Mild Androgen Insensitivity Syndrome presenting in male with infertility and sexual difficulties

Androgen insensitivity syndrome has a wide spectrum of presentations. It results from a mutation in androgen receptor (AR) gene. It ranges from mild androgen insensitivity syndrome (MAIS) which is the mildest form to complete androgen insensitivity syndrome (CAIS). In case of MAIS, the abnormality that can be observed appears to be male infertility and sexual difficulties including premature ejaculation and erectile dysfunction. In this case report, we discuss a case of MAIS in a 37-year-old male who presented with infertility, premature ejaculation, and secondary erectile dysfunction.Copyright © 2023, Ibn Sina Trust. All rights reserved.

Male fertility: summary overview of the publications January - March 2022.

The article presents an overview of the most significant publications on the topic of male infertility. The main selection criteria were the practical significance of the article, as well as the impact factor of the journal in which it was published, according to the SCImago Journal Rank (SJR). As a result, a list of 10 papers published in the first quarter (January - March) of 2022 was compiled. The review includes articles on the following issues: the role of coronavirus infection in male infertility, the effectiveness of aromatase inhibitors in infertile men, the effect of assisted reproductive technologies on the reproductive health of descendants, recurrent miscarriage, the effect of antibiotic therapy on the DNA fragmentation index, the role of antisperm antibodies in male infertility, the incidence of idiopathic male infertility, the Sixth Edition WHO guidelines for the ejaculate processing, as well as the relationship of depression with male infertility.Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

Male fertility: A review of the publications from April - June 2021.

The article provides an overview of the most significant publications on the topic of male infertility. The main selection criteria were considered the practical significance of the article, as well as the impact factor of the journal in which it was published, according to the SCImago Journal Rank (SJR). As a result, a list of 10 works published in the II quarter (April - June) of 2021 was formed. The review includes articles on the following issues: the effectiveness of repeated micro-TESE in non-obstructive azoospermia, the role of COVID-19 in male fertility, the effect of testosterone therapy on spermatogenesis, testicular microlithiasis, electroejaculation as a method of obtaining spermatozoa, harm from carrying cell phones near the genitals, prediction of the effectiveness of intrauterine insemination, the effect of advanced paternal age on sperm aneuploidy, and the importance of the microbiome for male fertility.Copyright © 2021 Rostovskii Gosudarstvennyi Meditsinskii Universitet. All Rights Reserved.

Off-label Uses of Selective Serotonin Reuptake Inhibitors (SSRIs).

Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are highly versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. Thus, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than a serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequently underestimated during common clinical practice, especially by nonpsychiatrists. Thus, some points must be addressed when using SSRIs. Among these, a psychiatric evaluation before every administration that falls outside the regulatory agencies-approved guidelines has to be considered mandatory. For these reasons, we aim with the present article to identify the risks of inappropriate uses and to advocate the need to actively boost research encouraging future clinical trials on this topic.

Relationship between COVID-19 and Male Sexual Dysfunction; A Prospective, Multicentric Study.

BACKGROUND: Sexual function is an excellent marker of psychological, systemic, and specifically vascular performance. Endothelial dysfunction is the main determinant of coronavirus disease 2019 (COVID-19) symptoms. Considering the adverse effects of the COVID-19 pandemic on psychological and sexual functions, we hypothesized potential differences and underlying factors if there is any erectile function and premature ejaculation status of male patients with COVID-19 by comparing both with the control group. METHODS: Hospitalized male patients diagnosed with COVID-19 pneumonia were evaluated. Male patients who applied to the Urology outpatient clinic were the control group. All participants completed the International Index of Erectile Function Form-15 (IIEF-15) and gave information regarding their premature ejaculation (PE) status if present. COVID-19 patients were called by phone to fill in the IIEF-15. Their PE status was questioned on the 45th and 90th days after discharge. The following parameters were in the data records: Age, comorbidity, length of hospital stay, treatment, oxygen saturation, pulmonary involvement, white blood cell (WBC), C-reactive protein (CRP), ferritin, fibrinogen, D-dimer, and sedimentation values. RESULTS: The study had 253 participants, including 168 COVID-19 patients and 85 volunteers as the control group. The number of PE cases was less, whereas erectile dysfunction (ED) cases were more in the COVID-19 patient group in comparison to the control group in the pre-pandemic period (p = 0.00) (p = 0.00). In the post-pandemic period, PE developed in 13 more COVID-19 patients on the 45th and 90th days (p = 0.00). The IIEF-15 scores of COVID-19 patients decreased by 4-point in the short term and by 3-point in the long term (p = 0.002). Age and sedimentation were responsible for the difference in PE status. On the other hand, comorbidity, length of hospital stay, treatment type, WBC, D-dimer, ferritin, CRP levels, and pulmonary infiltration were responsible for the difference in ED. CONCLUSIONS: Based on our findings, we can say that we have enough evidence to suspect COVID-19 sequelae can affect male sexual health. After the pandemic, male patients with andrological problems should have enough time to feel more comfortable and their organic and psychogenic conditions should be optimized.

