The effect of extended release tolterodine used for overactive bladder treatment on female sexual function

ABSTRACT Introduction Overactive bladder (OAB) is a common condition, especially in middle aged women, requiring long term therapy with anticholinergics to maintain symptoms relief. The aim of the study was to determine the effect of tolterodine extended release (ER) used for OAB treatment on the sexual function of women. Materials and Methods Between August 2010 and August 2014, 220 women with confirmed OAB, attended Urogynecology Outpatient Clinic and were prospectively enrolled in this study. 158 women were evaluated, with a comprehensive history, physical examination, urodynamic studies and Female Sexual Function Index (FSFI) questionnaire. 73 patients of group A (control group) received no treatment and 85 patients of group B received an anticholinergic regimen - tolterodine ER 4mg once daily. Data were evaluated again in accordance with FSFI after three months, using SPSS software. Results A statistically significant increase was noted in group B in domains of desire (pre-treatment 2.5±0.2 to 4.5±0.2 post-treatment), arousal (3.1±0.2 to 3.1±0.2 respectively), lubrication (3.4±0.3 to 4.3±0.3 respectively), orgasm (3.5±0.3 to 4.5±0.3 respectively), satisfaction (2.6±0.2 to 4.2±0.3 respectively) and pain (2.4±0.2 to 4.6±0.4 respectively) after three months treatment with tolterodine ER. In group A there were no statistically significant changes in pre and post treatment values (p>0.05). Total FSFI score for group B was significantly higher after tolterodine treatment (26.5±1.5) compared to pre-treatment values (17.4±1.4, p<0.01) and to control group A (17.7±1.2 and 17.9±1.5, p>0,05) respectively. Conclusions This preliminary study demonstrates that treatment of OAB with tolterodine ER was found to have positive effect on sexual function of patients with OAB.

Sexual addiction in drug addicts: The impact of drug of choice and poly-addiction / Dependência sexual em dependentes químicos: o impacto de diferentes drogas de escolha e de polidependência

Summary Objective: To compare the risk of comorbid sexual addiction in a sample of individuals with a diagnosis of substance dependence, stratifying the sample by drug of choice as well as by mono versus polysubstance addiction. Method: All data were collected at Santa Casa de São Paulo, Brazil. The study sample comprised all alcohol or drug dependents admitted to the Addiction Treatment Unit between November 2013 and August 2014. A generalized linear model with a binomial distribution was performed to compare the odds of having a Sexual Addiction Screening Test (SAST) score greater than 6 points in the subgroups analyzed. Results: A total of 133 participants were included in our analysis, all reporting cocaine/crack and/or alcohol as drug of choice. Polysubstance addicts had a significant higher risk of a positive screening for sexual addiction compared to monosubstance addicts, age-sex adjusted odds ratios of sexual addiction being respectively 2.72 (95CI 1.1-6.71) and 0.37 (95CI 0.15-0.91). The odds of a SAST score greater than 6 was not statistically different between the cocaine/crack and alcohol groups, respectively 0.38 (95CI 0.14-1.02) and 2.67 (95CI 0.98-7.25). We found a significant relation between stronger drug addiction and greater levels of sexual addiction in the cocaine/crack group (p=0.0012), but not in the alcohol group. Conclusion: Our study reinforces the importance of assessing sexual behavior of drug addicts in clinical practice, especially considering users of multiple substances or with severe dependence.

Resumo Objetivo: Comparar o risco de dependência sexual em uma amostra de indivíduos com diagnóstico de dependência química, estratificados por droga de escolha e por dependência única ou de múltiplas substâncias. Método: Todos os dados foram coletados na Santa Casa de São Paulo, Brasil. A amostra estudada correspondeu a todos os indivíduos dependentes de álcool ou outras substâncias admitidos no Ambulatório de Dependência Química entre novembro de 2013 e agosto de 2014. Modelos lineares generalizados com distribuição binomial foram utilizados para comparar o risco de escores maiores que seis na Escala de Rastreamento para Dependência de Sexo (SAST) nos subgrupos analisados. Resultados: Foram analisados os dados de 133 pacientes usuários de cocaína/crack e/ou álcool. Usuários de múltiplas substâncias apresentaram risco significativamente maior de um screening positivo para dependência sexual comparados com usuários de uma única substância. Os odds ratios de dependência sexual ajustados por sexo e idade obtidos nos dois grupos foram, respectivamente, 2.72 (IC95% 1.1-6.71) e 0.37 (IC95% 0.15-0.91). O risco de dependência sexual entre usuários de cocaína/crack e álcool foi estimado, respectivamente, em 0.38 (IC95% 0.14-1.02) e 2.67 (IC95% 0.98-7.25), não indicando diferença significativa. Foi encontrada uma relação significativa entre severidade de dependência química e maiores níveis de dependência sexual entre dependentes de cocaína/crack, mas não de álcool. Conclusão: Nosso estudo reforça a importância de avaliar o comportamento sexual de dependentes químicos na prática clínica, especialmente considerando usuários de múltiplas substâncias, ou casos de maior severidade.

