Review

14 pages, 276 KiB

Open AccessReview

The Interplay between Vascular Function and Sexual Health in Prostate Cancer: The Potential Benefits of Exercise Training

by Natalie K. Vear, Jeff S. Coombes, Tom G. Bailey and Tina L. Skinner

Med. Sci. 2020, 8(1), 11; https://0-doi-org.brum.beds.ac.uk/10.3390/medsci8010011 - 11 Feb 2020

Cited by 5 | Viewed by 3286

Abstract

Prostate cancer and its associated treatments can cause significant and lasting morbidities, such as cardiovascular and sexual dysfunctions. Various interventions have attempted to prevent or mitigate these dysfunctions. This review summarises the available evidence on the effects of exercise training on markers of [...] Read more.

Prostate cancer and its associated treatments can cause significant and lasting morbidities, such as cardiovascular and sexual dysfunctions. Various interventions have attempted to prevent or mitigate these dysfunctions. This review summarises the available evidence on the effects of exercise training on markers of cardiovascular disease (as assessed via vascular health outcomes) and sexual health in this prevalent cancer population. Current studies predominantly report blood pressure outcomes as a marker of vascular health, as well as various questionnaires assessing sexual health parameters, in men on active treatment (i.e., hormone or radiation therapies) or post-treatment. Preliminary evidence suggests that exercise interventions may elicit improvements in sexual function, but not blood pressure, in these populations. Future studies in more advanced and varied prostate cancer populations (i.e., those on chemotherapies or immunotherapies, or undergoing active surveillance) are required to ascertain the duration, intensity and frequency of exercise that optimises the effects of exercise training on cardiovascular and sexual dysfunctions (and their relationship) in men during and following treatment for prostate cancer. Full article

(This article belongs to the Special Issue Men's Sexual Health)

12 pages, 238 KiB

Open AccessReview

Ejaculatory and Orgasmic Dysfunction Following Prostate Cancer Therapy: Clinical Management

by Travis P. Green, Jose Saavedra-Belaunde and Run Wang

Med. Sci. 2019, 7(12), 109; https://0-doi-org.brum.beds.ac.uk/10.3390/medsci7120109 - 10 Dec 2019

Cited by 5 | Viewed by 4115

Abstract

The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side effects following the treatment of prostate cancer. Orgasmic dysfunction covers a range of issues including premature ejaculation, anorgasmia, dysorgasmia, and climacturia. [...] Read more.

The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side effects following the treatment of prostate cancer. Orgasmic dysfunction covers a range of issues including premature ejaculation, anorgasmia, dysorgasmia, and climacturia. This review provides an overview of prevalence and management options to deal with orgasmic dysfunction. A Medline Pubmed search was used to identify articles relating to these problems. We found that orgasmic dysfunction has a very large impact on patients’ lives following prostate cancer treatment and there are ways for physicians to treat it. Management of patients’ sexual health should be focused not only on erectile dysfunction, but on orgasmic dysfunction as well in order to ensure a healthy sexual life for patients and their partners. Full article

(This article belongs to the Special Issue Men's Sexual Health)

11 pages, 843 KiB

Open AccessReview

Premature Ejaculation: Aetiology and Treatment Strategies

by Nicholas Gillman and Michael Gillman

Med. Sci. 2019, 7(11), 102; https://0-doi-org.brum.beds.ac.uk/10.3390/medsci7110102 - 25 Oct 2019

Cited by 40 | Viewed by 15052

Abstract

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that is often neglected, presenting a currently unmet therapeutic need. The classification of PE has historically been varied and at times ambiguous, contributing to inaccurate prevalence estimates. This review uses the International Society [...] Read more.

Premature ejaculation (PE) is a highly prevalent male sexual dysfunction that is often neglected, presenting a currently unmet therapeutic need. The classification of PE has historically been varied and at times ambiguous, contributing to inaccurate prevalence estimates. This review uses the International Society for Sexual Medicine (ISSM) definition of PE, which includes reduced ejaculatory latency, lack of control and associated negative personal consequences. Patient assessment and management options differ depending on the classification of PE and it is the role of the clinician to appropriately classify patients and be aware of the correct management strategies. This review provides an overall background of PE in terms of classification and underlying physiology, patient assessment and management strategies along with the scientific rationale for treatment. Patients with lifelong and acquired PE are most likely to benefit from combination therapy of pharmacological treatment in the form of selective serotonin re-uptake inhibitor dapoxetine, psychosexual behavioural therapy and psychological therapy. Full article

(This article belongs to the Special Issue Men's Sexual Health)

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7 pages, 196 KiB

Open AccessReview

Sexuality in Ageing Male: Review of Pathophysiology and Treatment Strategies for Various Male Sexual Dysfunctions

by Eric Chung

Med. Sci. 2019, 7(10), 98; https://0-doi-org.brum.beds.ac.uk/10.3390/medsci7100098 - 20 Sep 2019

Cited by 11 | Viewed by 5136

Abstract

Sexual function among older men is often thought to decrease as part of normal ageing biology despite the fact that sexuality remains an important issue in the elderly. Sexual dysfunction in the aged male is likely multifactorial in nature, with the development and/or [...] Read more.

