Early Morning Erections Research Articles

Use of a Lab-Ordering Pathway to Improve Adherence to Endocrine Society (ES) Guidelines for Early AM Timing and Testosterone Assay Method for Establishing Testosterone Deficiency

Introduction: Primary care providers (PCPs) prescribe the bulk of testosterone replacement therapy (TRT) at our institution, but our data show they are less likely than endocrinologists (ENDOs) to follow ES Guidelines for diagnosis of hypogonadism, based on two unequivocally low early AM [T] levels by tandem mass spectrometry (LC/MS/MS, PCP:213/783[27%]; ENDO:104/164[63%];p<0.0001). Methods: A lab ordering pathway was promulgated to direct PCPs to order 8AM T based on whether it was for monitoring therapy or diagnosing hypogonadism. The former leads to an order for Total T by electrochemiluminescence immunoassay (ECLIA), whereas the latter presents a choice between “Initial (diagnostic)” T or “Confirmatory” T. Ordering an initial diagnostic T requires a symptom to be chosen from a list of Low Libido, Loss of Early Morning Erections (EME), Fatigue, Erectile Dysfunction, or Other. Low libido or EME loss leads to an order for 8AM total T by LCMSMS, with a pop up reminder to instruct the patient to present at 8AM. Choosing any other symptom triggers a warning of non-specific symptoms, and an option to order 8AM total T by ECLIA, with the same pop up warning regarding timing. Ordering a confirmatory T requires a low initial 8AM T. Objective: To compare adherence by PCPs to ES guidelines based on timing and assay method for diagnosis of hypogonadism in the 6 months before (PRE) and 6 months after (POST) the date the pathway was promulgated. Results: There were 678 PRE and 884 POST lab orders for a diagnostic T for suspected hypogonadism. Although, adherence to 8AM timing was similar before and after promulgation (PRE 362/678[53.4%]; POST 452/884[51.1%]), there was a significant increase in the use of the accurate assay LC/MS/MS (PRE 39/678 [5.7%]; POST 105/884[11.9%];p<0.001). The 6.3% increase in LC/MS/MS use was reflected in a proportionate 7.3% reduction in ECLIA use (PRE 323/678 [47.6%]; POST (347/884 [39.3%]). Of note, all 105 patients in the POST cohort had a specific symptom (Loss of libido/EME) to justify the LC/MS/MS assay, whereas there was no such justification in the 39 in the PRE cohort. Conclusions: Promulgating a lab ordering pathway induced more appropriate use of LC/MS/MS in patients with specific symptoms associated with a high pre-test probability of hypogonadism. Although encouraging, it remains to be determined whether the more appropriate use of LC/MS/MS assays impacted testosterone prescribing practice. On the other hand, the lab ordering pathway did not improve adherence to early AM timing, despite the inclusion of pop up reminders to instruct patients to report early for blood draw. It is unclear whether that is attributable to PCPs not following through with the reminders, or to patients not following instruction due to ignorance, non-compliance, or practical problems, such as transportation and/or wait times at the lab. The lack of adherence to early AM timing has major implications for TRT.

P28 Marfan syndrome? Think again!

