Erectile impotence precipitated by organic factors and perpetuated by performance anxiety.

A survey of 72 men with erectile impotence showed that for 14 the onset had been concurrent with the start of a temporary physical disability (in 8), temporary exposure to a chemical agent in doses thought to be significant (in 4) or the return of sexual opportunity after a long period of celibacy or near-celibacy (in 2 older men). After elimination of that possible cause the impotence had persisted owing to anxiety about sexual performance. In another 6 of the 72 there were persistent nonpsychic causes for the impotence. Thus, in 28% of the men surveyed the precipitating cause of erectile impotence was organic. A large proportion of the cases of erectile impotence participated by a temporary nonpsychic factor could probably have been prevented with appropriate professional advice--for example, at the time an antihypertensive drug capable of causing the dysfunction was first prescribed.     

Topical treatment of erectile dysfunction: randomised double blind placebo controlled trial of cream containing aminophylline,isosorbide dinitrate,and co-dergocrine mesylate.

OBJECTIVE--To examine the effectiveness in treating impotence to topically applied cream containing three vasodilators--aminophylline, isosorbide dinitrate, and co-dergocrine mesylate--which act by different mechanisms. DESIGN--Randomised double blinded placebo controlled crossover trial over two weeks. SUBJECTS--36 men with erectile dysfunction randomly allocated to two equal groups. INTERVENTIONS--Active cream containing aminophylline 3%, isosorbide dinitrate 0.25%, and co-dergocrine mesylate 0.05% for one week and placebo for another. MAIN OUTCOME MEASURES--Patients'' reported experience of penile responses and side effects of treatment in questionnaires. Penile tumescence and arterial flow in the laboratory. RESULTS--21 patients reported full erection and satisfactory intercourse with the active cream. Three men reported full erection and satisfactory intercourse with either cream. The active cream was more effective in psychogenic than organic impotence (eight out of nine men with psychogenic impotence achieved a full erection upsilon four out of eight with neurogenic impotence and two out of seven with arterial insufficiency). No major side effects were reported. In the laboratory the active cream increased penile arterial flow (0.19 (SD 0.08) m/s upsilon 0.02 (0.15) m/s with placebo) and induced tumescence in 24 patients. CONCLUSIONS--Topical treatment with a cream containing three different vasodilators might be considered before intracavernous injection of vasoactive agents, particularly in psychogenic impotence.     

Gender Differences in Owners Interacting with Pet Dogs: An Observational Study

Many studies show that people form strong affectional bonds with their dogs, treating them like family members or children. The present study investigates differences between women and men owners during interactions with their dogs, in a situation designed to investigate attachment and, thus, to promote emotional and affective responses: the Ainsworth's Strange Situation. Twenty‐five dog owners, 10 men and 15 women, were observed during free interactions with their pets in an adapted version of the ‘strange situation procedure’. Their behaviour towards their pets was videorecorded. Talking to the dog was evaluated together with the occurrence of affiliative and play behaviours. The owner's level of attachment to the dog was assessed using a questionnaire. Women and men differed in the use of verbal communication. Women talked more than men and had a shorter latency in starting talking. Their utterances resembled more closely infant‐directed speech or ‘motherese’. In contrast, there were no clear gender differences in affiliative and play behaviours. Both women and men engaged in play with their dogs and provided physical comfort. No differences emerged in the level of attachment reported by women and men owners in the questionnaire. These data support the hypothesis that the behaviour of modern pet owners towards their dogs is an interspecific parental behaviour, and suggest that behaviours evolved to provide care and comfort to human infants have been co‐opted for interacting with other social partners. The difference in verbal communication between women and men is in agreement with an evolutionary scenario suggesting a greater pre‐disposition in women to use language as a relational tool.     

