Abstract
Psychogenic erectile dysfunction (ED) has been defined as the persistent inability to attain and maintain an erection sufficient to permit sexual performance. It shows a high incidence and prevalence among men, with a significant impact on the quality of life. Few neuroimaging studies have investigated the cerebral basis of erectile dysfunctions observing the role played by prefrontal, cingulate, and parietal cortices during erotic stimulation. In spite of the well-known involvement of subcortical regions such as hypothalamus and caudate nucleus in male sexual response, and the key role of nucleus accumbens in pleasure and reward, poor attention was paid to their role in male sexual dysfunction. In this study, we determined the presence of grey matter (GM) atrophy patterns in subcortical structures such as amygdala, hippocampus, nucleus accumbens, caudate nucleus, putamen, pallidum, thalamus, and hypothalamus in patients with psychogenic ED and healthy men. After Rigiscan evaluation, urological, general medical, metabolic and hormonal, psychological and psychiatric assessment, 17 outpatients with psychogenic ED and 25 healthy controls were recruited for structural MRI session. Significant GM atrophy of nucleus accumbens was observed bilaterally in patients with respect to controls. Shape analysis showed that this atrophy was located in the left medial-anterior and posterior portion of accumbens. Left nucleus accumbens volumes in patients correlated with low erectile functioning as measured by IIEF-5 (International Index of Erectile Function). In addition, a GM atrophy of left hypothalamus was also observed. Our results suggest that atrophy of nucleus accumbens plays an important role in psychogenic erectile dysfunction. We believe that this change can influence the motivation-related component of sexual behavior. Our findings help to elucidate a neural basis of psychogenic erectile dysfunction.
Highlights
Psychogenic Erectile Dysfunction (ED) has been defined as the persistent inability to attain and maintain an erection sufficient to permit sexual performance
Numerous functional neuroimaging studies have focused on the brain regions that are evoked by sexually relevant stimuli, showing an involvement of different cortical and subcortical structures, such as cingulate cortex, insula caudate nucleus, putamen, thalamus, amygdala and hypothalamus [1,2,3,4,5]
The aim of this study is to investigate if psychogenic ED patients show macro-structural alterations of deep grey matter (GM) structures that are involved in the male sexual response, in pleasure and reward
Summary
Psychogenic Erectile Dysfunction (ED) has been defined as the persistent inability to attain and maintain an erection sufficient to permit sexual performance. Numerous functional neuroimaging studies have focused on the brain regions that are evoked by sexually relevant stimuli, showing an involvement of different cortical and subcortical structures, such as cingulate cortex, insula caudate nucleus, putamen, thalamus, amygdala and hypothalamus [1,2,3,4,5]. These studies have permitted to disentangle the role played by several brain regions in different stages of visually driven sexual arousal. According to Ferretti and colleagues [4] the hypothalamus can be brain area that triggers the erectile response evoked by erotic clips
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