Abstract Background A 21 year old male was referred to the adult hypermobility clinic from the local rheumatologist with a suspected diagnosis of Marfan syndrome, based on his body habitus although he had presented to his GP with painful toes. Methods He had a background of autism,learning difficulties and was wearing glasses due to amblyopia. He had a history of dental crowding with two previous teeth extractions. There was no family history of note. On examination, his arm span was not greater than his height, there was no arachnodactyly, his palate was normal, but he had gum hypertrophy. His skin texture was normal, with no abnormal scarring or bruising, but there was presence of striae. His Beighton score was 4/9 and he had flat feet. There was reduced muscle mass and hypotonia, which was felt to be the cause of his hypermobility, rather than increased ligamentous laxity. There was evidence of gynaecomastia and lack of facial hair. The working diagnosis was Klinefelter syndrome due to his tall stature, gynaecomastia and absence of secondary male characteristics. Subsequently, the patient was referred to endocrinology and for genetic testing. Results The endocrinology team recognised the clinical features of male hypogonadism with small phallus (Tanner stage 2/3) and small testes, confirmed also by ultrasound. The patient reported absence of early morning erections. Blood tests confirmed hypergonadotropic hypogonadism (high luteinizing hormone, low testosterone) and the patient was commenced on testosterone therapy. His bone mineral density values lied within the expected range for age. Karyotype analysis confirmed the presence of 48,XXYY which is a chromosomal condition characterized by the presence of an extra X and Y chromosome in males. In terms of management, he attended our Outpatient Hypermobility Exercise Programme and was given advice on footwear. He was provided with extensive written information about this condition by the Rare Chromosome Disorder Support Group, Unique. Conclusion Our case report illustrates the importance of considering 48,XXYY syndrome in patients with typical body habitus and joint hypermobility. Marfanoid habitus is associated with connective tissue diseases, like hypermobile Ehlers-Danlos syndrome and Marfan syndrome, but also described in homocystinuria and Klinefelter syndrome. 48,XXYY was considered previously as a variant of Klinefelter syndrome, but now it is regarded as a separate syndrome with overlapping features with the Klinefelter syndrome. As in our case, the classical phenotypic characteristicsinclude gynaecomastia, small testes and tall stature. Most affected individuals are infertile. This syndrome is also associated with behavioural problems, learning difficulties, congenital heart defects, bone abnormalities, tremor, obesity, type 2 diabetes and/orrespiratory problems. Patients have an essentially normal life expectancy but require regular medical follow-up. Disclosures A. Madenidou None. V. Choida None. V. Reddy None. H. Kazkaz None.

Idiopathic hypogonadotropic hypogonadism reversal after testosterone replacement in a 34-year-old male

A 34-year-old male presented to the endocrinology clinic with the complaint of the absence of facial, axillary and pubic hairs. Further history revealed absent ejaculations and decreased early morning erections....

Surgical reimplantation of penile glans amputation in children during circumcision

Circumcision is one of the oldest and most commonly performed surgical procedures. Unfortunately, various complications may occur during circumcision, ranging from trivial to tragic such as penile amputation which is a serious complication and a challenging injury to treat. We describe two cases of non-microsurgical successful reattachment of a distal penile glans which were amputated during circumcision. In the first case, a 5-year-old child underwent circumcision by an urologist under local anesthesia. In the second one, a 3-year-old child underwent circumcision by a general practitioner who used to make circumcision. In this article, the literature is reviewed; results and potential complications of this surgery are also discussed. Glans sensation was present, early morning erection was maintained, and there was an erectile response during penile manipulation in both cases. Although circumcision is not technically difficult, it should be taken seriously. The use of microsurgical reattachment is not always possible, especially in pediatric cases; it also requires special equipment and training.

Effects of Low-Dose Tamsulosin on Sexual Function in Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

PurposeThe aim of the present study was to evaluate the effects of low-dose tamsulosin on sexual function in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia.Materials and MethodsA total of 138 male LUTS patients aged more than 50 years with an International Prostate Symptom Score (IPSS) ≥8 were enrolled in this open-label, multicenter, prospective, noncomparative observational study. Clinical assessments included IPSS, quality of life (QoL) index, International Index of Erectile Function (IIEF), Danish Prostate Symptom Score (DAN-PSS), and an early morning erection questionnaire. The data were recorded at baseline and at 1 and 3 months after treatment with tamsulosin 0.2 mg/d. Adverse events were analyzed in all patients.ResultsDuring the study period of 3 months, the IPSS and QoL index significantly improved from baseline by -11.40±9.40 and -1.11±1.36, respectively (p<0.001). However, there were no clinically relevant changes in total IIEF score (mean difference, 1.63±15.50; p=0.406) or the 5 subdomains (p>0.05). Furthermore, DAN-PSS weighted scores (A×B) showed no clinically relevant changes (mean difference on Q1, Q2, and Q3: -0.45±2.94, 0.27±2.50, and -1.27±2.27, p>0.05). In addition, there were no clinically significant changes in responses on the early morning erection questionnaire.ConclusionsTamsulosin at the dose of 0.2 mg significantly improved the IPSS and the QoL index compared with baseline. However, tamsulosin did not exhibit any significant impact on sexual function or any negative impact on ejaculatory function.

