Discussion in 'Men's Health Forum' started by Michael Scally MD, May 20, 2015.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Prevalence and Predictors of Ejaculatory Dysfunction in Men Presenting For Andrological Evaluation

    Authors: Matthew Pagano, Alison Levy, Adam De Fazio, Peter Stahl, New York, NY

    Introduction and Objectives - Ejaculatory dysfunction can frequently coexist with other urologic problems and may be underdiagnosed. We sought to describe predictors of ejaculatory dysfunction in men presenting for andrological evaluation in order to identify factors that could be used to trigger screening in at risk men.

    Methods - This was a retrospective study of 678 men presenting to an andrologist for initial consultation from 1/2013 to 7/2014. Patients with a history of treated prostate cancer were excluded. Presenting complaint(s), demographic data, comorbidities, endocrine studies, and responses to the validated 25-question Male Sexual Health Questionnaire (MSHQ) were reviewed.

    Ejaculatory domain score (EjD) and ejaculation bother scores for each presenting complaint were compared by Mann-Whitney U test to a control group of men with normal sexual function who presented for vasectomy.

    Univariate linear regression modeling was conducted to identify clinical factors predictive of overall EjD score, and significant factors were studied in a multivariable model.

    Results - Characteristics of the patient cohort were as follows: mean age 46.6, rate of diabetes (DM) 12.1%, hypertension (HTN) 23.2%, depression 18.3%, benign prostatic hyperplasia (BPH) 11.2%.

    Mean erection domain (ED) and EjD scores were 8.9 (scale 0-15) and 25.7 (scale 1-35), respectively.

    Men who presented with infertility, scrotal pain, Peyronie’s disease (PD), penile pain, scrotal swelling, hypogonadism, and erectile dysfunction (ED) reported significantly lower EjD scores than controls, and most groups reported more bother related to ejaculation (Figure).

    Clinical factors associated with lower EjD score on univariate analysis included age, total testosterone, body mass index, coronary artery disease, HTN, hyperlipidemia, DM, chronic kidney disease, neurologic disease (ND), depression, BPH, tobacco use, and MSHQ ED score.

    On multivariable analysis ED score (p<0.0005), DM (p=0.025), and ND (p=0.006) were predictive of lower EjD score.

    Conclusions - Impaired ejaculatory function is highly prevalent in men seeking andrological evaluation and causes patient bother. Focused history taking or use of a validated instrument will identify men who may benefit from treatment. Patients with ED, DM, and neurologic disease are at high risk and should be screened.
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Ejaculation Frequency and Risk of Prostate Cancer: Updated Results from the Health Professionals Follow-Up Study

    Jennifer Ride, Kathryn Wilson, Rachel Kelly, Erika Ebot, Edward Giovannucci, Lorelei Mucci.

    Introduction and Objectives - Evidence, including from within the Health Professionals Follow-up Study, suggests high ejaculation frequency may be protective against future development of prostate cancer.

    The aim of this study was to update the HPFS findings including 10 additional years follow-up, and more comprehensively evaluate the association between ejaculation frequency and prostate cancer.

    Methods - At recruitment in 1992, 31,925 men from Health Professionals Follow-up Study were questioned on their average monthly ejaculation frequency during the ages of 20-29 and 40-49, and in the previous year (1991) from which a lifetime average was computed.

    During 437,490 person-years of follow-up, 3,839 of these men were diagnosed with incident prostate cancer, including 384 lethal cases.

    Cox proportional hazards models were used to compute the risk of prostate cancer associated with average monthly ejaculation frequency compared to a referent group reporting 4-7 ejaculations/month.

    Results - Ejaculation frequency was inversely associated with age, but positively associated with BMI, physical activity, divorce, history of sexually transmitted infection, and consumption of calories and alcohol.

    Having had a PSA test by 2008, total number of PSA tests, and frequency of prostate biopsy were similar across categories of ejaculation frequency, but differences in prostate cancer treatment were apparent.

    After controlling for potential confounders, higher monthly ejaculation frequency was associated with a statistically significant decreased risk of total prostate cancer compared to the reference group at every time period.

    The hazard ratios (95% CI) comparing at least 21 ejaculations/month to 4-7 ejaculations/month were 0.81 (0.72-0.91; p-trend<0.0001) at age 20-29; 0.78 (0.68-89; p-trend<0.0001) at age 40-49; 0.75 (0.61-93; p-trend=0.0007) in 1991; and 0.66 (0.52-0.83; p-trend<0.0001) for the lifetime average.

    The associations were driven by organ-confined and low-grade prostate cancer. Results were not modified by erectile dysfunction, vasectomy or PSA screening.

    Conclusions - These findings support a role for ejaculation frequency throughout adult life in the etiology of prostate cancer. The restriction of the apparent benefit to disease with more favorable outcomes may reflect differences in treatment preferences for men with high ejaculation frequency.
  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Spence AR, Rousseau M-C, Parent M-Ãl. Sexual partners, sexually transmitted infections, and prostate cancer risk. Cancer Epidemiology. 2014;38(6):700-7. http://www.cancerepidemiology.net/article/S1877-7821(14)00155-6/abstract

    Background: The etiology of prostate cancer (PCa) is poorly understood. Sexual activity and sexually transmitted infections (STIs) are among factors under scrutiny, with controversial findings to date.

