Tribulus terrestris for female sexual dysfunction: a systematic review / Tribulus terrestris para disfunção sexual feminina: uma revisão sistemática

Abstract Objective We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD). Data sources We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO,WHO-ICTR, Clinicaltrials.gov and OpenGrey databases. Selection of studies We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included. Data collection Data extraction was performed by two reviewers with a preestablished data collection formulary. Data synthesis Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, whichmeans that we have very little confidence in the effect estimates, and future studies are likely to change these estimates. Conclusion MoreRCTs are needed to supportor refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process. Number of Protocol registration in PROSPERO database: CRD42019121130

Resumo Objetivo Nós realizamos uma revisão sistemática para avaliar a efetividade e a segurança do Tribulus terrestris no tratamento da disfunção sexual feminina (DSF). Fontes de dados Nós realizados uma busca eletrônica irrestrita nas seguintes bases de dados: MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov, e OpenGrey. Seleção dos estudos Nós incluímos todos os ensaios clínico randomizados (ECR) que comparou T. terrestris com controles ativos/inativos. Após o processo de seleção, conduzido por 2 revisores, 5 ECRs (n = 279 participantes) foram incluídos. Extração de dados O processo de extração de dados foi realizado por dois revisores, utilizando-se um formulário de extração de dados pré-estabelecido. Síntese de dados Devido à falta de dados disponíveis e à heterogeneidade clínica entre os estudos incluídos, nós não realizamos meta-análises. O risco de viés foi avaliado pela tabela de risco de viés da Cochrane e, a certeza do corpo da evidência foi avaliada pelo Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Resultados Após 1 a três 3 meses de tratamento, mulheres na pré e pós-menopausa randomizadas ao T. terrestris tiveram um aumento significante nos escores de função sexual. O grupo com 3 meses de tratamento com T. terrestris exibiu um aumento significante dos níveis séricos de testosterona emmulheres pré-menopausa. Não houve relato de eventos adversos graves, e nenhum estudo avaliou qualidade de vida das participantes. A certeza da evidência foi considerada muito baixa, o que significa que existe pouca certeza na estimativa dos efeitos e que é provável que futuros estudos mudem estas estimativas. Conclusão Mais ECRs são importantes para apoiar ou refutar o uso do T. terrestris. A decisão de usar essa intervenção deve ser compartilhada com pacientes, e as incertezas sobre seus efeitos devem ser discutidas durante o processo de decisão clínica.

Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism

ABSTRACT Objective To summarize current evidence regarding testosterone treatment for women with low sexual desire. Materials and methods The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. Results Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. Conclusion Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8

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.

Randomized crossover trial of amoxapine versus vitamin B12 for retrograde ejaculation

ABSTRACT Objective To compare the efficacy and safety of amoxapine and vitamin B12 for treating retrograde ejaculation (RE). Materials and Methods Between May 2009 and November 2012, this open-label, randomized, crossover study enrolled 26 men suffering with RE at Department of Reproductive Medicine, Omori Hospital. Patients were randomly allocated into two groups (n=13 each). The amoxapine-B12 group received amoxapine (50 mg daily for 4 weeks, orally) followed (after a 1-week washout period) by vitamin B12 (500 μg three-times daily for 4 weeks). The B12-amoxapine group received the opposite regimen. All patients masturbated to ejaculation at least twice during each treatment period. The primary outcome was antegrade ejaculation of semen, as reported by the patient, on more than one occasion during either treatment period (defined as treatment success). Any adverse events were noted. Success rates were compared between treatments using Fisher’s exact test. Results One patient (B12-amoxapine group) withdrew for personal reasons (breakdown of marital relations); all other patients completed the study. Overall success rate was 88% (22/25). Success rate was higher for amoxapine than for vitamin B12 (80%, 20/25 vs 16%, 4/25; P<0.0001). 18 patients were responsive to amoxapine but not to vitamin B12, 2 patients were responsive to vitamin B12 but not amoxapine, 2 patients were responsive to both drugs, and 3 patients had no response to either drug. One patient (4%) reported sleepiness and 2 (8%) reported constipation while receiving amoxapine. No adverse events were reported during vitamin B12 treatment. Conclusions Amoxapine may be an effective, safe and well-tolerated therapy for RE.

