Audiovisual Sexual Stimulation Research Articles

The value of audiovisual sexual stimulation with virtual reality in diagnosing erectile dysfunction.

The traditional audiovisual sexual stimulation (AVSS) test may experience limitations including low erectile response rate and lack of unified diagnostic criteria. We aimed to explore the clinical value of AVSS with virtual reality (VR-AVSS) test in assessing erectile function and diagnosing erectile dysfunction (ED). Participants 18 to 60years of age were screened for analysis in 3 clinical centers from June 2020 to March 2022. Demographic data, 5-item International Index of Erectile Function (IIEF-5), erectile hardness score (EHS), and self-reported symptom questions were collected. The ED patients and control patients were confirmed according to the IIEF-5 and EHS. All subjects watched a 60-minute erotic video by VR device during RigiScan recording. The parameters including tip average rigidity, tip effective erectile duration (duration of rigidity ≥60%, tip effective erectile duration), base average rigidity, and base effective erectile duration were evaluated. The main outcome of interest was the application of VR immersion technology to improve the traditional AVSS test. A total of 301 ED cases and 100 eligible control patients were included for final analysis. Compared with control patients, ED cases had significantly lower IIEF-5 scores, EHS, positive response rate, and erectile rigidity and duration. The positive response rate of ED and control patients were 75.5% and 90.9%, respectively. The cutoff points of tip average rigidity, tip effective erectile duration, base average rigidity, and base effective erectile duration were 40.5% (sensitivity: 77.6%, specificity: 70.2%; P < .001), 4.75minutes (sensitivity: 75.9%, specificity: 75.4%; P < .001), 48.5% (sensitivity: 77.6%, specificity: 75.1%; P < .001), and 7.75minutes (sensitivity: 79.3%, specificity: 75.7%; P < .001). The technological superiority of VR will enable the VR-AVSS immersion test to be a more accurate detection than traditional AVSS modes. Our study applied VR immersion technology to establish the standard operation procedure for the AVSS test, which could effectively reduce the interference of adverse factors and minimize the detecting errors. However, the test data only included positive response subjects, so the true erectile status of men with a negative response to the AVSS test cannot be obtained. The VR-AVSS test can effectively improve the diagnostic accuracy of ED. The average rigidity and effective erectile duration were the optimal diagnostic parameters for excluding ED.

More Efficient Approach: Independent Diagnostic Value of Audiovisual Sexual Stimulation for Psychogenic Erectile Dysfunction

The diagnostic value of audiovisual sexual stimulation (AVSS) for psychogenic erectile dysfunction (ED) is still unclear. We investigated the independent diagnostic value and optimal cut-off parameter of AVSS for psychogenic ED. All participants had received the AVSS test and nocturnal penile tumescence and rigidity (NPTR) monitoring at least twice. ED patients were divided into psychogenic ED and organic ED according to NPTR examination. The diagnostic accuracy of AVSS parameters was evaluated with the receiver operating characteristic (ROC) curve, and the Youden index was employed to determine the optimal diagnostic cut-off values. A total of 346 patients with ED and 60 healthy men were included in this study, among which 162 and 184 cases of psychogenic and organic ED were identified based on NPTR, respectively. When comparing the two ED groups, the area under the curve (AUC) of AVSS parameters was 0.85–0.89. Six-selected AVSS parameters could precisely diagnose psychogenic ED, exhibiting increased diagnostic specificity compared with corresponding sensitivity. When comparing psychogenic ED with the control group, the AUC of the tumescence of the tip was superior to the AUC other parameters (0.81 vs. 0.58, 0.66, 0.59, 0.53, 0.68), and the best determined diagnostic cut-off value was the tumescence of the tip < 29.87%. Independent AVSS could diagnose psychogenic ED objectively and effectively, and its diagnostic value was highest when 1.50% ≤ tumescence of the tip < 29.87%.

Self-reported sexual response in transgender women to audiovisual stimulation protocol

Sexuality changes associated with the medical transition in transgender women are not well known; the few studies present discrepancies in labeling their sexual orientation and controlling surgery conditions. This study aimed to evaluate the self-reported sexual response to audiovisual sexual stimulation protocol in androsexual transgender women on hormone replacement therapy. This study also evaluated their sexual functioning to support the empirical protocol. Participated androsexual transgender women with (n = 16) and without hormone therapy (n = 15) in a non-sex reassignment surgery condition. Androsexual cisgender men (n = 25) and women (n = 24) also were included as contrast groups. All participants were assessed with the Short Form of the Changes in Sexual Functioning Questionnaire; then watched video clips with neutral and sexual content and informed their sexual responses through two self-report scales adapted from the Film Scale. The results showed trans women with hormone therapy, compared to trans women without treatment, experienced a less selective sexual response to sexual stimuli. Also, they registered the lowest scores for every sexual functioning except for pleasure. In conclusion, transgender women on hormone therapy without sex reassignment surgery showed fluidity in their self-reported sexual response and reduced sexual functioning.

