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Nomograms May Help Physicians Counsel Prostate Cancer Patients

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Nomograms May Help Physicians Counsel Prostate Cancer Patients Evidence-based models called nomograms might help prostate cancer patients understand what their erections could be like after treatment.

Nowadays, most men with prostate cancer receive their diagnosis in the earlier stages of the disease. And more men are living longer after treatment. Many remain sexually active well into their older years.

Radical prostatectomy (surgery to remove the prostate gland) is an effective treatment. However, the prostate is surrounded by nerves that are essential for good erections. As a result, some degree of erectile dysfunction (ED) can be expected, at least temporarily, after surgery.

To what extent? Unfortunately, urologists don’t have a crystal ball to determine how well a man will have erections after prostatectomy. Nomograms could provide an educated guess.

Researchers developed three nomograms for this purpose and explained their process in the Journal of Sexual Medicine.

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What Should Women Know About Testosterone Therapy?

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What Should Women Know About Testosterone Therapy?Some postmenopausal women with low libido might benefit from testosterone therapy, according to recently-issued guidelines.

The “Global Consensus Position Statement on the Use of Testosterone Therapy in Women” was developed by a panel of experts to guide healthcare providers who prescribe hormonal therapy to women. The statement was endorsed by 11 medical organizations, including the International Society for Sexual Medicine (ISSM) (The Sexual Medicine Society of North America, which produces SexHealthMatters.org, is affiliated with the ISSM.)

While the news may be a step forward for women’s sexual health, the panel was very specific in its recommendations, which covered how testosterone should be measured, prescribed, and monitored.

Here are some key points from the statement:

Testosterone therapy may be recommended for women with hypoactive sexual desire disorder (HSDD), but not for women with other types of sexual problems.

HSDD is a persistent lack of sexual desire that has no apparent cause. For example, it’s not a medication side effect, and it’s not a result of other health conditions associated with low libido. Another component of HSDD is distress. Women who have HSDD are bothered by their low sex drive. It might cause stress in their relationship, or they might miss the intimacy they once shared with a partner.

Testosterone therapy may be recommended for postmenopausal women, but not premenopausal women.

The menopause distinction is important. Currently, scientists don’t have enough information to recommend the use of testosterone in women who have not gone through menopause.

During menopause, a woman’s estrogen levels decline, and she stops having menstrual periods. Testosterone levels decline, too.

Women are considered to be postmenopausal (finished with menopause) when they have gone 12 months without a menstrual period. Before this benchmark, periods may be irregular, and many women think they have finished menopause when in fact they haven’t. Women who are unsure of their menopausal status should talk to their gynecologist.

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Peyronie’s Disease Could be Linked to Cancer, but More Research Needed

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Peyronie’s Disease Could be Linked to Cancer, but More Research NeededMen with Peyronie’s disease might be at higher risk for cancer, scientists report in Sexual Medicine.

They stress, however, that “although the risk may exist, it remains to be definitively proven.”

Peyronie’s disease is characterized by plaques of scar tissue that form on the penis, just below the skin’s surface. Because the plaques make the penis less flexible, deformities occur. Usually, the penis starts to bend. But it may also shorten or take on an hourglass shape. Peyronie’s disease can be painful, and some men find it difficult to have intercourse.

Previously, it was unknown whether there was any link between Peyronie’s disease and cancer. The research team considered that both Peyronie’s and cancer can run in families and decided to investigate.

They used a US-based insurance claims database and found data for 48,423 men who had been diagnosed with Peyronie’s disease between 2007 and 2013. For a comparison group, they also collected data from 484,230 men without Peyronie’s disease or erectile dysfunction (another condition that sometimes occurs with Peyronie’s disease). This control group was matched in age and number of follow-up doctor’s visits.

The men’s average age was 50 years. Men with Peyronie’s disease had an average of 5.6 outpatient visits per year, compared to 3.6 visits annually for the control group.

The men with Peyronie’s disease were at higher risk for cancer in general and for stomach cancer, testicular cancer, and melanoma (a type of skin cancer) in particular.

