Natural Treatment to Prevent Premature Ejaculation
SSRIs, including fluoxetine, are effective in the treatment of premature ejaculation, although increased latency to ejaculation is highest with paroxetine (Waldinger et al. 1998). In a 1-year follow-up study, patients treated with fluoxetine (20 mg day or less) in combination with sexual behavior therapy reported significant improvement in ejaculation latency (Graziottin et al. 1996). Another study demonstrated efficacy from a weekly fluoxetine dose of 90 mg (Manasia et al. 2003). Clear-cut dosing recommendations have not been clarified, however, and titration (upward or downward) may be necessary.
Treatment of Han NMRI mice with DES or 17b-estradiol on the first 3 days of life resulted in a 90-100 incidence of epithelial dysplasia of the peri-urethral glands, and the periurethral proximal parts of the dorsolateral prostate, coagulating glands, and seminal vesicles after 12-18 months 214, 215 . Subsequent treatment with DHT and 17b-estradiol from 9 to 12 months of age increased the severity of the dysplasia when the prostates were examined at 12 months, suggesting permanent estrogen hypersensitivity of these tissues. Arai et al. 210 treated Wistar rats with DES for the first 30 days of life. One group was neonatally castrated and the second group remained intact. Two of 11 castrated, DES-exposed rats developed squamous cell carcinomas in the area of the dorsolateral prostate, coagulating gland, and ejaculatory ducts, and all these animals had papillary hyperplasia and squamous metaplasia of the coagulating gland and ejaculatory duct. Squamous metaplasia was also found in some of...
The major adverse effect of PBZ is postural hypotension, often accompanied by reflex tachycardia and other arrhythmias. Hypotension can be particularly severe in hypovolemic patients or under conditions that promote vasodilation (administration of vasodilator drugs, exercise, ingestion of alcohol or large quantities of food). Reversible inhibition of ejaculation may occur because of impaired smooth muscle contraction in the vas deferens and ejaculatory ducts. PBZ is muta-genic in the Ames test the clinical significance of this finding is unknown.
A development in the last 10 or so years of SSRI research has been the attempt by companies such as Alza and Pfizer to develop rapid onset, short half-life SSRIs, such as dapoxetine 33 and UK-390957 (structure undisclosed), primarily for the treatment of premature ejaculation (PE) 23 . Dapoxetine is a potent SSRI which was in development specifically as a treatment for PE 24 . Despite showing some efficacy in clinical trials, it was given a not approvable letter by the FDA in 2005 25 . The rationale for a rapid onset
Plausibility of Adverse Effects of EDCs Mechanisms of Gonadal and Accessory Reproductive Organ Differentiation
There are a number of experimental studies in laboratory animals relating developmental exposure to EDCs to changes in testicular function in adulthood. For example, a single administration of a low dose (50 ng kg to 1 g kg of body weight) of dioxin to pregnant female rats on gestational day 15 resulted in altered sexual differentiation in male and female offspring 136 . The lowest dose of dioxin tested (50 ng kg body weight) resulted in a concentration in fetal organs of approximately 5 parts per trillion (5 pg g tissue). Since this dose is within the range of human exposure 137 , these results are environmentally relevant. A single administration of dioxin to pregnant female rats produced a decrease in circulating testosterone and in anogenital distance in male offspring at birth. Effects on adult sex behavior in male offspring included changes in mounting, intromitting, number of ejaculations and latency to ejaculation, as well as the exhibition of the female sexually receptive...
In some studies, the effects of exposure to DES during development were not noticeable prior to the animals reaching old age. For example, treatment of male rats with DES during the first month after birth did not result in observable malignancies at 6-9 months of age, but by 20 months (old age), squamous cell cancer was detected with involvement of the dorsolateral prostate, coagulating glands (dorsocranial prostate) and ejaculatory ducts 233 . There are not yet reports of prostate abnormalities in men exposed to DES during fetal life. However, DES was used in pregnancy during 1947-1971, with peak use in the 1950s and 1960s, so most DES sons are 40-50. Since few of these men have reached the age at which benign prostatic hyperplasia (BPH) or prostate cancer increases in frequency, prostate abnormalities in DES sons have not yet been studied and it is important that this cohort be monitored for these endpoints.
Later it was recognized that the biosynthesis of PGE mainly takes place in seminal vesicles, where particular high activities of prostaglandin endoperoxide PGE-isomerase (9-keto-prostaglandin-isomerase) are present 216 and that the contribution of the prostate to prostaglandin production is low. Prostaglandins are not enzymatically inactivated in seminal fluid. In spite of these early findings the biological functions of eicosanoids in the male reproductive tract have still not been fully evaluated. Possible actions include effects on sperm function, maturation and capacitation, mediation of ejaculation and induction of immune tolerance towards paternal antigen within the female reproductive tract.
