Biomedical subjects

Michael A Perelman

Publications and source records attributed to Michael A Perelman.

8 recordsLinked to original sources

PubMed2006

Retarded ejaculation.

Retarded ejaculation (RE) has a relatively low prevalence (<3%), yet this condition results in considerable distress, anxiety, and lack of sexual confidence for those suffering from it. Furthermore, men with partners often experience impairment of both the sexual and nonsexual aspects of their relationships, with such negative effects compounded when procreation is a consideration. The definition of RE is ambiguous, due to the variability and paucity of data regarding normal coital ejaculatory latency. RE is influenced by both biogenic and psychogenic components, which may vary over time both between and within individuals. While specific pathophysiology can often be identified, further elucidation of the biogenic components of this dysfunction will require greater understanding of the physiological mechanisms underlying ejaculation. Yet, the most useful strategies for understanding RE will integrate rather than isolate the various biogenic and psychogenic aspects of this dysfunction. Evidence based evaluation and treatment protocols for this disorder are lower than for other sexual dysfunctions, but reports suggest better treatment efficacy when the etiology is predominantly psychogenic. As with erectile dysfunction (ED) and premature ejaculation (PE), if safe and efficacious oral pharmaceuticals are eventually developed for this condition, the treatment algorithm is likely to undergo significant alteration. Even then, however, the most effective treatments are likely to result from a combination treatment that integrates sex coaching with pharmacotherapy.

Ejaculation↗

PubMed2006

Treatment of lower urinary tract symptoms in benign prostatic hyperplasia and its impact on sexual function.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common disorder in older men and may be associated with lower urinary tract symptoms (LUTS) and sexual dysfunction. Men who present with symptomatic BPH and LUTS are at increased risk for sexual dysfunction, including erectile dysfunction (ED) and ejaculatory dysfunction (EjD). OBJECTIVE: This review describes treatment options recommended by the 2003 American Urological Association (AUA) guideline panel for the relief of LUTS associated with BPH, with a focus on the effects of each treatment on ED and EjD. METHODS: Relevant articles were identified via MEDLINE searches of all English-language articles published from January 1984 to January 2005 using the following search terms: benign prostatic hyperplasia and sexual dysfunction, lower urinary tract symptoms and sexual dysfunction, alfuzosin, doxazosin, terazosin, tamsulosin, dutasteride, finasteride, transurethral resection of prostate, erectile dysfunction, and ejaculatory dysfunction. Data on the effects of BPH treatments on sexual function were extracted from the articles and summarized. Because properly designed, adequately powered, direct-comparator studies have not yet been conducted, the AUA's report provides the most comprehensive analyses regarding the efficacy and safety of the current BPH treatment options. RESULTS: LUTS are an independent risk factor for sexual dysfunction in aging men, even after controlling for age and comorbidities. Although surgery, minimally invasive therapies, and pharmacologic therapies can all improve LUTS and the peak urinary flow rate, some can cause or exacerbate ED (incidence rates: surgery, 10%; minimally invasive therapies, 1%-3%; pharmacologic monotherapy or combination therapy, 3%-10%) and EjD (incidence rates: surgery, 65%; minimally invasive therapies, 4%-16%; pharmacologic monotherapy or combination therapy, 0%-10%). Among pharmacologic therapies for BPH, the frequency of EjD appears to be greater with tamsulosin (10%) than with other alpha(1)-blockers (0%-1%) or the 5alpha-reductase inhibitor finasteride (4%), based on data from a single-arm meta-analysis conducted by the AUA. CONCLUSION: Sexual function should be assessed and discussed with the patient when contemplating the appropriate management strategy for LUTS associated with BPH, as well as when evaluating the patient's response to treatment.

Adrenergic alpha-Antagonists↗

PubMed2006

A new combination treatment for premature ejaculation: a sex therapist's perspective.

