Abstracts
Acupuncture (Impotence)
Acupuncture
Examined the effects of acupuncture and hypnotic suggestions.
Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were not significantly higher.
The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be an adjuvant therapy in non-organic male sexual dysfunction.
The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.
Aydin S et al., Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol, 1997 Jun, 31:3, 271-4.
Alcoholics
Alcoholics
Examined the contribution of alcoholism and marital conflict to sexual problems.
The male alcoholics and their wives experienced less sexual satisfaction across a range of variables and more sexual dysfunction-specifically husbands' diminished sexual interest, impotence and premature ejaculation, and wives' painful intercourse-than nonconflicted couples. However, impotence was the only aspect on which alcoholics reported more difficulties than did maritally conflicted couples.
Findings are consistent with a biopsychosocial formulation of alcoholics' sexual adjustment problems that implicates:
(1) marital conflict as a major contributing factor to most of these problems and
(2) the combined role of both marital conflict and the physical effects of chronic alcohol abuse as most relevant to the elevated rates of impotence and retarded ejaculation (among older alcoholics) and the steeper decline in intercourse frequency with age.
O'Farrell TJ et al., Sexual satisfaction and dysfunction in marriages of male alcoholics: comparison with nonalcoholic maritally conflicted and nonconflicted couples. J Stud Alcohol, 1997 Jan, 58:1, 91-9.
Corticospinal Impotence
Corticospinal Impotence
Used intrarectal local vibrotherapy in 151 patients with chronic "prostatitis"; of these, 72 had corticospinal impotence.
All patients derived apparent therapeutic benefit from vibratory message in a combined treatment of chronic prostatitis, having got well in the long run. Recovery of sex function was observed in 52%. In cases of fibrosis development in patients with impotence the only current hope for improvement in the condition is offered by stimulation with electrical current of the colliculus seminalis zone.
Havryliuk IP et al: [The treatment of chronic prostatitis complicated by sexual disorders with vibrotherapy]. Lik Sprava 1995, no. 5-6 pp. 169-72.
Erythropoietin
Erythropoietin
Erythropoietin (rHuEpo) therapy has been shown to improve sexual function in the male dialysis population, with several studies suggesting a direct effect upon endocrine function, as well as correction of anaemia. Nevertheless many male dialysis patients receiving rHuEpo continue to complain of sexual dysfunction.
Male dialysis patients complaining of sexual dysfunction after correction of anaemia with rHuEpo are characterized by higher levels of serum testosterone and SHBG, but not suppression of hyperprolactinaemia or hyperoestrogenism. Male peritoneal dialysis subjects receiving rHuEpo also demonstrated increased LH and FSH.
Lawrence IG et al., Erythropoietin and sexual dysfunction. Nephrol Dial Transplant, 1997 Apr, 12:4, 741-7.
Hypogonadism
Hypogonadism
Although hypogonadism is a rare cause of erectile failure, impotent men are frequently treated with supplemental androgens. The results of such treatment and the individual merits of available formulations remain controversial.
Testosterone undecanoate produced restoration of plasma testosterone levels in all patients but a measurable improvement in sexual attitudes and performance in only 61%. Visual analogue scores were effective discriminants of the therapeutic response but none of the conventional biochemical measures predicted or correlated with clinical outcome.
The most appropriate outcome measure for androgen supplementation is individual response to therapy, while conventional biochemical hormone determinations lack predictive value and fail to correlate with response.
Morales A et al., Testosterone supplementation for hypogonadal impotence: assessment of biochemical measures and therapeutic outcomes. J Urol, 1997 Mar, 157:3, 849-54.
Iron Overload
Iron Overload
Approximately 1.5 million persons in the United States are affected by iron overload diseases, which are primarily caused by hereditary hemochromatosis--the most common genetic disorder in the United States. Hereditary hemochromatosis is characterized by increased iron absorption in the gastrointestinal tract, which may cause lifelong excessive iron absorption and accumulation and serious health effects, including arthritis, cirrhosis, diabetes, impotence, heart failure, and death.
Although the disease was previously believed to affect primarily white males of northern European descent, recent data indicate hereditary hemochromatosis also occurs among blacks. Moreover, iron overload diseases are underdiagnosed among whites and may not be considered in other racial/ethnic groups (e.g., Hispanics) even when compatible symptoms and clinical findings are present.
