Monthly Archives: May 2012

PE: The ‘other’ male sexual problem

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PE: The ‘other’ male sexual problem

2012-05-10

Given the ease with which the average person can rattle off brand names like “Viagra” and “Cialis,” or joke about “four hour erections,” it would seem that erectile-dysfunction drugs are just about as common as ibuprofen.

We take it for granted, but the little blue pill has drastically changed the way we think about erectile disorder (ED).

Once known as “impotence,” ED was originally thought to be caused by anxiety, nerves, or low self-esteem; now it’s commonly known to be a health issue that hinges on the flow of blood to the penis and taking a pill to deal with the issue is often no big deal.

Don’t get me wrong: this is not to say that Viagra and its brethren – Levitra, Cialis and the new FDA-approved Stendra – are the be-all end-all, or even that they’re unequivocally effective. It’s just that these medications have helped to spur a national dialogue (and often a debate) that has changed the way we think about sexual problems.

But now that ED has come out of the shadows, what about the other major male sexual issue — premature ejaculation (PE)?

As I discussed in an earlier column, PE, (the inability to maintain intercourse for more than a minute without ejaculating) is known to affect up to a third of all men, making it even more prevalent than ED. And yet we tend to think about PE in much the same way we once thought about erectile disroder – shrouded in myth.

Most still think of PE as a function of psychology or behavioral conditioning, rather than physiology and neurochemistry. For example, many wrongly assume that:

PE only affects young men who are sexually selfish or immature
it’s the result of early masturbation habits
it hints at deeper, psychological issues

But in my professional work, I’ve observed that men who struggle with PE don’t do anything differently than men who don’t have the problem. They don’t masturbate differently; they don’t have different psychological issues; they don’t approach sex differently.

Much like a predisposition toward right-handedness, premature ejaculators are often just born that way.

Fortunately, PE is increasingly recognized as a health issue, and this is a relief to those men who struggle with it and can’t help but ask themselves: What’s wrong with me?

As with the little blue pill, the pharmaceutical industry has been on the hunt for a PE drug. Just as the discovery of Viagra was somewhat of an accident (its erectile-enhancing qualities were only discovered after the drug was being developed as a potential heart medication), it’s been observed that certain SSRI-based medications can delay ejaculation.

Ironically, what is a sexual side-effect to many may actually be a sexual boon to the man who suffers from PE, and so some doctors will prescribe the off-label use of an SSRI to help manage the condition.

One drug – Priligy – is a short-acting selective serotonin reuptake inhibitor that is being marketed in parts of Europe as a premature ejaculation pill, but it has not yet received FDA approval here in the U.S..

Another medication potentially awaiting FDA approval is PSD502, a topical numbing agent that can be applied to the penis to decrease penile sensitivity. The use of such numbing agents as a treatment for PE dates back to 1943, but these products have had their limitations.

For one thing, it’s been difficult to establish a recommended dosage.
For another, these topical solutions need to be applied at least 20 to 30 minutes before intercourse in order to be effective.
Additionally, if numbing agents are being used, the man may be required to use a condom to ensure that his partner’s genital area does not also become numb.
While helping to diminish penile sensitivity, a numbing agent does not address a man’s “ejaculatory trigger” which is neurochemically activated.

Still, those behind PSD502 claim to have developed a formula that doesn’t suffer from many of these drawbacks. Like Priligy, PSD502 is not yet available, but a very similar product has been FDA-approved based on a pre-existing monograph.

Dubbed Promescent, this product carries many of the same benefits of PSD502 and effectively decreases penile sensitivity without transmitting any numbness to a man’s partner.

But as helpful as a product like Promescent can be, I still counsel men to focus first on partner-communication, as well as “sex scripts” that de-emphasize intercourse while vouchsafing female pleasure – both of which I discuss exhaustively in my e-book, “Overcoming Premature Ejaculation.”

From there, many men who suffer from PE may find that they still need to pursue a broader “biopsychosocial” approach: one that combines behavioral, medical, and interpersonal approaches. In the absence of a single “silver bullet” to do away with PE, it’s often necessary to do a little bit of everything.