This article describes the diagnosis and treatment of premature ejaculation (PE) from a sex therapist's perspective and proposes that combination therapy integrating sex therapy and sexual pharmaceuticals is frequently the best treatment approach. Failure to appreciate the multimodal etiology and pathophysiology of PE makes the condition more difficult to diagnose and treat. Many physicians have tried pharmacologic approaches, but are limited to providing topical anesthetics or suggesting off-label uses of antidepressant and erectile dysfunction medications, because no medication is currently indicated specifically for PE. Furthermore, patients frequently relapse after discontinuation of the pharmaceutical. Sex therapists appreciate the multidimensional nature of PE for the patient and partner, but few patients seek out this approach, which is labor-intensive and often lacking long-term follow-up success. Most men with PE are not receiving treatment, secondary to their embarrassment about discussing their condition and a lack of clinician inquiry about sexual dysfunction. Even for those who do engage in discussion, diagnoses may be inconsistent, because a universally accepted definition of the condition and diagnostic criteria are nonexistent. Men with PE experience anxiety and lack sexual self-confidence; subsequently, their sexual and overall relationship frequently suffer. Because PE involves psychosocial and physiologic factors, treatment that addresses both should yield the best balance of function. There is interest in new agents designed specifically for PE to provide an improved pharmacotherapeutic opportunity. Yet, a combination treatment integrating pharmaceuticals and sex therapy would provide an optimized approach. Besides increasing coital latency directly, sexual pharmaceuticals could be used to provide greater opportunity for men to recognize their premonitory sensations to ejaculation more readily, facilitating a "choice point", which is key to facilitating behavioral change and learning. Such a combination approach would result in prolonged ejaculatory latency, improved treatment satisfaction, and superior long-term outcome.

Clinical Competence↗

PubMed2006

An effect on the subjective sexual response in premenopausal women with sexual arousal disorder by bremelanotide (PT-141), a melanocortin receptor agonist.

INTRODUCTION: Melanocortins affect multiple physiological responses, including sexual behaviors. Bremelanotide is a synthetic peptide melanocortin analog of alpha-melanocyte-stimulating hormone that is an agonist at melanocortin receptors MC3R and MC4R. AIM: To evaluate a single intranasal dose of bremelanotide for potential effects on physiological and subjective measurements of sexual arousal and desire in premenopausal women with sexual arousal disorder. MAIN OUTCOME MEASURES: Change in vaginal pulse amplitude during neutral and erotic videos after treatment with bremelanotide or placebo and subjects' perceptions of physiological and sexual response within 24 hours of treatment with bremelanotide or placebo. METHODS: Eighteen premenopausal women with a primary diagnosis of female sexual arousal disorder were randomly assigned to receive a single intranasal dose of 20 mg bremelanotide or matching placebo in a double-blind manner during the first in-clinic treatment session, and the alternate medication during the second in-clinic treatment session. During each session, subjects viewed a 20-minute neutral video followed by a 20-minute sexually explicit video. Vaginal photoplethysmography was used to monitor vaginal vasocongestion and questionnaires were used to evaluate perceptions of sexual response within the following 24-hour period. RESULTS: More women reported moderate or high sexual desire following bremelanotide treatment vs. placebo (P = 0.0114), and a trend toward more positive responses regarding feelings of genital arousal occurred after bremelanotide compared with placebo (P = 0.0833). Among women who attempted sexual intercourse within 24 hours after treatment, significantly more were satisfied with their level of sexual arousal following bremelanotide, compared with placebo (P = 0.0256). Vaginal vasocongestion did not change significantly while viewing erotic videos following bremelanotide administration compared with placebo. CONCLUSION: This preliminary evaluation suggests the potential for bremelanotide to positively affect desire and arousal in women with female sexual arousal disorder and indicates that bremelanotide is a promising candidate for further evaluation in an at-home study.

Adult↗

PubMed2005

Psychosocial evaluation and combination treatment of men with erectile dysfunction.

The Sexual Tipping Point forms the foundation of a biopsychosocial model to help conceptualize a combination treatment, where sex coaching and sexual pharmaceuticals are integrated into a clinical approach, which addresses organic, psychologic, and cultural issues for men with erectile dysfunction (ED). At any moment in the intervention pro-cess, the clinician determines the most elegant solution, which focuses the majority of effort on fixing the predominant factor while not ignoring the others. Clinicians using this model, can fully conceptualize ED by understanding the predisposing, precipitating,and maintaining psychosocial aspects of their patient's diagnosis and management, as well as organic causes and risk factors. The sex status or focused sex history, and continuous reassessment based on follow-up are the core elements of this method. Restoration of lasting and satisfying sexual function requires a multidimensional understanding of all of the forces that created the dysfunction, whether a solo clinician or multidisciplinary team approach is used. Each clinician needs to carefully evaluate their own competence and interests when considering the treatment of a man's ED, so that regardless of the modality used, the patient receives optimized care to restore sexual function and satisfaction.

