vitamin-b-12 and Sexual-Dysfunction--Physiological

Sexual dysfunction following stroke is common but often is poorly managed. As awareness of sexual dysfunction following stroke increases as an important issue, a clearer evidence base for interventions for sexual dysfunction is needed to optimise management.. To evaluate the effectiveness of interventions to reduce sexual dysfunction following stroke, and to assess adverse events associated with interventions for sexual dysfunction following stroke.. We conducted the search on 27 November 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; from June 2014), in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers.. We included randomised controlled trials (RCTs) that compared pharmacological treatments, mechanical devices, or complementary medicine interventions versus placebo. We also included other non-pharmacological interventions (such as education or therapy), which were compared against usual care or different forms of intervention (such as different intensities) for treating sexual dysfunction in stroke survivors.. Two review authors independently selected eligible studies, extracted data, and assessed study quality. We determined the risk of bias for each study and performed a 'best evidence' synthesis using the GRADE approach.. We identified three RCTs with a total of 212 participants. We noted significant heterogeneity in interventions (one pharmacological, one physiotherapy-based, and one psycho-educational), and all RCTs were small and of 'low' or 'very low' quality. Based on these RCTs, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the use of sertraline, specific pelvic floor muscle training, or individualised sexual rehabilitation.. Use of sertraline to treat premature ejaculation needs to be tested in further RCTs. The lack of benefit with structured sexual rehabilitation and pelvic floor physiotherapy should not be interpreted as proof of ineffectiveness. Well-designed, randomised, double-blinded, placebo-controlled trials of long-term duration are needed to determine the effectiveness of various types of interventions for sexual dysfunction. It should be noted, however, that it may not be possible to double-blind trials of complex interventions.

Topics: Adult; Aged; Aged, 80 and over; Antidepressive Agents; Female; Humans; Male; Middle Aged; Orgasm; Pelvic Floor; Premature Ejaculation; Quality of Life; Randomized Controlled Trials as Topic; Resistance Training; Sertraline; Sex Education; Sexual Dysfunction, Physiological; Sexual Partners; Stroke; Vitamin B 12; Vitamin B Complex; Young Adult

Exposure of animals to drugs which induce hepatic enzymes results in an acceleration of hydroxylation of endogenous as well as exogenous steroid hormones (Conney, A.H., Pharma. 19 [1967] 317). Fahim et al. in a two part study, noticed when phenobarbital was administered to sexually mature male rats, it accelerated the metabolism of androgen as reflected by significant reductions in weight and RNA content of male accessory organs [3]; it was also observed that vitamin B 12 is an enzyme inducer [2]. Currently we observed a significant synergism between vitamin B 12 and phenobarbital in acceleration of drug metabolizing enzymes in rats. This demonstration of drug-steroid interaction reinforces the possibility of utilizing such phenomena as therapeutic modalities for human reproductive syndromes associated with overprodduction of sex hormones. This was applied in a young 16 year old mildly retarded male who was having much difficulty coping with sexual urges. His serum testosterone level was 960 ng%, which is abnormally high for his age. The patient was treated with 30 mg phenobarbital, morning and evening, and 50 mcg vitamin B 12 daily. After three months of treatment, his testosterone level decreased significantly to 620 ng%, and his hypersexualized behavior with girls had completely dropped out. There were no side effects in his physical appearance or general health. This therapy encourages its utilisation in humans with androgen overproduction instead of utilizing estrogen or other drugs which may have side effects.

Topics: Adolescent; Androgens; Female; Humans; Hydroxylation; Intellectual Disability; Male; Microsomes, Liver; Phenobarbital; Sexual Dysfunction, Physiological; Testosterone; Vitamin B 12