Erectile dysfunction: A review and herbs used for its treatment

Erectile dysfunction (ED) or male impotence is defined as the inability to have or sustain an erection long enough to have a meaningful sexual intercourse. ED tends to occur gradually until the night time or early morning erections cease altogether or are so flaccid that successful intercourse does not occur. Sexual health is an important determinant of quality of life. Today, millions of men, young and old, suffer from ED due to high levels of synthetic hormones (known as Xenoestrogens) in our diet/environment; nutritionally imbalanced diet resulting from poor quality of produces; and extremely low levels of testosterone. To overcome the problem of sexual (or) ED various natural aphrodisiac potentials are preferred. The present review discusses about aphrodisiac potential of plants, its biological source, common name, part used and references, which are helpful for researchers to develop new aphrodisiac formulations. Key words: Aphrodisiac, erectile dysfunction, Phosphodiesterease

Sexual behaviour in a centre for epilepsy

The sexual behaviour and hormonal profiles in 97 patients with chronic epilepsy from an epilepsy centre were studied. Sexual behaviour relating to numbers of sexual contacts, orgasms, spontaneous erections, and early morning erections, whether there was difficulty in obtaining or maintaining an erection, or in ejaculation, was assessed at interview. Hormonal profiles consisted of LH, FSH, prolactin, total testosterone, free testosterone, and SHBG. Information was obtained relating to type of seizure, seizure frequency, age of onset, likely pathology, IQ, and medication. The study showed that this patient group was profoundly hyposexual and had a high level of sexual dysfunction. Serum free testosterone levels were low, and it is suggested that the high level of sexual dysfunction and lack of sexual interest may well have a hormonal basis. The reasons for this are discussed.

Low Sex Hormone-Binding Globulin and Testosterone Levels in Association with Erectile Dysfunction among Human Immunodeficiency Virus-Infected Men Receiving Testosterone and Oxandrolone

Men with acquired immunodeficiency syndrome (AIDS) wasting and hypogonadism are frequently treated with testosterone and oxandrolone, an orally administered anabolic-androgenic steroid hormone. We observed reductions in testosterone and sex hormone-binding globulin (SHBG) levels, in association with complaints of erectile dysfunction, after prolonged exposure to this therapeutic regimen. First description of an association between long-term receipt of oxandrolone with erectile dysfunction, low SHBG and testosterone. Case report of three human immunodeficiency virus-infected hypogonadal male patients receiving treatment for wasting syndrome and hypogonadism, and highly active antiretroviral therapy. All three patients received long-term oxandrolone in addition to testosterone replacement therapy. Testosterone and SHBG levels for patients 1, 2, and 3, respectively: total testosterone 183, 71, and 151 ng/dL (260-1,000 ng/dL); free testosterone (not done for patient 3) 58.3 and 26.9 pg/mL (50-210 pg/mL); SHBG 6, 9, and 6 nmol/L (7-50 nmol/L). No other hormonal abnormalities were detected. Following discontinuation of oxandrolone, levels of total testosterone rose, consistent with increase in SHBG. One patient received repeat SHBG assay documenting rise in SHBG level. Patient 2 reported return of libido and early morning erections several weeks after discontinuation of oxandrolone. Patients had erectile dysfunction in association with low testosterone and SHBG, in spite of exogenous testosterone replacement. Discontinuation of oxandrolone led to the normalization or improvement of testosterone levels in all three patients with symptomatic improvement in one patient. First pass metabolism of orally administered oxandrolone may decrease hepatic synthesis of SHBG, allowing exogenously supplied testosterone to be excreted. Further work is necessary to elucidate the relationship.

Change of Sexual Function in Patients Before and After Ho:YAG Laser Enucleation of the Prostate

