조루증의 치료에서 Paroxetine의 효과와 부작용

박광성,이재규,윤진상,권동득,오봉렬,류수방,박양일 全南大醫大 2001 전남의대학술지 Vol.37 No.1

조루증 환자에서 음경의 진동감각역치, 음경배부신경 구심성 신경전도로의 상태에 따른 경구용 약물요법의 효과

한지엽,서경근,김세철 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.6

조루증 치료약제의 약효 평가를 위한 생체실험 모델의 타당성 검증

백민기,김수웅,백재승 大韓泌尿器科學會 2002 Korean Journal of Urology Vol.43 No.11

조루증의 최신 개념

함원식,김원태,최형기,최영득 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.9

Premature ejaculation(PE) is the most prevalent male sexual complaint, yet it remains underdiagnosed and undertreated. The sympathetic, parasympathetic, and somatic spinal centers, under the influence of sensory genital and cerebral stimuli integrated and processed at the spinal cord level, act in synergy to command physiologic events occurring during ejaculation. Experimental evidence indicates that serotonin(5-HT), throughout brain descending pathways, exerts an inhibitory role on ejaculation and pharmacologic manipulation of the serotonergic system has been performed in rats, with the antidepressant selective serotonin reuptake inhibitors(SSRIs) exhibiting the greatest efficacy in delaying ejaculation. Over the last decade, an increasing number of studies of drug treatment of PE have been published. A meta-analysis of those studies demonstrated similar efficacies for daily treatment with the serotonergic antidepressants paroxetine hemihydrate, clomipramine, sertraline and fluoxetine, with paroxetine(hydrochloride) hemihydrate exerting the strongest effect on ejaculation. On the basis of fundamental insights into serotonergic neurotransmission, it has been suggested that on-demand selective serotonin reuptake inhibitor(SSRI) treatment will not lead to similarly impressive delays in ejaculation as has been observed with daily SSRI treatment. Apart from daily treatment with SSRIs, PE can be delayed by on-demand use of topical anaesthetics. Treatment with phosphodiesterase type 5 inhibitors may be used if PE is accompanied by erectile difficulties.

Urologist’s Practice Patterns Including Surgical Treatment in the Management of Premature Ejaculation: A Korean Nationwide Survey

양대열,고경태,이원기,박현준,이성원,문기학,김세웅,김수웅,조강수,문두건,민권식,양상국,손환철,박광성 대한남성과학회 2013 The World Journal of Men's Health Vol.31 No.3

Purpose: According to previous studies, the prevalence of premature ejaculation (PE) in Korea ranges from 11.3% to 33%. However, the actual practice patterns in managing patients with PE is not well known. In this study, we have endeavored to determine how contemporary urologists in Korea manage patients with PE.Materials and Methods: The e-mailing list was obtained from the Korean Urological Association Registry of Physicians. A specifically designed questionnaire was e-mailed to the 2,421 urologists in Korea from May 2012 to August 2012. Results: Urologists in Korea diagnosed PE using various criteria: the definition of the International Society for Sexual Medicine (63.4%), Diagnostic and Statistical Manual of Mental Disorders (43.8%), International Statistical Classification of Disease, 10th edition (61.7%), or perceptional self-diagnosis by the patient himself (23.5%). A brief self-administered questionnaire, the Premature Ejaculation Diagnostic Tool, was used by only 42.5% of the urologists. Selective-serotonin reuptake inhibitor (SSRI) therapy was the main treatment modality (91.5%) for PE patients. 40.2% of the urologists used phosphodiesterase type 5 inhibitors, 47.6% behavior therapy, and 53.7% local anesthetics. Further, 286 (54.3%) urologists managed PE patients with a surgical modality such as selective dorsal neurotomy (SDN).Conclusions: A majority of Korean urologists diagnose PE by a multidimensional approach using various diagnostic tools. Most urologists believe that medical treatment with an SSRI is effective in the management of PE. At the same time, surgical treatment such as SDN also investigated as one of major treatment modality despite the lack of scientific evidence.