Increased sexual arousal in patients with movement disorders / Exacerbação do impulso sexual em pacientes com distúrbios do movimento

ABSTRACT Increased of sexual arousal (ISA) has been described in different neurological diseases. The purpose of this study was present a case series of ISA in patients with movement disorders. Method Fifteen patients with different forms of movement disorders (Parkinson’s disease, Huntington’s disease, Tourette´s syndrome, spinocerebellar ataxia type 3), were evaluated in the Movement Disorders Unit of the Federal University of Paraná. Results Among Parkinson’s disease patients there were seven cases with different forms of ISA due to dopaminergic agonist use, levodopa abuse, and deep brain stimulation (DBS). In the group with hyperkinetic disorders, two patients with Huntington’s disease, two with Tourette’s syndrome, and four with spinocerebellar ataxia type 3 presented with ISA. Conclusions ISA in this group of patients had different etiologies, predominantly related to dopaminergic treatment or DBS in Parkinson’s disease, part of the background clinical picture in Huntington’s disease and Tourette’s syndrome, and probably associated with cultural aspects in patients with spinocerebellar ataxia type 3.

RESUMO A exacerbação do impulso sexual (EIS) tem sido descrita em diversas doenças neurológicas. O objetivo deste estudo foi apresentar uma série de casos de EIS em pacientes com distúrbios do movimento. Métodos Quinze pacientes com diferentes formas de distúrbios do movimento (Doença de Parkinson, doença de Huntington, síndrome de Tourette, ataxia espinocerebellar tipo 3), foram avaliados na Unidade de Distúrbios de Movimento-Universidade Federal do Paraná. Resultados Entre os pacientes com doença de Parkinson houve sete casos com diferentes formas de EIS devido ao uso de agonista dopaminérgico, abuso de levodopa ou estimulação cerebral profunda (DBS). No grupo com distúrbios hipercinéticos, dois pacientes com doença de Huntington, dois com síndrome de Tourette, e quatro com ataxia espinocerebelar tipo 3 apresentaram EIS. Conclusões EIS nesses pacientes decorreu de diferentes etiologias, relacionadas com o tratamento dopaminérgico ou DBS na doença de Parkinson, parte do quadro clinico na doença de Huntington e síndrome de Tourette, e provavelmente relacionado com aspectos culturais em pacientes com ataxia espinocerebelar tipo 3.

Molecular mechanisms that underlie the sexual stimulant actions of Avicennia marina [Forssk.] Vierh. and Crocus sativus L

The effects of extracts and sub-fractions of Avicennia marina, Crocus sativus and sildenafil on the sexual behavior of male rats and their effects on the intracavernosal pressure [I.CV], intracavernosal cyclic GMP and dihydrotestosterone plasma level were examined. The sexual behavior was followed for four hours using infra-red video cameras to quantify the effects on various male sexual behaviors. The results revealed that the active sub-fraction in case of A. marina was the hexane fraction of the chloroform extracts [C/H] whereas that of C. sativus was the hexane fraction of the alcoholic extract [A/H]. [C/H], [A/H] and sildenafil significantly increased the total sexual stimulation index from 53.8 +/- 2.7 [control] to 406 +/- 7.8, 225 +/- 4 and 401 +/- 30.1, respectively [P<0.001, N=6]. They significantly increased the index of successful mounting and ejaculation from 2.6 +/- 0.5 [control] to 40 +/- 2.7, 21 +/- 2.3 and 18 +/- 1.7, respectively [P<0.01, N=6]. They significantly increased the cyclic GMP level from 0.94 +/- 0.07 [control] to 3.1 +/- 0.13, 1.59 +/- 0.11 and 3.66 +/- 0.19 ng/mg wet tissue, respectively [P<0.05, N=7]. They did not affect dihydrotestosterone plasma level. [C/H], [A/H] and sildenafil increased the [I.CV] pressure by 4.8 +/- 0.3, 1.4 +/- 0.8 and 4.2 +/- 0.9 mmHg. The [C/H] seemed to be more active than sildenafil and twice active than [A/H]. Both extracts and sildenafil acted via an increase in cyclic GMP