Findings indicate that the prevalence of possible iron overload among Hispanic clients was consistent with the nationwide prevalence, based on a single screening test, for Hispanics of Mexican descent and non-Hispanic whites.
Anonymous: Iron overload disorders among Hispanics--San Diego, California, 1995. MMWR Morb Mortal Wkly Rep, 1996 Nov 15, 45:45, 991-3.
Nonsurgical Treatment (1)
Nonsurgical Treatment (1)
Evaluated treatments of patients with cavernosal venous leakage (CVL) with polyagent self-administered intracavernous pharmacotherapy and vacuum constriction devices (VCDs).
With standard polyagent pharmacotherapy, a response sufficient for satisfactory intercourse was achieved in 18 of 32 patients with mild CVL, 9 of 54 patients with moderate CVL, and in 0 of 17 patients with severe CVL.
With high-dose polyagent pharmacotherapy, a response sufficient for satisfactory intercourse was achieved in 22 of 32 patients with mild CVL, 29 of 54 patients with moderate CVL, and in 2 of 17 patients with severe CVL.
With a VCD, a response sufficient for satisfactory intercourse was achieved in 23 of 30 patients with mild CVL, 24 of 40 patients with moderate CVL, and in 10 of 15 patients with severe CVL.
CVL of mild to moderate severity can be treated with polyagent pharmacotherapy and VCDs with reasonable expectations of success. Severe CVL responds poorly to polyagent pharmacotherapy but can be treated with VCDs with reasonable results in motivated, adequately instructed patients.
McMahon CG: Nonsurgical treatment of cavernosal venous leakage. Urology, 1997 Jan, 49:1, 97-100.
Non-surgical Management (2)
Non-surgical Management (2)
Impotence is a common symptom which can cause considerable distress to both the sufferer and his partner. The use of pharmacotherapy to improve erectile function will continue to increase as safe and effective drugs are developed. However, restoring erectile function should not be the only treatment objective.
It is also essential to address personal and emotional factors in the sufferer, conflicts in his relationship with his partner, and sexual problems in his partner, all of which may be instrumental in causing or maintaining the presenting impotence.
A combined approach with appropriate medical treatment and sex and couple therapy is advocated.
Riley AJ & Athanasiadis L: Impotence and its non-surgical management. Br J Clin Pract, 1997 Mar, 51:2, 99-103, 105.
Sexual Function
Sexual Function
Identified factors that affect sexual function in men 50 to 80 years old and, therefore, may confound the comparison among groups of elderly men.
Factors associated with physiological impotence included prostate cancer, diabetes mellitus, myocardial infarction, medication with diuretics, hydrogen blockers and warfarin type anticoagulants.
Patients treated for prostate cancer were more likely to be physiologically impotent compared to those with no initial treatment, and this was true for all treatment protocols after adjustment for confounding factors. Men treated with radical prostatectomy were more likely to be physiologically impotent than men treated with external beam radiation therapy.
Waning sexual function in the prostate cancer patients was largely due to side effects of the treatment which could not be explained by confounding factors. In particular, confounding could not explain the greater risk of impotence after radical prostatectomy compared to external beam radiation therapy.
Helgason AR et al., Factors associated with waning sexual function among elderly men and prostate cancer patients. J Urol, 1997 Jul, 158:1, 155-9.
Vacuum Therapy
Vacuum Therapy
Assessed the continuing role of noninvasive vacuum therapy as treatment for erectile dysfunction and discusses the action of negative pressure in producing assisted erection.
The overall clinical success rate is approximately 90%. Significant success has been reported in more difficult patient populations, including those with veno-occlusive disorders and explanted penile prostheses.
A recently reported survey of 5,847 vacuum users showed that 83.5% of patients continue to use the device for intercourse as desired. Patients should receive individual instruction in the use of these devices and should expect a learning or practice period to achieve optimal results.
As newer treatments for erectile dysfunction gain increasing attention, it should be remembered that nearly every patient showing impotence is a candidate for vacuum therapy.
Lewis RW & Witherington R: External vacuum therapy for erectile dysfunction: use and results. World J Urol, 1997, 15:1, 78-82.
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