The aim of this study is to evaluate the effect of Ho:YAG laser enucleation of the prostate (HOLEP) to the sexual function of patients with benign prostatic hyperplasia (BPH). In the course of the study, 108 patients with BPH were recruited and accepted treatment with HOLEP. The effectiveness of treatment was evaluated by flow rate and the International Prostate Symptom Score (IPSS) before HOLEP and 6 months afterwards. Meanwhile, the sexual functions were evaluated with the Danish Prostate Symptom Score Sexual Function Questionnaire (DanPSS Sex). Before and 6 months after HOLEP treatment, the mean residual urine volume was reduced from 106.0 +/- 51.7 mL to 5.6 +/- 1.7 mL (P<.01), maximum flow rate was improved from 7.2 +/- 3.9 mL/s to 21.7 +/- 1.3 mL/s (P<.01), nocturia frequency was reduced from 5.5 to 1.5 (P<.01), and the mean IPSS score was decreased from 19.4 +/- 5.6 to 7.4 +/- 2.6 (P<.01). The proportion of patients satisfied with their libido was 55% before HOLEP and 57% 6 months afterwards, while 23.5% of the patients had no libido before and after HOLEP; 37% of the patients were satisfied with their erection before HOLEP and 40% after 6 months; 30% of the patients had completely satisfactory sex life before HOLEP, and 32% did 6 months later. The corresponding percentages of fully impotent patients increased from 33% before the procedure to 35% 6 months postoperation. Early morning erections were reported by 45% of the patients before the procedure and by 62% 6 months later (P<.01). In 70% of the patients with normal sex life, ejaculation was retrograde 6 months after HOLEP (P<.01). HOLEP does not affect the sexual function of patients with BPH but does did improve the ability of early morning erection, while causing retrograde ejaculation.

Treatment of “High-Flow” Priapism with Superselective Transcatheter Embolization: A Useful Alternative to Surgery

To review the efficacy of treatment of high-flow priapism with superselective transcatheter embolization. Over a 2-year period, we reviewed five patients who were treated for traumatic high-flow priapism with superselective embolization. All patients underwent diagnostic angiography that demonstrated a communication between the cavernosal artery and the corpora cavernosa. Each identified fistula was embolized using gel-foam, blood clot, microcoils, or a combination of these. All five patients had successful detumesence of priapism postprocedure. There was normal recurrence of early morning erection with successful detumescence for each patient within a 2- to 4-week period. Two of five patients (40%) presented with recurrence of priapism at 6 months and required a repeat embolization procedure. At 1 year, four of the five patients (80%) had normal erectile function. Superselective transcatheter embolization is a useful therapeutic modality in the treatment of high-flow priapism. It provides equivalent rates of detumesence when compared to surgical techniques, and appears to have a greater success in preserving erectile function.

Erectile dysfunction after fracture of the pelvis

Male sexual dysfunction after fracture of the pelvis is more common than previously supposed with rates as high as 30% reported when the complaint is specifically sought. With the increase in survival from major injuries, the long-term consequences of trauma are being seen with increasing frequency

Resistance to Luteinizing Hormone Releasing Hormone Agonist Therapy for Metastatic Prostate Cancer

A 49-year-old man with biopsy confirmed adenocarcinoma of the prostate presented with a serum prostate specific antigen (PSA) concentration of 79 ng./ml. (normal 0 to 4) and metastatic disease on bone scan. Therapy was initiated with a 7.5 mg. depot injection of leuprolide, which was preceded by 3 days of 50 mg. bicalutamide orally per day. One month after initiation of leuprolide therapy, the patient reported impotence and a decrease in obstructive urinary frequency. Serum PSA at that time was 6.3 ng./ml. Therapy was continued with a 30 mg. injection of leuprolide once every 4 months. After approximately 6 months of hormonal therapy, the patient reported that penile erections and obstructive urinary symptoms had started to recur, similar to the symptoms at initial presentation. Laboratory values at that time showed a serum testosterone of 68 ng./dl. (normal 300 to 1,100) and a PSA of 14.3 ng./ml. The patient was started on a regimen of 1, 10.8 mg. goserelin implant every 12 weeks. It is noteworthy that at that time he reported persistent redness and skin breakdown at the depot leuprolide injection site. Upon physical examination the buttock lesion was notable for redness and induration measuring 5.75 by 3 cm. Plastic surgery with a wide excision was used to debride a necrotic sterile abscess. Seven months after starting treatment PSA was 33.9 ng./ ml. and physical examination was notable for a large firm mass replacing the prostate. The area around the goserelin injection site was erythematous, and the patient complained of hot flashes and reported occasional early morning erections. Due to the clinical symptoms of ineffective testosterone ablation, serum total testosterone, follicle-stimulating hormone and luteinizing hormone concentrations were obtained, which were 433 ng./dl., 6.6 mIU/ml. (normal 1 to 12), and 4.1 mIU/ml. (normal 2 to 12), respectively. Due to ineffective chemical castration with both forms of LH-RH agonist therapy, bilateral orchiectomy was performed on September 24, 2001. Postoperatively the patient was asymptomatic and PSA decreased to 6.7 ng./ml. DISCUSSION