OFFICE BASED TRANSPERINEAL LASER ABLATION FOR BENIGN PROSTATIC HYPERPLASIA: 3 & 6 MONTHS OUTCOMES

INTRODUCTION AND OBJECTIVE: BPH affects tens of millions of men across the world. Most procedures require either general or regional anesthesia or a transurethral approach. Herein, we present the 3 & 6 months results of NCT04760483 is a phase I prospective, single center, interventional pilot study evaluating transperineal laser ablation (TPLA) of BPH tissues, carried in Office setting under local anesthesia. A detailed step by step video depiction of this procedure is available at the AUA video library. The objectives call for safety, feasibility, and impact in pertinent outcomes measures, such as Uroflowmetry, IPSS, Hematuria, Erectile function, and ejaculation METHODS: The study contemplated accrual of 20 men between 50 and 80 years with prostate volumes between 30 and 120 cc, IPSS scores >9, peak flows between 5 and 15 cc/s and void residuals under <250 ml. Any patient neurological conditions, history of any surgical intervention or urinary retention were excluded. IPSS assessments, Flow studies and prostate volume measures were conducted at 3 months. Herein we present the results. Bayesian analysis for continuous measurements were performed and non-parametric differences were evaluated using chi2 tests. RESULTS: Patients enrolled between December 2020 and February of 2021. The median (IQR) for age and BMI was 68 (58,73) and 29 (27,31), respectively. These parameters for room time, ablation time, watts and total joules were 29 (23,32), 9 minutes (7,12), 6 (5,7) watts and 3,400 (2,600, 3600) joules, respectively. 8(40%) were discharged with a Foley due to elevated residuals. 16 patients had erections and ejaculations before and 3 months after TPLA. 17/20 (85%) had significant improvement in their urinary profile after TPLA (See TABLE for details). One of the initial responders suffered from COVID- 19 infection and developed a CVA that hindered his urinary function. CONCLUSIONS: TPLA in the office setting is feasible and safe. Three month outcomes showed subjective and objective sustained improvement in over 80% of patients for at least 6 months. Furthermore, erections or ejaculations were not affected. This novel and promising approach demands further evaluation in phase II-III trials. (Figure Presented).

Transcranial Photobiomodulation Therapy for Sexual Dysfunction Associated with Depression or Induced by Antidepressant Medications

Sexual dysfunction (SD) is frequently encountered in patients suffering from depression. There is a bidirectional relationship between various types of SD and depression, so the presence or treatment of one condition may exacerbate or improve the other condition. The most frequent sexual problem in untreated depressed patients is declining sexual desire, while in treated depressed patients it is difficulties with erection/ejaculation and with orgasm. Numerous classes of neuropsychiatric medications, commonly used in depressed patients—such as antidepressant, antipsychotic, alpha sympathetic, and opioid drugs—may cause SD. Photobiomodulation (PBM) therapy, also called low-level light/laser therapy, is a novel neuromodulation technique for neuropsychiatric conditions, such as depression. Transcranial PBM (tPBM) targets the cellular metabolism—through the mitochondrial respiratory enzyme, cytochrome c oxidase—and has numerous cellular and physiological beneficial effects on the central nervous system. This paper represents a comprehensive review of the application of tPBM to SD, coexisting with depression or induced by antidepressant medications.

