Paolo Maria Michetti

Delayed ejaculation and alexithymia: what is the relationship?

Delayed Ejaculation (DE) is probably the least studied and understood of the male sexual dysfunctions (MSD). There is still little unanimity concerning its psychological/interpersonal aetiology. Previous studies found that MSD are strongly related with alexithymia, a multifaceted personality construct that describes a disturbance in the regulation of emotions.The aim of this study was to investigate the presence of alexithymia in men with DE and correlate alexithymia levels with DE severity. According to specific features of the symptoms, we hypothesized that alexithymia would not be correlated with this specific sexual disorder. 54 outpatients with a diagnosis of DE assessed at the Institute of Clinical Sexology and the Urology Department of Sapienza, University in Rome were enrolled in the study. DE was diagnosed after a specialist examination and according to Diagnostic and Statistical Manual of Mental Disorders -IV-TR criteria. Participants were provided with the Toronto Alexithymia Scale (20 items; TAS-20), a self-measure of the Intravaginal Ejaculation Latency Time and an ad hoc questionnaire to collect anamnestic data. 9.3% of patients could be categorized as alexithymics, 9.3% of them as borderline, while 81.4% of the sample was found to be non-alexithymic. The overall average TAS-20 score was 45.46. Results show that alexithymia is correlated neither with the presence of DE nor with its severity, in contrast to other MSDs, where this condition was found in about 30% of patients. The data presented suggest that DE, although not correlated to alexithymia, is probably related to other psychogenic features such as hypercontrol configuration. This paper can contribute to the understanding of DE, by excluding one of the possible etiological factors, previously found to be important in the onset and the maintenance of the other MSDs. More studies are needed in order to better understand DE and provide recommendations about treatment.

Understanding and treating male orgasmic dysfunction: an update

Objective Of all the male sexual dysfunctions, Male Orgasmic Dysfunction (MOD) is perhaps the least understood and most difficult to treat. Its occurrence is more common than generally believed, and physicians frequently undervalue the negative impact MOD can have on the quality of life. Furthermore, the DSM-IV classification does not separate orgasmic and ejaculatory dysfunctions, thus creating confusion of definitions. Design and method To explore, from both a neurobiological and psychological point of view, the development in knowledge of inhibited male orgasm with specific regard to therapeutic approach, a wide literature review was performed. Results During the last ten years, many scientific articles have been written on the topic of ejaculatory dysfunctions. However, these articles mostly relate to premature ejaculation, only giving the various definitions and nosography of MOD. Only a few studies relate to psycho-neurophysiology of male orgasm and sexological approach to MOD. Conclusions The understanding of the physiology of orgasm and ejaculation has improved with regard to both neuroanatomic regulation and neuroendocrine modulation. While orgasm in animals performs a reinforcement task in obtaining ejaculation and maintaining the species, in humans it appears to be a cerebral event, with a peculiar emotional meaning. The definition of MOD does not appear to have reached consensus amongst researchers. Scientific literature still displays a lack of interest in this dysfunction, probably as no effective and safe pro-ejaculatory drugs are available which could generate positive results in terms of marketing. The integration of future drugs and sex therapy will achieve more satisfactory treatment.

Extraversion and Neuroticism in Sexually Dysfunctional Men Suffering fromErectile Dysfunction and Premature Ejaculation: A Cross-Sectional Study

The role of personality traits in sexual complaints and dysfunctions is ever more evident. However, the literature is very scarce as to the possible relationships between such personality traits and specific sexual dysfunctions like ED, PE or both, their subtypes as to time of onset and severity levels. The main aim of the present study was to investigate if Neuroticism and Extraversion have different roles and trends in men suffering from PE and/or ED, both lifelong and acquired. Moreover, we verified if, by adopting DSM-IV-TR and DSM-5 criteria for diagnosing PE, some differences emerged in percentages of diagnosed cases. The sample consisted of 222 patients aged 18-70. The International Index of Erectile Function (IIEF-15) was used to assess erectile function, and the Premature Ejaculation Severity Index (PESI) was used to assess the severity of PE dysfunction. Neuroticism and Extraversion were measured with the Eysenck Personality Questionnaire-Revised (EPQ-R). In our results, Neuroticism and Extraversion were dependent on the kind of sexual dysfunction and its severity. These results suggest that type, time of onset and severity of sexual dysfunctions should be considered as related to specific personality characteristics and vice versa.