Influence of Dyslipidemia on the Quality of Sexual Life in Women in the Menacme using a Combined Oral Contraceptive / Influência da dislipidemia na qualidade de vida sexual de mulheres na menacme usando contraceptivos orais combinados

ABSTRACT Purpose: Female sexual dysfunction is a complex and common condition that affects women, and the relationship between sexual function and dyslipidemia is poorly studied. This study aims to assess this relationship in the reproductive life women in the menacme who use combined oral contraceptives (COCs) . Methods: A total of 49 healthy women who were sexually active received COC pills that contained ethinylestradiol 30 mcg (EE30) plus levonorgestrel 150 mcg (LNG150). The women were divided into two groups according to their lipid profiles. Dyslipidemia was defined as a high-density lipoprotein (HDL) level < 50 mg/dL or a low-density lipoprotein (LDL) level > 130 mg/dL. Sexual function was assessed using the Female Sexual Function Index (FSFI) Questionnaire. Lipid and lipoprotein parameters were obtained at baseline and after the sixth cycle. Results: After six cycles of the COCs, the total cholesterol and LDL cholesterol levels in the women with a LDL level > 130 mg/dL decreased by 14.7% and 22.1% respectively. In the women with a HDL level < 50 mg/dL at baseline, the HDL level increased by 15.5% at the end of the study. The arousal and orgasm domains and the FSFI total scores significantly increased in women with and without dyslipidemia. The desire and satisfaction domains increased only in the group without dyslipidemia at the end of the treatment period. Conclusions: The EE30/LNG150 formulation increased the sexual function and it was only positively correlated with the HDL cholesterol level. These data indicated a low correlation between sexual function and the changes in the lipid and lipoprotein metabolism.

RESUMO Objetivo: Disfunção sexual feminina é uma condição complexa acomete as mulheres, e a relação entre a função sexual e a dislipidemia é muito pouco estudada. Este estudo objetivou avaliar esta relação em mulheres na menacme que fazem uso de contraceptivos orais combinados (COCs). Métodos: Um total de 49 mulheres saudáveis com vida sexual ativa receberam pílulas anticoncepcionais contendo etinilestradiol 30 mcg (EE30) associado a levonorgestrel 150 mcg (LNG150). As mulheres foram divididas em dois grupos, de acordo com o perfil lipídico. Dislipidemia foi definida como nível de lipoproteína de alta densidade (HDL) < 50 mg/dL, ou nível de lipoproteína de baixa densidade (LDL) > 130 mg/dL. A função sexual feminina foi avaliada utilizando o questionário de Índice de Função Sexual Feminina (IFSF). O IFSF e os parâmetros lipídicos e lipoproteicos foram obtidos no início e após o sexto ciclo do estudo. Resultados: Após seis ciclos de uso dos COCs, as mulheres com LDL > 130 mg/dL, tiveram redução dos níveis de colesterol total e colesterol LDL de 14,7% e 22,1% respectivamente. Nas mulheres com níveis HDL < 50 mg/dL no momento basal, o nível de HDL aumentou 15,5% ao final do estudo. Os domínios de excitação, orgasmo e os escores totais do IFSF aumentaram significativamente nas mulheres com e sem dislipidemia. Os domínios de desejo e satisfação aumentaram no final do período de tratamento exclusivamente no grupo sem dislipidemia. Conclusões: A formulação EE30/LNG150 aumentou a função sexual das mulheres, sendo positivamente correlata somente com os níveis de colesterol HDL. Estes achados demonstram baixa correlação entre a função sexual e as alterações no metabolismo lipídico e lipoproteico.

Assessment of the Effects of Tribulus Terrestris on Sexual Function of Menopausal Women / Avaliação dos efeitos do Tribulus Terrestris na sexualidade de mulheres no climatério

