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ORIGINAL RESEARCH (original + research)

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Medical Sciences88%
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Humanities and Social Sciences2%
3 Other Domains7%

Terms modified by ORIGINAL RESEARCH

  • original research article
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  • original research publication
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    Selected Abstracts

    ORIGINAL RESEARCH,BASIC SCIENCE: Fluoxetine-Induced Decrements in Sexual Responses of Female Rats and Hamsters Are Reversed by 3,,5,-THP

    THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2010
    Cheryl A. Frye PhD
    ABSTRACT Introduction., Sexual dysfunction, as a result of selective-serotonin reuptake inhibitor (SSRI) treatment among women, is relatively common and is a factor in medication compliance. The mechanisms that underlie these side-effects of SSRIs are not well-understood. SSRIs can alter activity of catabolic enzymes that are involved in progesterone's conversion to 5,-pregnan-3,-ol-20-one (3,,5,-THP). 3,,5,-THP plays a key role in female reproductive physiology and behavior. Aims., This study aimed to determine whether 3,,5,-THP, in the midbrain ventral tegmental area (VTA) may be a potential mechanism for fluoxetine's reduction in sexual responding of female rodents. We hypothesized that if fluoxetine induces decrements in sexual responding in part through actions of 3,,5,-THP, then fluoxetine will inhibit sexual receptivity concomitant with reducing 3,,5,-THP levels, effects which can be reversed by 3,,5,-THP administration. Methods., Experiment 1 investigated effects of acute systemic fluoxetine [20 mg/kg intraperitoneal (IP)] and/or 3,,5,-THP [500 µg, subcutaneous (SC)] administration on sexual responding of ovariectomized, hormone-primed rats. Experiment 2 examined effects of 3,,5,-THP administration to the midbrain VTA (100 ng) on fluoxetine-induced decrements in lordosis of ovariectomized, hormone-primed rats and hamsters. Main Outcome Measures., Sexual responding was determined in rats and hamsters. For rats, the percentage of times that the lordosis response occurred following mounting by a sexually-vigorous male (lordosis quotients) was utilized. For hamsters, lateral displacement, the pelvic movement that females will make to facilitate intromissions by a male hamster, was utilized. Results., Fluoxetine significantly reduced lordosis, and this was reversed SC 3,,5,-THP. Intra-VTA 3,,5,-THP attenuated fluoxetine's detrimental effects on lordosis quotients and lateral displacement of rats and hamsters, respectively. Conclusions., Thus, fluoxetine's effects to disrupt female sexual responses may involve its effects on progestogens in the midbrain VTA. Frye CA, and Rhodes ME. Fluoxetine-induced decrements in sexual responses of female rats and hamsters are reversed by 3,,5,-THP. J Sex Med 2010;7:2670,2680. [source]

    ORIGINAL RESEARCH,WOMEN'S SEXUAL HEALTH: Vaginal Orgasm Is Associated with Vaginal (Not Clitoral) Sex Education, Focusing Mental Attention on Vaginal Sensations, Intercourse Duration, and a Preference for a Longer Penis

    THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2010
    Stuart Brody PhD
    ABSTRACT Introduction., Evidence was recently provided for vaginal orgasm, orgasm triggered purely by penile,vaginal intercourse (PVI), being associated with better psychological functioning. Common sex education and sexual medicine approaches might undermine vaginal orgasm benefits. Aims., To examine the extent to which women's vaginal orgasm consistency is associated with (i) being told in childhood or adolescence that the vagina was the important zone for inducing female orgasm; (ii) how well they focus mentally on vaginal sensations during PVI; (iii) greater PVI duration; and (iv) preference for above-average penis length. Methods., In a representative sample of the Czech population, 1,000 women reported their vaginal orgasm consistency (from never to almost every time; only 21.9% never had a vaginal orgasm), estimates of their typical foreplay and PVI durations, what they were told in childhood and adolescence was the important zone for inducing female orgasm, their degree of focus on vaginal sensations during PVI, and whether they were more likely to orgasm with a longer than average penis. Main Outcome Measures., The association of vaginal orgasm consistency with the predictors noted above. Results., Vaginal orgasm consistency was associated with all hypothesized correlates. Multivariate analysis indicated the most important predictors were being educated that the vagina is important for female orgasm, being mentally focused on vaginal sensations during PVI, and in some analyses duration of PVI (but not foreplay) and preferring a longer than average penis. Conclusions., Focusing attention on penile,vaginal sensation supports vaginal orgasm and the myriad benefits thereof. Brody S, and Weiss P. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis. J Sex Med 2010;7:2774,2781. [source]

    ORIGINAL RESEARCH,EJACULATORY DISORDERS: Evaluation of Tramadol on Demand Vs.

    THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2010
    Daily Paroxetine as a Long-Term Treatment of Lifelong Premature Ejaculation
    ABSTRACT Introduction., Premature ejaculation (PE) is the most common male sexual dysfunction with many lines of treatment that show conflicting results. Paroxetine and tramadol were both reported to be effective in treatment of PE. Aim., To investigate the effectiveness of long-term daily paroxetine vs. on-demand tramadol HCl in treatment of PE. Main Outcome Measures., Intravaginal ejaculatory latency time (IELT) and Arabic Index of PE (AIPE) were used to assess the efficacy of investigated drugs. Methods., Thirty-five cases with lifelong PE were enrolled in this study. Baseline recording of IELT using a stop watch and AIPE was done. Patients were randomized to take tramadol HCl on-demand or daily paroxetine. Reassessment was done after 6 and 12 weeks. A wash-out period for 2 weeks was given before cross-over to the other medication. Assessment of the effect of the second medication after 6 and 12 weeks was done. Results., Tramadol and paroxetine increased IELT significantly after 6 weeks by seven- and 11-folds, respectively, compared with baseline. After 12 weeks, a decline of IELT to fivefolds was recorded with tramadol whereas further increase of IELT to 22-folds was recorded with paroxetine compared with baseline (P < 0.05). Tramadol improved AIPE score significantly after 6 weeks but not after 12 weeks vs. baseline, whereas paroxetine increased the AIPE score after 6 and 12 weeks vs. baseline (P < 0.05). Conclusions., Daily paroxetine is more effective than on-demand tramadol for treatment of lifelong PE. Tramadol is not recommended as a long-term treatment of lifelong PE. Alghobary M, El-Bayoumy Y, Mostafa Y, E-HM Mahmoud, and Amr M. Evaluation of tramadol on demand vs. daily paroxetine as a long-term treatment of lifelong premature ejaculation. J Sex Med 2010;7:2860,2867. [source]

    ORIGINAL RESEARCH,EPIDEMIOLOGY: Effect of Sexual Function on Health-Related Quality of Life Mediated by Depressive Symptoms in Cardiac Rehabilitation.

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010
    Findings of the SPARK Project in 493 Patients
    ABSTRACT Introduction., Empirical evidence suggests associations between cardiovascular diseases, sexual functioning, depressive symptoms, and quality of life. However, to date, the interrelation of these constructs has not been examined simultaneously in a structural analysis. Aim., To estimate the prevalence of sexual disorders and depressive symptoms and to examine the association between sexual disorders, depressive symptoms, and quality of life in patients in the rehabilitation of cardiovascular disorders. Aim., A postal survey in five German inpatient rehabilitation centers for cardiovascular diseases was conducted. Prevalence of sexual disorders and depressive symptoms were assessed using psychometrically sound instruments. To analyze complex associations, structural equation modeling was used. Main Outcome Measures., For epidemiological questions, proportions with 95% confidence intervals were calculated. The strength of association in structural equation models was expressed as a standardized regression coefficient. Results., Data from 493 patients were analyzed (response rate 22.7%). At least moderate erectile dysfunction proved to be present in 20.3% of men. The prevalence of female sexual dysfunction lay at 43.1%. At least moderate depressive symptoms were present in 14.4% of men and 16.5% of women. A considerable association between sexual functioning and quality of life was found in both sexes, which was largely mediated by depressive symptoms. Major drawbacks of the study are imprecision of the estimates due to limited sample size and questionable generalizability of the findings due to possible self-selection bias. Conclusions., Considering the high prevalence of depressive symptoms and their role as a mediating factor between sexual functioning and quality of life, it is recommended to routinely screen for depression in men and women with cardiac disease. Kriston L, Günzler C, Agyemang A, Bengel J, and Berner MM. Effect of sexual function on health-related quality of life mediated by depressive symptoms in cardiac rehabilitation. Findings of the SPARK project in 493 patients. J Sex Med 2010;7:2044,2055. [source]

