Clinical guide to rare male sexual disorders

[madman]

Abstract

Conditions referred to as ‘male sexual dysfunctions’ usually include erectile dysfunction, ejaculatory disorders and male hypogonadism. However, some less common male sexual disorders exist, which are under-recognized and under-treated, leading to considerable morbidity, with adverse efects on individuals’ sexual health and relationships. Such conditions include post-fnasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-selective serotonin reuptake inhibitor (SSRI) sexual dysfunction, hard–faccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction. Information about these disorders usually originates from case–control trials or small case series; thus, the published literature is scarce. As the aetiology of these diseases has not been fully elucidated, the optimal investigational work-up and therapy are not well defned, and the available options cannot, therefore, adequately address patients’ sexual problems and implement appropriate treatment. Thus, larger-scale studies — including prospective trials and comprehensive case registries — are crucial to better understand the aetiology, prevalence and clinical characteristics of these conditions. Furthermore, collaborative efforts among researchers, health-care professionals and patient advocacy groups will be essential in order to develop evidence-based guidelines and novel therapeutic approaches that can effectively address these disorders. By advancing our understanding and refining treatment strategies, we can strive towards improving the quality of life and fostering healthier sexual relationships for individuals suffering from these rare sexual disorders.




Post-finasteride syndrome
-Aetiology, pathophysiology and diagnosis
-Treatment of PFS


Restless genital syndrome
-Aetiology, pathophysiology and diagnosis of ReGS
-Treatment of ReGS


Post-orgasmic illness syndrome
-Aetiology, pathophysiology and diagnosis of POIS
-Treatment of POIS


Post-SSRI sexual dysfunction
-Aetiology, pathophysiology and diagnosis of PSSD
-Treatment of PSSD


Hard–flaccid syndrome
-Aetiology, pathophysiology and diagnosis of HFS
-Treatment of HFS


Sleep-related painful erections
-Aetiology, pathophysiology and diagnosis of SRPEs
-Treatment of SRPEs


Post-retinoid sexual dysfunction
-Aetiology, pathophysiology and diagnosis of PRSD
-Treatment of PRSD




Future perspectives

Recognition and acknowledgement are needed to appreciate that rare sexual diseases can arise not only from psychological causes but also organic etiologies. Clinicians must not ignore these scarce and often debilitating conditions; on the contrary, they are obligated to pursue the possible pathophysiological mechanisms and develop more effective management strategies. In addition, clinicians have a duty of care to inform patients about the potential sexual side effects of 5ARIs and SSRIs before prescribing them. When possible, topical treatments should be used before systematic administration. Furthermore, investigating the presence of poor baseline sexual function before treatments are initiated might prevent worsening of the symptoms.

Patients with rare sexual male disorders should be encouraged to participate in clinical trials. Owing to the rarity of these syndromes, multinational, multicentre organizations can be helpful in shaping understanding of these disorders. Without a deeper understanding of their causes and management, patients with rare sexual diseases could be continued to be stereotyped and stigmatized by clinicians, which leads not only to dissatisfied patients but also to a barrier to understanding the underlying mechanisms of the conditions. Increasing awareness — in clinicians and patients — is key.




Conclusions

Rare sexual disorders are under-recognized and undertreated and can cause a great deal of physiological and psychiatric morbidities in affected patients. Such disorders can be the result of medication for an unrelated problem, such as PRSD, which arises after treatment with isotretinoin, an acne treatment, or PFS. Others can arise seemingly idiopathically, such as SRPEs, which have no known causative factors but might be related to lifestyle, or HFS.

In order to address the sexual dysfunctions described by these patients and implement appropriate treatments, physicians must become more familiar with the existence of these disorders and actively seek to investigate them in patients in whom they form part of the differential diagnosis.

 

[Nelson Vergel]

First time I hear about this:

"Hard Flaccid Syndrome (HFS) is a rare disorder where a man's penis is constantly in a semi-erect, semi-flaccid state. At the height of sexual arousal, the condition prevents the penis from getting erect, often falling short of its true potential. In the best-case scenario, the penis feels numb at rest."