Objective The aim of this study was to study the effects of Tribulus terrestris on sexual function in menopausal women. Methods This was a prospective, randomized, double-blind, placebo-controlled clinical trial that included 60 postmenopausal women with sexual dysfunction. The women were divided into two groups, placebo group and Tribulus group, and evaluated by using the Sexual Quotient-female version (SQ-F) and Female Intervention Efficacy Index (FIEI) questionnaires. Results There was no significant difference between the groups in age, age at menopause, civil status, race, and religion. In the evaluation with the SQ-F questionnaire, there were significant differences between the placebo (7.6±3.2) and Tribulus (10.2±3.2) groups in the domains of desire and sexual interest (p d" 0.001), foreplay (3.3±1.5 versus 4.2±1.0) (p d" 0.01), arousal and harmonious interaction with the partner (5.7±2.1 versus 7.2±2.6) (p d" 0.01), and comfort in sexual intercourse (6.5±2.4 versus 8.0±1.9) (p d" 0.01). There was no significant difference between the placebo and Tribulus groups in the domains of orgasm and sexual satisfaction (p = 0.28). In the FIEI questionnaire, there was a significant improvement (p < 0.001) in the domains of vaginal lubrication during coitus and/or foreplay (20 versus 83.3%), sensation in the genitalia during sexual intercourse or other stimuli (16.7 versus 76.7%), sensation in the genital region (20 versus 70%), sexual intercourse and/or other sexual stimulations (13.3 versus 43.3%), and the ability to reach orgasm (20% versus 73.3%). There was no significant difference in adverse effects between the two groups. Conclusions After 90 days of treatment, at the doses used, we found Tribulus terrestris to be effective in treating sexual problems among menopausal women.

Objetivo Estudar os efeitos doTribulus terrestris na função sexual demulheres após a menopausa. Métodos Ensaio clínico, prospectivo, randomizado, duplo-cego, placebo controlado, com 60 mulheres após a menopausa com disfunção sexual, divididas em dois grupos: Grupo Placebo e Grupo Tribulus, avaliadas através dos questionários Quociente Sexualversão Feminina (QS-F) e Female Intervention Efficacy Index (FIEI). Resultados Não houve diferença significante entre os grupos quanto à idade, idade de menopausa, estado civil, raça e religião. Na avaliação do questionário QS-F houve diferença significante entre os grupos Placebo (7,6±3,2) e Tribulus (10,2±3,2) nos aspectos desejo e interesse sexual (p d" 0,001), preliminares (3,3±1,5 versus 4,2±1,0) (p d" 0,01), excitação da mulher e sintonia com o parceiro (5,7±2,1 versus 7,2±2,6) (p d" 0,01) e no aspecto conforto na relação sexual (6,5±2,4 versus 8,0±1,9) (p d" 0,01). O aspecto orgasmo e satisfação sexual não houve diferença significante entre o Grupo Placebo e Tribulus (p = 0,28). No questionário FIEI houve melhora significante (p < 0,001) na lubrificação vaginal durante o coito e/ou preliminares (20 versus 83,3%), na sensação nas genitálias durante a relação sexual ou outros estímulos (16,7 versus 76,7%), na sensação na área genital (20 versus 70%), nas relações sexuais e/ou outras estimulações sexuais (13,3 versus 43,3%) e na capacidade de ter orgasmo (20% versus 73,3%). Quanto aos efeitos colaterais não houve diferença significante entre os dois Grupos. Conclusões Após noventa dias, podemos concluir que o Tribulus terrestris nas doses utilizadas demonstrou ser efetivo no tratamento das queixas sexuais dasmulheres após a menopausa.

Câncer de mama e seus efeitos sobre a sexualidade: uma revisão sistemática sobre abordagem e tratamento / Breast cancer and its effects on sexuality: a sistematic review on the evaluation and treatment

O câncer de mama e seu tratamento afetam amplamente a sexualidade das mulheres acometidas. O impacto pode durar vários anos, mesmo após um tratamento bem-sucedido para a doença, decorrente dos diversos efeitos colaterais da terapêutica e dos eventos psíquicos resultantes do processo. Estudos mostram alterações físicas decorrentes da quimioterapia, hormonioterapia e tratamento cirúrgico que interferem na sexualidade, promovendo distúrbios no funcionamento sexual em suas diferentes fases, como desejo, excitação, lubrificação e orgasmo. Experiências psíquicas incluem medo da perda da fertilidade, imagem corporal negativa, sentimento de não ser sexualmente atraente, depressão e ansiedade, enquanto fatores sociais e relacionais exercem influência sobre o ajuste ao tratamento e à doença. A qualidade prévia do relacionamento com o parceiro é considerada o mais importante fator preditivo da qualidade do relacionamento sexual após o término do tratamento. Conclui-se que o estudo da sexualidade no contexto do câncer de mama não pode considerar separadamente os aspectos físicos dos psicossociais, e que a identificação das causas dos diferentes tipos de disfunção sexual neste subgrupo possibilita o desenvolvimento de intervenções fisiológicas e psicossociais que contribuam para a manutenção da qualidade da atividade sexual.(AU)