    ORIGINAL RESEARCH,BASIC SCIENCE: Neuroanatomical Evidence for a Role of Central Melanocortin-4 Receptors and Oxytocin in the Efferent Control of the Rodent Clitoris and Vagina

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010
    Helene Gelez PhD
    ABSTRACT Introduction., The clitoris and the vagina are the main peripheral anatomical structures involved in physiological changes related to sexual arousal and orgasm. Their efferent control and, more particularly, the neurochemical phenotype of these descending neuronal pathways remain largely uncharacterized. Aim., To examine if brain neurons involved in the efferent control of the clitoris and the vagina possess melanocortin-4 receptor (MC4-R) and/or contain oxytocin (OT). Methods., Neurons involved in the efferent control of the vagina and clitoris were identified following visualization of pseudorabies virus (PRV) retrograde tracing. PRV was injected into the vagina and clitoris in adult rats in estrous. On the fifth day postinjection, animals were humanely sacrificed, and brains were removed and sectioned, and processed for PRV visualization. The neurochemical phenotype of PRV-positive neurons was identified using double or triple immunocytochemical labeling against PRV, MC4-R, and OT. Double and triple labeling were quantified using confocal laser scanning microscopy. Main Outcome Measure., Neuroanatomical brain distribution, number and percentage of double-labeled PRV/MC4-R and PRV-/OT-positive neurons, and triple PRV-/MC4-R-/OT-labeled neurons. Results., The majority of PRV immunopositive neurons which also expressed immunoreactivity for MC4-R were located in the paraventricular and arcuate nuclei of the hypothalamus. The majority of PRV positive neurons which were immunoreactive (IR) for OT were located in the paraventricular nucleus (PVN), medial preoptic area (MPOA), and lateral hypothalamus. PRV positive neurons were more likely to be IR for MC4-R than for OT. Scattered triple-labeled PRV/MC4-R/OT neurons were detected in the MPOA and the PVN. Conclusion., These data strongly suggest that MC4-R and, to a less extent, OT are involved in the efferent neuronal control of the clitoris and vagina, and consequently facilitate our understanding of how the melanocortinergic pathway regulates female sexual function. Gelez H, Poirier S, Facchinetti P, Allers KA, Wayman C, Alexandre L, and Giuliano F. Neuroanatomical evidence for a role of central melanocortin-4 receptors and oxytocin in the efferent control of the rodent clitoris and vagina. J Sex Med 2010;7:2056,2067. [source]

    ORIGINAL RESEARCH,WOMEN'S SEXUAL HEALTH: Prevalence of Sexual Dysfunction and Impact of Contraception in Female German Medical Students

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010
    Christian W. Wallwiener MD
    ABSTRACT Introduction., Female sexual dysfunction (FSD) is a very common disorder, with an estimated prevalence of having at least one sexual dysfunction of about 40%. Aim., To investigate the prevalence and types of FSD and the relationship between hormonal contraception (HC) and FSD in female German medical students. Main Outcome Measures., Female Sexual Function Index (FSFI) with additional questions on contraception, sexual activity, and other factors that may influence sexual function. Methods., An online questionnaire based on the FSFI was completed by students from six medical schools. Obtained data were screened for inconsistencies by programmed algorithms. Results., A total of 1,219 completed questionnaires were received, and 1,086 were included in the analyses after screening. The mean total FSFI score was 28.6 +/, 4.5. 32.4% of women were at risk for FSD according to FSFI definitions. Based on domain scores, 8.7% for were at risk for FSD concerning orgasm, 5.8% for desire, 2.6% for satisfaction, 1.2% for lubrication, 1.1% for pain and 1.0% for arousal. The method of contraception and smoking were factors with significant effect on the total FSFI score whereby hormonal contraception was associated with lower total FSFI scores and lower desire and arousal scores than no contraception and non-hormonal contraception only. Other variables such as stress, pregnancy, smoking, relationship and wish for children had an important impact on sexual function as expected according to earlier studies. Conclusions., The prevalence of students at high risk for FSD was consistent with the literature although domain subscores differed from samples previously described. The contraception method has a significant effect on the sexual functioning score and women using contraception, especially hormonal contraception, had lower sexual functioning scores. Stress and relationship among other variables were found to be associated with sexual function and may thus provide insight into the etiology of sexual disorders. Wallwiener CW, Wallwiener L-M, Seeger H, Mück AO, Bitzer J, and Wallwiener M. Prevalence of sexual dysfunction and impact of contraception in female german medical students. J Sex Med 2010;7:2139,2148. [source]

    ORIGINAL RESEARCH,PAIN: Vaginismus and Dyspareunia: Automatic vs.

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010
    Deliberate Disgust Responsivity
    ABSTRACT Introduction., The difficulty of penetration experienced in vaginismus and dyspareunia may at least partly be due to a disgust-induced defensive response. Aims., To examine if sex stimuli specifically elicit: (i) automatic disgust-related memory associations; (ii) physiological disgust responsivity; and/or (iii) deliberate expression of disgust/threat. Methods., Two single target Implicit Association Task (st-IAT) and electromyography (EMG) were conducted on three groups: vaginismus (N = 24), dyspareunia (N = 24), and control (N = 31) group. Main Outcome Measures., st-IAT, to index their initial disgust-related associations and facial EMG for the m. levator labii and m. corrugator supercilii regions. Results., Both clinical groups showed enhanced automatic sex-disgust associations. As a unique physiological expression of disgust, the levator activity was specifically enhanced for the vaginismus group, when exposed to a women-friendly SEX video clip. Also at the deliberate level, specifically the vaginismus group showed enhanced subjective disgust toward SEX pictures and the SEX clip, along with higher threat responses. Conclusions., Supporting the view that disgust is involved in vaginismus and dyspareunia, for both, clinical groups' sex stimuli automatically elicited associations with disgust. Particularly for the vaginismus group, these initial disgust associations persisted during subsequent validation processes and were also evident at the level of facial expression and self-report data. Findings are consistent with the notion that uncontrollable activated associations are involved in eliciting defensive reactions at the prospect of penetration seen in both conditions. Whereas deliberate attitudes, usually linked with the desire for having intercourse, possibly generate the distinction (e.g., severity) between these two conditions. Borg C, de Jong PJ, and Schultz WW. Vaginismus and dyspareunia: Automatic vs. deliberate disgust responsivity. J Sex Med 2010;7:2149,2157. [source]

    ORIGINAL RESEARCH,PEYRONIE'S DISEASE: Predicting Delay in Presentation in Men with Peyronie's Disease

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010
    John P. Mulhall MD
    ABSTRACT Introduction., Many men with Peyronie's disease (PD) delay presentation to a urologist. The reasons for this are unclear. Aim., To define the differences in men who present early compared to those presenting in a delayed fashion and to determine predictors of delayed presentation. Methods., A retrospective analysis of all patients presenting for the first medical evaluation of PD. All patients underwent a standard history and physical examination and had a standardized deformity assessment. Demographic and PD parameters were recorded. Main Outcome Measures., Statistical comparison was used to define factors that were different between early and delayed presenters and multivariable analysis was used to define predictors of presentation >12 months. Results., 482 patients were analyzed, 61% presenting ,12 months, 39% >12 months. Mean patient age was 52 ± 13 years and mean duration of PD was 17 ± 30 months. Mean measured curvature was 42° ± 19°. Multivariable analysis revealed that delayed presentation patients were significantly more likely to be older (odds ratio [OR] = 4.0), to be in long-term relationships (OR = 3.6), to have dorsal curvature (OR = 2.5), to have curvature <45° (OR = 3.3), to be heterosexual (OR = 2.0), and to have simple deformity (OR = 1.5). Conclusions., One-third of men with PD presented in a delayed fashion and they tended to be older, to be in long-term relationships, to have dorsal curvature, or to have simple deformity. Mulhall JP, Alex B, and Choi JM. Predicting delay in presentation in men with Peyronie's disease. J Sex Med 2010;7:2226,2230. [source]