Selecting an Individualized Treatment Approach: The Predictive Value of Erotic Stimulation and Nocturnal Erections for Efficacy of Tadalafil and Cure in Patients With Erectile Dysfunction.

PurposeThis study aimed to evaluate two modes of Rigiscan for predicting tadalafil response, and to identify which Rigiscan variables are the most efficient at making these predictions.MethodsAll patients received at least two rounds of nocturnal penile tumescence and rigidity (NPTR) testing and/or audiovisual sexual stimulation (AVSS), then completed the International Index of Erectile Function-5 (IIEF-5) questionnaire, followed by oral 5 mg tadalafil daily for 4 weeks. After a 4-week washout period, all respondents underwent an the IIEF-5 questionnaire again. ED patients were then categorized into tadalafil responders and tadalafil non-responders, who were then further divided into cured patients and uncured patients.ResultsWhen predicting tadalafil responders, the area under the curve (AUC) of NPTR was superior to that of AVSS (0.68~0.84 VS 0.69~0.73), and the predicted optimal cut-off values were DOEE60≥17.75 min in NPTR, compared to other parameters regardless of AVSS or NPTR (P<0.05). When predicting which patients would be cured, the AUC of AVSS was superior to NPTR parameters (0.77~0.81 vs 0.61~0.76), and the determined best diagnostic cut-off values were DOEE≥4.125min in AVSS, compared to other parameters regardless of AVSS or NPTR (P < 0.05).ConclusionRigiscan was able to predict the efficacy of daily tadalafil accurately and efficiently. Its diagnostic value was at maximum when DOEE60 ≥17.75 min of NPTR in tadalafil responders and DOEE ≥ 4.125 min of AVSS in cured patients.

Standardization of penile hemodynamic evaluation through color duplex-doppler ultrasound.

The vascular evaluation of the erectile function through Color Duplex-Doppler Ultrasound (CDDU) of the penis can benefit the therapeutic decision-making process. Unfortunately, there is no standard procedure for CDDU conduction, a fact that results in high result-interpretation variability. The aims of this review are to promote greater standardization during CDDU of the penis and discuss the fundamental principles for its accurate conduction. CDDU is initially conducted with the penis in the flaccid state; the whole penis must be assessed (images at B mode) with a high-frequency linear transducer (7.5-18 MHz). Intracavernous injection of vasodilating agents (prostaglandin E1, papaverine, phentolamine) is performed to induce a rigid erection. Serial measurements at different times should be taken during the CDDU session and penile rigidity must be assessed in each evaluation. It is important to monitor the erection response after the vasoactive agent (hardness scale), and scanning during the best-quality erection should be contemplated. Manual self-stimulation, audiovisual sexual stimulation (AVSS), and vasoactive agent re-dosing protocols must be taken into account to reduce the influence of psychogenic factors and to help the patient to get the hardest erection possible. Such measurements contribute to the maximal relaxation of the erectile tissue, so the hemodynamic parameters are not underestimated. CDDU is a relevant specialized tool to assess patients with erectile dysfunction; therefore, this guideline will help to standardize and establish uniformity in its conduction and interpretation, taking into consideration the complexity and heterogeneity of CDDU evaluations of the penis.

Audiovisual Sexual Stimulation Improves Diagnostic Accuracy of Penile Doppler Ultrasound in Patients With Erectile Dysfunction

IntroductionAlthough penile Doppler ultrasound (PDU) is a useful tool in evaluating erectile dysfunction (ED), an optimal erectile response might be limited because of an increased sympathetic discharge. Audiovisual sexual stimulation (AVSS) has been suggested to help improving PDU performance. AimTo evaluate the use of AVSS as a tool to improve diagnostic accuracy of PDU studies. MethodsA total of 40 men (mean age: 61.8 ± 10.2 years) with ED were enrolled. PDU sessions were performed in a randomized fashion as follows: session A under intracavernous injection (ICI) alone and session B under ICI and AVSS with 7-day interval between sessions. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were measured 5, 10, 15, and 20 minutes after ICI. Main Outcome MeasureComparisons between PSV, EDV, and RI values were performed with and without AVSS. Univariable and multivariable analyses including clinical and demographic parameters were performed to evaluate predictors of an abnormal PDU. Results23 patients performed the first session without AVSS, and 17 performed the first session with AVSS. EDV and RI were better in AVSS session (p = 0.022 and 0.019). PSV was not influenced by AVSS (p = 0.768). The proportion of patients whose diagnosis was changed because of the AVSS was 4 of 40 (10.0%, 95% confidence interval [CI]: 2.8–23.7%). Of 12 patients with venous leak observed on the PDU without AVSS, 3 turned into normal after AVSS (25.0%, 95% CI: 5.5–57.2%). Of 4 men with arterial insufficiency observed on the PDU on ICI alone, 1 became normal after AVSS (25.0%, 95% CI: 0.6–80.6%). International Index of Erectile Function-5 scores were lower in patients with abnormal PDU (6.3 ± 3.3 vs 12.0 ± 5.8, p=0.003). On multivariable analysis, DM and International Index of Erectile Function-5 scores were the only independent predictors of abnormal PDU studies. Clinical ImplicationsFalse diagnoses of venous leak during PDU with ICI could be a result of an increased adrenergic discharge during the examination. Routine AVSS may be helpful to avoid error in diagnosis. Strength & LimitationsThe study has randomized the use of AVSS in different session orders. Only one previously published study has used this strategy to control the accommodation effect in repeat studies, a common source of bias in the PDU literature. The main limitation is the absence of a rigidity assessment and a redosing protocol. ConclusionAdding AVSS during PDU improves ICI response and may help clinicians evaluate penile hemodynamics more accurately.Carneiro F, Nascimento B, Miranda EP, et al. Audiovisual Sexual Stimulation Improves Diagnostic Accuracy of Penile Doppler Ultrasound in Patients With Erectile Dysfunction. J Sex Med 2020;17:249–256.