There are differences between the nociceptive processes involved in visceral pain compared to those in somatic pain. However, it is well established that central hypersensitivity changes can occur in both types of pain. The implications are that normal sensory stimuli can be perceived in a magnified form with the result that innocuous sensations may be perceived as pain or that normally unperceived sensory stimuli become perceived. The latter dysaesthesias may be the cause of urinary frequency and urgency in the bladder pain syndromes, the urge to defecate in bowel hyper-sensitivities and sensory changes associated with ejaculation in the prostate pain syndromes. These central changes may occur as a result of an acute painful insult such as associated with infection. The insult to the organ results in activation of normally silent,
Finasteride (propecia) inhibits the type II isozyme of 5a-reductase, the enzyme that converts testosterone to dihydrotestosterone (see Chapter 58). The type II 5a-reductase is found in hair follicles. Balding areas of the scalp are associated with increased dihydrotesterone levels and smaller hair follicles than nonbalding areas. Orally administered finasteride (1 mg day) has been shown to variably increase hair growth in men over a 2-year period, increasing hair counts in the vertex and the frontal scalp. Finasteride is approved for use only in men. Pregnant women should not be exposed to the drug because of the potential for inducing genital abnormalities in male fetuses. Adverse effects of finasteride include decreased libido, erectile dysfunction, ejaculation disorder, and decreased ejaculate volume. Each of these occurs in
Head-to-head comparisons between paroxetine and other medications in the treatment of GAD are sparse. One such study compared paroxetine 20-50 mg day with escitalopram 10-20 mg day (Bielski et al. 2005). Although there was no significant difference in efficacy between the two medications, as measured by the Ham-A, the authors noted considerably higher rates of adverse events, leading to withdrawal from the trial, in patients treated with paroxetine compared with those treated with escitalopram (22.6 vs. 6.6 ). Treatment-emergent side effects recorded more frequently with paroxetine therapy included insomnia, constipation, ejaculation disorder, anorgasmia, and decreased libido. Conversely, diarrhea and upper respiratory tract infection were more common with escitalopram than with paroxetine. One possible explanation for the divergence in dropout rates may be the seeming disparity in dose ranges between the two medications. Paroxetine was titrated to high-normal doses (between 30 and 50...
Paimleaf Raspberry Fruit is the dried fruit of Rutin* chtngii Ilu (Fam. Rosaceae). Action To benefit the kidney, and arrest seminal discharge and excessive urination. Indications Enuresis, frequent urination. impotence, premature ejaculation, seminal emission and spermatorrhea in de-Jiiitmy syndrome of the kidney. Dosage 12g.
Concern has been expressed that some phytoestrogens may disrupt the developing endocrine system similarly to the effects of other endogenous estrogens 264,265 . Much of this concern has stemmed from animal research. There are well-described examples of phytoestrogen-containing plants inhibiting fertility via estrogenic activity in animals. For instance, sheep grazing on Australian pastures containing a particular type of clover rich in formononetin, which is converted to daidzein in the rumen during fermentation, developed a widespread infertility in the 1940s 248, 266 . Other examples are the moldy corn syndrome in pigs and cattle fed corn contaminated by Fusarium sp., which produces the estrogenic b-resorcyclic acid lactone, zearalenone 267 , and the inhibition of reproduction of California quail by phytoestrogens produced by plants growing in dry conditions 266 . The use of soybean in captive cheetah in Cincinnati zoo was also shown to be responsible for an infertility syndrome,...
Tamsulosin (flomax), a benzenesulfonamide, is an a1 receptor antagonist with some selectivity for a1A and a1D subtypes, favoring a1A blockade in prostate. Tamsulosin is efficacious in the treatment of BPH with little effect on blood pressure. The drug is well absorbed, has a t122 of 5-10 hours, and is extensively metabolized by CYPs. Tamsulosin may be administered at a 0.4-mg starting dose. Abnormal ejaculation is an adverse effect of tamsulosin.
Indoramin is a competitive a1 antagonist that also antagonizes agonist effects at H1 and 5-HT receptors. Via a1 antagonism, indoramin lowers blood pressure with minimal tachycardia and decreases the incidence of attacks of Raynaud's phenomenon. Indoramin has modest bioavailability (
Treating the target symptom (e.g., ondansetron for nausea, lorazepam for insomnia). More troublesome and persistent are sexual adverse effects, including anorgasmia, decreased libido, ejaculation disturbances, and erectile dysfunction. Transient adverse effects are likely the result of acute stimulation of postsynaptic serotonin receptors however, efforts to link these symptoms to specific receptor subtypes are speculative. Table 8 lists common adverse effects associated with SSRIs, and options for clinical management.
Prostatic hyperplasia (section 7.4.1) Cautions avoid alcohol (enhances rate and extent of absorption) control incipient heart failure before initiating indoramin elderly Parkinson's disease (extrapyramidal disorders reported) epilepsy (convulsions in animal studies) history of depression cataract surgery (risk of intra-operative floppy iris syndrome) interactions Appendix 1 (alpha-blockers) Driving Drowsiness may affect performance of skilled tasks (e.g. driving) effects of alcohol may be enhanced Contra-indications established heart failure Hepatic impairment manufacturer advises caution Renal impairment manufacturer advises caution Pregnancy no evidence of teratogenicity manufacturers advise use only when potential benefit outweighs risk Breast-feeding no information available Side-effects see section 7.4.1 also sedation less commonly fatigue, weight gain, failure of ejaculation
Typically, data derived from clinical studies estimate sexual disability attributed to SRIs to be less than 20 , whereas in clinical practice the incidence appears to be significantly higher, perhaps as high as 40 . This side effect clearly has an adverse effect on medication adherence, partly because discussion of sexual issues is difficult for patients and clinicians alike. Although all SRIs and venlafaxine have been associated with male and female sexual dysfunction, there is a prevailing view among clinicians that this side effect might be more problematic with paroxetine, although few controlled data are available to address this issue. In a comparison study of 200 subjects treated with paroxetine, fluoxetine, fluvoxamine, or sertraline, paroxetine treatment was associated with higher rates of anorgasmia or difficulty with ejaculation and impotence in both men and women (Montejo-Gonzalez et al. 1997). Significant differences among the four drugs were not noted with respect to...
5 Secrets to Lasting Longer In The Bedroom
How to increase your staying power to extend your pleasure-and hers. There are many techniques, exercises and even devices, aids, and drugs to help you last longer in the bedroom. However, in most cases, the main reason most guys don't last long is due to what's going on in their minds, not their bodies.