Nonresponders to Daily Paroxetine and Another SSRI in Men With Lifelong Premature Ejaculation: A Pharmacokinetic Dose-Escalation Study for a Rare Phenomenon

Paddy K.C. Janssen,Daan Touw,Dave H. Schweitzer,Marcel D. Waldinger 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.9

Purpose: Nonresponse to any selective serotonin reuptake inhibitor (SSRI) treatmentis rare. In this study, we aimed to investigate ejaculation delay nonresponse to paroxetinetreatment in men with lifelong premature ejaculation (PE) who were also knownto be nonresponders to other SSRIs. Materials and Methods: Five males with lifelong PE who were known nonrespondersto paroxetine and other serotonergic antidepressants and eight males with lifelong PEwho were specifically recruited were included. Blood sampling occurred 1 month and1 day before the start of treatment and at the end of three consecutive series of 4 weeksof daily treatment with 10-, 20-, and 30-mg paroxetine, respectively. Blood samples formeasurement of leptin and paroxetine were taken at 8:30 AM, 9:30 AM, 10:30 AM, and11:30 AM, respectively. At 9:00 AM, one tablet of 10-, 20-, or 30-mg paroxetine was takenduring the first, second, and third month, respectively. Intravaginal ejaculatory latencytime (IELT) was measured with a stopwatch. The main outcome measures were the foldincrease in the geometric mean IELT, serum leptin and paroxetine concentrations, bodymass index (BMI), 5-HT1A receptor C-1019G polymorphism, and CYP2D6 mutations. Results: Between the 7 paroxetine responders and 6 nonresponders, the fold increasein the geometric mean IELT was significantly different after daily 10-mg (p=0.003),20-mg (p=0.002), and 30-mg paroxetine (p=0.026) and ranged from 2.0 to 8.8 and from1.1 to 1.7, respectively. BMI at baseline and at the end of the study was not significantlydifferent between responders and nonresponders. Serum leptin levels at baseline weresimilar in responders and nonresponders and did not change during treatment. Theserum paroxetine concentration increased with increasing dosage and was not significantlydifferent between responders and nonresponders. There was no associationbetween the fold increase in the geometric mean IELT and serum paroxetine levels duringthe three treatment periods nor between leptin levels during the treatment periodsand serum paroxetine levels. For the 5-HT1A receptor C-1019G variation, all respondershad the CC genotype and all nonresponders had the GC genotype, respectively. Conclusions: Complete absence of paroxetine-induced ejaculation delay is presumably relatedto pharmacodynamic factors and perhaps to 5-HT1A receptor gene polymorphism.