146 Effects of Depression Status on Penile Hemodynamics in Men with Erectile Dysfunction

Depression is an important psychological factor that is associated with erectile dysfunction (ED). However, to date, few studies have been conducted on the organic pathologic changes caused by depression. This study aims to investigate the effects of depression on penile hemodynamics in Chinese men with ED. Male subjects aged 20-50 years with ED complaint were screened by a detailed questionnaire that allowed analyses of their sexual experience and history. Men with acute and/or chronic disease (including diagnosed hypertension and diabetes) and those receiving long-term pharmacotherapy were excluded. Evaluation of ED was conducted by the International Index of Erectile Function-5 (IIEF-5). Detection of penile hemodynamic was based on oral PDE-5 inhibitor usage combined with audiovisual sexual stimulation. A self-rating depression scale (SDS) was used to evaluate the depression status; and the depression score index (DSI) was calculated as total SDS scores divided by 80. Depression status and non-depression status were defined as DSI ≥0.5 and DSI <0.5, respectively. Biochemical indicators related to metabolism (including fasting blood glucose, insulin, cholesterol and triglyceride) and sex hormones were detected. Comparison analyses on the data between depression and non-depression groups were conducted.

292 The effect of real-time erectile rigidity tested by Rigiscan on diagnosis of erectile dysfunction

Penile color duplex ultrasonography (CDU) is believed as an effective measure for penile artery and venous function and a common objective test for etiological diagnosis of erectile dysfunction(ED). But it is an invasive test and some patients are unwilling to undergo this test. This study aimed to investigate if real-time rigidity test by Rigiscan could predict the CDU results. 306 patients suspected ED were included in this study from 2014 to 2016. All patients were performed real-time rigidity test by Rigiscan after taking sildenafil 100mg one hour and receiving audiovisual sexual stimulation (AVS). All patients were performed CUD in another day after intracavernous injection of Alprostadil 10mg 15 minutes. The median age was 29 years old. The median course of ED was 1.5 (range from 0.5 to 4) years. The mean IIEF-5 score was 6.25. The median maximal rigidity tested by AVS-Rigiscan was 30% (0-40%) at the tip and 35% (0-50%) at the base. The median duration was 6 (1-18) minutes. The vascular function tested by CDU was normal in 137 patients and abnormal in 169 patients. There was no statistical correlation between CDU results and age (p=0.869), duration of disease (p=0.596) and IIEF-5 score (p=0.450). As for the relationship with AVS results, although not related to erectile duration (p=0.180), significant higher maximal rigidity was noted both at tip (p=0.035) and at base (p=0.019) in patients with normal CDU results. The ROC curves indicating the relationship between CDU results and the maximal rigidity were made with an AUC of 0.575 for tip and 0.571 for base. A maximal Youden’s index was found when maximal rigidity was over 37.5% at tip and 30.5% at base. A combined ROC curved was generated and the highest Youden’s index was achieved when a cut-off was set at rigidity over 37.5% at tip and 30.5% at base, with satisfied sensitivity and negative predictive value.

Audiovisual Sexual Stimulation and RigiScan Test for the Diagnosis of Erectile Dysfunction.

