MedicalResearch.com Interview with:
Darius A. Paduch, MD, PhD
Associate Professor of Urology and Reproductive Medicine
Director Sexual Health and Medicine
Research Director of Male Infertility Fellowship
Co-Director Male Infertility Genetics Laboratory
Weill Cornell Medical College
Dept of Urology
New York, NY 10065
Medical Research: What is the background for this study? What are the main findings?
Dr. Paduch: Ejaculatory dysfunction, inability to ejaculate or delayed ejaculation affects 10-8% of men. Inability to ejaculate either intravaginally or at all is independent of erectile function.
Men with normal erection may take very long time to ejaculate (>30 min) or not able to ejaculate at all. The men in our study had either normal erections or minimal erectile dysfunction.
Men of all ages have spontaneous erections but don’t ejaculate just from erection, it is progression of arousal and activation of spinal cord motor generator for ejaculation which is necessary for ejaculation.
One of important factors in our ability to ejaculate is testosterone (T), testosterone allows for normal function of CNS centers for ejaculation, it is a modulator and is necessary; preadolescent boys don’t ejaculate because their spinal cord centers for ejaculations are not mature – process dependent on testosterone. However testosterone is just one of many neurotransmitters and hormones needed of normal ejaculation.
Actually our study showed that in men who achieved normal levels of testostosterone the ejaculatory function have improved. As this was first double blinded and randomized clinical trial we had to report our results based on radomization to testosterone treatment or placebo. Unfortunately only 70-80% of men treated with topical testosterone preparation will achieve normal testosterone level , we simply didn’t reach statistical significance based on randomization and considering relatively low number of patients in each group. But in men who achieved normal testosterone levels the difference was statistically significant.
Testosterone should not be used to treat any conditions, including ejaculatory dysfunction, in absence of low testosterone level.
EjD is very common but it bares significant embarrassment stigma, it is difficult for the couple to bear fact that male partner can’t ejaculate, it also creates issues within couple and question about attraction and fidelity.
We have previously showed that treatment with tadalafil improves ejaculatory and orgasmic dysfunction and these data has been published.
This study was focused on effect of testosterone, but its main significance was it’s design: we developed new tools to assess ejaculatory function and learned a lot about when patients or their partners start to be bothered by EjD. If time to ejaclate takes > 30 min
We are now looking into novel and available pharmacotherapy modulating dopaminergic and canabioid signaling and reward mechanisms. I am also very excited about our potential work in direct spinal cord motor generator nano stimulator, this could be very useful for men with spinal cord injuries and diabetic patients. We paved the road for others and I am sure new treatments are just a matter of time.
Medical Research: What should clinicians and patients take away from your report?
Dr. Paduch: Message to clinician: in 2015 we need to understand that sexual experience is much more than just having rigid penis, disorders of ejaculation, orgasm, desire and arousal are common but poorly understand in men.
For centuries we were thought that only women fail to achieve orgasm . The work of my team at WCMC and our collaborators at Eli LillY has shown that not only EJD is common, but failure of orgasm affects men same as women. We hope that by sharing our research we will stimulate further interest in this area and bring more funding from pharma and federal sources to treat this common yet not understood condition.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Paduch: We are focusing in my lab on identifying if genetic mutations and single nucleotide polymorphisms modulate delayed ejaculation and how small RNAs affect nerve and vascular function in the penis and modulate sensory processing in the spinal cord and brain. This research would uncover completely novel pathways of treatment of male sexual dysfunction
Paduch DA, Polzer PK, Ni X, Basaria S. Testosterone Replacement in Androgen-Deficient Men With Ejaculatory Dysfunction: A Randomized Controlled Trial. Journal of Clinical Endocrinology & Metabolism. 2015.
Darius A. Paduch, MD, PhD (2015). Ejaculatory Issues Common and Not Helped By Testosterone Treatment