    ORIGINAL RESEARCH,EJACULATORY DISORDERS: Baseline Characteristics and Treatment Outcomes for Men with Acquired or Lifelong Premature Ejaculation with Mild or No Erectile Dysfunction: Integrated Analyses of Two Phase 3 Dapoxetine Trials

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2010
    Hartmut Porst MD
    ABSTRACT Introduction., Premature ejaculation (PE) is classified as an acquired or lifelong condition but data on baseline characteristics and response to treatment of men with acquired or lifelong PE and mild erectile dysfunction (ED) or normal erectile function (EF) is limited. Aim., To present integrated analyses of baseline characteristics and treatment outcomes from phase 3 dapoxetine trials in men with acquired or lifelong PE and mild or no ED. Methods., Data were analyzed from two randomized, double-blind, placebo-controlled, phase 3 clinical trials (International and Asia-Pacific) that evaluated efficacy and safety of dapoxetine (30 mg or 60 mg as needed [PRN]) in patients with PE. Men were ,18 years, in a stable monogamous relationship for ,6 months, met DSM-IV-TR criteria for PE for ,6 months, had an International Index of Erectile Function EF domain score ,21, and had an intravaginal ejaculatory latency time (IELT) ,2 minutes in ,75% of intercourse episodes. Main Outcome Measures., Demographics, sexual history, and PE symptomatology at baseline, and mean IELT and patient-reported outcomes (PROs) at study end (week 12), were analyzed for men with acquired or lifelong PE and mild or no ED (EF score 21,25 vs. ,26). Results., Baseline characteristics except duration of PE were similar in men with acquired and lifelong PE, with no other differentiating features by ED status. Dapoxetine treatment improved significantly mean IELT (arithmetic and geometric) and PRO responses (perceived control over ejaculation, satisfaction with sexual intercourse, ejaculation-related personal distress, and interpersonal difficulty) for acquired and lifelong subtypes, but presence of mild ED diminished PRO responsiveness in both subtypes, particularly those with lifelong PE. Conclusions., Baseline characteristics and treatment outcomes were generally similar in men with acquired and lifelong PE. The presence of mild ED appears to be associated with a more modest treatment response, irrespective of lifelong or acquired PE subtype. Porst H, McMahon CG, Althof SE, Sharlip I, Bull S, Aquilina JW, Tesfaye F, and Rivas DA. Baseline characteristics and treatment outcomes for men with acquired or lifelong premature ejaculation with mild or no erectile dysfunction: Integrated analyses of two phase 3 dapoxetine trials. J Sex Med 2010;7:2231,2242. [source]

    ORIGINAL RESEARCH,BASIC SCIENCE: Acute and Repeated Flibanserin Administration in Female Rats Modulates Monoamines Differentially Across Brain Areas: A Microdialysis Study

    THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2010
    Kelly A. Allers PhD
    ABSTRACT Introduction., Hypoactive sexual desire disorder (HSDD) is defined as persistent lack of sexual fantasies or desire marked by distress. With a prevalence of 10% it is the most common form of female sexual dysfunction. Recently, the serotonin-1A (5-HT1A) receptor agonist and the serotonin-2A (5-HT2A) receptor antagonist flibanserin were shown to be safe and efficacious in premenopausal women suffering from HSDD in phase III clinical trials. Aim., The current study aims to assess the effect of flibanserin on neurotransmitters serotonin (5-HT), norepinephrine (NE), dopamine (DA), glutamate, and ,-aminobutyric acid (GABA) in brain areas associated with sexual behavior. Methods., Flibanserin was administered to female Wistar rats (280,350 g). Microdialysis probes were stereotactically inserted into the mPFC, NAC, or MPOA, under isoflurane anesthesia. The extracellular levels of neurotransmitters were assessed in freely moving animals, 24 hours after the surgery. Main Outcome Measures., Dialysate levels of DA, NE, and serotonin from medial prefrontal cortex (mPFC), nucleus accumbens (NAC), and hypothalamic medial preoptic area (MPOA) from female rats. Results., Acute flibanserin administration decreased 5-HT and increased NE levels in all tested areas. DA was increased in mPFC and MPOA, but not in the NAC. Basal levels of NE in mPFC and NAC and of DA in mPFC were increased upon repeated flibanserin administration, when compared to vehicle-treated animals. The basal levels of 5-HT were not altered by repeated flibanserin administration, but basal DA and NE levels were increased in the mPFC. Glutamate and GABA levels remained unchanged following either repeated or acute flibanserin treatment. Conclusions., Systemic administration of flibanserin to female rats differentially affects the monoamine systems of the brain. This may be the mechanistic underpinning of flibanserin's therapeutic efficacy in HSDD, as sexual behavior is controlled by an intricate interplay between stimulatory (catecholaminergic) and inhibitory (serotonergic) systems. Allers KA, Dremencov E, Ceci A, Flik G, Ferger B, Cremers TIFH, Ittrich C, and Sommer B. Acute and repeated flibanserin administration in female rats modulates monoamines differentially across brain areas: A microdialysis study. J Sex Med 2010;7:1757,1767. [source]

    ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Efficacy and Tolerability of Lodenafil Carbonate for Oral Therapy of Erectile Dysfunction: A Phase III Clinical Trial

    THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2010
    Sidney Glina MD
    ABSTRACT Introduction., This is a phase III, prospective, randomized, double-blind, placebo-controlled clinical trial on lodenafil carbonate (LC), a novel phosphodiesterase 5 inhibitor developed in Brazil. Aim., Expanding information on LC efficacy and safety. Main Outcome Measures., International Index of Erectile Function (IIEF) erectile domain, positive answers to the sexual encounter profile (SEP)-2 and SEP-3 questions and incidence of adverse events (AEs). Methods., A total of 350 men with erectile dysfunction (ED) of all degrees were randomized to placebo, LC 40 mg or LC 80 mg and followed for 4 weeks. They completed the IIEF and answered the SEP questions 2 and 3 after each intercourse without and with the use of LC. Results., IIEF Erectile Domain scores without and with the use of medication were the following (mean [M] ± standard deviation [SD]): placebo = 13.9 ± 5.2 and 14.8 ± 7.8; LC 40 mg = 13.6 ± 5.3 and 18.6 ± 8.0; LC 80 mg = 13.4 ± 4.9 and 20.6 ± 7.7 (analysis of variance [anova]P < 0.01). Positive answers to SEP-2 without and with the use of medication were the following (M ± SD): placebo = 55.3 ± 43.2% and 52.1 ± 41.4%; LC 40 mg = 46.4 ± 44.3% and 63.5 ± 42.0%; LC 80 mg = 50.2 ± 40.9% and 80.8 ± 32.3% (anovaP < 0.01). Positive answers to SEP-3 were the following: placebo = 20.2 ± 32.3% and 29.7 ± 38.1%; LC 40 mg = 19.6 ± 34.3% and 50.8 ± 44.4%; LC 80 mg = 20.8 ± 33.2% and 66.0 ± 39.3% (anovaP < 0.01). The patients with at least one AE were placebo = 28.7%, LC 40 mg = 40.9%, and LC 80 mg = 49.5%. AEs whose incidence was significantly higher with LC than with placebo included rhinitis, headache, flushing, visual disorder, and dizziness. Conclusions., LC showed a satisfactory efficacy,safety profile for oral therapy of ED. Glina S, Fonseca GN, Bertero EB, Damião R, Rocha LCA, Jardim CRF, Cairoli CE, Teloken C, Torres LO, Faria GE, da Silva MB, and Pagani E. Efficacy and tolerability of lodenafil carbonate for oral therapy of erectile dysfunction: A phase III clinical trial. J Sex Med 2010;7:1928,1936. [source]