Background:Currently available evaluation criteria for penile tumescence and rigidity have been fraught with controversy. In this study, we sought to establish normative Chinese evaluation criteria for penile tumescence and rigidity by utilizing audiovisual sexual stimulation and RigiScan™ test (AVSS-Rigiscan test) with the administration of phosphodiesterase-5 inhibitor.Methods:A total of 1169 patients (aged 18–67 years) complained of erectile dysfunction (ED) underwent AVSS-RigiScan test with the administration of phosphodiesterase-5 inhibitor. A total of 1078 patients whose final etiological diagnosis was accurate by means of history, endocrine, vascular, and neurological diagnosis, International Index of Erectile Function 5 questionnaire, and erection hardness score were included in the research. Logistic regression model and receiver operating characteristic curve analysis were performed to determine the cutoff value of the RigiScan™ data. Then, the multivariable logistic analysis was used in the selected variables.Results:A normal result is defined as one erection with basal rigidity over 60% sustained for at least 8.75 min, average event rigidity of tip at least 43.5% and base at least 50.5%, average maximum rigidity of tip at least 62.5% and base at least 67.5%, △tumescence (increase of tumescence or maximum−minimum tumescence) of tip at least 1.75 cm and base at least 1.95 cm, total tumescence time at least 29.75 min, and times of total tumescence at least once. Most importantly, basal rigidity over 60% sustained for at least 8.75 min, average event rigidity of tip at least 43.5%, and base at least 50.5% would be the new normative Chinese evaluation criteria for penile tumescence and rigidity. By multivariable logistic regression analysis, six significant RigiScan™ parameters including times of total tumescence, duration of erectile episodes over 60%, average event rigidity of tip, △tumescence of tip, average event rigidity of base, and △tumescence of base contribute to the risk model of ED. In logistic regression equation, predict value P < 0.303 was considered as psychogenic ED. The sensitivity and specificity of the AVSS-RigiScan test with the administration of phosphodiesterase-5 inhibitor in discriminating psychogenic from organic ED was 87.7% and 93.4%, respectively.Conclusions:This study suggests that AVSS-RigiScan test with oral phosphodiesterase-5 inhibitors can objectively assess penile tumescence and rigidity and seems to be a better modality in differentiating psychogenic from organic ED. However, due to the limited sample size, bias cannot be totally excluded.

Subjective sleep quality, unstimulated sexual arousal, and sexual frequency.

IntroductionREM sleep deprivation increases unstimulated erections in rats, and total sleep deprivation increases erections during audiovisual sexual stimulation in men, but the effects of sleep problems on human unstimulated sexual arousal are unknown.ObjectiveWe examined the associations of subjective sleep quality with unstimulated sexual arousal, satisfaction with sex life, and sexual frequency and desire over the past month.Methods275 Portuguese (169 women) reported their anxiety, sexual arousal and sexual desire during a resting state, and completed the Pittsburgh Sleep Quality Index, the sexual satisfaction subscale of the LiSat scale, the Desire dimensions of the Female Sexual Function Index (women only) and International Index of Erectile Function (men only). They additionally reported how many days in the past month they engaged in penile-vaginal intercourse, noncoital sex, and masturbation. Salivary testosterone (T) was assayed by luminescence immunoassays.ResultsPoorer sleep quality correlated with greater unstimulated sexual arousal in men with higher T levels and in women with higher T levels not taking oral contraceptives. In women with lower T, poorer subjective sleep quality correlated with greater sexual dissatisfaction. In both sexes, sleep quality was uncorrelated with sexual desire and sexual frequency over the past month.DiscussionConsistently with other studies in humans and animals, the findings are congruent with the notion that lack of sleep can increase sexual arousal, but not sexual frequency. T might play a role in the sexual arousal caused by lack of appropriate sleep.

Glans-reconstruction with preputial flap is superior to primary closure for post-surgical restoration of male sexual function in glans-preserving surgery.

We conducted this study to investigate whether glans-reconstruction with preputial flap would be more helpful for post-operative restoration of patients' sexual potency than primary closure. From 2007 to 2013 at four centres, 46 cases reconstructed with preputial flap and 59 with primary closure were selected for the investigation from 142 consecutive cases of superficial glans cancer, with the largest diameter of lesion ≤2.5 cm, who undergoing glans-preserving surgery (GPS). Subjective evaluation for patients' sexual performance was investigated using the International Index of Erectile Function-15. Objective evaluation was carried out by the Audio Visual Sexual Stimulation test with RigiScan-Plus. The degree of satisfaction for penile appearance and patients' confidence and partners' acceptability for intercourse were evaluated by 5-point scales. Patients with preputial flap reconstruction showed significant better performance in three domains (orgasmic function, intercourse satisfaction and overall satisfaction, all p < 0.05) and significantly higher ratios of appearance satisfaction (78.3% vs. 57.6%, p = 0.026) and intercourse confidence (69.6% vs. 49.2%, p = 0.035) compared with those undergoing primary closure at post-operative month 6 ends. Their sexual partners in the preputial flap group also exhibited significantly higher ratios of appearance satisfaction than in the primary closure group (67.4% vs. 42.4%, p = 0.011). Reconstruction with preputial flap contributes to a more acceptable cosmetic appearance of the penis and minimizes post-operative negative psychological impediments. Patients can benefit more from reconstruction with preputial flap than primary closure. Glans-reconstruction with preputial flap should be considered the primary reconstruction technique in GPS.