Breast cancer and its treatment widely affect the sexuality of female patients. The impact may last for several years, even after successful treatment of the disease, due to the many side effects of the treatment and psychical events that emerge from the process. Studies refer to physical changes derived from chemotherapy, hormone therapy and surgical treatment, that intervenes in the sexuality, promoting disturbances regarding sexuality in different phases, such as desire, arousal, lubrication and orgasm. Psychical experiences include fear of losing fertility, negative body image, feeling of not being sexually attractive, depression and anxiety, while social and relational factors affect the adjustment to the treatment and the disease. The previous quality of the relationship with the partner is considered the most important predictive factor of the quality of sexual relationship after the treatment. We conclude that the study of sexuality in the context of breast cancer must consider both physical and psychosocial aspects, and that identifying the causes of different types of sexual dysfunction in this subgroup will enable the development of physiological and psychosocial interventions that may contribute to maintaining the quality of sexual activity of the patients.(AU)

effect of amantadine on clomipramine induced sexual dysfunction in male rats

Several studies have reported that Clomipramine has the ability to suppress male rat sexual behavior. Literature indicates that the activation of brain D2 receptors causes facilitation of penile erection, and a number of reports have indicated dopamine's involvement in sexual function. Hence this study was undertaken to investigate the effect of Amantadine, a dopamine agonists on the Clomipramine induced sexual dysfunction. The study subjects involved a total of 48 males and 48 females, 4 months old Sprague-Dawley albino rats, all housed in a group of six males and females separately in plexi glass cages in an acclimatized colony room [25 +/- 0.5[degree sign]C] maintained on a 12/12 hr light/dark cycle. The male rats were randomly divided into four groups of 12 male rats each. Group I served as controls. Group II, III, and IV were treated with Amantadine [9 mg/kg body weight, p.o] 30 min, prior to the treatment with 13.5 mg/kg, 27 mg/Kg and 54 mg/Kg bodyweight p.o of Clomipramine respectively for 60 days. The control group received vehicle 1 ml / kg p.o. The sexual behavior of the male rats was observed to determine the following parameters: mount latency, intromission latency, ejaculation latency, post ejaculatory pause, and intromission frequency. As well as the sexual behavior; serum testosterone and histopathology of the testes were also investigated in this study. The results indicate that Amantadine in all aspects failed to antagonize Clomipramine induced sexual dysfunction in male rats. Even the sexual competence of male rats treated with 1/2 therapeutic dose [TD] of Clomipramine failed to regain their sexual competence in the presence of Amantadine. Testicular damage and decline in testosterone levels continued in the presence of Amantadine. Overall, the results suggest that Amantadine could not be a safe antidote to antagonize Clomipramine induced sexual dysfunction

Deficiência androgênica na mulher / Androgen deficiency in women

As evidências sugerem que a deficiência androgênica na mulher exibe como principal manifestação clínica a disfunção sexual, especialmente a queda da libido. Entretanto, outros fatores podem também estar implicados na gênese da disfunção sexual, como o relacionamento interpessoal, os estressores sociais, o sedentarismo e o próprio fator masculino. A prevalência da disfunção sexual feminina oscila entre 9 por cento e 43 por cento e recentemente muitos estudos têm mostrado que a reposição com androgênios não só melhora o desempenho sexual, mas também os distúrbios do humor e sintomas vasomotores. Por isso, o profissional de saúde deve sempre incluir no diagnóstico diferencial da disfunção sexual a Síndrome de Deficiência Androgênica, mesmo em mulheres com concentrações séricas normais de estrogênios. O presente artigo tem como objetivo revisar os aspectos práticos da Síndrome de Deficiência Androgênica, enfocando especialmente o diagnóstico e tratamento. Para tanto, nos valemos da análise de 105 artigos publicados em revistas indexadas no PUBMED nos últimos 51 anos (até maio de 2010), incluindo consensos e opiniões de especialistas. Como conclusão, a Síndrome de Deficiência Androgênica na mulher é negligenciada, existindo ainda muitas controvérsias quanto ao seu diagnóstico e terapêutica, especialmente no tocante à escolha do androgênio, a via de administração e o tempo de duração de uso.