Elderly men over 65 years of age with late-onset hypogonadism benefit as much from testosterone treatment as do younger men

PURPOSE: To investigate the potential benefits of testosterone administration to elderly men (>65 years) with late-onset hypogonadism (LOH) in comparison with younger men and to assess the safety of testosterone administration to elderly men. MATERIALS AND METHODS: A total of 561 hypogonadal men from two registry studies were divided into age groups of 65 years (group O, n=111; range, 66-84 years). Following an initial 6-week interval, all men were treated with 3-month injections of parenteral testosterone undecanoate for up to 6 years. RESULTS: Over the 6 years, there was a progressive decrease of body weight and waist circumference. Beneficial effects on lipids and other metabolic factors and on psychological and sexual functioning progressed over the first 24 to 42 months and were sustained. Rather than a deterioration, there was an improvement of urinary parameters. Prostate volume and prostate-specific antigen increased moderately. Hematocrit levels increased but remained within safe margins. CONCLUSIONS: The benefits of restoring serum testosterone in men with LOH were not significantly different between men older than 65 years of age and younger men. There were no indications that side effects were more severe in elderly men. The effects on prostate and urinary function and hematocrit were within safe margins. Age itself need not be a contraindication to testosterone treatment of elderly men with LOH.

A Case of Mental Retardation with Paraphilia Treated with Depot Leuprorelin

Paraphilia is a psychiatric disease that has been difficult to cure. However, recently developed therapeutic methods hold promise. The patient was a 20-yr-old male with chief complaints of continuous masturbation, genital exposure, and aggressive behavior that started 2 yr ago. We administered leuprorelin 3.6 mg intramuscular injection per month, a depot gonadotrophin-releasing hormone analogue, to this patient who a severe mentally retardation with paraphilia. The clinical global impression (CGI)-severity, CGI-improvement and aberrant behavior checklist were performed. After one month, we observed significant improvement in symptoms, such as decreases of abnormal sexual behavior and sexual desire. The GnRH analogues are suggested to be used as an alternative or supplementary therapeutic method for sexual offenders after clinical studies.

Protective effect of maternal prenatal melatonin administration on rat pups born to mothers submitted to constant light during gestation

We studied the effects of adverse conditions such as constant light (LL) on the circadian rhythm of malate (MDH, EC 1.1.1.37) and lactate (LDH, EC 1.1.1.27) dehydrogenase activities of the testes of male Wistar rats on postnatal day 28 (PN28), anxiety-like behavior (elevated plus-maze test) at PN60 and sexual behavior at PN120. The rats were assigned to mother groups on day 10 of pregnancy: control (12-h light/dark), LL (light from day 10 to 21 of pregnancy), and LL+Mel (LL and sc injection to the mothers of a daily dose of melatonin, 1 mg/kg body weight at circadian time 12, from day 17 to 21 of pregnancy). LL offspring did not show circadian rhythms of MDH (N = 62) and LDH (N = 63) activities (cosinor and ANOVA-LSD Fisher). They presented a 44.7 percent decrease in open-arm entries and a 67.9 percent decrease in time (plus-maze test, N = 15, P < 0.001, Mann-Whitney U-test and Kruskal-Wallis test), an increase in mounting (94.4 percent), intromission (94.5 percent) and ejaculation (56.6 percent) latencies (N = 12, P < 0.01, Mann-Whitney U-test and Kruskal-Wallis test) and lower numbers of these events (61, 59 and 73 percent, respectively; P < 0.01, N = 12) compared to controls. The offspring of the LL+Mel group presented MDH and LDH circadian rhythms (P < 0.05, N = 50, cosinor and ANOVA-LSD Fisher), anxiety-like and sexual behaviors similar to control. These findings supported the importance of the melatonin signal and provide evidence for the protective effects of hormones on maternal programming during gestation. This protective action of melatonin is probably related to its entrainment capacity, favoring internal coupling of the fetal multioscillatory system.