Glans Preservation Contributes to Postoperative Restoration of Male Sexual Function: A Multicenter Clinical Study of Glans Preserving Surgery

We evaluated whether glans preserving surgery would be more helpful for patients to regain satisfactory sexual competency postoperatively than conventional partial amputation. From 2004 to 2012 at 4 centers a total of 135 men treated with glans preserving surgery and 36 treated with partial amputation were selected for evaluation from a total of 273 consecutive patients with penile cancer. Subjective evaluation for patient sexual performance was investigated using the IIEF-15. Objective evaluation was done using the audiovisual sexual stimulation test with the RigiScan® Plus. The degree of satisfaction with penile appearance, and patient confidence and partner acceptability for intercourse were evaluated by 5-point scales. Patients treated with glans preserving surgery had better performance in 4 IIEF-15 domains (erectile function, orgasmic function, intercourse satisfaction and overall satisfaction) and 1 RigiScan parameter (tip rigidity) (each p<0.01). They also had significantly higher appearance satisfaction (64.4% vs 13.9%) and intercourse confidence (55.6% vs 5.6%) than men who underwent partial amputation. Sexual partners in the glans preserving group also showed significantly higher appearance satisfaction (51.1% vs 5.6%) and intercourse acceptability (37.8% vs 16.7%) than in the partial amputation group. Glans preserving surgery effectively preserves the functional anatomy and cosmetic appearance of the glans penis. Glans preservation contributes to minimizing postoperative erectile dysfunction and negative psychological impediments, and promotes return to satisfactory sexual performance. Patients treated with glans preservation have more advantages in obtaining sexual acceptance from their partners than those who undergo amputation.

The Use of Intracavernous Injection and Audiovisual Sexual Stimulation during Real-Time Pharmacopenile Doppler Ultrasonography in Vasculogenic Erectile Dysfunction

Introduction: The objective of this study was to explore the role of intracavernous injection (ICI) and audiovisual sexual stimulation (AVSS) during real-time pharmacopenile Doppler ultrasonography (PDDU) in vasculogenic subtypes of erectile dysfunction. Materials and Methods: A total of 200 consecutive men with erectile dysfunction (ED) were enrolled. Each patient received 2 sessions of real-time PDDU. Session A was performed under ICI alone. Session B was performed under ICI plus AVSS. The interval between sessions was 7 days. Penile vascular parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index, were monitored 5, 10 and 20 min after the start of the test. Patients were asked to describe the level of sexual arousal generated by choosing one of the pre-set answers. Results: In veno-occlusive ED, during session A, EDV at 10 min was significantly greater than at 5 and 20 min (p < 0.05). During session B, there was a significant difference regarding PSV in arteriogenic ED (p < 0.05). Mixed vasculogenic ED showed significant differences in PSV levels during session B, and EDV at 5 min was greater than at 10 and 20 min (p < 0.05). PDDU under ICI alone diagnosed 34 (17%), 35 (17.5%), 31 (15.5%) and 100 (50%) cases of arteriogenic, veno-occlusive, mixed vasculogenic and nonvasculogenic ED, respectively. The combination of ICI plus AVSS diagnosed 27 (13.5%), 44 (22%), 7 (3.5%) and 122 (60.7%) cases, respectively. Conclusions: Adding AVSS during PDDU improves the recording of physiologic erectile response and may help the physician to accurately evaluate the cause of ED.

