Topical Agents for Premature Ejaculation: A Review.

INTRODUCTION: Premature ejaculation (PE) is among the most common sexual dysfunctions that affect men. Currently, topical medications are considered a first-line treatment option for PE, with no specific medication having market approval in the United States specifically for the treatment of PE. Topical agents for PE include eutectic mixture of local anesthetics cream, topical eutectic mixture for premature ejaculation spray, severance secret-cream, resiniferatoxin, and an assortment of over-the-counter treatments, including medicated condoms, sprays, and wipes. AIM: Given the paucity of controlled studies for these treatment modalities, the goal of this article is to review the currently available options for PE to help educate providers in appropriate treatment options. METHODS: Comprehensive review of published literature, as well as clinical experience were evaluated to determine efficacy of known treatments for PE. MAIN OUTCOME MEASURE: The topical treatment options and efficacy of these options for PE were reviewed. Eutectic mixture of local anesthetics, topical eutectic mixture for premature ejaculation, severance secret-cream, resiniferatoxin, and medicated condoms are the mainstay of treatment. Each has certain risks and benefits associated with use as described, as well as relative cost of use. RESULTS: Although data supporting the effectiveness of topical agents for PE is limited, prior clinical trials demonstrate increases in timed intravaginal ejaculatory latency time and improved patient-partner sexual satisfaction survey scores on some treatment options. CONCLUSION: More research is needed to evaluate efficacy, cost-effectiveness, potential side effects, and benefits of combined medical and psychological intervention for better ejaculatory control. Butcher MJ, Zubert T, Christiansen K, et al. Topical Agents for Premature Ejaculation: A Review. Sex Med Rev 2020;8:92-99.

The International Society for the Study of Women's Sexual Health Process of Care for the Identification of Sexual Concerns and Problems in Women.

Sexual problems are common in women of all ages. Despite their frequency and impact, female sexual dysfunctions (FSDs) are often unrecognized and untreated in clinical settings. In response, the International Society for the Study of Women's Sexual Health convened a multidisciplinary, international expert panel to develop a process of care (POC) that outlines recommendations for identification of sexual problems in women. This POC describes core and advanced competencies in FSD for clinicians who are not sexual medicine specialists and serve as caregivers of women and, therefore, is useful for clinicians with any level of competence in sexual medicine. The POC begins with the expectation of universal screening for sexual concerns, proceeds with a 4-step model (eliciting the story, naming/reframing attention to the problem, empathic witnessing of the patient's distress and the problem's impact, and referral or assessment and treatment) that accommodates all levels of engagement, and delineates a process for referral when patients' needs exceed clinician expertise. Distressing problems related to desire, arousal, and orgasm affect 12% of women across the lifespan. Low desire is the most common sexual problem, but sexual pain and other less common disorders of arousal and orgasm are also seen in clinical practice. Screening is best initiated by a ubiquity statement that assures the patient that sexual concerns are common and can be revealed. Patient-centered communication skills facilitate and optimize the discussion. The goal of the POC is to provide guidance to clinicians regarding screening, education, management, and referral for women with sexual problems.

The International Society for the Study of Women's Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women.

The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emotional and psychological states and medical conditions including depression. The algorithm was developed using a modified Delphi method to reach consensus among the 17 international panelists representing multiple disciplines. The POC starts with the health care professional asking about sexual concerns, focusing on issues related to low sexual desire/interest. Diagnosis includes distinguishing between generalized acquired HSDD and other forms of low sexual interest. Biopsychosocial assessment of potentially modifiable factors facilitates initiation of treatment with education, modification of potentially modifiable factors, and, if needed, additional therapeutic intervention: sex therapy, central nervous system agents, and hormonal therapy, guided in part by menopausal status. Sex therapy includes behavior therapy, cognitive behavior therapy, and mindfulness. The only central nervous system agent currently approved by the US Food and Drug Administration (FDA) for HSDD is flibanserin in premenopausal women; use of flibanserin in postmenopausal women with HSDD is supported by data but is not FDA approved. Hormonal therapy includes off-label use of testosterone in postmenopausal women with HSDD, which is supported by data but not FDA approved. The POC incorporates monitoring the progress of therapy. In conclusion, the International Society for the Study of Women's Sexual Health POC for the management of women with HSDD provides a rational, evidence-based guideline for health care professionals to manage patients with appropriate assessments and individualized treatments.