Improved Ejacultory Control And Sexual Satisfaction In Pilot Study Of Men Taking Hypericum Perforatum Extract

摘要

The most common male sexual dysfunction is premature ejaculation (PE) and yet there are no approved currently effective therapies. Based on research that Hypericum perforatum, a natural supplement has been demonstrated pharmacologically to delay ejaculation in a rat model of PE, we evaluated the effects of hyperforin extract of Hypericum perforatum on the ejaculatory reflex duration by using the intravaginal ejaculatory latency time (IELT) and sexual satisfaction.Sixteen men who desired longer sexual intercourse and without erectile dysfunction were treated with Hypericum perforatum immediately prior to sexual activity. An intercourse diary was used to document baseline data for 2 weeks and throughout the study period of 4 weeks. Partners were asked to measure IELT using a stopwatch as well as complete a sexual function questionnaire both pre and post treatment. All 16 subjects completed the study (average age 35.0 ± 4.6 years old). There was a significant increase in mean IELT times from 246±29 to 331±34 seconds (p<0.002) in subjects taking hyperforin extract. Fourteen of 16 men (87.5%) reported an improvement in IELT. The increase was seen in both the men who reported PE as bothersome and those who did not feel that PE was a problem for them. There was also significant increase in male satisfaction scores from 3.8±0.27 to 4.25 ±0.21 (p<0.03). Female satisfaction scores also showed a significant increase from 4.9±0.27 to 5.2±0.23 (p<0.04). This pilot study was limited by the lack of placebo control. No systemic or adverse effects on erectile function or orgasm were reported.Hyperforin extract of Hypericum perforatum can increase the duration of sexual intercourse and improve sexual satisfaction for men with and without complaints of PE. Background Premature ejaculation (PE) is a common, embarrassing and significantly undertreated medical condition that affects men and their partners. Approximately one third of sexually active men in the United States report this condition. Though, the prevalence of PE is approximately twice that of erectile dysfunction (ED), many healthcare practitioners have few treatment options for most men with PE [1,2]. The neurotransmitter 5-HT has been implicated in the control of many autonomic and behavioral functions including ejaculation. The link between 5-HT and ejaculation is most likely mediated by the medial preoptic area and paraventricular nucleus of the hypothalamus as these regions have been shown to integrate the sexual responses of men [3,4]. Several lines of evidence suggest that an enhanced synaptic availability of 5-HT in the central nervous system results in an inhibition of ejaculation [5,6,7]. From this perspective, PE is associated with an ejaculation reflex that is genetically “set” at a lower point [8,9]. There are currently no pharmacotherapies specifically approved for the treatment of PE, but a number of selective serotonin reuptake inhibitors (SSRIs) such as paroxetine, sertraline and fluoxetine have been prescribed “off label” as a treatment strategy for PE symptoms [2,10]. Placebo controlled clinical trials have shown fluoxetine, paroxetine, and sertraline increase IELT. A randomized, double-blind, placebo-controlled study found that paroxetine significantly improved PE complaints. After 6 weeks of treatment fluoxetine, paroxetine, and sertraline all significantly increased the mean IELT above the placebo group [10]. Daily treatment with SSRIs can lead to the desired delay in the ejaculation, but their use is associated with side effects that include: nausea, drowsiness, cognitive impairments, anticholinergic and sexual side-effects. Specific unintended sexual effects include abnormal ejaculation, decreased libido, reduced sexual desire, and genital anesthesia [11]. Further drawbacks of SSRIs include the slow onset of action of and relatively long half-life of these agents with the risk of accumulation and an exacerbation of SSRI-related adverse events [1,11]. Side effects