1232 A REAL-TIME MOTION ANALYSIS OF HUMAN EJACULATION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation (I)1 Apr 20131232 A REAL-TIME MOTION ANALYSIS OF HUMAN EJACULATION Jintetsu Soh, Noriyuki Kanemitsu, Yoshio Naya, Yasuyuki Naitoh, Atsushi Ochiai, kazumi Kamoi, Akihiro Kawauchi, and Tsuneharu Miki Jintetsu SohJintetsu Soh Kyoto, Japan More articles by this author , Noriyuki KanemitsuNoriyuki Kanemitsu Kyoto, Japan More articles by this author , Yoshio NayaYoshio Naya Kyoto, Japan More articles by this author , Yasuyuki NaitohYasuyuki Naitoh Kyoto, Japan More articles by this author , Atsushi OchiaiAtsushi Ochiai Kyoto, Japan More articles by this author , kazumi Kamoikazumi Kamoi Kyoto, Japan More articles by this author , Akihiro KawauchiAkihiro Kawauchi Kyoto, Japan More articles by this author , and Tsuneharu MikiTsuneharu Miki Kyoto, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2586AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There have been no reports of real-time image analysis of human ejaculation. Using Turbo-FLASH MRI, we were able to obtain a series of high resolution images through human ejaculation. The aim of this study was to analyze the dynamic morphological changes in the prostate and seminal vesicle during a normal ejaculation. METHODS The participants in this study included 5 healthy volunteers without experience of erctile dysfunction and ejaculation disorder. Ages ranged from 20 to 33 (median 25) years. IIEF-5 score ranged from 23 to 25 (median 24) points. Audio-visual sexual stimulation was used to induce erection and ejaculation. MRI was conducted using Siemens MAGNETOM Sonata 1.5T with body array and spine coils. True-FISP sequence was used with conditions of TR: 4.38 ms, TE: 2.19 ms, and scan time: 0.85 sec/slice. Using dynamic images, the length and width of the prostate plus seminal vesicle were consecutively calculated in sagittal section during all phases of a normal ejaculation. Morphological changes were evaluated with the changes in length and width of the prostate plus seminal vesicle. RESULTS The mean length of the prostate plus seminal vesicle were 6.85 to 1.2 cm and the mean width were 2.67 to 0.6 cm in sagittal section. The length changed from 6.21 to 7.69 cm and the width changed from 2.6 to 3.28 cm in sagittal section. The width changed from 2.6 to 3.28 cm and the width changed from 2.6 to 3.28 cm in sagittal section. Increasing rate of the length was 24 % and increasing rate of the width was 26 % in sagittal section during all phases of a normal ejaculation. CONCLUSIONS By using Turbo-FLASH MRI, dynamic phases of a normal ejaculation can be analyzed calculating the changes in length and width of the prostate plus seminal vesicle. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e505 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jintetsu Soh Kyoto, Japan More articles by this author Noriyuki Kanemitsu Kyoto, Japan More articles by this author Yoshio Naya Kyoto, Japan More articles by this author Yasuyuki Naitoh Kyoto, Japan More articles by this author Atsushi Ochiai Kyoto, Japan More articles by this author kazumi Kamoi Kyoto, Japan More articles by this author Akihiro Kawauchi Kyoto, Japan More articles by this author Tsuneharu Miki Kyoto, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Gender difference in brain activation to audio-visual sexual stimulation; do women and men experience the same level of arousal in response to the same video clip?

Factors related to sexual arousal are different in men and women. The conditions for women to become aroused are more complex. However, the conventional audio-visual stimulation (AVS) materials used to evaluate sexual arousal are universal. In the present study, we investigated sexual differences in the response to different types of AVS by studying activated areas of the brain using functional magnetic resonance imaging (fMRI). fMRI was performed during two types of AVS in 20 healthy heterosexual volunteers (aged 20-28 years, 10 men and 10 women). The two AVS types were: (1) mood type, erotic video clips with a concrete story and (2) physical type, directly exposing sexual intercourse and genitalia. fMRI images were analyzed and compared for each stimulation with a Mann-Whitney U test, with statistical significance set at P<0.05. Men preferred the physical type of AVS to the mood type (mean arousal score 2.14 vs 1.86 in females) and women preferred the mood type (mean arousal score 2.14 vs 1.86 in males) (P<0.05). Degrees of activation in brain areas differed between genders and types of AVS for each gender. This should be considered when applying the AVS method to evaluate and diagnose female sexual dysfunction.

Standardization of Vascular Assessment of Erectile Dysfunction

ABSTRACT Introduction In-office evaluation of erectile dysfunction by color duplex Doppler ultrasound (CDDU) may benefit the decision-making process in regard to choosing the most appropriate therapy. Unfortunately, there is no uniform standardization in performing CDDU resulting in high variability in data expression and interpretation when comparing results among various centers, especially when conducting multicenter trials. Establishing standard operating procedures (SOPs) is a major step that will help minimize such variability. Aim This SOP describes CDDU procedure with focus on establishing uniformity and normative parameters. Main Outcome Measure Measure intra-arterial diameter, peak systolic velocity, end-diastolic velocity, and resistive index for each cavernosal artery. Methods After initial discussion with the patient about his history and International Index of Erectile Function evaluation describe procedural steps to the patient. Perform the CDDU in a relaxed state, scanning the entire penis (in B-mode image) using a 7.5- to 12-MHz linear array ultrasound probe. An intracorporal injection of a single or combination of vasoactive agents (e.g., prostaglandin E1, phentolamine, and papaverine) is then administered and CDDU performed at various time points, preferably with audiovisual sexual stimulation (AVSS). Results Monitor penile erection response (tumescence and rigidity) near peak blood flow. Self-stimulation or AVSS leaving the patient alone in room or redosing may be considered to decrease any anxiety and help achieve a maximum rigid erection. Conclusion Considering the complexity and heterogeneity of CDDU evaluation, this communication will help in standardization and establish uniformity in such data interpretation. When indicated, invasive diagnostic testing involving (i) penile angiography and (ii) cavernosography/cavernosometry to establish veno-occlusive dysfunction may be recommended to facilitate further treatment options.