Efeitos do Trifolium pratense nos sintomas climatéricos e sexuais na pós-menopausa / Effects of Trifolium pratense on the climacteric and sexual symptoms in postmenopause

OBJETIVO: Avaliar os efeitos do tratamento com Trifolium pratense nos sintomas climatéricos e na satisfação sexual de mulheres na pós-menopausa. MÉTODOS: Este estudo foi prospectivo, randomizado, duplo-cego e controlado com placebo. Foram selecionadas 120 mulheres na faixa etária de 45 anos a 65 anos com sintomas climatéricos, amenorreia superior a um ano e sem tratamento nos últimos seis meses. Após a seleção, foram divididas em dois grupos: GT -receberam Trifolium pratense na dose de 40 mg, 1 capsula/dia; GP -receberam placebo (controle), contendo lactose, 1 cápsula/dia. A duração do tratamento foi de 12 meses. As pacientes foram avaliadas clinica e laboratorialmente antes do tratamento e com quatro, oito e 12 meses de tratamento. Foi empregado também o Índice Menopausal de Kupperman (IMK) e o Inventário de Satisfação Sexual Golombok Rust. No final do estudo, cada grupo tinha 50 pacientes. RESULTADOS: Houve melhora significante dos sintomas menopausais após quatro meses de tratamento pelo IMK, principalmente em relação aos fogachos, comparando os dados antes do tratamento nos dois grupos, porém, não houve diferença significante entre os grupos. Não houve melhora na sexualidade antes e após o tratamento. CONCLUSÃO: O tratamento por 12 meses com Trifolium pratense, na dose de 40mg/dia, não promoveu melhora significante dos sintomas menopausais e na satisfação sexual.

OBJECTIVE: To evaluate effects of treatment with Trifolium pratense on climacteric symptoms and sexual satisfaction in postmenopausal women. METHODS: This study was prospective, randomized, double-blind and placebo-controlled. We selected 120 women, aged between 45 and 65 years with climacteric symptoms, with absence of menstruation (amenorrhea) for more then one year and without any treatment in the last six months. After selection, women were divided into two groups: GT received 40 mg of Trifolium pratense (one capsule per day); GP received placebo (control, one capsule of lactose per day). Treatment lasted 12 months and women were evaluated before and after four, eight and twelve months of treatment by clinical (Kupperman Menopausal Index -KMI and the Golombok Rust Inventory of Sexual Satisfaction) and laboratory exams. At study end, each group had 50 patients. RESULTS: There was a significant decrease of symptoms after four months of treatment according to the KMI, mainly of hot flashes in relation to baseline data for both groups, but not between both groups. Evaluation of sexual satisfaction did not disclose any difference in both groups before and after treatment. CONCLUSION: The 40mg/day Trifolium pratense treatment may not ameliorate menopausal symptoms or improve sexual satisfaction.

[Treatment effect of onion on sexual behavior after induces an antiepileptic drug [lamotrigine] in male rat]

The medicinal use of onion dates back to ancient China and India. Men with epilepsy have reduced fertility, and antiepileptic drugs may affect semen quality. Disturbances of reproductive endocrine hormones are more often found in men with epilepsy than in the general population. There is an ongoing debate whether this can be attributed to chronic use of antiepileptic drugs or to the epilepsy itself. The aim of the present study was to evaluate the beneficial degree of sexual behavior in male rats after inducement onion in lamotrigine receiving groups. Forty wistar rats, randomized into four groups [n=10], were used for this study, five of them male and five of them female. Animals in Group A served as the control and was drinking distilled water. Animals in Groups B: treated with 3cc/rat of onion juice, in Groups C: received10mg/kg/day lamotrigine, in Groups D: received10mg/kg/day lamotrigine plus 3cc/rat of onion juice. In All treatments were for 5 weeks. 48 hours before end of study estradiol benzoate [25 micro gr/kg/day, s.c.] and 6 hours before end of study progesterone 0.3muM were injected. Results showed the percentage of erections and couplings and serum testosterone in onion treated groups were significantly increased [p<0.01] when compared to other groups. onion and its constituents are stated to has antioxidant. Enhanced oxidative stress and changes in antioxidant capacity are considered to play an important role in the pathogenesis in diseases. These findings lead to the conclusion that onion significantly lowered the adverse effects of lamotrigine, and can do beneficial effect on sexual behavior in male rat