케겔(Kegel)의 골반기저근 강화운동과 하타요가(Haṭhayoga)의 무드라(Mudrā)와 반다(Bandha) 수련 비교

강위달(Kang, Wee-Dal),이거룡(Lee, Geo-Lyong) 한국인도학회 2016 印度硏究 Vol.21 No.1

인간은 척추가 수직으로 세워져 몸무게를 지탱하는 생리적 불균형과 임신과 출산, 그리고 노화로 인하여 골반 기저근육들이 약해지면서 아래로 늘어지는 현상 때문에 골반 내 장기들이 압박을 받아 본래의 기능들이 떨어지게 된다. 여성은 방광이 압박을 받아 복압성 요실금이 생길 뿐만 아니라, 반복적인 성관계, 임신과 출산으로 질의 탄력이 떨어지고 골반근육이 약해지면 성생활 만족도도 낮아지게 된다. 이를 해결하기 위한 방법으로 미국의 산부인과 의사 아놀드 케겔이 골반기저근육인 항문거근 중, 치골미골근(Pubococcygeus muscle)과 질을 둘러싼 구해면체근(Bulbospongiosus)을 수축시켜 강화시키는 질회음운동법이라는 획기적인 치료법을 1948년에 개발해서 보급했다. 남성의 경우에도 발기와 사정을 담당하는 구해면체근, 회음횡근(Transverse perineus), 치골미골근 등 골반기저근을 강화시킴으로써 발기부전과 조루증이 개선된다는 의료인과 성 의학자들의 보고들이 많이 있다. 또한 여기에 인도 하타요가의 무드라와 반다 수행에서 항문괄약근을 수축하는 아쉬비니무드라(aśvinī-mudrā), 회음을 수축하는 물라반다(mūlabandha), 성기 부위를 수축하는 바즈롤리무드라(vajrolī-mudrā)와 사하졸리무드라(sahajolī-mudrā)운동 등을 통해 여성의 성기능 개선과 남성의 조루증을 개선한다는 놀라운 유사성을 발견하게 된다. 쿤달리니요가(Kuņḍalinī Yoga)와 케겔운동을 해부학에 기초한 생리적인 접목을 시도한다는 것은 다소 섣부른 감이 있지만, 각각의 수행 방법과 결과에서 같은 방향을 향하고 있다. In human beings, pelvic floor muscles come to droop backwards as they become weak due to pregnancy, childbirth and ageing as well as the physiological unbalance of supporting the body weight resulting from the uprightly standing backbone. So the organs within the pelvis come to have their lowered original functions as they are placed under pressure because of this phenomenon. Woman not only comes to have both stress urinary incontinence due to the bladder being under pressure but comes to have the lowered level of sexual gratification if she has the lowered vaginal elasticity and weakened pelvic muscles due to repeated sexual intercourses, pregnancy and childbirth. To resolve these problems, Arnold Kegel, the American ob-gyn doctor, developed and disseminated, in 1948, an innovative therapeutics called the Vaginoperineal Exercise Method of contracting and strengthening levator ani muscles such as the pubococcygeus muscle and the bulbocavernous muscle (M. bulbospongiosus) surrounding the vagina. Many medical practitioners and medical scientists specializing in sex have largely reported that erectile dysfunction and premature ejaculation in men are improved by strengthening pelvic floor muscles such as bulbocavernous muscle, transverse perineus and pubococcygeal muscle which take responsibility for erection and ejaculation. Here, this study comes to find a remarkable similarity between the Kegel exercise and the Mudra-Bandha training of Indian Haṭhayoga that is known to improve women’s sexual function and men’s premature ejaculation through exercises such as the aśvinī-mudrā exercise of contracting the anal sphincter, the mūlabandha exercise of contracting the perineum, the vajrolī-mudrā and sahajolī-mudrā exercises of contracting the genital region. It is felt that it may be premature to make an attempt at the physiological combination of basing both the kuņḍalinī yoga and the Kegel exercise on anatomy. But as a matter of fact, they are oriented towards the same direction in terms of the training method and the ultimate outcome.

The effects of SS-cream and its individual components on rabbit corpus cavernosal muscles

Xin, Zhong Cheng,Choi, Young Deuk,Choi, Hyung Ki Yonsei University, College of Medicine 1996 Yonsei medical journal Vol.37 No.5

조루증 환자 치료에서 Sertraline 필요시 자가복용요법: 단기 추적 결과

백재승,임대정,서성일,김수웅 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.9

Synthesis and Biological Properties of New 5-Cyano-1,1-disubstituted Phthalans for the Treatment of Premature Ejaculation

Kim, Dong-Sung,Kang, Kyung-Koo,Lee, Kyung-Seok,Ahn, Byoung-Ok,Yoo, Moo-Hi,Yoon, Seung-Soo Korean Chemical Society 2008 Bulletin of the Korean Chemical Society Vol.29 No.10

The synthesis of new 5-cyano-1,1-disubstituted phthalans having aromatic and aminoalkyl groups at C-1 position of phthalan ring and their biological evaluation are described. Most compounds exhibited comparable ejaculation-retarding effects to citalopram. Of these compounds, 3a, e showed excellent efficacy in delaying ejaculation.