Dysfonction érectile d’origine médicamenteuse: effet indésirable sous-estimé en pharmacovigilance

Some drugs can induce erectile dysfunction (priapism or impotence) due to their pharmacological properties. Some adverse effects (ADRs) are only detected after marketing of the drug with a low frequency (unexpected ADRs). Pharmacovigilance and pharmacoepidemiologic studies collect data about real drug use and contribute to a better evaluation of the benefit/risk ratio. Data about cases of erectile dysfunction spontaneously reported to the French Pharmacovigilance system were collected over a 5-year period (2000 to 2004). 39 cases of drug-induced priapism were identified, 25 of which were classified as serious (62.5%), mainly due to anticoagulants (12 cases), psychotropic drugs (8 cases), phosphodiesterase inhibitors (8 cases) and beta-blockers (2 cases). During the same period, 214 cases of impotence either isolated or associated with ejaculation dysfunction were reported, mainly with antiretroviral drugs, fibrates and HMG CoA reductase inhibitors, psychotropic drugs and beta-blockers. Our data indicate that some ADRs, such as erectile dysfunction, are severely under-reported. Spontaneous reporting and pharmacoepidemiologic studies could contribute to a better knowledge of drugs and their rational use.     

Synthetic nitrovasodilators are effective, in vitro, in relaxing penile tissue from impotent men: the findings and their implications

Normal penile erectile function is dependent on arterial adequacy, appropriate venous occlusion, neurohumoral factors, and finally the relaxation of penile cavernous trabecular smooth muscle. The present experiments were designed to test whether compounds related to endothelium-derived relaxing factor have a role in penile smooth muscle relaxation and whether this role is preserved in clinically impotent tissue. Isometric tension experiments were conducted using strips of human tissue (appropriately obtained) from patients found to be impotent by clinical criteria. Glyceryl trinitrate and isosorbide dinitrate produced maximal relaxations of 66 and 63%, respectively, in tissues contracted with norepinephrine: 50% relaxation was observed at 6 x 10(-7) and 8 x 10(-5) M, respectively. The finding of a relaxant response to synthetic nitrovasodilators in "impotent" tissue implies that (i) complete end organ (smooth muscle) failure is not always, if ever, seen, (ii) endothelium-derived factors probably play a role in erectile tissue parallel with their role in other vascular tissues, (iii) more proximal factors may be responsible for clinical impotence, and (iv) synthetic nitrovasodilators may have a role in the therapy of clinical impotence.     

Socio-épidémiologie de l’impuissance masculine:Évolution des conceptions nosographiques et des données épidémiologiques

Male impotence is currently a matter of increasing interest and change at the conceptual, epidemiological and clinical levels. The first part of the paper provides a historical perspective on conceptions of male impotence: the introduction of the new concept of erectile dysfunction and the problem of its definition, its frequency and its degree are discussed. It is argued that there is no consensus on definitions. In the second part, epidemiological studies among the general population and in inclinical samples are presented and their methodology is discussed. Until 1990, the prevalence of male impotence was estimatod between 5% and 10%. Since 1994, estimates have shifted to from 5% to 50% depending on criteria used in studies.     

Hyperprolactinemia and sexual function in men

Male hyperprolactinemia (HPRL) is known to induce different types of sexual dysfunctions. In order to determine the incidence of HPRL among patients referred for sexual dysfunction, serum prolactin (PRL) was assayed in 1053 clinically idiopathic cases. Among 850 cases complaining of erectile impotence, 10 with marked HPRL (1.1%, PRL above 35 ng/ml) were found, of whom 6 cases were associated with a pituitary adenoma. 17 mild HPRL (2%, PRL 20-35 ng/ml) were also found. Among 124 cases with premature ejaculation, 13 (10%) mild HPRL were found. Serum PRL was normal in 51 cases complaining of an ejaculation without orgasm, and 27 patients exclusively complaining of reduced sexual desire. Our results lay stress on the fact that serum PRL must be assayed in every case of clinically idiopathic erectile impotence. Indeed, 5 of the 10 marked HPRL patients would have been misdiagnosed if we had only assayed this hormone when plasma testosterone was below the normal range. Moreover, in order to shed some light on the mechanisms by which HPRL disturbs male sexual function, the sexual behaviour of 17 markedly HPRL males was compared to their serum levels of PRL and testosterone, first before treatment, then at regular intervals during treatment. Our main conclusion is that impotence cannot be totally explained by a decrease in plasma testosterone, because this steroid hormone was within the normal range 7 of the 16 impotent patients. Moreover, when serum PRL was lowered by bromocriptine, 6 patients recovered their potency before plasma testosterone clearly increased, and in 3 of those patients before it reached the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sexual behaviour, contraceptive practice and knowledge of AIDS of Oxford University students