Pelvic Floor HIFEM in Men Improves Ejaculation

Introduction: High-Intensity Focused Electromagnetic (HIFEM) field technology utilizes rapidly changing magnetic fields that generate electrical currents in the underlying tissue where it depolarizes motor neurons and causes muscle contractions. BTL Emsella provides non-invasive electromagnetic stimulation of pelvic floor musculature for the purpose of rehabilitation of weak pelvic muscles and restoration of neuromuscular control for the treatment of male and female incontinence. Novel protocol U2 is intended for men and uses a field intensity max of 2.5 T and a 10 cm depth of penetration for 28 minutes. Objective: Determine the effects of High-Intensity Focused Electromagnetic (HIFEM) field technology on the intensity and duration of ejaculation in men, with additional observations on erectile function using the IIEF-15 and urination using the IPSS. Methods: We looked at the effects of HIFEM on ejaculation, erectile function, and urination. Our IRB-approved protocol was one 28 minutes pelvic floor treatment per week for 4 weeks. At baseline, end of treatment, and one month post-treatment, the patient completed the IIEF-15, IPSS, and the LuBE Score, a four-question 5 point Likert style questionnaire created specifically for this study to investigate patient-reported aspects of orgasm, including volume, force, duration, and intensity of ejaculation. 0 is no change, 1 is increased, 2 is dramatically increased, -1 is decreased, -2 is dramatically decreased. Men participated with their sexual partners who also received four weekly treatments. Results: 12 men, average age of 57, completed the protocol. The range of the LuBE score is -8 to 8. The LuBE Score increased from baseline 0 up to 2.1 (median is 3 with a range of -1 to 5) to 2.7 (median of 3 with a range of 0 to 4) one month after the completion of treatment. The IIEF-15 increased from 54 at baseline to 60.3 at the completion of treatment and 60.4 one month after the completion of treatment. The IPSS declined from 7.1 to 4.6 at the completion of treatment and down to 3.3 one month after th Conclusions: We conclude that the U2 protocol for HIFEM boosts the strength of the bulbocavernosus and ischiocavernosus muscle and the pelvic floor resulting in an increase in volume, force, duration and intensity of ejaculation. In addition, there was a six-point increase in IIEF-15 score. There was a 3 to 4 point drop in IPSS score. We were surprised to see improvements in IIEF-15 and IPSS, and this should be investigated further. COVID limited patient recruitment, but the results indicate that pelvic HIFEM potentially improves ejaculation. Based on patient communications, I believe that more treatments than the four provided will add to the benefits. I plan on studies with more participants and extended treatment sessions. Disclosure: Yes, this is sponsored by industry/sponsor: BTL Clarification: No industry support in study design or execution Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science

Effect of SARS-CoV-2 infection upon male sexual function: A multi-center analytic study

Introduction & Objectives: There has been a few report regarding the SARS-CoV-2 infection impact on male sexual function during the coronavirus disease 2019 (COVID-19) epidemic. we aim to discuss the potential clinical impact of the COVID-19 infection on sexual function inactive sexual men, and to evaluate possible risk factors.Materials & Methods: We conducted retrospective study and analyzed data for all active sexual men admitted in two university hospital From Mai2020 to April 2021 for COVID-19 infection. we included subjects had to be men aged 18 years or older, with documented COVID infection, andhad a history of regular sexual intercourse. We didn’t include Patients stayed in intensive care units, history of neurological or psychiatric pathologyand heart disease. All subjects gave written informed consent before entering the study and Ethical committee approval has been obtained. Theevaluation was carried out by self-questionnaire comprising this items: The International Index of Erectile Function-5 items (IIEF-5), PrematureEjaculation Diagnostic Tool (PEDT), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire (PHQ-9), and the detailed frequencyof sexual life and physical exercise. Subjects completed the questionnaires based on both their condition 4 months before and 4 months after theepisode of COVID-19 infection. A significant p was fixed <0,05.Results:Altogether, 235 questionnaires were collected, and 193 (82%) respondents completed the questionnaire. The median age for all subjects was 34years (interquartile range [IQR] 21-52). A total of 96 (40.8%) subjects were unmarried, 129 (55.8%) were married, and 10 (4.2%) were divorced orwidowed. Erectile dysfunction has been reported by 28 patients (12.1%), and 21 subjects (9%) reported deterioration ejaculation control ability.The median score of the IIEF-5 decreased from 22 (range 7-25, IQR 14-24) to 18 (range 5-23, IQR 11-22), and there is significant differenceregarding the mean value (19.13 ± 5.34 vs 16.5 ± 8.35, t = 4.867, P <.000). There was no significant change in the mean PEDT scores beforeand after the COVID infection (3.95 ± 3.24 vs 4.08 ± 2.90, t = 0.968, P =0.334). If we compare Patients with normal (Group I) versus deterioratedsexual function (Group II), we found in G II a higher BMI than GII (P <.001), a history of smoking (P <.001), increased anxiety after the COVIDinfection (P =.001). if we stratified both Group according to the depression and anxiety scale, G II had a higher GAD-7 score before and after theInfection (P =0.025 and P <.001), a higher PHQ-9 score before and after the outbreak (P =.002 and P <.001), a decreased frequency of physicalactivity (P = 0.01) and decreased partner time (P <.001).Conclusions: the COVID-19 infection have an impact on sexual function in a certain proportion of adult men, and the risk factors include increasedanxiety and depression, and decreased frequency of sexual life

