SEXUAL DYSFUNCTION: USE OF TAMSULOSIN IN TREATMENT OF ORGASM-ASSOCIATED PAIN

1. SEXUAL DYSFUNCTION: USE OF TAMSULOSIN IN TREATMENT OF ORGASM-ASSOCIATED PAIN Danylo Halytsky L’viv National Medical Universuty Aleksander Shulyak, Aleksander Borzhievskyi, Dmytro Vorobets

2. Sexual dysfunction is distressing a grate problem for men who suffer from it, which negatively impacts quality of lifeand relationships • Post-orgasmic pain (dysorgasmia or orgasmalgia) represents a subcategory of sexual dysfunction that has received little attention in the medical literature[Koeman M., van Driel M.F., Schultz W.C., Mensink H.J. Orgasmafter radical prostatectomy//Brit. J. Urol. – 1996. – V.77. – P.861-864] • No uniform theory exists pertaining to the etiology of this problem in men, however it is our belief that pelvic floor muscle and/or bladder neck spasm are key to the development of this condition

3. Dysorgasmia is not an uncommon complaint of the patients who have undergone prostatectomy • [Bergman B., Nilsson S., Petersen I. The effect on erection and orgasm of cystectomy, prostatectomy and vesiculectomy for cancer of the bladder: a clinical and electromyographic study //Brit. J. Urol. – 1979. – V.51. – P.114-120., • Goriunov V.G., Davidov M.I. Sexual readaptation after the surgical treatment ofbenign prostatic hyperplasia // Urol. Nefrol. Mosk. – 1997. – P.20-24.] • have been exposed to pelvic radiation • [Francisca E.A., d’Ancona F.C., Meuleman E.J. Debruyne F.M., de la Rosette J.J. • Sexual function following high energy microwave thermotherapy://J.Urol.–1999.–V.161.–P.486-490., • Merrick G.S., Wallner K., Butler W.M. Lief J.H., Sutlief S. Short-term sexual function after prostate brachytherapy // Int. J. Cancer – 2001. – V.96. – P.313-319.] • and in young men diagnosed with chronic pelvic pain disorder • [Nickel J.C., Narayan P., McKay J., Doyle C. Treatment of chronic prostatitis/chronic pelvic pain syndrome with tamsulosin: a randomized double blind trial // J. Urol. – 2004. – V.171. – P.1594-1597.]

4. 1АD–blocker – tamsulosinusually prescribed to alleviate lower urinary tract symptoms related to benign prostatic hyperplasia [Narayan P., Evans C.P., Moon T., 2003] Tamsulosinacts via smooth muscle relaxation of the bladder neck and prostate resulting in reduced bladder outlet obstruction [Abrams P., Schulman C.C., Vaage S., 1995]

5. Case reports have also suggested tamsulosin to be effective in alleviating painful ejaculation in clinically depressed patients • [Demyttenaere K., Huygens R. Painful ejaculation and urinary hesitancy in association with antidepressant therapy: relief with tamsulosin // Eur. Neuropsychopharmacol. – 2002. – V.12. – P.337-341.] • Randomized, placebo-controlled, multi-center clinical trial studying the efficacy of tamsulosin in treating patients with chronic prostatitis/chronic pelvic pain has demonstrated improvement in pain using tamsulosin • [Nickel J.C., Narayan P., McKay J., Doyle C. Treatment of chronic prostatitis/chronic pelvic pain syndrome with tamsulosin: a randomized double blind trial // J. Urol. – 2004. – V.171. – P.1594-1597.]

6. Given the aforementioned postulated theory for the genesis of dysorgasmia and the uroselective nature of tamsulosin, it was selected as a potential therapeutic candidate for male dysorgasmia

7. Aim To assess the effect of the alpha-blocking medication, tamsulosin on post-orgasmic pain

8. Study population RP– patients with dysorgasmia after radical prostatectomy RT- patients with dysorgasmia after pelvic radiation therapy GG – general group unrelated to the other two etiologies Patients meeting inclusion criteria were instructed to use tamsulosin 0.4 mg dayly for at least 4 weeks No placebo arm was included in this proof-of-concept stydy

9. At baseline and at a time point at least one month after the commencement of medical therapy, patients completed 3 inventories IIEF (the international index of erectile function) VAS (visual analog scale for pain) an incontinence scale

10. Results 56 patients were enrolled in this study The mean age was4217years Hypertension was found in27% Dyslipidemia in36%, diadetes in7,5% 11patients had undergone radical prostatectomy (~ 106months) 17had radiation therapy(~ 8±2 months) 39 patients of general group The mean interval between completion of pre- and post-tamsulosin treatment questionnaries was 21,5months

11. Pain was located: In the penis37 (66.1%) testis8 (14.3%) rectum9(16%) abdomen2 (3.6%) Pain for a duration of1 to 5 minutesexperienced29 (51.7%)patients < 1 minutes21 (37.5%)пацієнтів > 5 minutes5 (10%) пацієнтів > 15 minutes1(1.7%) пацієнтів After tamsulosin treatment: 45 (80.4%)patients reported improvement in pain 9 (16%) – noted complete resolution of pain

12. Visual analog scale before and after following tamsulosin treatment * * * * * values are statistically significantly lower than the pre-treatment values

13. IIEF libido domain scores before and after tamsulosin treatment * * * * * Values are statistically significantly greater than the pre-treatment values Libido scores increases with statistical significance is more likely as the result of decreasing pain and thus increasing satisfaction with sexual activity rather than a direct effect of tamsulosin

14. Incontinence scores before and after tamsulosin treatment * Only the radical prostatectomy group has an improvement in incontinence score after treatment * Patients who had undergone radical prostatectomy had better continence levels, this may merely represent the natural evolution of continence return after operation and most probably unrelated to the use of their medication

15. CONCLUSIONS • This non placebo-controlled study demonstrates that tamsulosin decreases the intensity of orgasmic pain and improves libido in men with dysorgasmia • This study also highlights the association between post-orgasmic pain and radical prostatectomy or pelvic radiation therapy

16. 3. The utility of -blocker therapy in orgasm-associated pain supports postulate that the pain may be related to bladder neck and/or pelvic floor muscle spasm 4. Furthermore, randomized, placebo-controlled studies will be necessary to further define the role of alpha-blocker therapy in the management of this disorder