Let’s not wait for the next blockbuster drug to arrive in order to have a meaningful, well-informed conversation about PE. It may never come, but the conversation should.
Post by: Ian Kerner Ph.D. – sex counselor

Study: Depression in Middle Age Linked to Dementia Later On

Psycological Health

Study: Depression in Middle Age Linked to Dementia Later On

Middle-aged men and women suffering from depression may be more susceptible to dementia down the line, a recent study reports in the Archives of General Psychiatry.

Previous studies have linked depression in older adults with dementia and Alzheimer’s disease, but it has never been clear which came first: was depression a risk factor for dementia or an early symptom? The new study sought to look at depression at younger ages to see if the condition preceded memory decline.

“We wanted to look at whether depression is truly causal, or if it’s a reaction to cognitive impairment, or if the changes in the brain are causing both depression and cognitive decline at the same time,” says study author Dr. Deborah Barnes of the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center.

(MORE: Study: Eating Omega-3s May Help Reduce Alzheimer’s Risk)

To clarify the timing of depression and memory loss onset, the research team conducted a life-course study that first looked at the incidence of depression in midlife. The team included more than 13,000 people ages 40 to 55 who were part of the Kaiser Permanente Medical Care Program of Northern California and participated in a health examination called the Multiphasic Health Checkup between 1964 and 1973.

As part of the examination, the participants answered detailed questions about their health behaviors and medical histories, and had their height, weight and blood pressure recorded. Researchers were able to determine whether people had suffered from depression based on the self-reported information. The researchers then looked at the same people again between 1994 and 2000 to see if they were depressed in older age. Some years later, between 2003 to 2009, when the average age of the participants was 81, the researchers followed up to see whether they were diagnosed with dementia or Alzheimer’s disease.

The study found that 14.1% of study participants had midlife depression only, 9.2% had depression only in late life, and 4.2% were depressed during both life stages. During the final six years of follow-up, 22.5% of patients were diagnosed with dementia, 5.5% were diagnosed with Alzheimer’s disease and 2.3% were diagnosed with vascular dementia — a type of dementia resulting from brain damage due to impaired blood flow to the brain. (By contrast, Alzheimer’s disease is caused by protein deposits that interfere with brain function.)

(MORE: New Research on Understanding Alzheimer’s)

Overall, compared with people who had never been depressed, those who had depressive symptoms in middle age (but not later in life) were about 20% more likely to develop dementia later on. People who became depressed in later life were even worse off: they were 70% more likely to develop dementia than their non-depressed peers.

Further, people with late-life depression were twice as likely to have Alzheimer’s disease as those who were depression-free, and those with both midlife and late-life depressive symptoms had more than a three-fold increase in vascular dementia risk.

Because of its observational nature, the study could not firmly establish a causal association, but the findings do suggest that depression precedes vascular dementia. “The people who had depression in their mid- and late-life had an increased risk of developing vascular dementia, and [the depression] could be a true causal risk factor,” says Barnes.

She notes that it’s possible that vascular changes in the brain attributable to depression — particularly in those who have chronic depression — may increase later dementia risk. “These ongoing vascular problems are probably why they had increased risk of vascular depression,” she says.

(MORE: To Ward Off Dementia, Try Staying Healthy from Head to Toe)

As far as the link with Alzheimer’s disease is concerned, however, Barnes says depression may more likely be an early symptom, a part of the overall neurodegenerative process that leads to memory loss. “Some of the neurons in the brain that are being influenced could deal with memory and cognitive functions, but some might also be related to mood changes,” says Barnes.

The authors say that further research is needed to confirm their findings, and they acknowledge that the current study had some weaknesses: for one thing, midlife depression was assessed using a single question on a questionnaire. The dementia diagnoses were also based only on reported symptoms and medical histories and did not involve brain imaging or tests of spinal fluid. The researchers also did not look at depression history prior to midlife nor did they take into account the influence of genetic factors on Alzheimer’s disease.