In 1987, a questionnaire was sent to 584 undergraduate students at Oxford University requesting information about their sexual behavior and contraceptive practices as well as the impact of acquired immunodeficiency syndrome (AIDS) on both these factors. Of the 374 responders, 65% of the women and 62% of the men had experienced sexual intercourse; 1st intercourse had occurred at ages 16-20 years for 89% of the experienced women and 83% of the men. For 36% of women and 37% of men intercourse had been with 1 partner only, for 28% of women and 27% of men with 2-3 partners, and for 36% of both men and women with more than 3 partners. 27% of the women reported no contraceptive was used at the time of 1st intercourse. During the 4 weeks preceding completion of the questionnaire, 15% of sexually active female undergraduates reported not using adequate contraception. Users during this period selected the pill (64%), condom (19%), IUD or diaphragm (9%), or withdrawal/rhythm (8%). General knowledge about AIDS was highly accurate among these students. Most students considered themselves to be at lower risk of contracting AIDS than others of their age and sex. Of the 78% of students describing themselves as at lower than average risk, 14% had had intercourse with more than 3 partners, while 50% of the 20% of students who ranked themselves as at average risk had this number of partners. Only 2% placed themselves as at above average risk, and 65% of these students had had more than 3 sexual partners. Of students who were sexually active, 35% of the females and 44% of the males indicated they are now more likely to use a condom because of fear of AIDS. 49% of the females and 30% of the males indicated they had, or would have, fewer sexual partners because of the AIDS risk. However, there was no association between increased likelihood of condom use and the total number of sexual partners and having had intercourse with someone in a high-risk group for AIDS (prostitutes). Overall, however, these findings suggest that the AIDS threat is producing reductions in high-risk behaviors.     

Future strategies for treating erectile dysfunction

Erectile dysfunction affects over half of all men between 50 and 70 years of age, and by the age of 40, about 40% of men may suffer from some form of erectile dysfunction. Many disease states, such as diabetes, hypertension, depression, and vascular disease, are associated with the condition, which may occur many years prior to the onset of these disorders. The phenomenal success of sildenafil in improving erections in men with erectile dysfunction is due to the fact that the drug, as a phosphodiesterase inhibitor, improves the relaxation of smooth muscle cells, which become dysfunctional with the aging process. However, not everyone responds to this medication, mainly because the efficacy of the drug is directly dependent on the release of nitric oxide from the nerve terminals of the cavernosal nerve, and this may become defective with aging/certain disease states. The goal of gene therapy for organic impotence is to allow the patient to sustain physiologically elicited erections without resorting to pharmacological treatment immediately prior to the sexual act. Experimental efforts in gene therapy for erectile dysfunction are likely to continue intensively in a series of directions, some specific to the nature of the selected gene to be manipulated or the physiology of the corpora cavernosa itself, and others extrapolatable from the advancement of gene therapy in general.     

Cavernous nerve reconstruction to preserve erectile function following non-nerve-sparing radical retropubic prostatectomy: a prospective study

Erectile dysfunction following radical prostatectomy for treatment of clinically localized prostate cancer remains a problem that deters many men from seeking surgical treatment. Sparing the cavernous nerves has been popularized as a method of preserving potency, but men with locally advanced disease may be at increased risk for positive margins with this technique. In this study, sural nerve grafting of the cavernous nerve bundles, to preserve postoperative potency while potentially maximizing cancer control, was examined. Thirty men were enrolled in this prospective phase I study and underwent non-nerve-sparing radical prostatectomy performed by one of two protocol surgeons. Preoperative erectile function was assessed both objectively, using a RigiScan (Timm Medical Technologies, Inc., Eden Prairie, Minn.), and subjectively. The cavernous nerves were identified and resected during the operation with the use of an intraoperative mapping device (CaverMap; Alliant Medical Technologies, Norwood, Mass.). Bilateral autologous sural nerve grafting to the cavernous nerve stumps was performed by one of two protocol plastic surgeons. Postoperative erectile dysfunction therapy, using intracorporeal injection, a vacuum pump, and/or oral sildenafil therapy, was instituted 6 weeks after the operation. Spontaneous erectile activity was subjectively and objectively measured every 3 months after the operation. Follow-up periods ranged from 13 to 33 months (mean, 23 months). Overall, 18 of 30 patients (60 percent) demonstrated both objective and subjective evidence of spontaneous erectile activity. Of those 18 men, 13 (72 percent) were able to have intercourse (seven unassisted and six with the aid of sildenafil). No disease or biochemical recurrences have been noted in this group of patients with locally advanced disease. In conclusion, autologous sural nerve grafting after non-nerve-sparing radical prostatectomy is an effective means of preserving spontaneous erectile activity after the operation while maximizing cancer control potential.     

Multidisciplinary survey of erectile impotence.

A study was done of 220 men referred principally by family physicians to a multidisciplinary erectile dysfunction study group to determine the factors causing or contributing to impotence that had persisted for more than 2 months and for which no cause was apparent. The men were aged 21 to 79 (mean 50.3) years, and the duration of impotence was a few months to 15 years (mean 2.65 years). The men were to be assessed from general medical, endocrinologic/metabolic, psychiatric and urogenital viewpoints. The significance of the causal or contributory factors detected was scored by application of defined criteria and a four-point scale. The degree of loss of potency and of libido as well as level of concern were also scored by each specialist. Impotence was complete in 60%, and an associated decline in libido was reported by 38%. The level of concern was high--that is, normal--in 81% and slightly reduced in 9%. Full investigation by all the specialists was precluded by the severity of other conditions in 16 patients, by the return of potency following relief of anxiety/depression or genitourinary tract infection in 16 and for logistic or other reasons in 34. Although the cause of the impotence could be attributed in 186 of the patients, only 154 were fully assessed. Among these patients general medical factors were contributory in 46%, endocrinologic/metabolic factors in 44%, psychogenic factors (primary or secondary) in 60% and urogenital factors in 49%. Multiple contributing factors were identified in 65%, which underscores the importance of a multidisciplinary approach to assessing many cases of impotence.     

A Qualitative Exploration of Sexual Risk and HIV Testing Behaviors among Men Who Have Sex with Men in Beirut,Lebanon

Men who have sex with men (MSM) may account for most new HIV infections in Lebanon, yet little is known about the factors that influence sexual risk behavior and HIV testing in this population. Qualitative interviews were conducted with 31 MSM living in Beirut, and content analysis was used to identify emergent themes. Mean age of the participants was 28.4 years, and all identified as either gay (77%) or bisexual (23%). Half reported not using condoms consistently and one quarter had not been HIV-tested. Many described not using condoms with a regular partner in the context of a meaningful relationship, mutual HIV testing, and a desire to not use condoms, suggesting that trust, commitment and intimacy play a role in condom use decisions. Condoms were more likely to be used with casual partners, partners believed to be HIV-positive, and with partners met online where men found it easier to candidly discuss HIV risk. Fear of infection motivated many to get HIV tested and use condoms, but such affect also led some to avoid HIV testing in fear of disease and social stigma if found to be infected. Respondents who were very comfortable with their sexual orientation and who had disclosed their sexuality to family and parents tended to be more likely to use condoms consistently and be tested for HIV. These findings indicate that similar factors influence the condom use and HIV testing of MSM in Beirut as those observed in studies elsewhere of MSM; hence, prevention efforts in Lebanon can likely benefit from lessons learned and interventions developed in other regions, particularly for younger, gay-identified men. Further research is needed to determine how prevention efforts may need to be tailored to address the needs of men who are less integrated into or do not identify with the gay community.     

The dynamics of condom use with regular and casual partners: analysis of the 2006 national sexual behavior survey of Thailand

Objective

This study aims to determine factors associated with levels of condom use among heterosexual Thai males in sex with regular partners and in sex with casual partners.

Methods

The data used in this study are from the national probability sample of the 2006 National Sexual Behavior Study, the third nationally representative cross-sectional survey in Thailand. A subtotal of 2,281 men were analyzed in the study, including young (18–24) and older (25–59) adults who were residents of rural areas of Thailand, non-Bangkok urban areas, and Bangkok. Two outcomes of interest for this analysis are reported condom use in the past 12 months by males in relationships with the most recent regular and casual partners who were not sex workers. Chi-square statistics, bivariate regressions and the proportional odds regression models are used in the analysis.

Results

Condom use for men with their regular partner is revealed to be positively related to education, knowledge of condom effectiveness, and pro-condom strategy, and negatively related to non-professional employment, status of registered marriage, and short relationship duration. Condom use with casual partner is positively determined by education, condom knowledge, non-professional occupation, short relationship duration, and lack of history of paid sex.

Conclusion

The national survey emphasized the importance of risk perceptions and condom motivations variables in explaining condom use among men in Thailand. These factors include not only education and knowledge of condom effectiveness and pro-condom strategy but also types of partners and their relationship context and characteristics. Program intervention to promote condom use in Thailand in this new era of predominant casual sex rather than sex with sex workers has to take into account more dynamic partner-based strategies than in the past history of the epidemics in Thailand.     

Men's social networks and contraception in Ghana

In this paper, longitudinal data from northern Ghana is used to assess the effects of encouragement to use family planning that men receive from their personal network partners on the adoption of modern contraception by their wives. The study tests a conceptual model that, in addition to the effect of men's network encouragement, incorporates the effect of encouragement to use family planning that women receive from their respective network partners and the effect of spousal communication on reproductive matters and approval of family planning. Results show that encouragement received by men from their social networks significantly increases the likelihood of subsequent contraceptive use by their wives but this effect operates primarily by galvanizing spousal communication on reproductive matters. The effect of encouragement received by women from their respective network partners is largely independent from the effect of male network encouragement but it influences contraceptive adoption both directly and through spousal communication.     

Risk behaviours for HIV infection among drug users in prison.

OBJECTIVE--To study a group of injecting drug users to establish the degree of illicit drug use in prisons, the prevalence of risk behaviours for HIV infection, and the uptake of treatment for drug dependency with drugs within the prison system. DESIGN--Anonymous, self administered, questionnaire. SETTING--Two drug agencies in central London; one operating a scheme for exchanging needles, and the other offering drug advice and information. SUBJECTS--50 (42 Men, eight women) self selected injecting drug users (mean age 31.2 (range 21-42)), all of whom had been held in custody at some time since 1982. MAIN OUTCOME MEASURES--Details about periods served in custody since 1982; the number of respondents who took drugs (orally or by injection), either illicitly or prescribed, while in prison and the types of substances taken; the respondents'' sexual activity in prison and between periods in custody. RESULTS--The average time spent in custody before the study was 20.6 months (range 1-72). Most prosecutions were directly or indirectly related to drug taking. 47 Of the 50 respondents reported taking at least one illicit drug while in custody; 33 by injection, 26 of whom had shared injecting equipment. 30 Had been treated for drug dependency by the prescribing of drugs while in prison. While in custody, one woman and four men (with a mean of seven (range 2-16) male partners) had had sex. Between periods spent in custody, men reported having a mean of eight (range 0-90) female partners and women a mean of one (range 0-3) male partner. Three men had had sex with other men, with a mean of six (range 2-11) partners. Since their last period in custody, men had had a mean of two (range 0-18) female partners and women had had a mean of two (range 1-3) male partners. Five men had also had male partners. CONCLUSIONS--A high prevalence of injecting and sexual risk behaviours among injecting drug users within and between periods in custody has been shown. Most of these offenders continued to take drugs while in custody, and just over half not only injected drugs but shared equipment. Some of the male prisoners compounded their risk of HIV infection by engaging in sexual activity with multiple partners. Prisoners who then have multiple sexual partners after release place their partners in the community at particular risk of HIV infection. Although many of the drug users were prescribed drugs for their dependency, limited access to appropriate treatment, counselling, and health education may compound the situation.     

Synthese de la table ronde: “Apport de la Prostaglandine E1 dans l’exploration et le traitement de l’impuissance”

Intracavernosal injections of prostaglandin E1 (PGE1) have induced positive erectile responses in 70% of subjects investigated. Mild pain was reported in 15% of cases, with only 5% describing the pain as annoying. Prolonged erections were uncommon and priapism extremely rare. No systemic or generalised complication has ever been reported in about 1500 subjects. Pharmaco-Döppler, using intracavernosal 10 μg PGE1 injections, and pharmacocavernosometry have been investigated. Self-administered injections are obviously of great interest due to the high prevalence of positive responses and absence of complications. Long-terme tolerance is excellent, far better than with other drugs. PGE1 has also been used, with favourable preliminary findings as a treatment for specific conditions, particularly venous leakage and intractable erectile failure with combined organic and psychogenic lesions. PGE1 is becoming progressively more important in the investigation and management of impotence, principally because of its reliability and innocuous nature.     