    ORIGINAL RESEARCH,ERECTILE DYSFUNCTION: Independent Determinants of Coronary Artery Disease in Erectile Dysfunction Patients

    THE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010
    Shih-Tai Chang MD
    ABSTRACT Introduction., There is growing evidence of a link between erectile dysfunction (ED) and coronary artery disease (CAD). Aims., The purpose of this study was to explore the independent determinants of CAD in ED outpatients. Methods., This study enrolled 243 patients, ranging in age from 21 to 81 years old, suffering from ED as diagnosed by the International Index of Erectile Function (IIEF) scores. All patients underwent exercise stress tests or thallium-201 single-photon emission computed tomography perfusion imagings. Based on examination results, patients were divided into study (22 patients with a positive finding) and control groups (221 patients with a negative finding). Main Outcome Measures., The differences of demographic characteristics, biochemical profiles, pro-inflammatory and inflammatory markers, and echocardiographic characteristics between study and control group were compared. Results., The age, presence of DM and current smoking status were significant high in the study group. A significant lower high-density lipoprotein (HDL) cholesterol level, a higher percentage of HDL cholesterol level < 40 mg/dL, and a higher apo-lipoprotein B/A1, high sensitive C-reactive protein (hs-CRP) and homocysteine found in the study group. The Framingham cardiac risk scores, the ratio of mitral inflow velocity to early diastolic velocity in the annulus derived by tissue Doppler imaging (E/Et), the ratio of E/Et , 15, the value of carotid intima-media thickness (IMT), and IMT , 1 mm were higher in study group than in the control group. In stepwise multiple logistic regression analysis, a high waist-to-hip ratio (WHR), high IMT, high E/Et, hs-CRP levels, LDL cholesterol , 130 mg/dL, smoking status, and the presence of DM and metabolic syndrome (MS) were independent determinants of CAD in ED patients. Conclusions., This study first shows the independent determinants of CAD in ED outpatients. This novel finding may improve the screening of low-risk ED patients for CAD. Chang S-T, Chu C-M, Hsu J-T, Hsiao J-F, Chung C-M, Ho C, Peng Y-S, Chen P-Y, and Shee J-J. Independent determinants of coronary artery disease in erectile dysfunction patients. J Sex Med 2010;7:1478,1487. [source]

    ORIGINAL RESEARCH,SURGERY: A Large Multicenter Outcome Study of Female Genital Plastic Surgery

    THE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010
    Michael P. Goodman MD
    ABSTRACT Introduction., Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? Aim., This study was designed to produce objective, utilizable outcome data regarding FGPS. Main Outcome Measures., 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. Methods., This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. Results., Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6,42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients undergoing vaginal tightening/perineal support procedures. Complications were acceptable and not of major consequence. Conclusions., While emphasizing that these female genital plastic procedures are not performed to correct "abnormalities," as there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. From the results of this large study pooling data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent. Goodman MP, Placik OJ, Benson RH III, Miklos JR, Moore RD, Jason RA, Matlock DL, Simopoulos AF, Stern BH, Stanton RA, Kolb SE, and Gonzalez F. A large multicenter outcome study of female genital plastic surgery. J Sex Med 2010;7:1565,1577. [source]

    ORIGINAL RESEARCH,MEN'S SEXUAL HEALTH: Orgasmic Dysfunction After Open Radical Prostatectomy: Clinical Correlates and Prognostic Factors

    THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010
    Yvette Dubbelman MD
    ABSTRACT Introduction., Erectile function after radical retropubic prostatectomy (RRP) is extensively discussed in literature. However, less is known about orgasm after RRP. Aim., To analyze sexual function, in particularly orgasmic function, in men before and after RRP. Methods., Between 1977 and 2007 a RRP was performed in 1,021 men. All men were interviewed by their follow-up physician using a standardized interview about sexual function before and after RRP at regular intervals during a 2-year follow-up. The questions were related to sexual interest, sexual activity, spontaneous erections, and orgasmic function. Main Outcome Measures., Sexual function, in particularly orgasmic function, before and after RRP. Factors potentially influencing orgasmic function, such as patients age, type of operation, pathological stage and continence status were analyzed for their predictive value. Results., Information about preoperative and postoperative sexual activity and spontaneous erection was available in 596 and 698 men, respectively. Additional questions were asked on sexual interest (N = 425) and orgasmic function (N = 458). Pre-operatively, sexual interest, sexual activity, spontaneous erections and orgasmic function were normal in 99%, 82.1%, 90.0% and 90% of men, respectively. After operation these values decreased to 97.2%, 67.3%, 29.4% and 66.8%, respectively. Orgasmic function was preserved in 141 of 192 men (73.4%) after a bilateral nerve sparing procedure, in 90 out of 127 men (70.9%) after a unilateral nerve-sparing procedure and in 75 of 139 men (54.0%) after non-nerve sparing technique. Postoperatively, orgasm was present in 123 (77.4%) men below the age of 60 years and in 183 (61.2%) men of 60 years and older (P < 0.0001). Orgasmic function was significantly affected by age ,60 years, non-nerve sparing procedure and severe incontinence (more than two pads/day). Conclusions., After RRP, orgasmic function is still present in the majority of men. A non-nerve sparing operation, age, and severe urinary incontinence are risk factors for orgasmic dysfunction after RRP. Dubbelman Y, Wildhagen M, Schröder F, Bangma C, and Dohle G. Orgasmic dysfunction after open radical prostatectomy: Clinical correlates and prognostic factors. J Sex Med 2010;7:1216,1223. [source]

    ORIGINAL RESEARCH,ENDOCRINOLOGY: A Comparative Study of the Effects of Local Estrogen With or Without Local Testosterone on Vulvovaginal and Sexual Dysfunction in Postmenopausal Women

    THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010
    Chitra Raghunandan MD
    ABSTRACT Introduction., A significant number of postmenopausal women suffer from distressing problems because of urogenital atrophy secondary to the decline in circulating estrogen levels. Treatment with topical hormones may provide relief in such women when used judiciously. Aim., To study the effects of local estrogen with or without local testosterone on urogenital and sexual health in postmenopausal women. Methods., Seventy-five postmenopausal women symptomatic for urogenital atrophy and sexual dysfunction were randomly divided into two study groups and one control group. The women in study group 1 received local estrogen cream; study group 2 received local estrogen and testosterone cream; the control group received nonhormonal lubricant KY gel for 12 weeks. The urogenital and sexuality score, along with the vaginal health index and the vaginal maturation index (VMI), was calculated at the beginning of therapy and 12 weeks later. Main Outcome Measures., Changes in the urogenital and sexuality score along with vaginal health index and VMI. Results., After 12 weeks of therapy, there was a significant improvement in all the four study parameters, which correlated well with the improvement in symptoms of urogenital atrophy and sexual dysfunction in both the study groups as compared with the control group. Improvement in sexuality score was greatest with combined estrogen,androgen therapy. There were no adverse effects and the therapies were well accepted without any compliance issue. Conclusion., Local estrogen either alone or with androgen is highly effective in relieving symptoms of urogenital atrophy and in improving sexual function in symptomatic postmenopausal women. Raghunandan C, Agrawal S, Dubey P, Choudhury M, and Jain A. A comparative study of the effects of local estrogen with or without local testosterone on vulvovaginal and sexual dysfunction in postmenopausal women. J Sex Med 2010;7:1284,1290. [source]

    ORIGINAL RESEARCH,SURGERY: Sexual Function after Loop Electrosurgical Excision Procedure for Cervical Dysplasia

    THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010
    Namfon Inna MD
    ABSTRACT Introduction., Loop electrosurgical excision procedure (LEEP) is an effective tool for management of cervical dysplasia. However, removal of a part of the cervix might have a negative impact on sexual function. Aim., To examine the effect of LEEP on overall sexual satisfaction and other specific aspects of sexual function in women with cervical dysplasia. Methods., Eighty-nine premenopausal women with cervical dysplasia who had undergone LEEP at least 3 months previously were interviewed once on post-LEEP follow-up visits with a questionnaire on pre- and post-procedural sexual function. Data on frequency of sexual intercourse, the presence of dysmenorrhea, dyspareunia, and postcoital bleeding were compared using the McNemar test. Data on specific aspects of sexual function rated by the 6-point Likert scale were analyzed using Wilcoxon signed ranks test. Main Outcome Measure., The main outcome is the overall sexual intercourse satisfaction. Results., The mean age was 41.7 years. The median interval from LEEP to the time of interview was 29.3 weeks. The time of resumption of sexual intercourse after LEEP was 8.1 weeks on the average. The changes in the frequency of sexual intercourse, dysmenorrhea, and dyspareunia after LEEP were not statistically significant. The changes in overall satisfaction, vaginal elasticity, and orgasmic satisfaction appeared statistically significant (P < 0.05). Conclusion., Having LEEP done along with other "non-surgical" parts of cervical pre-cancer management is associated with small but statistically significant decreases in overall sexual satisfaction, vaginal elasticity, and orgasmic satisfaction when interviewed near to the procedure at 29.3 weeks post-operation. However, the changes on other aspects of sexual function are insignificant. The LEEP procedure itself appears to have a minimal, if any, clinically important adverse effect on sexual function. Inna N, Phianmongkhol Y, and Charoenkwan K. Sexual function after loop electrosurgical excision procedure for cervical dysplasia. J Sex Med 2010;7:1291,1297. [source]

    ORIGINAL RESEARCH,PSYCHOLOGY: Sexual Motivation in Women as a Function of Age

    THE JOURNAL OF SEXUAL MEDICINE, Issue 12 2009
    Cindy M. Meston PhD
    ABSTRACT Introduction., Women's motivations to engage in sex are likely influenced by their past sexual experiences, the type of relationship in which they are involved in, and numerous lifestyle factors such as career and family demands. The influences of these factors undoubtedly change as women age. Aim., This study aimed to examine potential differences in sexual motivation between three distinct age groups of premenopausal women. Methods., Women aged 18,22 years (N = 137), 23,30 years (N = 103), and 31,45 years (N = 87) completed an online survey that assessed the proportion with which they had engaged in sexual intercourse for each of 140 distinct reasons. Main Outcome Measures., The YSEX? Questionnaire by Meston and Buss [1] was used to measure sexual motivation. The items of this questionnaire were composed of four primary sexual motivation factors (physical, goal attainment, emotional, insecurity), and 13 subfactors. Results., Women aged 31,45 years reported a higher proportion of engaging in sex compared with one or both of the younger age groups of women for nine of the 13 YSEX? subfactors: stress reduction, physical desirability, experience seeking, resources, social status, revenge, expression, self-esteem boost, and mate guarding. At an item level, the top 25 reasons for having sex were virtually identical across age groups. Conclusion., Women aged 31,45 have more motives for engaging in sex than do women aged 18,30, but the primary reasons for engaging in sex do not differ within this age range. Women aged 18,45 have sex primarily for pleasure, and love and commitment. The implications for diagnosis and treatment of women with sexual dysfunctions were discussed. Meston CM, Hamilton LD, and Harte CB. Sexual motivation in women as a function of age. J Sex Med 2009;6:3305,3319. [source]

    ORIGINAL RESEARCH,MEN'S SEXUAL HEALTH: Sexual Function in Male Patients Undergoing Treatment for Renal Failure: A Prospective View

    THE JOURNAL OF SEXUAL MEDICINE, Issue 12 2009
    Anmar Nassir MD, FRCS(C)
    ABSTRACT Introduction., Chronic renal failure in males causes wide-ranging disturbances including sexual dysfunction. The percentage and progression of sexual dysfunction in patients entering a dialysis program require further evaluation. Aim., Our aim was to determine the ongoing effect of standard renal failure treatment on sexual function. Methods., The sexual function was assessed prospectively, upon initiation of dialysis and every 10,12 months while on dialysis or after kidney transplantation. Participants were adult males with sexual partners. Main Outcome Measure., The semiquantitative standard International Index of Erectile Function questionnaire was used initially as a baseline and compared with all subsequent follow-up measures. Results., Fifty-two patients fulfilled the eligibility criteria and completed the questionnaire. Of the 52 subjects, 25 were on hemodialysis and 27 were on peritoneal dialysis. Only 17.3% of participants were potent upon entry into the study. Of the rest, 71% was classified as suffering from severe erectile dysfunction (ED). Sexual desire appeared less affected when compared with other domains. Of the study participants, 67% expressed an interest in treatment for ED, but only 12% had ever received any such therapy. Follow-up ranged from 10 months to 48 months. After excluding kidney-transplanted patients, ED scores on entry and at four subsequent reassessments were almost identical and showed no significant statistical differences. Patients showed significant improvement in ED score after kidney transplantation, with scores remaining high for 20,36 months of follow-up, compared with pre-transplantation. Conclusions., This prospective study suggests that dialysis does not benefit sexual function, although a benefit was seen in a subset of men undergoing renal transplantation. We conclude that sexual function in men beginning dialysis should be assessed, and treatment for ED should be offered if appropriate. Nassir A. Sexual function in male patients undergoing treatment for renal failure: A prospective view. J Sex Med 2009;6:3407,3414. [source]

    ORIGINAL RESEARCH,SURGERY: Short Term Impact on Female Sexual Function of Pelvic Floor Reconstruction with the Prolift Procedure

    THE JOURNAL OF SEXUAL MEDICINE, Issue 11 2009
    Tsung-Hsien Su MD
    ABSTRACT Introduction., The Prolift system is an effective and safe procedure using mesh reinforcement for vaginal reconstruction of pelvic organ prolapse (POP), but its effect on sexual function is unclear. Aim., To evaluate the impact of transvaginal pelvic reconstruction with Prolift on female sexual function at 6 months post-operatively. Methods., Thirty-three sexually active women who underwent Prolift mesh pelvic floor reconstruction for symptomatic POP were evaluated before and 6 months after surgery. Their sexual function was assessed by using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and after surgery. The quality of life was also evaluated with the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) as a control for efficacy of the procedure. The Pelvic Organ Prolapse Quantification system was used to evaluate the degree of prolapse. Main Outcome Measures., PISQ-12 scores at 6 months post-operatively. Results., The total PISQ-12 score decreased from 29.5 ± 9.0 to 19.3 ± 14.7 (P < 0.001), indicating worsening of sexual function 6 months post-operatively. The behavioral, physical, and partner-related domains of PISQ-12 were each significantly reduced (5.2 ± 3.7 vs. 2.9 ± 3.7, P = 0.016; 15.4 ± 4.7 vs. 10.4 ± 8.6, P = 0.001; 8.9 ± 3.8 vs. 6.4 ± 5.5, P = 0.01, respectively). UDI-6 and IIQ-7 scores were significantly improved at the 6-month follow-up, as was anatomic recovery. Of the 33 subjects, 24 (73%) had worse sexual function 6 months after the procedure. Conclusion., The Prolift procedure provided an effective anatomic cure of POP, but it had an adverse effect on sexual function at 6 months after surgery. Su TH, Lau HH, Huang WC, Chen SS, Lin TY, Hsieh CH, and Yeh CY. Short term impact on female sexual function of pelvic floor reconstruction with the Prolift procedure. J Sex Med 2009;6:3201,3207. [source]

    ORIGINAL RESEARCH,INTERSEX AND GENDER IDENTITY DISORDERS: A Report from a Single Institute's 14-Year Experience in Treatment of Male-to-Female Transsexuals

    THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2009
    Ciro Imbimbo MD
    ABSTRACT Introduction., Gender identity disorder or transsexualism is a complex clinical condition, and prevailing social context strongly impacts the form of its manifestations. Sex reassignment surgery (SRS) is the crucial step of a long and complex therapeutic process starting with preliminary psychiatric evaluation and culminating in definitive gender identity conversion. Aim., The aim of our study is to arrive at a clinical and psychosocial profile of male-to-female transsexuals in Italy through analysis of their personal and clinical experience and evaluation of their postsurgical satisfaction levels SRS. Methods., From January 1992 to September 2006, 163 male patients who had undergone gender-transforming surgery at our institution were requested to complete a patient satisfaction questionnaire. Main Outcome Measures., The questionnaire consisted of 38 questions covering nine main topics: general data, employment status, family status, personal relationships, social and cultural aspects, presurgical preparation, surgical procedure, and postsurgical sex life and overall satisfaction. Results., Average age was 31 years old. Seventy-two percent had a high educational level, and 63% were steadily employed. Half of the patients had contemplated suicide at some time in their lives before surgery and 4% had actually attempted suicide. Family and colleague emotional support levels were satisfactory. All patients had been adequately informed of surgical procedure beforehand. Eighty-nine percent engaged in postsurgical sexual activities. Seventy-five percent had a more satisfactory sex life after SRS, with main complications being pain during intercourse and lack of lubrication. Seventy-eight percent were satisfied with their neovagina's esthetic appearance, whereas only 56% were satisfied with depth. Almost all of the patients were satisfied with their new sexual status and expressed no regrets. Conclusions., Our patients' high level of satisfaction was due to a combination of a well-conducted preoperative preparation program, competent surgical skills, and consistent postoperative follow-up. Imbimbo C, Verze P, Palmieri A, Longo N, Fusco F, Arcaniolo D, and Mirone V. A Report from a single institute's fourteen year experience in treatment of male-to-female transsexuals. J Sex Med 2009;6:2736,2745. [source]

    ORIGINAL RESEARCH,COUPLES' SEXUAL DYSFUNCTIONS: Erectile Dysfunction (ED) is a Shared Sexual Concern of Couples I: Couple Conceptions of ED

    THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2009
    William A. Fisher PhD
    ABSTRACT Introduction., Erectile dysfunction (ED) may be regarded as a shared sexual concern with a significant negative impact on both patients and their partners. Aim., The current research sought to explore the degree of concordance or divergence of couple members' perceptions of the specific functional impairments characterizing the man's ED, and the concordance or discordance of their attitudes, beliefs and experiences about the male partner's erectile difficulty. Methods., Questionnaires were sent to partners of men who participated in the Men's Attitudes to Life Events and Sexuality (MALES) 2004 study, who consented to their partner's involvement. A modified version of the questionnaire used in the MALES study was employed, adapted to reflect the female partner's perspective. Questionnaire responses were analyzed in relation to responses provided by male study participants. Main Outcome Measure., A 65-item questionnaire assessing women's perceptions, beliefs, and attitudes regarding aspects of ED. Results., High levels of concordance between couple members were observed across almost all items. Women's perceptions of both the specific functional impairments characterizing their partner's ED and the frequency of the partner's erection difficulty were strongly associated with assessments the men themselves had made. Significant associations were also observed between couple members' responses relating to their beliefs about the causes of ED, effects of ED on the relationship, communication about ED, finding a solution to ED, and attitudes toward medication. A number of specific male,female discordant perceptions and attitudes were also identified. Conclusions., Findings of this study demonstrate a high degree of concordance in couple members' perceptions of the male partner's ED, and in their attitudes and beliefs about ED. Specific instances of discordance between couple members may contribute to treatment avoidance or couple conflict. Fisher WA, Eardley I, McCabe M, and Sand M. Erectile Dysfunction (ED) is a shared sexual concern of couples I: Couple conceptions of ED. J Sex Med 2009;6:2746,2760. [source]

    ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Sildenafil Citrate 100 mg Starting Dose in Men with Erectile Dysfunction in an International, Double-Blind, Placebo-Controlled Study: Effect on the Sexual Experience and Reducing Feelings of Anxiety About the Next Intercourse Attempt

    THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2009
    Oleg B. Loran MD
    ABSTRACT Introduction., Sildenafil citrate 50 mg is the recommended starting dose for men with erectile dysfunction (ED); however, most men are later titrated to sildenafil 100 mg for improved efficacy. Aim., Assess the tolerability and efficacy of sildenafil initiated at the 100-mg dose in men with ED. Methods., Men with ED (score ,25 on the Erectile Function domain of the International Index of Erectile Function) who had received ,6 total doses of a phosphodiesterase type 5 inhibitor and none within 4 weeks were randomized to 8 weeks of double-blind, placebo-controlled (DBPC), fixed-dose treatment (50 or 100 mg sildenafil or placebo) followed by 4 weeks of open-label flexible-dose sildenafil (50 or 100 mg). Main Outcome Measures., Efficacy, tolerability, treatment satisfaction, and other end points were measured at baseline and/or the end of the double-blind and open-label phases and compared between placebo and sildenafil initiated at doses of 50 and 100 mg. Results., Improvements in DBPC patient-reported outcomes from baseline were statistically significant for both sildenafil 50 and 100 mg compared with placebo. At the end of DBPC treatment, 56% of men on the 100-mg dose felt no anxiety about the next intercourse attempt compared with 39% in the 50-mg group (odds ratio 2.03; P = 0.0197). Changes in functional scores from baseline were not statistically significant with the 100-mg dose compared with the 50-mg dose in the DBPC. Measures of treatment satisfaction and sexual experience significantly favored the 100-mg dose compared with the 50-mg dose in the DBPC. There was no increase in adverse events with the higher dose. Conclusions., Sildenafil at 50 mg or 100 mg significantly improved erection quality, treatment satisfaction, anxiety levels, and the sexual experience compared with placebo during DBPC. Sildenafil 100 mg improved the sexual experience and treatment satisfaction, and reduced feelings of anxiety compared with the 50-mg dose. Loran OB, Ströberg P, Lee SW, Park NC, Kim SW, Tseng LJ, Collins S, and Stecher VJ. Sildenafil citrate 100 mg starting dose in men with erectile dysfunction in an international, double-blind, placebo-controlled study: Effect on the sexual experience and reducing feelings of anxiety about the next intercourse attempt. J Sex Med 2009;6:2826,2835. [source]

    ORIGINAL RESEARCH,EPIDEMIOLOGY: The Incidence of Invasive Breast Cancer Among Women Prescribed Testosterone for Low Libido

    THE JOURNAL OF SEXUAL MEDICINE, Issue 7 2009
    Susan R. Davis MD
    ABSTRACT Introduction., Although the efficacy of testosterone for the treatment of hypoactive sexual desire disorder is well established, the effect of testosterone therapy on breast cancer risk remains uncertain. Aim., The incidence of invasive breast cancer among past and current testosterone users. Methods., Retrospective cohort study of 631 women ever treated with testosterone between January 1989 and December 2007 in a clinical endocrinology practice. Main Outcome Measure., The incidence of invasive breast cancer since first exposure, and the standardized incidence rate ratio (IRR) calculated using Australian age-specific incidence rates for 2005. Results., The mean age of the women at first exposure to testosterone therapy was 49.1 ± 8.2 years, median treatment duration, 1.3 years, and mean follow-up of 6.7 ± 4.6 years, providing 4,015 woman-years of follow-up. Twelve cases of invasive breast cancer occurred among 599 women breast cancer-free before treatment, giving an age adjusted IRR of 1.35 (95% confidence interval 0.76,2.38). There was no evidence of an independent effect of duration of exposure on breast cancer risk. Conclusion., In this study, testosterone use was not associated with a significant increase in breast cancer risk. Davis SR, Wolfe R, Farrugia H, Ferdinand A, and Bell RJ. The incidence of invasive breast cancer among women prescribed testosterone for low libido. J Sex Med 2009;6:1850,1856. [source]