The researchers weren’t sure why cancer risk was higher for the men with Peyronie’s disease, but they suggested a genetic connection.

They also acknowledged some limitations to their research. For example, they did not know how long men had had Peyronie’s disease or how severe it was. The also did not have further details about the men’s cancer, such as grade or stage.

More study on the relationship between Peyronie’s disease and cancer was recommended.

Resources

Sexual Medicine

Pastuszak, Alexander W., MD, PhD, et al.

“Increased Risk of Cancer in Men With Peyronie’s Disease: A Cohort Study Using a Large United States Insurance Claims Database”

(Full-text. Published online: September 14, 2019)

https://www.smoa.jsexmed.org/article/S2050-1161(19)30176-X/fulltext

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Addyi Manufacturer Announces Changes | SexHealthMatters.org

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Addyi Manufacturer Announces ChangesThe manufacturer of Addyi (flibanserin), an oral drug used to treat general, acquired hypoactive sexual desire disorder (HSDD) in premenopausal women, has announced some changes for prescribers.

Affecting about 1 in 10 women, HSDD refers to a loss of sex drive accompanied by distress that can’t be easily explained by specific causes, like a health condition or drug side effect. HSDD is acquired if it happens after a period of healthy sex drive. It is considered general if it happens all the time, not just in certain sexual situations or with specific partners.

Addyi is a pill that balances the levels of three brain neurotransmitters: serotonin, dopamine, and norepinephrine. It is typically taken at bedtime.

The drug was approved by the FDA in the spring of 2015.

Alcohol Use

One of the labeling changes concerns alcohol use with Addyi.

When the drug was first approved, the FDA required Sprout Pharmaceuticals, the company that produces Addyi, to include a boxed warning (the strictest required by the FDA) that instructed women to avoid drinking any alcohol while taking Addyi.

At that time, “the FDA reviewed data that included several concerning cases of severe hypotension (low blood pressure) and syncope (passing out) when Addyi and alcohol were taken together,” the agency reported in an April 2019 press release.

Since the approval, subsequent post-marketing studies have shown that while there are still concerns about drinking alcohol and using Addyi, women can do so if they are careful and as long as the timing isn’t too close. The FDA still requires a boxed warning, but the language has been updated.

The current instructions are as follows, according to the Addyi website:

If a woman has had one or two alcoholic drinks, she should wait at least two hours before taking Addyi at bedtime.

If she has had three or more alcoholic drinks in one evening, she should skip her bedtime dose of Addyi.

If she has taken her regular dose of Addyi, she should not drink any alcohol until the next day.

Sprout Pharmaceuticals defines “1 standard alcoholic drink” as one 12-ounce regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits or shot.

Taking Addyi and drinking alcohol too close together could lead to severe low blood pressure and fainting.

REMS Certification

Before October 2019, clinicians who prescribed Addyi were required to have Risk Evaluation and Mitigation Strategy (REMS) certification through the FDA. REMS is a drug safety program for medications with safety concerns. Now, prescribers are no longer required to have REMS certification for Addyi.

More Information

Some of the more common side effects of Addyi are dizziness, drowsiness, nausea, fatigue, insomnia, and dry mouth.

A woman’s doctor can best advise on whether Addyi is an appropriate choice for her.

Resources

Addyi.com

“Important Safety Information”

https://addyi.com/faq/

International Society for Sexual Medicine

“FDA Modifies Boxed Warning for Addyi”

(April 22, 2019)

https://www.issm.info/news/sex-health-headlines/fda-modifies-boxed-warning-for-addyi/

Sprout Pharmaceuticals

Correspondence dated October 16, 2019 concerning changes for Addyi.

U.S. Food and Drug Administration (FDA)

“FDA orders important safety labeling changes for Addyi”

(Press release. April 11, 2019)

https://www.fda.gov/news-events/press-announcements/fda-orders-important-safety-labeling-changes-addyi

“Risk Evaluation and Mitigation Strategies | REMS”

(Content current as of August 8, 2019)

https://www.fda.gov/drugs/drug-safety-and-availability/risk-evaluation-and-mitigation-strategies-rems

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