 

[madman]

 

[madman]

Fig. 1 | Restless genital syndrome has the characteristics of small-fibre sensory neuropathy of the dorsal nerve of the penis, possibly triggered by hormonal changes, drugs, stress, trauma and other unknown contributors. Symptoms include pre-orgasmic genital arousal, dysaesthesia and overactive-bladder-like symptoms, as well as symptoms similar to restless leg syndrome. SFSN, small-fibre sensory neuropathy; SSRI, selective serotonin reuptake inhibitor

 

[madman]

Fig. 2 | The hypothetical pathophysiology of post-orgasmic illness syndrome in men. Several hypotheses have been proposed for the pathophysiology of post-orgasmic illness syndrome (POIS). First, an immunological and/or allergic phenomenon, whereby a possible immunological reaction occurs against a substance in the seminal fluid. Second, hypersensitivity, whereby the mucosal epithelium lining the urinary tract launches a hyperactive immune response to the seminal fluid. Third, the syndrome may be caused by opioid-like withdrawal, as orgasm triggers the consumption of large amounts of endogenous opioids, reducing their circulating levels. Finally, a neuroendocrine response and deregulation of the autonomic nervous system might underlie POIS, in which the released catecholamines and neurotransmitter substances contribute to excessive arousal during orgasm.

 

[madman]

 

[madman]

Fig. 3 | Potential pathophysiology of hard– flaccid syndrome. A trauma-like event, for example, sustained during masturbation or sexual intercourse, might harm the pudendal nerve and/or artery at the level of the radix penis, which could trigger penile hypoxia, inflammation and neuropathy. Neuropathy and penile hypoxia can result in symptoms of coldness and numbness in the penile shaft and glans, whereas muscle spasms might be responsible for chronic prostatitis/chronic pelvic pain syndrome-like voiding symptoms. Furthermore, emotional stress arising from hard–flaccid syndrome (HFS) might worsen the pelvic muscle spasms and further deteriorate the patient’s symptoms in a vicious cycle.

 

[madman]

 

[madman]

Key points

• Rare male sexual disorders include post-finasteride syndrome, restless genital syndrome, post-orgasmic illness syndrome, post-elective serotonin reuptake inhibitor sexual dysfunction, hard– flaccid syndrome, sleep-related painful erections and post-retinoid sexual dysfunction.

• The exact mechanisms of these disorders are unclear and the conditions could involve both physical and psychological components.

• Post-finasteride syndrome symptoms can persist for months or even years after discontinuing treatment with 5α reductase inhibitors.

• Symptoms of restless genital syndrome include unwanted and unpleasant genital sensations, often perceived as an imminent orgasm without sexual desire or stimuli, and a sense of restlessness in the genital area.

• Post-orgasmic illness syndrome presents as a combination of local (mucosal) and systemic flu-like and allergic symptoms.

• Post-selective serotonin reuptake inhibitor sexual dysfunction symptoms can occur even with a single dose of the drug and are not necessarily dose dependent.

• Hard–flaccid syndrome often occurs following penile trauma, such as excessive masturbation.

• In post-retinoid sexual dysfunction, symptoms can occur during retinoid treatment and persist after discontinuation, whereas in some patients symptoms can appear or worsen after isotretinoin is stopped.

 

[madman]

First time I hear about this:

"Hard Flaccid Syndrome (HFS) is a rare disorder where a man's penis is constantly in a semi-erect, semi-flaccid state. At the height of sexual arousal, the condition prevents the penis from getting erect, often falling short of its true potential. In the best-case scenario, the penis feels numb at rest."

Here is an older thread.

Hard flaccid syndrome: initial report of four cases

Abstract Hard flaccid (HF) is a group of symptoms that significantly affects a man’s sexual and social life. As this syndrome has only been reported in several patient forums, exact prevalence of this rare condition is unknown. Currently, no scientific literature exists of the syndrome. We...

www.excelmale.com

 

[madman]

Finasteride and Antidepressant Induced Sexual Dysfunction in Men

Maria Uloko, MD, discusses symptoms, causes, and treatments for post-finasteride syndrome (PFS) and post-SSRI sexual dysfunction (PSSD) in men. She explains the controversy behind the PFS diagnosis and discusses the attention it has gathered in urology, citing the NIH’s inclusion of PFS in its...

www.excelmale.com