REIMPLANTATION OF AN AMPUTATED PENIS IN PREPUBERTAL BOYS

Case 1. A 7-year-old boy presented to the emergency room from elsewhere 1 hour after distal penile amputation, which had occurred accidentally during circumcision. The penis had been completely severed 5 mm. proximal to the corona, transecting the urethra and the corpora, and devascularizing the distal portion (fig. 1). The amputated part had been placed in sterile ice saline solution and it accompanied the patient. Using general anesthesia the proximal stump and amputated penis were irrigated with normal saline. Under operating microscopy the deep dorsal and cavernous arteries, veins and nerve fibers were not identifiable. A tourniquet was applied around the proximal stump to gain vascular control of the proximal cavernosum during the procedure. A 8Fr Foley catheter was inserted through the urethra of the amputated part and remaining proximal urethral stump, and passed on into the bladder (fig. 1). End-to-end urethral mucosa anastomosis was formed with 6-zero polyglactin interrupted sutures over the Foley catheter. The corpus spongiosum was then repaired using interrupted 6-zero polyglactin sutures. The tunica albuginea was closed with interrupted 5-zero polyglactin to restore corporeal continuity. The fascial layer and skin were then closed with a 6-zero polyglactin suture. A mild compressive gauze dressing was placed over the distal penis to control bleeding. Parenteral broad-spectrum antibiotics were administered for antimicrobial prophylaxis. Testosterone enanthate (25 mg.) was injected on day 1 after the operation. By the end of postoperative week 1 a thin eschar was forming around the meatus on the glans penis. The Foley catheter was removed at the end of postoperative week 3. The thin eschar around the meatus gradually peeled off, leaving appropriate glans tissue and a meatus with a good cosmetic appearance at week 4 (fig. 2). Two months postoperatively penile cosmesis was excellent, glans sensation was present, and early morning erection and erectile response to touch had been reestablished. Voiding was normal. Case 2. A 12-year-old boy presented 1 hour after accidental amputation of the distal glans penis during circumcision. The excised tissue included the whole glans penis and distal urethra. Amputation had occurred at the level of the coronal sulcus dorsolaterally and the urethra was transected just proximal to the meatus. A 8Fr Foley catheter was inserted into the bladder to stabilize the amputated penis. Under operating microscopy the urethra was anastomosed with interrupted 6-zero polyglactin sutures over the catheter. The edge of the amputated glans was closed over the reattached part of the proximal penile shaft skin and fascial layer with interrupted 6-zero polyglactin sutures. A mild compressive dressing was placed on the glans penis. Testosterone enanthate (50 mg.) was injected on day 1 after the operation. The Foley catheter was removed after 2 weeks. Eschar around the meatus remained until 7 weeks postoperatively. At 3 months there was mild meatal stenosis. Early morning erection was maintained and there was an erectile response during penile manipulation. Glans sensation was present but decreased.

Predictive value of patient history and correlation of nocturnal penile tumescence, colour duplex Doppler ultrasonography and dynamic cavernosometry and cavernosography in the evaluation of erectile dysfunction.