The evidences suggest that androgen deficiency in women induces sexual dysfunction as the main clinical manifestation, especially reduction of libido. However, other factors may be involved in the disease genesis, such as interpersonal relationships, social stressors, sedentarism and the partner. Prevalence of sexual problems among women ranges from nine to 43 percent and, recently, many studies have reported that androgens are beneficial not only for the sexual function of women, but for mood disorders and vasomotor symptoms. That is why the physician should include androgen deficiency syndrome as differential diagnosis, even in women with adequate levels of estrogen. Our goal was to present practical aspects of this disease, emphasizing diagnosis and focusing on treatment. This survey covered all the publications indexed in PUBMED in the last 51 years ending May 2010, including consensus and expert opinions; 105 articles were identified. We conclude that the syndrome of androgen deficiency in women is overlooked in clinical practice. There is controversy in literature regarding diagnosis and treatment including choice of drug, route of administration and time of application.

[Efficacy and safety of herbal drug, Hypericum perforatum in the treatment of premature ejaculation]

Premature ejaculation is the most prevalent form of male sexual dysfunction. Efforts to develop novel drugs safer than existing therapies are continued. Assessment of efficacy of Hypericum Perforatum in the treatment of premature ejaculation. This is the double blind, randomized placebo- controlled study. In this study were selected 50 married men [18-50 years old] who were referred to urology department of Razi hospital in Rasht from 2007 to 2008 with premature ejaculation were selected. These patients were divided to control and cases groups. Hypericum [160mg tablets] were prescribed for case group and placebo for control group. All participants completed IIEF-15 questionnaire before and after treatment. Intra vaginal latency time [IVLT] was measured before and after treatment. The results were analyzed using chi-square and paired t-test. After 4 weeks, there was difference in IVLT between 2 groups. This difference was statically significant [P<0.001]. There was an increase in two variables of the IIEF-15 [Intercourse satisfaction and overall satisfaction] in hypericum perforatum group [p<0.001]. In 3 participants drug was discontinued because of adverse reactions. It seems that hypericum perforatum may be regarded as a safe and effective alternative in the treatment of premature ejaculation

A systematic review on clinical management of antipsychotic-induced sexual dysfunction in schizophrenia

INTRODUCTION: Sexual dysfunction frequently occurs in patients with schizophrenia under antipsychotic therapy, and the presence of sexual side effects may affect compliance. The aim of this study was to review and describe clinical findings relating to the appropriate management of such dysfunctions. MATERIAL AND METHODS: The research was carried out through Medline (from 1966 to March 2005), PsycInfo (from 1974 to March 2005), and Cochrane Library (from 1965 to March 2005) and included any kind of study, from case reports to randomized trials. RESULTS: The most common sexual dysfunctions found in the literature were libido decrease, difficulties in achieving and maintaining erection, ejaculatory dysfunction, orgasmic dysfunction, and menstrual irregularities. Thirteen papers were found: eight of them were open-label studies, four were descriptions of cases, and only one was a randomized clinical trial. All of them were short-term and had small sample sizes. The agents used were: bromocriptine, cabergoline, cyproheptadine, amantadine, shakuyaku-kanzo-to, sildenafil and selegiline. DISCUSSION: There was no evidence that those agents had proper efficacy in treating the antipsychotic-induced sexual dysfunction. An algorithm for managing sexual dysfunction induced by antipsychotics is suggested as a support for clinical decisions. Since the outcome from schizophrenia treatment is strongly related to compliance with the antipsychotics, prevention of sexual dysfunction is better than its treatment, since there is a scarcity of data available regarding the efficacy of intervention to deal with these problems.

INTRODUÇÃO: Disfunção sexual freqüentemente ocorre em pacientes com esquizofrenia em terapia com antipsicóticos e a presença de efeitos adversos sexuais pode afetar a adesão ao tratamento. O objetivo do estudo é rever e descrever achados clínicos relacionados ao manejo apropriado de tais disfunções. MATERIAIS E MÉTODOS: A pesquisa foi feita pelo Medline (de 1966 a março de 2005), PsycInfo (de 1974 a março de 2005) e Biblioteca Cochrane (de 1965 a março de 2005) e incluiu qualquer tipo de desenho de estudo de relato de caso a estudos clínicos randomizados. RESULTADOS: As disfunções sexuais mais comuns encontradas na literatura foram diminuição da libido, dificuldades em alcançar e manter ereção, disfunção ejaculatória, orgásmica e irregularidades menstruais. Treze artigos foram encontrados: oito deles eram estudos abertos, quatro descrições de casos e somente um estudo clínico randomizado. Todos eram de curta duração e com tamanho de amostra pequeno. Os agentes usados foram: bromocriptina, cabergolina, ciproheptadina, amantadina, shakuyaku-kanzo-to, sildenafil e selegilina. DISCUSSÃO: Não há evidências de eficácia apropriada destes agentes no tratamento da disfunção sexual induzida por antipsicóticos. Um algoritmo foi sugerido para manejo da disfunção sexual induzida por antipsicóticos, suportando decisões clínicas. Como o desfecho da esquizofrenia é fortemente relacionado a adesão ao tratamento com antipsicóticos, a prevenção da disfunção sexual é melhor que seu tratamento, visto que muito poucos dados estão disponíveis sobre a eficácia de intervenções destes problemas.