[Effect of melatonin on sexual behavior in male diabetic rats]

Several clinical studies indicate deterioration of sexual behavior in diabetic patients. The pathophysiological mechanisms of diabetic sexual impotence remain obscure. In this study the therapeutic effects of melatonin on sexual behavior were investigated through the central serotonergic system in diabetic rats. In this study, 30 male adult Wistar rats, weighing 200 +/- 20 g, were used. Animals were divided into three groups, the controls [C], diabetic [D] and the melatonin-treated diabetic [M] group. Experimental diabetes was induced by intraperitoneal injection of 50 mg/kg streptozotocin. Melatonin was injected [10 mg/kg i. p.] after 3 days of streptozotocin injection for 30 days. At the end of the administration period, the sexual behavior of each male rat to an ovariectomized female rat was assessed for 40 min. Serotonergic type 2 [5-HT2A] receptor activities were investigated through spontaneous WDS behavior, and experimental data were statistically analyzed. First mount, first intromission and first ejaculation latencies significantly [p<0. 05] increased in diabetic rats as compared to controls. Melatonin treatment significantly [p<0. 05] reduced these responses in the M group, compared to the D one. Also the number of mounts, intromissions and ejaculations significantly [p<0. 05] decreased in diabetic rats compared to controls. Administration of melatonin significantly [p<0. 05] increased these activities in the M group as compared to the D one. Calculation of copulatory efficiency and the sexual activity index of each rat indicate that reproductive activity in diabetic rats was significantly [p<0. 05] less than other two groups. The number of WDS responses was significantly [p<0. 05] different in all three groups. Sexual dysfunction in diabetic animals was accompanied by decreasing of 5-HT2A receptor activities, and melatonin prevented the diabetes-induced sexual impotence by modulating of central serotonergic system activity

Effects of Permethrin on sexual behaviour and plasma concentrations of pituitary-gonadal hormones in adult male NMRI mice

Pyrethroids are commonly used as insecticides for both household and agricultural purposes, and recently have been shown to have detrimental effects on endocrine system. Permethrin is a type I pyrethroid which is used widely in Iran. In the present study the effects of permethrin on sexual behavior and plasma level of PG [pituitary-gonadal] hormones of adult male mice were investigated. Mice received daily Intra peritoneal injection of permethrin [10, 15, 20 mg/kg] for 5 weeks. Using receptive females, permethrin-treated male mice exhibited reduced sexual behavior [i.e. decrease in the number of sniffing, following, mounting and mating]. The concentrations of plasma testosterone, LH and FSH were measured by means of ELISA method. Serum testosterone levels were reduced significantly [p<0.05] in the experimental group versus control group, whereas FSH and LH values were not altered significantly. The results of this study indicate permethrin can have detrimental effects on plasma testosterone level and sexual behavior. In regard to considerable use of this insecticide in Iran, it's necessary to restrain its use and extent of human contact to prevent hazards of this insecticide on human body tissues

Consumo de sustancias y conductas de riesgo en consumidores de pasta base de cacaína no consultantes a servicios de rehabilitación / Substance use and risk behaviors of out-of-treatment cocaine base paste and cocaine hydrochloride users

Background: In Chile, cocaine base paste (CBP) is the illegal substance that produces the highest rate of addiction. Nonetheless, a marginal number of users receive treatment each year. Aim: To compare the consumption patterns and risk behavior of CBP and cocaine hydrochloride (CH) users who do not attend rehabilitation services. Material and Methods: In a prospective research design, through a study methodology called Privileged Access Interview of hidden populations, 28 surveyors recruited 231 CBP users (group 1) and 236 CH users (group 2). The Risk Behavior Questionnaire was applied in four communities of Metropolitan Santiago, that have the highest prevalence of PBC and CH use. Results: CBP users showed higher schools drop-out and unemployment rates. Subjects of both groups were predominantly polysubstance and polyaddicted users. The severity of addiction to CBP of group 1 was significantly higher than the severity of addiction to CH of group 2 (5.5 versus 5.1: p<0.001). CBP users showed significantly higher rates of sexual risk behaviors, antisocial behavior, self infliction of injuries, suicide attempt and child neglect. Conclusions: A higher vulnerability was shown for users of CBP than those of CH. Attention is drawn to the need for developing community interventions in order to alter substance abuse and the risk behavior of these vulnerable groups.

