Download PDF by R. Taylor Segraves: Diagnosis and Treatment of Erectile Disturbances: A Guide

Diagnosis

By R. Taylor Segraves

This publication is the results of an off-the-cuff organization among the editors which extends again to 1974. in the beginning, it was once a tenuous alliance among physicians in rather diverse scientific subspecialties-urology and psychiatry. because the alliance used to be solid, subspecialty rivalries and distrust have been changed via a typical scientific curiosity within the prognosis and remedy of erectile difficulties. We fast turned conscious of the excessive incidence of such issues, how poorly ready we have been to make exact and re­ sponsible prognosis and cures, and the way complex an etiol­ ogical prognosis may end up to be. various organic and mental impacts endure on sexual functionality, and in lots of medical contexts, prognosis and remedy making plans contains attention of complicated interactive var­ iables. the necessity for an elevated multidisciplinary staff grew to become seen. The considered necessary wisdom base prolonged throughout too many subspecialty barriers, and the required details was once now not to be had in a conve­ nient resource. As we begun gathering the data base, we grew to become acutely aware that this data may be of price to different physicians. The authors benefit from the luxurious of an instructional surroundings during which particular services may be effectively assembled. Such assets are frequently unavailable to the healthcare professional in perform. hence, it really is our wish that this article can function a multi uniqueness crew for the medical professional in solo perform. R. TAYLOR SEGRAVES New Orleans, Louisiana HARRY W.

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Occur as late as 3-4 weeks after therapy is begun. Sexual side effects have usually been reported at the 60 to 75-mg/day dose range. 185-186 Other MAOIs There have also been case reports of pargyline187,188 and mebanazine188 causing ejaculation inhibition. Bennett189 reported successfully using both iproniazid and isocarboxazid to treat premature ejaculation. TRICYCLIC ANTIDEPRESSANTS The major tricyclic antidepressants-imipramine, desipramine, amitriptyline, nortriptyline, and protriptyline-are structurally similar to the phenothiazines.

The scientific community subsequently documented the fact that testicular hormones (which are not readily watersoluble) are behaviorally active. Research on the physiological effects of these hormones continues to the present. 3 However, the sites and mechanisms of the behavioral effects of androgen are not well defined. Other investigators have reported that penile erection and sexual activity persist for many years after castration. 4,S Bancroft6 found that androgen replacement therapy in hypogonadal men had no effect on erections to erotic slides but appeared to enhance erectile responsiveness to sexual fantasy.

Impotence was reported at doses as low as 75 mg/day,192 and inhibited ejaculation has been reported at a 125-mg dose level. These effects may be dose-related, as two investigators reported that the difficulty remitted when the dosage was lowered. 184,19I Painful ejaculation has also been reported with imipramine. 188 The sexual side effects of tricyclic antidepressants have been postulated to be the result of peripheral anticholinergic activity associated with these drugs. In this regard, it is of note that Everett190 reported that bethanechol, a cholinergic drug, did not relieve sexual problems in two male patients taking imipramine.

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