Bethanecol chloride for treatment of clomipramine-induced orgasmic dysfunction in males

OBJETIVO: Investigar se o uso do cloridato de betanecol é uma alternativa útil no manejo clínco da disfunção orgásmica induzida pela clomipramina, relatada por até 96 % dos usuários do sexo masculino. MÉTODOS: Foram estudados 12 pacientes do sexo masculino em remissão completa de transtorno de pânico porém com queixas de disfunção orgásmica grave secundária ao uso da clomipramina. Os pacientes foram aleatoriamente distribuídos ao tratamento com cloridrato de betanecol (20 mg quando necessário) ou placebo em um estudo duplo cego "crossover" de dois períodos. RESULTADOS: Foi observado um benefício claro no período de uso da droga ativa. Não foram observados efeito placebo ou "carry-over" nos pacientes inicialmete alocados ao medicamento ativo. CONCLUSÕES: Os resultados deste estudo sugerem que o cloridato de betanecol, usado em doses únicas, 45 minutos antes da relação sexual, pode ser útil em pacientes do sexo masculino apresentado disfunção orgásmica secundária ao uso da clomipramina.

Penile vibratory threshold changes with various doses of SS-cream in patients with primary premature ejaculation

SS-cream made with extracts from natural products is a topical agent for treating premature ejaculation (PE). In order to elucidate the penile vibratory threshold changes and clinical effects of various doses of SS-cream, 53 patients with primary PE were investigated in a double-blind randomized placebo-controlled study. The mean age was 37.3 +/- 6.4 years and mean ejaculatory latency was 1.37 +/- 0.52 minutes. Neither the patients nor their sexual partners were satisfied with their sexual lives. Vibratory threshold at the glans penis, penile shaft, scrotum and index finger were measured using a biothesiometer twice during the screening period and three times one hour after the application of respective creams (SS-cream 0.05, 0.10. 0.15, 0.20 gm and placebo 0.10 gm) on the glans penis according to the order of the allocation table in a randomized fashion. The efficacy of SS-cream was defined as when the vibration threshold increased by more than 4 microns compared to the value tested during the screening period. The vibratory thresholds at the glans penis increased significantly in a dose-dependent manner after the application of various doses (0.05, 0.10, 0.15, 0.20 gm) of SS-cream (p < 0.001), and the efficacy of SS-cream on the penile vibration threshold increased according to the increased dosage (penile shaft: 48.4, 51.6, 54.8, 64.5%, glans penis: 58.1, 67.7, 77.4, 83.9%, respectively). With these results, we concluded that SS-cream increased the penile sensory threshold dose dependently, and therefore it is clinically effective for treating the heightened penile sensory response in patients with PE.

Sertralina en el tratamiento de la eyaculación precoz / Sertraline in the treatment of early ejaculation

Los tratamientos con antidepresivos frecuentemente se asocian con efectos colaterales en la esfera sexual. Aquellos que actúan inhibiendo la recapacitación de la serotonina como la sertralina retardan el orgasmo en hombres y mujeres. Se trataron con sertralina 92 pacientes, terminaron su período de observación 72 de ellos. De los pacientes que completaron tratamiento 64 de ellos refirieron estar mejor, 8 manifestaron estar igual y ninguno empeoró. La impresión de sus parejas fue de mejoría en 65 pacientes y permanecieron igual 7 casos. El tiempo de eyaculación por tratamiento fue de 2,5 minutos y el post tratamiento fue de 5,5 minutos (p<0,05). De los 64 pacientes que obtuvieron una adecuada respuesta terapéutica, 17 de ellos recidivaron durante el período final de observación, cuando ya no estaban recibiendo el medicamento. De este modo podemos concluir que la sertralina es un medicamento eficaz y seguro en el tratamiento de la eyaculación precoz, sin embargo, existe un porcentaje no despreciable de pacientes que no completa su tratamiento por diversas, razones y otro porcentaje que recidiva al suspender el tratamiento