T10-O-29 Male sexual health and prevention

Objective The aim of this study was to assess the knowledge and attitude towards sexual health care among men. Design and methods. A sample of 160 men was interviewed during an andrological examination (experimental group, EG) and data were compared (using Chi square) with a control group (CG) matched for demographic characteristics and absence of medical condition. A structured interview with closed questions was used for data collection. A hierarchical cluster analysis was conducted on the total sample with between-group linkage method to identify a men group with an adequate preventive attitude. Results Significant differences between groups (all α-levels lower than 0.05) were found in the items: “knowledge concerning condom use”, “knowledge of male reproductive system”, “importance of andrological prevention” and “importance of trustworthy specialist”. Conclusion The respondents had poor knowledge of sexual health care, particularly concerning STDs. Men belonging to EG showed significantly higher preventive attitude than CG. Furthermore, the results showed that single, not married men, with a mean age of 37 and without children have better preventive attitudes than elder men with a partner and with children. Since hierarchical cluster analysis is an exploratory method, results should be treated as tentative until they are confirmed with an independent sample.

T05-O-12 Erectile dysfunction as early marker of cerebral ischemic damage. Is it useful performing neurological investigations?

Objective Erectile dysfunction (ED) is evidence of atherosclerosis and index of endothelial damage. Many authors demonstrated association with cardiovascular events and coronary artery diseases (CAD); the severity of ED was correlated with the angiographic extension of coronary atherosclerotic process. Few studies have given information about association between ED and subclinical cerebral ischaemic damage. This study was planned to test the hypothesis that patients with isolated ED, without signs of systemic and carotid atherosclerosis, compared to healthy population, have a reduced cerebral vasoreactivity ( CVR) as a marker of endothelial damage. Design and method 15 patients with erectile dysfunction (ED+ ) and 15 without erectile dysfunction(ED-) subjects, matched for age and vascular risk factors, were submitted to andrological and neurolological screening. Ecocolordoppler of cavernous arteries and nocturnal penil tumescence rigidometry were performed. Neurological assessment was performed by carotid duplex ultrasound and Transcranial Doppler and by assessing cerebrovascular reserve on both middle cerebral arteries calculating Vasomotor Reserve (VMR), after breath holding and hyperventilation. Results Carotid Duplex showed a light carotid stenosis in 3 patients: 2 in the ED+ and 1 in the ED-. No differences about intima-media thickness between ED+ and ED-. Slight slower mean middle cerebral arteries (MCA) flow velocities in ED+ in respect to ED -. ED+ showed a reduced VMR in respect to ED. Conclusions Reduced VRM in ED+ may represent a marker of early cerebral vasomotor dysfunction due to subclinical endothelial damage. So performing neurological investigations is unnecessary, but further studies about the relation between ED and cerebral ischaemic damage are needed.

