Transcript Document

SEXUAL DYSFUNCTION: USE OF
TAMSULOSIN IN TREATMENT OF
ORGASM-ASSOCIATED PAIN
Danylo Halytsky L’viv National Medical Universuty
Aleksander Shulyak, Aleksander Borzhievskyi,
Dmytro Vorobets
• Sexual dysfunction is distressing a grate problem for
men who suffer from it, which negatively impacts
quality of life and relationships
• Post-orgasmic pain (dysorgasmia or orgasmalgia)
represents a subcategory of sexual dysfunction that
has received little attention in the medical literature
[Koeman M., van Driel M.F., Schultz W.C., Mensink H.J. Orgasm after radical
prostatectomy //Brit. J. Urol. – 1996. – V.77. – P.861-864]
• No uniform theory exists pertaining to the etiology of
this problem in men, however it is our belief that
pelvic floor muscle and/or bladder neck spasm are
key to the development of this condition
• Dysorgasmia is not an uncommon complaint of
the patients who have undergone prostatectomy
[Bergman B., Nilsson S., Petersen I. The effect on erection and orgasm of cystectomy,
prostatectomy and vesiculectomy for cancer of the bladder: a clinical and
electromyographic study // Brit. J. Urol. – 1979. – V.51. – P.114-120.,
Goriunov V.G., Davidov M.I. Sexual readaptation after the surgical treatment of benign
prostatic hyperplasia // Urol. Nefrol. Mosk. – 1997. – P.20-24.]
• have been exposed to pelvic radiation
[Francisca E.A., d’Ancona F.C., Meuleman E.J. Debruyne F.M., de la Rosette J.J.
Sexual function following high energy microwave thermotherapy://J.Urol.–1999.–
V.161.–P.486-490.,
Merrick G.S., Wallner K., Butler W.M. Lief J.H., Sutlief S. Short-term sexual function
after prostate brachytherapy // Int. J. Cancer – 2001. – V.96. – P.313-319.]
• and in young men diagnosed with chronic pelvic
pain disorder
[Nickel J.C., Narayan P., McKay J., Doyle C. Treatment of chronic prostatitis/chronic
pelvic pain syndrome with tamsulosin: a randomized double blind trial // J. Urol. –
2004. – V.171. – P.1594-1597.]
1АD –blocker – tamsulosin usually prescribed to
alleviate lower urinary tract symptoms related to benign
prostatic hyperplasia
[Narayan P., Evans C.P., Moon T., 2003]
Tamsulosin acts via smooth muscle relaxation of the
bladder neck and prostate resulting in reduced bladder
outlet obstruction
[Abrams P., Schulman C.C., Vaage S., 1995]
• Case reports have also suggested tamsulosin to be
effective in alleviating painful ejaculation in clinically
depressed patients
[Demyttenaere K., Huygens R. Painful ejaculation and urinary hesitancy in
association with antidepressant therapy: relief with tamsulosin // Eur.
Neuropsychopharmacol. – 2002. – V.12. – P.337-341.]
• Randomized, placebo-controlled, multi-center
clinical trial studying the efficacy of tamsulosin in
treating patients with chronic prostatitis/chronic
pelvic pain has demonstrated improvement in pain
using tamsulosin
[Nickel J.C., Narayan P., McKay J., Doyle C. Treatment of chronic
prostatitis/chronic pelvic pain syndrome with tamsulosin: a randomized double
blind trial // J. Urol. – 2004. – V.171. – P.1594-1597.]
Given the aforementioned postulated theory
for the genesis of dysorgasmia
and the uroselective nature of tamsulosin,
it was selected as
a potential therapeutic candidate for male
dysorgasmia
Aim
To assess the effect
of the alpha-blocking medication,
tamsulosin on post-orgasmic pain
Study population
RP – patients with dysorgasmia after
radical prostatectomy
RT - patients with dysorgasmia after
pelvic radiation therapy
GG – general group unrelated to the other two
etiologies
Patients meeting inclusion criteria were instructed to use
tamsulosin 0.4 mg dayly for at least 4 weeks
No placebo arm was included in this proof-of-concept stydy
At baseline and at a time point at least one
month after the commencement of medical
therapy, patients completed
3 inventories
IIEF (the international index of erectile function)
VAS (visual analog scale for pain)
an incontinence scale
Results
56 patients were enrolled in this study
The mean age was 4217 years
Hypertension was found in 27%
Dyslipidemia in 36%, diadetes in 7,5%
11 patients had undergone radical prostatectomy
(~ 106 months)
17 had radiation therapy
(~ 8±2 months)
39 patients of general group
The mean interval between completion of pre- and posttamsulosin treatment questionnaries was 21,5 months
Pain was located:
In the penis 37 (66.1%)
testis 8 (14.3%)
rectum 9 (16%)
abdomen 2 (3.6%)
Pain for a duration of 1 to 5 minutes experienced 29 (51.7%) patients
< 1 minutes 21 (37.5%) пацієнтів
> 5 minutes 5 (10%) пацієнтів
> 15 minutes 1 (1.7%) пацієнтів
After tamsulosin treatment:
45 (80.4%) patients reported improvement in pain
9 (16%) – noted complete resolution of pain
Visual analog scale before and after
following tamsulosin treatment
total group
RP
RT
general
8
7
6
5
*
4
*
*
3
2
1
0
pre-treatment
post-treatment
* values are statistically significantly lower than the pre-treatment values
*
IIEF libido domain scores before and after
tamsulosin treatment
total group
7
RP
RT
general
*
*
*
*
6
5
4
3
2
1
0
pre-treatment
post-treatment
* Values are statistically significantly greater than the pre-treatment values
Libido scores increases with statistical significance is more likely as the result of
decreasing pain and thus increasing satisfaction with sexual activity rather than
a direct effect of tamsulosin
Incontinence scores before and after
tamsulosin treatment
total group
RP
RT
general
7
* Only the radical
prostatectomy group has an
improvement in incontinence
score after treatment
6
5
*
4
3
2
1
0
pre-treatment
post-treatment
Patients who had undergone radical prostatectomy had better continence
levels, this may merely represent the natural evolution of continence return after
operation and most probably unrelated to the use of their medication
CONCLUSIONS
1. This non placebo-controlled study
demonstrates that tamsulosin decreases the
intensity of orgasmic pain and improves
libido in men with dysorgasmia
2. This study also highlights the association
between post-orgasmic pain and radical
prostatectomy or pelvic radiation therapy
3. The utility of -blocker therapy in orgasmassociated pain supports postulate that the
pain may be related to bladder neck and/or
pelvic floor muscle spasm
4. Furthermore, randomized, placebocontrolled studies will be necessary to
further define the role of alpha-blocker
therapy in the management of this disorder