The Audio Visual Sexual Stimulation (AVSS) Test in the Clinical Approach to Erectile Disorders

Abstract

ABSTRACT: The Audio Visual Sexual Stimulation (AVSS) test represents a simple method to investigate impotence (Condra et al, 1991). It represents the most physiological and less invasive test that is able to induce an erectile response in the laboratory (Wagner et al, 1981). It does not require complicated tools and gives us much information concerning the nature of erectile disorders and also a first insight on the etiological causes (Virag, 1987). The patient is placed in a diagnostic room that should be sufficiently comfortable and watches an “erotic” videotape. The patient also uses earphones to stimulate the hearing and to be isolated from the ambient.A Rigiscan Is applied to obtain a real‐time recording of the erectile response elicited by the AVSS (Pozza et al, 1990). The same procedure is utilized performing the AVSS after intracavemous Injection (ICI) test if the induced erection is not completely rigid.We can have four different responses to AVSS: (1) completely negative or absent response with a fiat tracing on Rigiscan, (2) feeble erectile activity when the Rigiscan shows erectile activity with rigidity of less than 50%, (3) moderate or fair activity if the erection is between 50 and 70% in rigidity, (4) good response when the patient gets an erection with rigidity above 70%.We can also obtain an erectile response characterized by moderate to good but of very brief duration. That means that there is a loss of rigidity during the blank periods of the AVSS.A group of 250 patients complaining of erectile disorders was investigated. The relationships with intracavernous injection of vasoactive drugs and conclusive diagnosis were evaluated.Good responses exclude the presence of relevant organic disease. Negative responses to the AVSS test could be due to relevant organic disease but also to cultural, social, and angiogenic factors. Feeble or moderate responses are considered to be related to organic factors and require other investigations. The presence of alternating erections is independent from the degree of penile rigidity. This pattern is very frequent in patients affected by venogenic impotence. Only 10 psychogenic patients (14.2%) showed feeble response compared to 42 arteriogenic (46.1%) and 19 venogenic ones (40.4%). A good response was observed in 13 venogenic patients (27.6%) even if with alternating erections. It was also observed in seven arteriogenic (7.7%), whereas it was present in 22 psychogenic patients (31.4%). Actually, we found that a feeble erection was associated with organicity in 84.8% of cases (73 out of 86), and a good one was associated with psychogenic causes in 37.5% (15 out of 40).A particular group of patients is that affected by corporal venoocclusive dysfunction (CVOD). Many of these patients show a peculiar erectile response characterized by good, complete erections during the AVSS with sudden decrease of rigidity during the blank periods of the video. Many patients (41 out of 54 cases: 75.9%) with such erectile response showed CVOD, which was confirmed by dynamic cavernometry. The AVSS represents the ideal test in the diagnostic approach to erectile disorders also because it is simple, cheap, and not invasive. The test could represent an acceptable diagnostic tool for those patients who refuse the ICI test or who have diseases that make the ICI dangerous (coagulation problems, hemodialysis, etc.).