Influence of Sildenafil on Genital Engorgement in Women with Female Sexual Arousal Disorder

We previously described dynamic, noncontrast magnetic resonance imaging (MRI) of the female genitalia as a reproducible, nonintrusive, objective means of quantifying sexual arousal response in women without sexual difficulties. These studies showed an increase in clitoral engorgement ranging from 50 to 300% in healthy women during sexual arousal. This study sought to evaluate the genital arousal response in women with female sexual arousal disorder (FSAD) after administration of sildenafil and placebo. We performed a multicenter, double-blind, placebo-controlled, cross-over study to assess the clitoral engorgement response using dynamic MRI in women with FSAD after administering sildenafil and placebo followed by audiovisual sexual stimulation (AVSS). Nineteen premenopausal women with FSAD underwent two MRI sessions. Subjects were randomized to receive either (i) sildenafil 100 mg during the first session followed by placebo during the second session, or (ii) placebo followed by sildenafil. During each session, baseline MR images were obtained while subjects viewed a neutral video. Subjects then ingested sildenafil or placebo. After 30 minutes, a series of MRIs were obtained at 3-minute intervals for 10 time points while subjects viewed AVSS. A positive sexual arousal response was achieved if clitoral volume increased ≥50% from baseline. Thirteen of 19 (68%) subjects achieved a ≥50% increase in clitoral engorgement from baseline when administered sildenafil or placebo 30 minutes after dose administration. At 60 minutes after administration, 17/19 (89%) subjects receiving sildenafil and 16/19 (84%) subjects receiving placebo had responded (P value 0.3173). Sildenafil did not augment the genital response in women with FSAD. Secondarily, a majority of women in this study did not have impaired clitoral engorgement as measured by MRI, suggesting that FSAD is not predominantly a disorder of genital engorgement.

1143 A REAL-TIME MOTION ANALYSIS OF PENILE ERECTION WITH TURBO-FLASH MR IMAGING SYSTEM

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation I1 Apr 20121143 A REAL-TIME MOTION ANALYSIS OF PENILE ERECTION WITH TURBO-FLASH MR IMAGING SYSTEM Jintetsu Soh, Noriyuki Kanemitsu, Atsushi Ochiai, Yasuyuki Naitoh, Yoshio Naya, kazumi Kamoi, Akihiro Kawauchi, and Tsuneharu Miki Jintetsu SohJintetsu Soh Kyoto, Japan More articles by this author , Noriyuki KanemitsuNoriyuki Kanemitsu Kyoto, Japan More articles by this author , Atsushi OchiaiAtsushi Ochiai Kyoto, Japan More articles by this author , Yasuyuki NaitohYasuyuki Naitoh Kyoto, Japan More articles by this author , Yoshio NayaYoshio Naya Kyoto, Japan More articles by this author , kazumi Kamoikazumi Kamoi Kyoto, Japan More articles by this author , Akihiro KawauchiAkihiro Kawauchi Kyoto, Japan More articles by this author , and Tsuneharu MikiTsuneharu Miki Kyoto, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1253AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There have been no reports of real-time image analysis in the corpus cavernosum from the initiation to the end of erection without artificial induction. Using Turbo-FLASH MRI, we were able to obtain a series of high resolution images through tumescence, maintenance and detumescence phases of erection. The aim of this study was to analyze the dynamic morphological changes in the penis during a normal erection. METHODS The participants in this study included 5 healthy volunteers without experience of erectile dysfunction. Ages ranged from 22 to 47 (median 33) years. IIEF-5 score ranged from 22 to 25 (median 23) points. Audio-visual sexual stimulation was used to induce erection. MRI was conducted using Siemens MAGNETOM Sonata 1.5T with body array and spine coils. True-FISP sequence was used with conditions of TR: 4.38 ms, TE: 2.19 ms, and scan time: 0.85 sec/slice. Using dynamic images, the volume of the corpus cavernosum within the tunica albuginea were consecutively calculated by measuring length, width, and thickness in sagittal and coronal section during all phases of a normal erection (Figure 1). Morphological changes were evaluated with indices including the maximum changes in the volume between latent and full erection phases of the corpus cavernosum as well as the consecutive volume increase rate per second. RESULTS From initiation to completion of erection, range of time required from 110 to 120 (median 115) seconds, changes in volume of corpus cavernosum ranged from 28 to 35 (median 32) ml. Maximum volume increase rate ranged from0.5 to 0.8 (median 0.66) ml/sec (Figure 2). CONCLUSIONS By using Turbo-FLASH MRI, dynamic phases of a normal erection can be analyzed calculating the maximum changes in volume of corpus cavernosum as well as volume increase rate per second. Further study is warranted to prove these novel parameters as a measurement of vascular function. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e463-e464 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jintetsu Soh Kyoto, Japan More articles by this author Noriyuki Kanemitsu Kyoto, Japan More articles by this author Atsushi Ochiai Kyoto, Japan More articles by this author Yasuyuki Naitoh Kyoto, Japan More articles by this author Yoshio Naya Kyoto, Japan More articles by this author kazumi Kamoi Kyoto, Japan More articles by this author Akihiro Kawauchi Kyoto, Japan More articles by this author Tsuneharu Miki Kyoto, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Feasability of a Novel Audio-Video Sexual Stimulation System: An Adjunct to the Use of Penile Duplex Doppler Ultrasonography for the Investigation of Erectile Dysfunction

