but only 11 (14%) agreed to continue with it at home. Of the remaining 74 patients, 69 with no contraindications were given sildenafil and 14 (20%) had a positive response. Sixty patients were then treated with intracorporal injection and 51 (85%) had a positive response; four of the nine failures in phase III responded to intracorporal injection plus vacuum therapy. Five patients failed all four protocols. After 1 year of follow-up, 76 of the 80 patients were successfully continuing treatment at home; seven (9%) used the vacuum erection device, 11 (14%) sildenafil, 54 (71%) intracorporal injection and four (5%) intracorporal injection plus the vacuum erection device.. Overall, this progressive treatment method gave a positive response in 80 of the 85 patients (94%). After 1 year of follow-up, 76 of the 80 patients (95%) continued to respond well. Of all the methods used, intracorporal injection was the most effective for ED after RRP.

Topics: Aged; Erectile Dysfunction; Humans; Injections; Male; Middle Aged; Papaverine; Phosphodiesterase Inhibitors; Piperazines; Postoperative Care; Prostatectomy; Prostatic Neoplasms; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Treatment Failure; Urination Disorders; Vacuum; Vasodilator Agents

Topics: Ejaculation; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Reaction Time; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: Age Factors; Female; Genitalia, Female; Genitalia, Male; Hormone Replacement Therapy; Humans; Hysterectomy; Male; Menopause; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Ultrasonography; Vasodilator Agents

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Administration, Oral; Adult; Aged; Cardiovascular Diseases; Contraindications; Erectile Dysfunction; Female; Humans; Male; Menopause; Middle Aged; Orgasm; Phosphodiesterase Inhibitors; Piperazines; Purines; Risk Factors; Sexual Dysfunction, Physiological; Sexual Partners; Sildenafil Citrate; Sulfones

Topics: Aged; Aged, 80 and over; Erectile Dysfunction; Female; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sexually Transmitted Diseases; Sildenafil Citrate; Sulfones

Topics: Female; Humans; Libido; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: Antidepressive Agents, Second-Generation; Bupropion; Female; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Coitus; Erectile Dysfunction; Female; Heart Diseases; Humans; Male; Phosphodiesterase Inhibitors; Physician-Patient Relations; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: Adult; Antidepressive Agents; Depressive Disorder; Female; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones

Topics: Enzyme Inhibitors; Erectile Dysfunction; Female; Humans; Injections; Male; Piperazines; Purines; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones