Fluoxetine and premature ejaculation: a double-blind, crossover, placebo-controlled study.

The purpose of this study was to investigate the effect of fluoxetine on sexual function in men with premature ejaculation and/or erectile dysfunction and control subjects in a prospective, double-blind, placebo-controlled, crossover study. There were four groups: (1) premature ejaculation (PE, N = 9); (2) premature ejaculation and erectile dysfunction (PE/ED, N = 9); (3) erectile dysfunction (ED, N = 7); and (4) healthy, sexually functional control subjects (N = 15). The study consisted of three 4-week periods: fluoxetine, washout, and placebo (or vice versa). Fluoxetine began at 5 mg/day for 2 weeks, followed by 10 mg/day for 2 weeks. At weeks 0, 4, 8, and 12, subjects visited the laboratory for evaluation of sexual function and assessment of erectile response, ejaculation, and sexual arousal to visual erotic stimulation without and with concomitant vibrotactile stimulation to the penis. At home, daily logs for sexual activities and feelings of well-being were maintained, and nocturnal penile tumescence was measured. The latency to ejaculation increased significantly in the PE/ED group (p = 0.03) and in the PE and the PE/ED group taken together (p = 0.007) but not in the PE group alone. Fluoxetine stimulated objectively but not subjectively measured erectile response during laboratory assessment in all groups. No major side effects were reported. In conclusion, fluoxetine (5-10 mg/day) was effective in increasing latency to ejaculation in patients with PE (PE and PE/ED groups combined).

Flesinoxan: a prosexual drug for male rats.

Two tests were carried out to compare the stimulatory (i.e., prosexual) effects of the 5-HT1A receptor agonists flesinoxan and 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) on sexual behavior in male Wistar rats. Two groups of rats were used: normal males and males with impaired masculine sexual behavior due to neonatal treatment with the aromatase inhibitor 1,4,6-androstatriene-3,17-dione (ATD). In Experiment 1, flesinoxan (0.3 and 1.0 mg/kg) stimulated ejaculation frequency and number of animals displaying this behavior, both in controls and ATD males. With 0.3 mg/kg flesinoxan ATD males did not differ from controls in ejaculation frequencies. There was a concomitant decrease in latency to first ejaculation. No 'premature' ejaculations (i.e., at first or second intromission) were observed. In Experiment 2, the effects of 0.4 mg/kg 8-OH-DPAT, 0.3, 1.0 and 3.0 mg/kg flesinoxan and saline were tested in two ejaculation series. 'Premature' ejaculations only occurred during first ejaculation series with 8-OH-DPAT in 8 of 10 controls and in 6 of 9 ATD males; it did not occur during flesinoxan treatment nor in the second ejaculation series with 8-OH-DPAT treatment. Thus, flesinoxan stimulates sexual behavior in control rats and in rats with impaired sexual behavior. Unlike 8-OH-DPAT flesinoxan does not render them into 'premature' ejaculators. Therefore, flesinoxan could be considered a prosexual drug for male rats.

Clomipramine and sexual function in men with premature ejaculation and controls.

PURPOSE: We determined whether clomipramine taken as needed increases ejaculation latency in men with premature ejaculation and controls. MATERIALS AND METHODS: The study included 8 patients with primary premature ejaculation, 6 with premature ejaculation and erectile dysfunction, and 8 controls. A prospective, double-blind, placebo controlled, crossover design was used that included 2, 3-week periods with clomipramine and placebo. During treatment phases subjects took either 25 mg. clomipramine or placebo as needed, that is 12 to 24 hours before anticipated sexual activity (coitus or masturbation). Subjects also visited the laboratory during these phases for evaluation of sexual response using visual erotic stimulation with and without vibration to the penis. Daily logs of sexual activities were maintained during treatment phases. RESULTS: Clomipramine significantly increased the latency to ejaculation during sexual activity (coitus or masturbation) from approximately 2 to 8 minutes in men with primary premature ejaculation. There were no significant effects in controls and men with premature ejaculation plus erectile dysfunction. Laboratory assessment indicated that men with primary premature ejaculation were better able to control ejaculatory response with clomipramine therapy. In these men clomipramine also resulted in increased satisfaction with sex life and relationship. Clomipramine inhibited nocturnal penile tumescence in all subjects. CONCLUSIONS: Clomipramine (25 mg. as needed) effectively increases ejaculatory latency in men with primary premature ejaculation, while treatment is not effective in those with premature ejaculation and erectile dysfunction.

High tissue factor concentration in the omentum, a possible cause of its hemostatic properties.

The hemostatic properties of the pedicled omentoplasty turned out to be helpful in difficult hemorrhages in extensive surgery. As suggested by others, a high concentration of tissue factor (TF) in the omentum could be responsible for this favourable property. The authors investigated the nature of that property in 11 patients who underwent laparotomy. In omentum and striated muscle (controls) the TF-concentrations in both tissues were estimated by the ELISA method. A significant difference between TF-concentration in omentum and striated muscle could be demonstrated.

Testosterone is required for the stimulatory effects of 8-OH-DPAT on sexual behavior in castrated male rats.