Penile color Doppler ultrasonography (CDUS) with pharmacotesting has become an important tool for evaluating vascular erectile dysfunction (ED), and audio-visual sexual stimulation (AVSS) has been suggested to be helpful in assisting the performance of CDUS during the examination. To investigate the feasibility of using a novel, remotely controllable AVSS system to assist CDUS. This prospective randomized cross-over study recruited 60 consecutive ED patients. Each patient received three randomized sessions of CDUS under different conditions-AVSS, intracavernous injection (ICI) of alprostadil 20 microgram, or AVSS plus ICI. Clinical responses (rigidity) and penile vascular parameters including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured. At the end of the study, patients were asked about how they perceived the AVSS system in generating sexual arousal. PSV, EDV, RI, and rigidity. Fifty-eight ED patients (aged 21-79) underwent 174 sessions of CDUS. The mean PSV and maximal rigidity of patients under ICI alone were significantly greater than those of patients under AVSS alone (48.25 ± 22.78 vs. 36.54 ± 23.25 cm/second and 65.00 ± 23.93% vs. 43.28 ± 31.79%, respectively; both P < 0.05). The mean PSV of patients under AVSS plus ICI (55.38 ± 28.81 cm/second) was significantly greater than that of patients under ICI alone (P < 0.05), while the mean maximal rigidity (72.50 ± 22.03%) was only marginally greater (P = 0.082). EDV or RI was of no significant difference among the different conditions. Ultrasonographic diagnoses of ED under different conditions varied substantially. Fifty-four (93%) patients considered the AVSS system "very satisfactory" or "satisfactory" in evoking sexual arousal. The novel, remotely controllable AVSS system is well accepted by patients and, in conjunction with ICI, helps to produce higher PSV for patients undergoing CDUS.

The effects of three phosphodiesterase type 5 inhibitors on ejaculation latency time in lifelong premature ejaculators: a double‐blind laboratory setting study

Study Type--Therapy (RCT) Level of Evidence 1b. What's known on the subject? and What does the study add? Several authors have reported their experience with PDE5 inhibitors alone or in combination with selective serotonin re-uptake inhibitors for treating premature ejaculation. However, to our knowledge, this is the first laboratory design study to evaluate the effects of three PDE5 inhibitors throughout the ejaculation process in men with lifelong premature ejaculation. In this laboratory setting study PDE5 inhibitors seem to prolong ELT but the difference from placebo is significant only in vardenafil. The quality of penile rigidity is better with PDE5 inhibitors in the post-ejaculatory period but the difference is significant only in sildenafil and vardenafil. • To evaluate the effects of three phosphodiesterase type 5 (PDE5) inhibitors on the ejaculation process in men with lifelong premature ejaculation using a double-blind laboratory setting. • Eighty men with lifelong premature ejaculation, 20 in each group, received placebo, vardenafil (10 mg), sildenafil (50 mg) or tadalafil (20 mg) in a double-blind study design. Placebo or PDE5 inhibitor was ingested after at least 2 h fasting and non-smoking. The subjects were placed in a silent room immediately and real-time penile rigidity and tumescence was monitored. • Subjects read some magazines or newspapers without any sexually stimulating material for 1.5 h. At the end of this period audiovisual sexual stimulation began with a video film and after the 8th minute the subject began vibratory stimulation to the frenular area. • At the beginning of ejaculation the patient stopped stimulation. When the patient began and stopped stimulation, the light near the observer turned on and off and the observer calculated the ejaculation period with a chronometer. The elapsed time was the ejaculation latency time (ELT) in seconds. • There was no interaction between subjects and observer during the test. The ELT, and the qualities of base and tip rigidities during ELT and after ejaculation were calculated. • Median age of patients was 29 (range 22-39) years and median duration of premature ejaculation was 60 (range 7-180) months and there was no significant difference between groups. Median duration of vibratory stimulation (ELT) of subjects who received placebo was 48.5 s: 53.5 s for sildenafil, 70.0 s for tadalafil and 82.5 s for vardenafil. Compared with the placebo group, ELT was significantly longer only in subjects receiving vardenafil (P = 0.019). • In the post-ejaculatory refractory period, times to last recorded base rigidities were significantly longer than placebo in vardenafil and sildenafil groups with better erection quality (P < 0.01 for each). • The PDE5 inhibitors seem to prolong ELT and the quality of penile rigidity is better with PDE5 inhibitors in post-ejaculatory period. • These findings suggest that PDE5 inhibitors might have some beneficial effects in men with lifelong premature ejaculation.