A double blind randomized control trial, comparing effect of drospirenone and gestodene to sexual desire and libido.

BACKGROUND: Oral contraceptive is the most commonly used method of fertility control. Yasmin is a combination of a novel progestogen with anti-androgenic and anti-mineralcorticoid activities (3 mg Drospirenone (DRSP) and 30 microg ethinylestradiol (EE)). It has been shown in many clinical trials that Yasmin is an efficacious oral contraceptive, lacking undesired effects as with other oral contraceptives such as weight gain. However the effects of Yasmin on sexual desire and libido have not been intensively investigated so far OBJECTIVE: Investigate the effects of Yasmin on sexual desire, libido and changes in the free androgen index (FAI) compare to Meliane (75 microg gestodene + 20 microg ethinylestradiol). MATERIAL AND METHOD: The authors' report the results of a double blind randomized controlled study using a translated version of the Female Sexual Function Index questionnaire (FSFI) for the assessment of the sexual function. The free androgen index was calculated from measurements of testosterone and sexual hormone binding globulin. RESULT: The result shows statistically significant improvements regarding sexual desire, arousal and overall satisfaction in the Yasmin group. Additionally, an increased frequency of orgasms in the Meliane group was reported. Statistically significant differences between the two treatments regarding changes in the FSFI score and changes in the free androgen index have not been observed. CONCLUSION: The novel oral contraceptive containing drospirenone (Yasmin) and the non-anti-androgenic progestin containing oral contraceptive (Meliane) do not show unfavorable effects on sexual response and libido.

Insuficiência androgênica na mulher e potenciais riscos da reposicão terapêutica / Female androgen insufficiency and potencial risks of therapeutic replacement

Na mulher, os androgênios decrescem lenta e progressivamente a partir da quarta década e por toda a vida. O declínio dos androgênios pode gerar um estado de deficiência que se manifesta insidiosamente por diminuicão da funcão sexual, bem estar e energia, alteracões na composicão corporal e perda de massa óssea. Se há história de ooforectomia bilateral, pan-hipopituitarismo, supressão da androgênese adrenal e/ou os níveis séricos de testosterona biodisponível se encontram reduzidos, é provável que estes sinais e sintomas sejam aliviados pela administracão criteriosa de androgênios, cuja prática tem se difundido. Nas doses atualmente preconizadas, parece que os benefícios sobre massa óssea, sexualidade e qualidade de vida são alcancados sem importantes efeitos colaterais de virilizacão. Entretanto, trabalhos bem controlados são necessários para validar a hipótese de que a administracão terapêutica de androgênios em mulheres não tem, a longo prazo, repercussões significativas na incidência sobre câncer de mama ou conseqüências metabólicas indesejáveis.

study of Khar-e-Khasak Khurd [tribulus terrestris linn., fruits] on sexual behaviour

Khar-e-Khasak Khurd [Tribulus terrestris Linn, fruit] is used for treating sexual dysfunctions in the Unani System of Medicine. The effects of aqueous extract of drug were studied on sexual behaviour of male rats. In this study copulatory behaviour, penile erection, licking, grooming of genitals and copulatory movement in absence of female rats were observed. Androgenic and anabolic activities were also assessed by recording the weight of ventral prostate and levator ani muscle. The results show that test drug 500 mg/kg orally produced a significant increase in mounting frequency by 54%, Intromission frequency by 87%, mounting latency by 92%, Intromission latency by 107%, ejaculatory latency by 52% and post-ejaculatory interval by 24%. The drug produced significant increase in penile erection index, weight of prostate and levator ani muscles by 73% and 51.6%. This study supports the use of this drug in treatment of impotence, premature ejaculation and depressed libido