AIMTo study the effect of yohimbine in the treatment of men with orgasmic dysfunction.

METHODSA 20-mg dose of yohimbine was first given to 29 men with orgasmic dysfunction of different aetiology in the clinic. Patients were then allowed to increase the dose at home (titration) under more favourable circumstances. The outcome and side effects were subsequently assessed.

RESULTSThe patients were classified into three groups of orgasmic dysfunction: primary complete (13), primary incomplete (8) and secondary (8). Nocturnal emissions were present in 75%, 40% and 50% of patients in the above groups, respectively (overall average 62%). The men presented because of fertility problems (52%) or because they wanted to experience the pleasure of orgasm (48%). Of the 29 patients who completed the treatment, 16 managed to reach orgasm and were able to ejaculate either during masturbation or sexual intercourse. A further three achieved orgasm, but only with the additional stimulation of a vibrator. A history of preceding nocturnal emissions was present in 69% of the men in whom orgasm was induced but only 50% who failed treatment. Of the patients, two have subsequently fathered children (one set of twins) and another 3 men were also cured. Side effects were not sufficient to cause the men to cease treatment.

CONCLUSIONYohimbine is a useful treatment option in orgasmic dysfunction.

Adrenergic alpha-Antagonists ; therapeutic use ; Adult ; Aged ; Dose-Response Relationship, Drug ; Ejaculation ; drug effects ; physiology ; Humans ; Male ; Middle Aged ; Sexual Dysfunctions, Psychological ; drug therapy ; physiopathology ; Treatment Outcome ; Yohimbine ; therapeutic use

OBJECTIVETo 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.

DATA SOURCESUsing 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.

STUDY SELECTIONPE, 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.

RESULTSMany 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.

CONCLUSIONThe 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.

Clinical Trials as Topic ; Ejaculation ; drug effects ; Humans ; Male ; Piperazines ; therapeutic use ; Purines ; therapeutic use ; Serotonin Uptake Inhibitors ; adverse effects ; pharmacology ; therapeutic use ; Sexual Dysfunction, Physiological ; drug therapy ; Sildenafil Citrate ; Sulfones ; therapeutic use

Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie's disease. Currently, there is a variety of options for the correction of residual curvature, including penile modeling, plication techniques, as well as tunical incision/excision with or without grafting. A literature search of PubMed and Medline databases was conducted from 1964 until 2020, using search terms for all articles in the English language. In this article, we provide a review of the techniques and the outcomes, according to the published literature.