Progres recents des explorations vasculaires

After a long period of general conviction that erectile dysfunction is mostly of psychogenic origin, the introduction of vascular diagnostics into the evaluation of impotence enabled a more refined etiologic assignment. Today, the etiology of erectile dysfunction can mostly be attributed to different etiologic factors; even in the presence of significant organogenic findings, a considerable psychogenic overlay may be found. The first arterial evaluation available, and the goldstandard for longtime, was the selective pudendal arteriography. Today we know that this method gives too many false negative results. The mostly used method now is Doppler examination of the penile arteries after intracavernous injection; its disadvantage is the imprecise localization of the deep arteries and the imprecise detection of the flow velocities. Duplex scanning and color ultrasound minimize these drawbacks. For all examination mentioned there are no real control groups in the literature, such as old aged men or potent diabetics. For venous evaluation, pharmaco-cavernosometry and — graphy are well standardized today and data of healthy control groups are available. Nonetheless, we must keep in mind that all vascular examinations are easily influenced by psychogenic factors, such as stress or anxiety. Therefore, abnormal results in otherwise organically normal men must be interpreted carefully.     

The influence of method-related partner violence on covert pill use and pill discontinuation among women living in La Paz, El Alto and Santa Cruz, Bolivia

Intimate partner violence is widespread worldwide. While assumed to impact women's ability to use contraceptive methods, few data are available to support this claim. In this study, eight focus group discussions were conducted to guide questionnaire development and to provide contextual information. Participants were women who were currently using the pill and women who had used the pill previously. In addition, 300 women were interviewed who initiated oral contraceptive pill use between December 1995 and April 1996. Participants were interviewed 3-6 months later to investigate the role intimate partner violence played in covert pill use and pill discontinuation. Special study procedures for asking women questions about violence were employed. Nineteen per cent of the women interviewed were using the pill covertly. The odds of covert pill use were four times higher in El Alto and La Paz than in Santa Cruz. Women who used the pill covertly were more likely to have experienced method-related partner violence (OR = 21.27) than women whose partners knew of their pill use. One-third of the women had discontinued pill use at the time of the interview. In the final multivariate analysis, having experienced side-effects (OR = 2.37) was a significant predictor of pill discontinuation and method-related partner violence was marginally predictive (OR = 1.91; 95% CI 1.0-3.66). While efforts are ongoing to incorporate men into family planning programmes, some male partners oppose, and in some situations violently oppose, contraceptive use. The needs of women with these types of partners must not be overlooked.     

La dysfonction éréctile au Sénégal: Profil épidemiologique

Methodology

This was a transverse randomized survey of subjects over the age of 18 years. Subjects completed a self-administered questionnaire composed of two parts. The first part contained information on demographic characteristics, associated diseases, erectile dysfunction and associated sexual disorders and the second part was based on IIEF5. Two groups were identified: a group with erectile dysfunction (ED group) and another group without erectile dysfunction (No ED group). Differences between the two groups were considered to be statistically significant for p ≤ 0.05 on the Chi-square test.

Results

The global prevalence of erectile dysfunction was 26%. The prevalence by age-group revealed a progressive increase of ED with age from 11% between 20 and 30 years to 76% between 70 and 80 years. The rate of polygamous men was significantly higher in the group with ED (29.2%) compared to the group without ED (6.6%) (p < 0.0001) and the severity of ED increased in relation to the number of wives. Chronic alcoholism was significantly more frequent in the group with ED (p = 0.023). The frequency of ED increased with the duration of cigarette smoking from 11.9% for less than 5 years, 16.9% between 5 years and 10 years and 71.2% for more than 10 years. Some diseases (diabetes, hypertension and depression) were significantly more frequent in the group with ED. Analysis of the type of ED revealed that secondary erectile dysfunction was more frequent (95.6%) than primary erectile dysfunction (4.4%). Associated sexual disorders were significantly more frequent in the group with ED.