Archive: Feb 2020

  1. Premature Ejaculation & Testosterone Deficiency.Highlights from the European Society of Sexual Medicine Meeting

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    Premature Ejaculation & Testosterone Deficiency

    Highlights from the European Society of Sexual Medicine Meeting

    Dr. Savage attended the European Society of Sexual Medicine Meeting in Prague 23 – 26th January 2020.

    Premature ejaculation

     One of the topics discussed was the management of premature ejaculation and in particular discussing some newer medications. One of the medications discussed was Fortacin. This is a topical local anaesthetic spray which is used on the tip of the penis prior to sexual intercourse. It is effective and popular with patients. Of the patients who had been prescribed it 60% of them were still using it at 6 month review whereas Priligy tablets (Depoxitine) patients were very disappointed and 90% of them were not using it at 12 month review. Other popular treatments are the use of daily SSRI anti- depressants such as Paroxetine 20mg which are very effective. Dr. Savage finds that treatment very popular with his patients.

    Testosterone deficiency

    Evidence again was shown of the dangers of leaving male Testosterone deficiency patients untreated. In the UK BLAST study of type 2 diabetics with Testosterone deficiency after 5 years in the untreated group of patients, 20% had died versus 3.6% in the patients treated with Testosterone. The best reduction in mortality was seen in the 70 – 80 year old age group.

    Chronic use of opiate pain relievers, such Oxycontin, high strength Co-Codamol can produce a significant reduction in Testosterone in men and having a low level of Testosterone increases risk of death. A study showed that these male patients who have to continue on their pain relievers show a 40% reduction in mortality if treated with Testosterone.

    For some time there has been a suggestion that environmental pollutants, especially chemicals leaking from plastics may be a cause of reduced Testosterone. Dr. Savage learned at the conference that there is some evidence that Testosterone deficiency is commoner in men in the urban population in support of that view.

  2. Post Radical Prostatectomy. Highlights from European Society of Sexual Medicine.

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    Highlights from the European Society of Sexual Medicine attended by Dr. Savage 23 – 26 January 2020

    Post Radical Prostatectomy patients

    Most of these patients suffer with severe erectile dysfunction and even 2 years after surgery only about 50% have regained a degree of potency.

    So, what can be do?

    Most of these patients are prescribed tablets such as Viagra (Sildenafil) or, Cialis (Tadalafil) but unfortunately, most do not respond to these treatments, this is because of nerve damage from the surgery, despite “nerve sparing” surgery. At the conference, we discussed the evidence from animal research that suggested that taking regular tablets i.e. daily dosing with Tadalafil 5mg should help but in actual fact clinical experience in patients is often very disappointing, so that patients are understandably looking for alternative treatments. These will be either self-injection treatment or vacuum pumps or using both.

    Vacuum pumps can be used on a daily basis for penile rehabilitation i.e. they help reduce penile shortening and help keep the penile tissues healthier whilst some degree of recovery occurs with time. Self-injection treatment is very effective in these patients to produce an adequate erection for intercourse and it seems very sad that many of these patients are either not offered that form of treatment or, think it sounds so painful that the patients declines the offer.

    Dr. Savage finds at the Leger Clinic that the self-injection drug Invicorp is highly effective and virtually painless and patients and their partners are generally thrilled with the excellent results.

    Can Testosterone be prescribed post Radical Prostatectomy?

    Traditionally, a diagnosis of Prostate Cancer even after treatment, has been a strict contraindication for Testosterone Therapy but there is now a significant amount of research showing that in many such patients this can be used safely and indeed bizarrely in patients with a high risk of recurrence, that this recurrence rate may well be lower in those treated with Testosterone.