T09-O-03 Regulation of emotions, alexithymia and male sexual well-being

Objective Alexithymia is a multi-facet personality construct characterized by difficulty identifying and describing emotions, paucity of fantasies and externally orientated cognitive style. Recent research investigated the role of alexithymia in male sexuality finding high scores for alexithymia in patients with Erectile Dysfunction (ED) and with Premature Ejaculation (PE) with a positive correlation between alexithymia level and the sexual symptoms’ severity. We present a summary of our studies discussing the potential implication of alexithymia for male sexual well-being. Design and method We assessed Alexithymia in 240 male outpatients with sexual dysfunction (120 with ED and 120 with PE) in comparison with a control group of 120 volunteers (age range 20-60). Alexithymia was measured through the twenty-item Toronto Alexithymia Scale (TAS-20), ED severity by the International Index of Erectile Function (IIEF) and PE severity by the Premature Ejaculation Severity Index (PESI). Results Subjects with sexual dysfunctions resulted significantly more alexithymic than controls (p Conclusions Patients alexithymic features could have some important implications in the clinical approach to male sexual dysfunctions. In the clinical relationship, special attention should be paid to the empathic attunement helping the patient to recognize, to name and to express his emotions. Body-oriented techniques, hypnosis and imaginative methods can be useful instruments in the treatment of alexithymic patients. Alexithymia also supports the importance of the partners involvement in the clinical practice.

Eiaculazione precoce e disregolazione delle emozioni: ricerca e implicazioni cliniche (Premature ejaculation and dysregulation of emotions: research and clinical implications)

Premature ejaculation and dysregulation of emotions: research and clinical implications - The alexithymia construct describes a cluster of cognitive and affective characteristics initially observed among patients with classic psychosomatic diseases and later among patients with various medical and psychiatric disorders. The salient features of the construct are: difficulty in identifying and in describing subjective feelings, difficulty in distinguishing between feelings and the bodily sensations of emotional arousal, constricted imaginative activity and externally oriented cognitive style. This study shows significantly higher alexithymia levels in patients with lifelong PE than in controls (p < 0.001). Moreover, alexithymia level is positively correlated with PE severity (p < 0.001). Alexithymia, assessed at base-line, could be a useful predictor of treatment outcome and could contribute to the therapeutic orientation. In the clinical relationship special attention should be paid to the patient’s alexithymic difficulties. Body-oriented techniques, relaxation training, focalized body awareness, hypnosis, imaginative methods and combined pharmacological- psychological treatments could be particularly indicated in the treatment of alexithymic patients with PE. The partner’s involvement is generally important in both the diagnostic process and the treatment of PE, but is particularly indicated if the EP patient presents alexithymic features. Key words: premature ejaculation, alexithymia, emotions, treatment, psychotherapy, psychological factors.

Complete Intermittent Androgenic Deprivation in Prostate Cancer: Our Experience

Our study aimed at a retrospective evaluation of clinicAL/biochemical progression in prostate cancer patients treated with intermittent androgenic deprivation (IAD) after a period of continuous cut off (CAD). Methods From 1996 to 2003 40 patients have been screened. 8 (gr.A) with increased PSA after radical prostatectomy (pT2N0M0); 32 (gr.B) had no surgical treatment due to age or other pathologies (Gleason ≤ 8). Patients have been monitored dosing out PSA every 3 months. CAD has been applied for an average period of 40 ± 10 months (med. 36). IAD has been performed by an “off” stage of interruption, alternately with an “on” stage of treatment. The cut-off for the suspension/resumption of therapy has been 0.4 ng/mL of PSA for group A and 3 ng/mL for group B. All patients have been received at least 3 cycles of therapy, each including “on” and “off” stages. Results After an average follow-up of 48 ± 12 months (med. 42) since the beginning of IAD, the progression-free survival has been 100% for group A and 96.8% for group B. The intermediate time of stage “off” during IAD pointed out a progression increment from the first cycle (51.6% gr. A, 46.6% gr. B) to the third cycle (73.5% gr. A, 76% gr. B). Conclusions The study pointed out that the actual average time of pharmacological treatment has been 47% for the period CAD+IAD and 31.5% for IAD only, keeping the PSA always near the nadir. Besides keeping the progression close to 0, we obtained an appreciable saving on the pharmacological costs and an improvement in the quality of life of patients due to the regression of the side-effects of therapy during stage “off”. Nevertheless it is still controversial in the Litterature on the pharmacological procedure to adopt, on the more suitable values of cut-off in PSA and on the timing of monitoring of patients.