    Methods: We examined the association between the number and gender of sexual partners, STIs and PCa risk in the context of PROtEuS, a population-based case–control study set amongst the mainly French-speaking population in Montreal, Canada. The study included 1590 histologically-confirmed PCa cases diagnosed in a Montreal French hospital between 2005 and 2009, and 1618 population controls ascertained from the French electoral list, Montreal residents, frequency-matched to cases by age. In-person interviews elicited information on sociodemographic, lifestyle and environmental factors. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between sexually related factors and PCa risk, adjusting for age, ancestry, family history of PCa, and PCa screening history.

    Results: Subjects with more than 20 sexual partners in their lifetime had a decreased risk of PCa (OR 0.78, 95% CI 0.61–1.00) as did subjects who specifically had more than 20 female sexual partners (OR 0.72, 95% CI 0.56–0.94). By contrast, having had several male sexual partners appeared to confer some excess in risk of PCa. No association emerged for history of STIs and PCa but STIs prevalence was low.

    Conclusion: Our findings are in support of a role for the number of sexual partners in PCa development. The gender of sexual partners should be taken into account in future studies investigating this association.
  4. Doesn't that say it all! :oops:
    Michael Scally MD likes this.
  5. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Leitzmann MF, Platz EA, Stampfer MJ, Willett WC, Giovannucci E. Ejaculation Frequency and Subsequent Risk of Prostate Cancer. JAMA. 2004;291(13):1578-1586. http://jama.jamanetwork.com/article.aspx?articleid=198487

    Context Sexual activity has been hypothesized to play a role in the development of prostate cancer, but epidemiological data are virtually limited to case-control studies, which may be prone to bias because recall among individuals with prostate cancer could be distorted as a consequence of prostate malignancy or ongoing therapy.

    Objective To examine the association between ejaculation frequency, which includes sexual intercourse, nocturnal emission, and masturbation and risk of prostate cancer.

    Design, Setting, and Participants Prospective study using follow-up data from the Health Professionals Follow-up Study (February 1, 1992, through January 31, 2000) of 29 342 US men aged 46 to 81 years, who provided information on history of ejaculation frequency on a self-administered questionnaire in 1992 and responded to follow-up questionnaires every 2 years to 2000. Ejaculation frequency was assessed by asking participants to report the average number of ejaculations they had per month during the ages of 20 to 29 years, 40 to 49 years, and during the past year (1991).

    Main Outcome Measure Incidence of total prostate cancer.

    Results During 222 426 person-years of follow-up, there were 1449 new cases of total prostate cancer, 953 organ-confined cases, and 147 advanced cases of prostate cancer. Most categories of ejaculation frequency were unrelated to risk of prostate cancer. However, high ejaculation frequency was related to decreased risk of total prostate cancer. The multivariate relative risks for men reporting 21 or more ejaculations per month compared with men reporting 4 to 7 ejaculations per month at ages 20 to 29 years were 0.89 (95% confidence interval [CI], 0.73-1.10); ages 40 to 49 years, 0.68 (95% CI, 0.53-0.86); previous year, 0.49 (95% CI, 0.27-0.88); and averaged across a lifetime, 0.67 (95% CI, 0.51-0.89). Similar associations were observed for organ-confined prostate cancer. Ejaculation frequency was not statistically significantly associated with risk of advanced prostate cancer.

    Conclusions Our results suggest that ejaculation frequency is not related to increased risk of prostate cancer.
  6. double-leg

    double-leg Member

    Creame freashe

    Attached Files:

    DirtyRandy likes this.
  7. BBC3

    BBC3 Member

    I don't know man. Every time I get at least two months away from that nasty man hater I married - MY DICK STARTS WORKING LIKE A CHARM>>>!:D

    That demon in that cunt could shut down EVAN STONE with 5 fluffers working over time...!

  8. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Ejaculate Deterioration with Male Age, and Its Amelioration in Drosophila

    Declining ejaculate performance with male age is taxonomically widespread and has broad ramifications for fertility and fitness. However, we have a poor understanding of age-related changes to specific ejaculate components, how they cause reduced performance, and whether the decline is ameliorable.

    Here, we show that, in Drosophila, sperm production chronologically declines with age, invariant to mating activity, while repeated mating causes infertility via reduced sperm stores and viability.

    However, changes to sperm do not fully explain ejaculate deterioration: impacts on seminal fluid contribute to aspects of reduced ejaculate performance, associated with shifts in proteome abundance and quality.

    We show that ablation of insulin-like peptide-producing cells in males ameliorates aspects of ejaculate performance loss, suggesting that anti-ageing interventions can be coopted to benefit male reproductive health.

    Sepil I, Hopkins BR, Dean R, et al. Ejaculate deterioration with male age, and its amelioration in Drosophila. bioRxiv 2019:624734. http://biorxiv.org/content/early/2019/06/28/624734.abstract
  9. Sworder

    Sworder Member

    I can understand the fertility part, but fitness? Hmm...
    Michael Scally MD likes this.
  10. SaneDog

    SaneDog Member

    Good information. Thanks again man.