Sexual function among older men is often thought to decrease as part of normal ageing biology despite the fact that sexuality remains an important issue in the elderly. Sexual dysfunction in the aged male is likely multifactorial in nature, with the development and/or progression of medical comorbidities often resulting in decline in male sexual function and poor treatment response. At present, sexual dysfunction in the ageing male is poorly investigated and understood, and current treatment strategies aim at improving sexual desire and erectile function with limited data on ejaculatory and orgasmic dysfunctions. In addition, men are often reticent to seek help for health concerns including sexual dysfunction. The following article provides a narrative review of strategies to address various aspects of sexual dysfunction in the ageing male. Clinicians need to be educated to be sensitive when discussing sexuality issues among older men and to present practical solutions that take into account individual and cultural differences. Full article

(This article belongs to the Special Issue Men's Sexual Health)

16 pages, 287 KiB

Open AccessReview

Medical Management of Peyronie’s Disease: Review of the Clinical Evidence

by Patrick Teloken and Darren Katz

Med. Sci. 2019, 7(9), 96; https://0-doi-org.brum.beds.ac.uk/10.3390/medsci7090096 - 18 Sep 2019

Cited by 6 | Viewed by 5771

Abstract

Peyronie’s disease is a condition that causes abnormal healing of the tunica albuginea, causing penile curvature. It is difficult to treat and its management is continuing to evolve. Proposed non-surgical treatments have included oral, topical, intralesional, extracorporeal shockwave, and traction therapy. The study [...] Read more.

Peyronie’s disease is a condition that causes abnormal healing of the tunica albuginea, causing penile curvature. It is difficult to treat and its management is continuing to evolve. Proposed non-surgical treatments have included oral, topical, intralesional, extracorporeal shockwave, and traction therapy. The study of Peyronie’s disease is made difficult by heterogeneity in the timing of presentation, severity and characteristics of deformity, and associated complaints. Moreover, meta-analyses of studies are difficult due to inconsistencies across study endpoints and the duration of treatments. This article reviews the current clinical evidence and guideline recommendations, with a focus on an improvement in penile curvature. Full article

(This article belongs to the Special Issue Men's Sexual Health)

11 pages, 268 KiB

Open AccessReview

A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction

by Eric Chung

Med. Sci. 2019, 7(9), 91; https://0-doi-org.brum.beds.ac.uk/10.3390/medsci7090091 - 29 Aug 2019

Cited by 15 | Viewed by 9575

Abstract

Contemporary treatment algorithms for erectile dysfunction (ED) involve the use of medical therapies such as phosphodiesterase type 5 (PDE5) inhibitors and intracavernosal injection therapy of vasoactive agents, as well as vacuum erection devices and penile prosthesis implants in medically refractory cases. However, the [...] Read more.

Contemporary treatment algorithms for erectile dysfunction (ED) involve the use of medical therapies such as phosphodiesterase type 5 (PDE5) inhibitors and intracavernosal injection therapy of vasoactive agents, as well as vacuum erection devices and penile prosthesis implants in medically refractory cases. However, the current therapeutic options only address the symptoms of ED and not the underlying pathogenesis that results in ED. Newer and novel ED therapies aspire to reverse ED conditions by preventing cavernosal fibrosis, promoting endothelial revascularization and modulating various neuro-hormonal pathways. Regenerative therapeutic strategies such as low-intensity shock wave, gene and cellular-based therapies, and penile transplants are designed to improve penile hemodynamics and revitalize the cavernosal smooth muscle to mitigate and/or reverse underlying ED. This state-of-art article evaluates current and emerging therapeutic options for ED. Full article

(This article belongs to the Special Issue Men's Sexual Health)

12 pages, 388 KiB

Open AccessReview

Erectile Dysfunction: A Primer for in Office Management

by Samir Sami, Noah Stern, Andrew Di Pierdomenico, Brandon Katz and Gerald Brock

Med. Sci. 2019, 7(9), 90; https://0-doi-org.brum.beds.ac.uk/10.3390/medsci7090090 - 29 Aug 2019

Cited by 1 | Viewed by 4804

Abstract

Introduction: Optimizing erectile dysfunction (ED) remains a clinically significant endeavor as insufficient outcomes from oral, injectable and even surgical approaches to treatment remain less than ideal. In this report, we integrate evolving knowledge and provide an algorithmic approach for the clinician to fine-tune [...] Read more.