The authors are hopeful that continued research will explore all of these unanswered questions and, most importantly, determine whether treating depression in midlife can help stave off later dementia. It’s a difficult area of research since it is unethical not to treat someone with reported depression and thus hard to find comparisons.

“One of our take home messages is that depression in older adults is not something that should be ignored,” says Barnes. “Depression is not a normal part of aging. … Depression can be devastating by itself, but it can also be associated with increased risk of developing dementia and it is likely to a precursor to dementia. Older adults should be followed a little closer to see if they develop these impairments and depression.”

Read more: http://healthland.time.com/2012/05/08/study-depression-in-middle-age-linked-to-dementia-later-on/#ixzz1uRjDGp8v

No Such Thing as a ‘Normal’ Vagina?

Sexual Health

No Such Thing as a ‘Normal’ Vagina?

2012-05-07

Perhaps it need not be said that one vagina is not the same as the next, but medically speaking, doctors have long thought that all “healthy” vaginas had certain things in common — namely levels of some good bacteria.

But a new study led by Jacques Ravel at the University of Maryland School of Medicine reports that in fact not all women are created equal. The vaginal microbiome — the community of bacteria living in the vagina — varies considerably between women, the study found, and even within the same woman at different times.

The results, published this week in Science Translational Medicine, suggest that there may not be a single standard for a “normal” or “healthy” vaginal environment. Levels of bacteria that may signify bacterial infection in one woman may be healthy in another. The study involved 32 women who submitted vaginal bacterial swabs taken twice a week for 16 weeks.

“We were surprised at the extent of differences we saw between women, and the uniqueness of patterns observed with various individuals,” says Larry Forney, director of the Institute for Bioinformatics and Evolutionary Studies at the University of Idaho and one of the co-authors of the paper. “When you look at the 32 women, it’s hard to find two who are the same when it comes to their vaginal microbiota.”

(MORE: A Surprising Link Between Bacteria and Colon Cancer)

It’s the first study to document such dynamic differences, and could change the way doctors currently diagnose and treat vaginal infections. Yeast and bacterial infections affect about 25% to 30% of women in the U.S. on any given day. Rather than using a one-size-fits-all approach to treatment, each woman may require more tailored treatment.

Previous studies of the bacterial communities found in the vagina have relied only on samples taken at one point in time. Ravel and his colleagues took a series of samples because they wanted to learn more about changes to the bacterial communities over time: Do they fluctuate consistently? Do they differ between women? What external factors, like sexual intercourse or exposure to compounds, affect the makeup of the bacterial communities? Are certain microbial recipes better at warding off infections?

Scientists have known that in general that certain bacteria living in the vagina — Lactobacillus bacteria —can help combat yeast infections by releasing lactic acid and other acidic compounds that kill yeast and other bugs. But no studies had looked at the vaginal communities over time, and none had applied the latest genomic technology to DNA fingerprint the types of bacteria living in the organ.

Ravel and colleagues’ genomic analysis confirmed the existence of five main groups of bacterial communities in the vagina, but revealed for the first time that not all women harbor the same breakdown of these populations. In fact, even among the small number of women in the study, the researchers found great variation by race: Hispanic and African-American women tended to have microbiomes that are not thought to protect against infection as effectively as the bacteria that were more commonly found in white and Asian women.

But a bacterial makeup that may put one woman at risk of infection may just be a normal state for another. Similarly, even within the same woman, changes in the microbiome over time may be normal.

These results may help doctors individualize the diagnosis and treatment of vaginal infections. Currently, doctors treat all infections with the same antibiotics, as if they were caused by the same bacterial problems. The results aren’t ideal. On average, about 70% of women who are treated for bacterial vaginal infections will experience a recurrence, says study co-author Rebecca Brotman, assistant professor of epidemiology and public health at the Institute for Genome Sciences at the University of Maryland.

“With the microbiome of the vaginal communities, we can start thinking about personalized medicine for women,” says Ravel.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

Read more: http://healthland.time.com/2012/05/04/no-such-thing-as-a-normal-vagina/#ixzz1uAP9qpgp