The stimulatory effects of 8-OH-DPAT (8-hydroxy-2-(di-n-propylamino)tetralin) on male sexual behavior in the absence and presence of testosterone were investigated. Male rats (n = 12) were castrated and tested for sexual behavior (15 min, with an estrous female) up to 1 year after castration. Castration caused an abrupt decrease (50%) in the number of intromissions before first ejaculation, and the number remained stable for about 8 weeks. Between 8-12 weeks after castration, when ejaculation frequency was low, 0.2 or 0.4 mg/kg 8-OH-DPAT had no effect on ejaculation frequency, but significantly decreased the number of intromissions before first ejaculation. In weeks 17-18 after castration, 0.4 mg/kg 8-OH-DPAT no longer affected copulatory behavior. A 5-mm testosterone-filled Silastic capsule (implanted at week 19 after castration) resulted in subnormal plasma testosterone levels (mean 4.4 nmol/l) and did not fully restore male copulatory behavior. Administration of 8-OH-DPAT (0.2 and 0.4 mg/kg) was followed by an increase in ejaculation frequency and a decrease in ejaculation latency. Five months later, when plasma testosterone levels were very low (mean 0.6 nmol/l), 8-OH-DPAT (0.4 mg/kg) significantly increased the mean number of intromissions and ejaculations and decreased the number of intromissions before first ejaculation, intromission latency and ejaculation latency (borderline). The present results suggest that testosterone is required for the activating effects of 8-OH-DPAT on sexual behavior in castrated male rats, tested 17-52 weeks after castration.

Penile sensitivity in men with premature ejaculation and erectile dysfunction.

Previous research indicates that penile sensitivity is typically lower in men with erectile dysfunction than in age-matched controls. On the assumption that sensitivity might be greater in men with short ejaculation latency (premature ejaculation), the present research investigated penile threshold (sensitivity) to vibrotactile stimulation in men with premature ejaculation, erectile dysfunction, or a combination of the two. Premature ejaculators showed thresholds commensurate with controls, while men with erectile dysfunction, or combined erectile dysfunction and premature ejaculation, showed significantly elevated thresholds. Although premature ejaculators did not show penile hypersensitivity, there was a significant correlation in this group between ejaculation latency and threshold. Overall, these findings argue against a primary role for penile sensitivity in ejaculation latency, and suggest that other somatic factors or cognitive factors may play the more critical role in premature ejaculation.

Bisoprolol and hypertension: effects on sexual functioning in men.

OBJECTIVES: To investigate prospectively the effects of the selective beta 1 adrenoceptor blocker bisoprolol on sexuality of men with hypertension. DESIGN: In newly diagnosed patients (group I): double-blind, crossover, placebo controlled. In men with hypertension on antihypertensive treatment (group II): crossover design. SETTING: Large area in and around Rotterdam, The Netherlands. PATIENTS: Twenty-six men (criteria: between 25 and 70; no disease etc. known to affect sexual functioning) were recruited through their general practitioners. Group I (n = 13) fulfilled the selection criteria, sitting blood pressure systolic > or = 160 mm Hg and/or diastolic > or = 95 mm Hg, measured on 3 different days. Group II (n = 13) patients already on antihypertensive treatment. MAIN OUTCOME MEASURES: Data on blood pressure. Qualitative and quantitative data on sexuality through questionnaires, including personal and sexual history, sexual functioning, sexual satisfaction and erectile difficulties. RESULTS: Bisoprolol is an effective antihypertensive drug with no detrimental effects on sexuality in newly diagnosed men with hypertension. In men already on antihypertensive medication bisoprolol improved sexuality in some parameters, i.e. firmness of erection during coitus, contentedness with sexual functioning and satisfaction with own sexuality. CONCLUSION: Bisoprolol is an effective antihypertensive agent with no sexual side effects.

Sex behavior of male and female Wistar rats affected by the serotonin agonist 8-OH-DPAT.

Four experiments were carried out to test the stimulatory effects of 8-OH-DPAT on various aspects of "masculine" sexual behavior of male and female rats and on the sexual attractivity of male rats. In Experiment 1 8-OH-DPAT (0.2 mg/kg) stimulated ejaculation frequency in middle-aged (approx. 15 months old) males, both sexually inactive and active subjects. There was a coinciding decrease in total number of mounts, intromissions, intromissions to first ejaculation and latency to first ejaculation. In Experiment 2 the effects of two doses (0.2 and 0.4 mg/kg) 8-OH-DPAT on the first ejaculation cycle were investigated. Especially, the higher dose made a high percentage (45-55%) of males to ejaculate "prematurely," i.e., at the first or second intromission. Latency to ejaculation decreased. With the higher dose, 25-35% of the males ejaculated extravaginally. In Experiment 3 8-OH-DPAT did not make males more attractive for an estrous female than saline-treated males, as judged by the time spent in their vicinity. However, estrous females received much more ejaculations from the tethered 8-OH-DPAT males, with the lowest latencies to first ejaculation, than from the saline-treated males. In Experiment 4 8-OH-DPAT stimulated mounting behavior in female rats only when they were long-term treated with testosterone. In that condition also shortest latencies to first mount were found with 8-OH-DPAT treatment.