Combined Modality Therapy↗

PubMed2004

Drivers and barriers to seeking treatment for erectile dysfunction: a comparison of six countries.

OBJECTIVE: To identify predictors of treatment-seeking behaviour in men with erectile dysfunction (ED) and the predictors (correlates) of individual drivers and barriers to seeking treatment. Although the prevalence and epidemiology of ED have been reviewed, there is little information about the treatment-seeking behaviour of men with this disorder. SUBJECTS AND METHODS: Data from the Cross-National Survey on Male Health Issues conducted between March and September 2000 were assessed by multivariate analysis. A cohort of 32 644 men aged 20-75 years was recruited during visits to their physicians. The men completed a short screening questionnaire, covering their overall health, and prostate, urinary and erectile problems. Men identified as having ED completed a detailed follow-up questionnaire. Logistic regression methods were used to identify predictors of treatment-seeking behaviour, and individual drivers and barriers to seeking treatment. RESULTS: Most men with ED had not sought treatment. The analyses suggested that ED, in conjunction with a desire to have sex, was necessary for men to seek treatment. Men seeking treatment commonly identified themselves as self-motivated or that they were influenced by a spouse or sex partner. The youngest group (20-39 years) was least likely to seek treatment. Among those who did not seek treatment, younger men were likely to believe that their ED would resolve spontaneously, whereas older men resisted seeking treatment because they felt that ED was a natural part of ageing. CONCLUSIONS: The data from this survey of men using the healthcare system confirmed other population-based reports that a minority of men with ED seek treatment. Subset analyses showed that treatment-seeking behaviour tended to be driven primarily by the man or by his sex partner. Common barriers to seeking treatment included the belief that ED would resolve spontaneously (younger men) and that ED was a normal part of ageing (older men).

Age Distribution↗

PubMed2003

Quality of life aspects in kidney cancer patients: data from a national registry.

GOALS: We investigated quality of life aspects, including health-related quality of life, psychological functioning, relationship issues and sexual functioning in kidney cancer patients. PATIENTS AND METHODS: We conducted an anonymous, cross-sectional survey of a random sample of patients with kidney cancer from a national database. A questionnaire was mailed to 301 members of the Kidney Cancer Association. The questionnaire included demographics, medical history, the Watts Sexual Function Questionnaire (WSFQ), the SF-12 Health Survey, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Revised Dyadic Adjustment Scale (RDAS). RESULTS: Of the 266 eligible participants, 84 (33%) returned the questionnaire. The mean ages of the respondents were 57.5 and 57.9 years for men and women, respectively. Overall, the total WSFQ scores as well as the four domain scores (desire, arousal, orgasm and satisfaction) were similar in men and women, and lower than in female breast cancer and male hypertensive populations reported in the literature, indicating relatively worse sexual function. While subjects reported health-related quality of life and relationship scores similar to the general population, 51% of men and 57% of women reported depressive symptoms (CES-D >/=16). CONCLUSIONS: This is the first study in which sexual function in patients with renal cancer has been addressed. While most patients remain sexually active in non-distressed relationships, many reported depressive symptoms, and sexual functioning may be worse than in comparable chronically ill populations. Quality of life and sexual function issues should be addressed when counseling urological cancer patients.

Adult↗

PubMed2002

FSD partner issues: expanding sex therapy with sildenafil.

Sildenafil reinvigorated sex therapy, expanding the number and range of individuals restored to sexual health. Sildenafil used adjunctively with sex therapy accelerated therapy and improved outcome in treating erectile dysfunction (ED). For women, sildenafil initially was used "off label" as a primary treatment for female sexual dysfunction (FSD). However, sildenafil could also be used in conjunction with sex therapy for dysfunctional male partners of women with FSD, so that his ED does not sabotage her treatment. This article describes an integrated treatment, where adjunctive sildenafil use was an important strategic component in the sex therapy of a couple's unconsummated marriage in which the wife's vaginismus, dyspareunia, and anorgasmia was complicated by her husband's ED and retarded ejaculation (RE).

Adult↗