COVID-19 and Male Sexual Functioning: A report of 3 Recovered Cases and Literature Review.

COVID-19 is a new global pandemic. It can affect multiple body systems and functions. However, the relationship between COVID-19 and male sexual activity did not yet get much consideration. Herein, we report the impact of COVID-19 on sexual function in 3 men who recovered from the disease. Compared with their condition before catching the infection, the men showed, in different degrees, a decline in all aspects of sexual function as assessed by the international index of erectile function. They started to develop premature ejaculation or exacerbate an already existing condition according to the premature ejaculation diagnostic tool scoring. Beck's depression inventory revealed deterioration of the men's moods up to severe depression. The sex-related hormones (testosterone-total and free, luteinizing hormone, follicle-stimulating hormone, prolactin, and estradiol) of these men were within normal levels. To the best of our knowledge, this is the first case report documenting deleterious changes in mood and several aspects of sexual functioning in males after recovery from the COVID-19 using validated measurement tools. Follow-up and psychological support of the recovered men may help mend their moods and consequently upgrade their sexual functioning.

An Online Questionnaire Survey on the Sexual Life and Sexual Function of Chinese Adult Men During the Coronavirus Disease 2019 Epidemic.

INTRODUCTION: There has been no report regarding the impact on male sexual life or sexual function by changes in lifestyle during the coronavirus disease 2019 (COVID-19) epidemic. AIM: To investigate the changes in sexual life and sexual function of Chinese men during the COVID-19 epidemic. METHODS: An online questionnaire was created and the survey was administered through social media to Chinese adult men. MAIN OUTCOME MEASURE: The main end point was the deteriorated erectile function or ejaculatory control ability, defined by self-evaluation or by decreased International Index of Erectile Function-5 items (IIEF-5) scores or increased premature ejaculation diagnostic tool (PEDT) scores. RESULTS: Altogether, 612 questionnaires were collected. About 322 (52.6%) subjects were unmarried. About 8.4% and 8.5% subjects reported deteriorated erectile function or ejaculation control ability by self-evaluation, whereas 31.9% and 17.9% subjects showed decreased IIEF-5 scores or increased PEDT scores. Subjects with deteriorated erectile function by self-evaluation and decreased IIEF-5 scores had higher General Anxiety Disorder-7 (P < .001 and P = .001) and higher Patient Health Questionnaire-9 score (P < .001 and P = .002) after the epidemic, decreased frequency of sexual life (P < .001 and P < .001) and physical exercise (P = .009 and .007) after the epidemic. Subjects with deteriorated ejaculation control ability by self-evaluation and increased PEDT scores had higher General Anxiety Disorder-7 (P < .001 and P < .001) and higher Patient Health Questionnaire-9 score (P < .001 and P = .002) after the epidemic. Subjects with decreased frequency of sexual life had reduced income (P < .001), increased anxiety (P < .001) and depression (P < .001). Married subjects had higher proportion of improved depression (P = .048) and increased frequency of sexual life (P = .010). CONCLUSION: During the COVID-19 epidemic, decreased sexual function was present in a certain proportion of adult men, and the risk factors include increased anxiety and depression, and decreased frequency of sexual life. Fang D, Peng J, Liao S, et al. An Online Questionnaire Survey on the Sexual Life and Sexual Function of Chinese Adult Men During the Coronavirus Disease 2019 Epidemic. Sex Med 2021;9:100293.