Introduction: Optimizing erectile dysfunction (ED) remains a clinically significant endeavor as insufficient outcomes from oral, injectable and even surgical approaches to treatment remain less than ideal. In this report, we integrate evolving knowledge and provide an algorithmic approach for the clinician to fine-tune management. Methods: We performed a PubMed and Medline search of Erectile Dysfunction treatment optimization, enhanced patient efficacy for ED, and why men fail ED treatment. All relevant papers for the past two decades were reviewed. Results: Establishing the goals and objectives of the patient and partner while providing detailed instructions for treatment can minimize failures and create an environment that allows treatment optimization. A thorough work-up may identify reversible or contributing causes. We identified several areas where treatment of ED could be optimized. These include; management of associated medical conditions, lifestyle improvements, PDE5 inhibitor prescription strategies, management of hypogonadism and the initiation of intracavernosal injection therapy (ICI). Conclusions: In our view, once a man presents for help to the clinician, use of the simple strategies identified in this review to optimize the tolerability, safety and effectiveness of the selected treatment should result in enhanced patient and partner satisfaction, with improved outcomes. Full article

(This article belongs to the Special Issue Men's Sexual Health)

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6 pages, 200 KiB

Open AccessReview

Contemporary and Novel Imaging Studies for the Evaluation of Erectile Dysfunction

by Eric Chung

Med. Sci. 2019, 7(8), 87; https://doi.org/10.3390/medsci7080087 - 09 Aug 2019

Cited by 3 | Viewed by 3229

Abstract

Traditionally, it was thought that the pathogenesis of erectile dysfunction (ED) can be divided into psychological and organic factors. However, recent literature supports the development and progression of ED due to multidimensional alterations of a complex interplay of central and peripheral systems, from [...] Read more.

Traditionally, it was thought that the pathogenesis of erectile dysfunction (ED) can be divided into psychological and organic factors. However, recent literature supports the development and progression of ED due to multidimensional alterations of a complex interplay of central and peripheral systems, from neural cognitive and efferent networks to loco-regional neuro-hormonal factors which are responsible for impaired penile vascular hemodynamics and ensuing lack of, or suboptimal, blood flow into the penis and/or veno-occlusive dysfunction. It is recognised that ED is strongly correlated with cardiovascular health and published clinical guidelines advocate screening for cardiovascular and metabolic risk factors in men presenting with ED. Over the past few decades, various imaging modalities have been developed and utilised to provide objective evaluation for ED to better characterise the state of penile health and exclude psychogenic components. The following article evaluates current and emerging imaging diagnostic tools for ED. Full article

(This article belongs to the Special Issue Men's Sexual Health)

13 pages, 248 KiB

Open AccessReview

The Use of MRI and PET Imaging Studies for Prostate Cancer Management: Brief Update, Clinical Recommendations, and Technological Limitations

by Margaret Mansbridge, Eric Chung and Handoo Rhee

Med. Sci. 2019, 7(8), 85; https://0-doi-org.brum.beds.ac.uk/10.3390/medsci7080085 - 05 Aug 2019

Cited by 14 | Viewed by 4145

Abstract

Multi-parametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET) using prostate-specific membrane antigen (PSMA) targeting ligands have been adopted as a new standard of imaging modality in the management of prostate cancer (PCa). Technological advances with hybrid and advanced computer-assisted technologies such [...] Read more.

Multi-parametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET) using prostate-specific membrane antigen (PSMA) targeting ligands have been adopted as a new standard of imaging modality in the management of prostate cancer (PCa). Technological advances with hybrid and advanced computer-assisted technologies such as MR/PET, MR/US, multi-parametric US, and robotic biopsy systems, have resulted in improved diagnosis and staging of patients in various stages of PCa with changes in treatment that may be considered “personalized”. Whilst newer clinical trials incorporate these novel imaging modalities into study protocols and as long-term data matures, patients should be made aware of the potential benefits and harm related to these technologies. Published literature needs to report longer-term treatment efficacy, health economic outcomes, and adverse effects. False positives and negatives of these imaging modalities have the potential to cause harm and the limitations of these technologies should be appreciated. The role of a multi-disciplinary team (MDT) and a shared-decision-making model are important to ensure that all aspects of the novel imaging modalities are considered. Full article

(This article belongs to the Special Issue Men's Sexual Health)

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