    ORIGINAL RESEARCH,ANATOMY/PHYSIOLOGY: Satisfaction (Sexual, Life, Relationship, and Mental Health) Is Associated Directly with Penile,Vaginal Intercourse, but Inversely with Other Sexual Behavior Frequencies

    THE JOURNAL OF SEXUAL MEDICINE, Issue 7 2009
    Stuart Brody PhD
    ABSTRACT Introduction., Some sex therapists and educators assume that many sexual behaviors provide comparable sexual satisfaction. Evidence is required to determine whether sexual behaviors differ in their associations with both sexual satisfaction and satisfaction with other aspects of life. Aims., To test the hypothesis that satisfaction with sex life, life in general, sexual partnership, and mental health correlates directly with frequency of penile,vaginal intercourse (PVI) and inversely with frequency of both masturbation and partnered sexual activity excluding PVI (noncoital sex). Methods., A representative sample of 2,810 Swedes reported frequency of PVI, noncoital sex, and masturbation during the past 30 days, and degree of satisfaction with their sex life, life in general, partnership, and mental health. Main Outcome Measures., Multivariate analyses (for the sexes separately and combined) considering the different satisfaction parameters as dependent variables, and the different types of sexual activities (and age) as putative predictors. Results., For both sexes, multivariate analyses revealed that PVI frequency was directly associated with all satisfaction measures (part correlation = 0.50 with sexual satisfaction), masturbation frequency was independently inversely associated with almost all satisfaction measures, and noncoital sex frequencies independently inversely associated with some satisfaction measures (and uncorrelated with the rest). Age did not confound the results. Conclusions., The results are consistent with evidence that specifically PVI frequency, rather than other sexual activities, is associated with sexual satisfaction, health, and well-being. Inverse associations between satisfaction and masturbation are not due simply to insufficient PVI. Brody S, and Costa RM. Satisfaction (sexual, life, relationship, and mental health) is associated directly with penile-vaginal intercourse, but inversely with other sexual behavior frequencies. J Sex Med 2009;6:1947,1954. [source]

    ORIGINAL RESEARCH,ED PHARMACOTHERAPY: Post-Radical Prostatectomy Pharmacological Penile Rehabilitation: Practice Patterns Among the International Society for Sexual Medicine Practitioners

    THE JOURNAL OF SEXUAL MEDICINE, Issue 7 2009
    Patrick Teloken MD
    ABSTRACT Introduction., Despite the fact that there is minimal evidence-based data supporting it, the concept of pharmacological penile rehabilitation following radical prostatectomy (RP) is receiving great attention. Aim., To define attitudes and practice patterns of clinicians who were members of the International Society for Sexual Medicine (ISSM) and/or its affiliated societies. Methods., Members of the ISSM and its regional affiliates were invited to participate in a web-based survey. Main Outcome Measures., Demographic factors, current practice status, and opinions regarding post-RP erectile dysfunction and penile rehabilitation. The statistical methods used included chi-square, Student's t -tests, and logistic regression analysis. Results., Three hundred-one physicians from 41 countries completed the questionnaire (82% were urologists). Sixty-five percent of the responders had formal sexual medicine specialty training, 44% had uro-oncology specialty training, and 60% performed RPs. Eighty-seven percent performed some form of rehabilitation. As part of the primary rehabilitation strategy, 95% used phosphodiesterase type 5 inhibitors (PDE5), 30% used vacuum device, 75% used intracavernosal injections, and 9.9% used intraurethral prostaglandin. Fifty-four percent commenced rehabilitation immediately/just after urethral catheter removal, and 37% within the first 4 months after RP. Neither the number of years in medical practice, clinician age, nor country/region of practice differed between rehabilitation performers and nonperformers. With regard to the primary reason for avoiding rehabilitation: 50% responded said it is the cost; 25% said the fact that it is not evidence-based; and 25% said they were not familiar with the concept. Performing rehabilitation was positively associated with urologic oncology training (P = 0.03), performing RP (P < 0.001), and seeing over 50 post-RP patients per year (P = 0.011). Conclusions., Among ISSM members post-RP penile rehabilitation is widely practiced, commenced early, and based predominantly on PDE5 inhibitors and intracavernosal injections. Clinicians who perform RP or see over 50 such patients per year are the most likely to perform rehabilitation. Cost represents the most common reason for rehabilitation neglect. Teloken P, Mesquita G, Montorsi F, and Mulhall J. Post-radical prostatectomy pharmacological penile rehabilitation: Practice patterns among ISSM practitioners. J Sex Med 2009;6:2032,2038. [source]

    ORIGINAL RESEARCH,BASIC SCIENCE: Effect of Estrogen Deprivation on the Expression of Aquaporins and Nitric Oxide Synthases in Rat Vagina

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009
    Sun-Ouck Kim MD
    ABSTRACT Introduction., The expression of aquaporin (AQP) water channels in rat vagina was recently reported. Aim., The purposes of this study were to investigate the effect of 17,-estradiol on the expression of the AQP-1 and AQP-2 water channels and nitric oxide synthase (NOS) isoforms in rat vagina. Methods., Female Sprague-Dawley rats (230,240 g, N = 90) were divided into three groups: control (N = 30), bilateral ovariectomy (N = 30), and bilateral ovariectomy, followed by subcutaneous injections of 17,-estradiol (50 µg/kg/day, N = 30). After 4 weeks, genital hemodynamics and vaginal secretions were measured after pelvic nerve stimulation, and the animals were then killed. The expression and cellular localization of AQP-1, AQP-2, endothelial NOS (e-NOS), and neuronal NOS (n-NOS) were determined in each group by immunohistochemistry and Western blot. Main Outcome Measures., The expression and cellular localization of AQPs and NOS isoforms after estrogen deprivation. Results., Estimated vaginal secretions (mg, mean ± standard error) were significantly lower in the ovariectomized group (2.9 ± 0.62) than in the control group (5.7 ± 1.25) and returned to the control value in the group after treatment with 17,-estradiol (6.5 ± 1.22) (P < 0.05). Both AQP-1 and e-NOS immunoreactivities were localized in the capillaries and venules of the lamina propria of the vagina, and n-NOS was expressed in the nerve fibers of the subepithelial lamina propria. The expression of AQP-2 was localized solely in the superficial layer of the vaginal epithelium. The protein expressions of AQP-2, e-NOS, and n-NOS were significantly lower after ovariectomy and were restored to the control level after 17,-estradiol treatment. However, there was no significant change in AQP-1 expression. Conclusions., Decreased vaginal secretion after estrogen deprivation may be partly due to functional changes in both AQPs and NOS isoforms in the vagina. The potential role of AQPs in water transport in the vagina might differ according to the type of AQP. Kim S-O, Lee H-S, Ahn K, and Park K. Effect of estrogen deprivation on the expression of aquaporins and nitric oxide synthases in rat vagina. J Sex Med 2009;6:1579,1586. [source]

    ORIGINAL RESEARCH,WOMEN'S SEXUAL HEALTH: Biofeedback, Electrical Stimulation, Pelvic Floor Muscle Exercises, and Vaginal Cones: A Combined Rehabilitative Approach for Sexual Dysfunction Associated with Urinary Incontinence

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009
    Massimo Rivalta MD
    ABSTRACT Introduction., Urinary incontinence (UI) is often associated with sexual dysfunction. We present our preliminary experience with a combined rehabilitative approach consisting of biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones. Aim., The potential impact of such practice on UI and sexual function was analyzed in our case series and discussed. Main Outcome Measures and Methods., We evaluated three women affected by UI and sexual dysfunction. The patients underwent combined pelvic floor rehabilitation (PFR), kept voiding diaries, and filled out the Female Sexual Function Index (FSFI questionnaire) before and after the completion of PFR. We evaluated each domain score, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Results., After the combined rehabilitation program, none of them had UI requiring pad use or referred urine leakage during sexual activity, including intercourse. Before PFR, FSFI score ranged from 16 to 21; after treatment, the FSFI score ranged from 22.1 to 29.3. There was an improvement in patients regarding desire, arousal, lubrication, orgasm, satisfaction, and pain. Conclusions., A complete rehabilitation can provide a beneficial effect on sexual function. A larger trial, on a more extended female population, is currently in progress, in order to confirm our findings. The effectiveness of a complete PFR scheme, together with the lack of side effects, makes it a suitable approach to sexual dysfunction that is associated with UI. Rivalta M, Sighinolfi MC, De Stefani S, Micali S, Mofferdin A, Grande M, and Bianchi G. Biofeedback, electrical stimulation, pelvic floor muscle exercises, and vaginal cones: A combined rehabilitative approach for sexual dysfunction associated with urinary incontinence. J Sex Med 2009;6:1674,1677. [source]

    ORIGINAL RESEARCH,EJACULATORY DISORDERS: Quantitative Sensory Testing of Peripheral Thresholds in Patients with Lifelong Premature Ejaculation: A Case-Controlled Study

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009
    Andrea Salonia MD
    ABSTRACT Introduction., The main functional factors related to lifelong premature ejaculation (PE) etiology have been suggested to be penile hypersensitivity, greater cortical penile representation, and disturbance of central serotoninergic neurotransmission. Aims., To quantitatively assess penile sensory thresholds in European Caucasian patients with lifelong PE using the Genito-Sensory Analyzer (GSA, Medoc, Ramat Yishai, Israel) as compared with those of an age-comparable sample of volunteers without any ejaculatory compliant. Methods., Forty-two consecutive right-handed, fully potent patients with lifelong PE and 41 right-handed, fully potent, age-comparable volunteers with normal ejaculatory function were enrolled. Each man was assessed via comprehensive medical and sexual history; detailed physical examination; subjective scoring of sexual symptoms with the International Index of Erectile Function; and four consecutive measurements of intravaginal ejaculatory latency time with the stopwatch method. All men completed a detailed genital sensory evaluation using the GSA; thermal and vibratory sensation thresholds were computed at the pulp of the right index finger, and lateral aspect of penile shaft and glans, bilaterally. Main Outcome Measures., Comparing quantitatively assessed penile thermal and vibratory sensory thresholds between men with lifelong PE and controls without any ejaculatory compliant. Results., Patients showed significantly higher (P < 0.001) thresholds at the right index finger but similar penile and glans thresholds for warm sensation as compared with controls. Cold sensation thresholds were not significantly different between groups at the right index finger or penile shaft, but glans thresholds for cold sensation were bilaterally significantly lower (P = 0.01) in patients. Patients showed significantly higher (all P , 0.04) vibratory sensation thresholds for right index finger, penile shaft, and glans, bilaterally, as compared with controls. Conclusions., Quantitative sensory testing analysis suggests that patients with lifelong PE might have a hypo- rather than hypersensitivity profile in terms of peripheral sensory thresholds. The peripheral neuropathophysiology of lifelong PE remains to be clarified. Salonia A, Saccà A, Briganti A, Carro UD, Dehò F, Zanni G, Rocchini L, Raber M, Guazzoni G, Rigatti P, and Montorsi F. Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation: A case-controlled study. J Sex Med 2009;6:1755,1762. [source]

    ORIGINAL RESEARCH,ENDOCRINOLOGY: Evaluation of the Effects of Cigarette Smoking on Testosterone Levels in Adult Men

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009
    Graziele Halmenschlager MS
    ABSTRACT Introduction., Cigarette smoking is highly prevalent among men. Many studies have evaluated the effect of cigarette smoking on levels of male reproductive hormones; however, the findings still remain controversial. Aim., To evaluate the influence of cigarette smoking on serum levels of total testosterone (TT), free testosterone (FT), bioavailable testosterone (BT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Methods., A total of 255 men (90 smokers and 165 nonsmokers), aged 30 to 70 years, were investigated. Weight and height were obtained and body mass index (BMI) was calculated. Also, waist circumference and hip circumference were measured and waist-to-hip ratio was obtained. Fasting blood samples were drawn for determination of plasmatic glucose levels and serum levels of total cholesterol, high-density lipoprotein cholesterol (HDL-c), triglycerides, albumin, prolactin, TT, SHBG, LH, and FSH. The values of low-density lipoprotein cholesterol (LDL-c) were determined by Friedwald equation and the values of FT and BT were calculated from TT, SHBG, and albumin. Statistical significance was set at P , 0.05. Main Outcome Measures., The influence of smoking on levels of TT, FT, and BT. Results., No significant difference was observed in the mean values of TT (P = 0.580), FT (P = 0.869), BT (P = 0.933), SHBG (P = 0.279), LH (P = 0.573), and FSH (P = 0.693) in the different levels of pack-years when compared to nonsmokers. Moreover, after multivariate logistic regression, no association between increased pack-years of smoking and increased odds ratio for occurrence of low hormones and SHBG levels was observed. Conclusion., In this study, smokers and nonsmokers had similar mean values of androgens, gonadotropins and SHBG. However, it is necessary to standardize pack-years of smoking in order to elucidate the influence of cigarette smoking on sex hormone levels, as well as to minimize differences among studies and to confirm our results. Halmenschlager G, Rossetto S, Lara GM, and Rhoden EL. Evaluation of the effects of cigarette smoking on testosterone levels in adult men. J Sex Med 2009;6:1763,1772. [source]

    ORIGINAL RESEARCH,BASIC SCIENCE: Cavernous Neurotomy in the Rat is Associated with the Onset of an Overt Condition of Hypogonadism

    THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2009
    Linda Vignozzi MD
    ABSTRACT Background., Most men following radical retropubic prostatectomy (RRP) are afflicted by erectile dysfunction (ED). RRP-related ED occurs as a result of surgically elicited neuropraxia, leading to histological changes in the penis, including collagenization of smooth muscle and endothelial damage. Aim., To verify whether hypogonadism could contribute to the pathogenesis of RRP-ED. Methods., Effects of testosterone (T), alone or in association with long-term tadalafil (Tad) treatment in a rat model of bilateral cavernous neurotomy (BCN). Main Outcome Measures., Penile tissues from rats were harvested for vasoreactivity studies 3 months post-BCN. Penile oxygenation was evaluated by hypoxyprobe immunostaining. Phosphodiesterase type 5 (PDE5), endothelial nitric oxide synthase (eNOS), and neuronal nitric oxide synthase (nNOS) mRNA expression were quantified by Real Time quantitative reverse transcription polymerase chain reaction (qRT-PCR). Results., In BCN rats, we observed the onset of an overt condition of hypogonadism, characterized by reduced T plasma level, reduced ventral prostate weight, reduced testis function (including testis weight and number of Leydig cells), with an inadequate compensatory increase of luteinizing hormone. BCN induced massive penile hypoxia, decreased muscle/fiber ratio, nNOS, eNOS, PDE5 expression, increased sensitivity to the nitric oxide donor, sodium nitroprusside (SNP), and reduced the relaxant response to acetylcholine (Ach), as well as unresponsiveness to acute Tad dosing. In BCN rats, chronic Tad-administration normalizes penile oxygenation, smooth muscle loss, PDE5 expression, SNP sensitivity, and the responsiveness to the acute Tad administration. Chronic Tad treatment was ineffective in counteracting the reduction of nNOS and eNOS expression, along with Ach responsiveness. T supplementation, in combination with Tad, reverted some of the aforementioned alterations, restoring smooth muscle content, eNOS expression, as well as the relaxant response of penile strips to Ach, but not nNOS expression. Conclusion., BCN was associated with hypogonadism, probably of central origin. T supplementation in hypogonadal BCN rats ameliorates some aspects of BCN-induced ED, including collagenization of penile smooth muscle and endothelial dysfunction, except surgically induced altered nNOS expression.Vignozzi L, Filippi S, Morelli A, Marini M, Chavalmane A, Fibbi B, Silvestrini E, Mancina R, Carini M, Vannelli GB, Forti G, and Maggi M. Cavernous neurotomy in the rat is associated with the onset of an overt condition of hypogonadism. J Sex Med 2009;6:1270,1283. [source]