The results of history and physical examination, nocturnal penile tumescence testing (NPT), colour flow duplex Doppler ultrasonography and dynamic infusion cavernosometry and cavernosography (DICC) were retrospectively correlated in 207 patients with erectile dysfunction. The predictive value of the patient's own subjective assessment of early morning and nocturnal erections, history of cigarette smoking, the presence of vascular risk factors was correlated to the outcome of investigations. The result of Rigiscan NPT was correlated to the peak systolic velocity (PSV) and the resistance index (RI) determined at colour flow duplex Doppler ultrasonography, and the maintenance flow rate (Qm) determined at DICC. Eighty-five out of two hundred and seven patients (41%) had normal NPT comprising 48 out of 85 patients (56%) who described rigid early morning and nocturnal erections, 15 out of 85 patients (18%) who smoked cigarettes and 9 out of 85 patients (11%) with other positive vascular risk factors. 72 out of 85 patients (85%) had a normal PSV (>30 cm/s), 80 out of 85 patients (94%) had a normal RI (>0.85) and 82 out of 85 patients (96%) had a normal Qm), (<10 ml/min). Vascular investigations in this group identified 71 out of 85 patients (84%) with no penile vascular disease, 11 out of 85 patients (13%) with arteriogenic impotence, 2 out of 85 patients (2%) with mixed vasculogenic impotence and 1 out of 85 patients (1%) with cavernosal venous leakage (CVL). One hundred and twenty-two out of two hundred and seven patients (59%) had an abnormal NPT comprising 18 out of 122 patients (15%) who continued to experience rigid early morning erections, 65 out of 122 patients (53%) who smoked cigarettes, 59 out of 112 patients (48%) with other positive vascular risk factors, 36 out of 112 patients (29%) had an abnormal PSV (<30 cm/s), 49 out of 122 patients (40%) had an abnormal RI (<0.85) and 55 out of 122 patients (45%) had an abnormal Qm (>10 ml/min). Vascular investigations in this group identified five patients with no penile vascular disease, 51 out of 122 patients (41%) with arteriogenic impotence, 31 out of 122 patients (25%) with cavernosal venous leakage (CVL) and 35 out of 122 patients (29%) with mixed vasculogenic impotence. (1) a history of cigarette smoking and positive vascular risk factors are good predictors of organic impotence whereas the patient's subjective assessment of his own early morning erections is unreliable; (2) normal NPT correlates well with normal PSV, RI and Qm but does not exclude organic impotence; (3) abnormal NPT correlates well with abnormal PSV, RI and Qm.

Sexual function following radical radiotherapy for bladder cancer

Background and purpose: The effect of radical radiotherapy (RT) for bladder cancer on sexual function has not been previously investigated. The current study was designed as a pilot to assess sexual function in males pre- and post-radiotherapy. Materials and methods: An anonymous questionnaire was devised to examine the following sexual domains: libido, frequency of sexual function, erectile capacity, orgasm and ejaculation in the 6 months prior to radiotherapy and following treatment. Serum testosterone, FSH and LH were measured in 10 patients. Results: Eighteen patients completed the questionnaire from 10 to 56 months following irradiation, 13 of whom were able to achieve an erection prior to RT. Over half of these patients noted a decline in the quality of erections after RT, with a similar proportion noting decreased libido and frequency of sexual activity. Three patients lost the ability to have any erections whatsoever. Of the 10 patients retaining erectile capacity, three noted reduced frequency of early morning erections suggesting a physical aetiology, five had decreased frequency of ejaculation and four had reduced intensity of orgasms. Seventy-one percent (12/17) felt their sex life was worse following RT but only 56% (9/16) were concerned about the deterioration. Testosterone levels were normal in all but one patient. Conclusions: Radical RT to the bladder can cause a decrease in sexual function in males.

Sexual functions in patients with benign prostatic hyperplasia before and after transurethral resection of the prostate.

The purpose of this prospective study was to evaluate the sexual function of patients with benign prostatic hyperplasia (BPH) before and after transurethral resection of the prostate (TURP). The sexual functions of 155 patients with BPH were evaluated before TURP and 6 and 12 months afterwards. The mean age of the patients was 69 years (range 49-86 years). The only significant change in sexual function after TURP was improvement in early morning erections (P < 0.01). Sixty-eight per cent of the patients were satisfied with their sex life before TURP, 69% after 6 months and 67% after 12 months. The corresponding percentages of patients satisfied with their libido were 60%, 59% and 54%. Only 26% of the patients had completely satisfactory erections before TURP, while 22% had them 6 months later and 24% 12 months later. The proportion of fully impotent patients was 11% before the procedure, 13% after 6 months and 16% after 12 months. In 84% of the patients ejaculation was retrograde 6 months and 12 months after TURP. We conclude that TURP does not affect the sexual function of patients with BPH, with the exception of retrograde ejaculation.

A Double-Blind Placebo Controlled Trial of Medroxyprogesterone Acetate and Cyproterone Acetate with Seven Pedophiles

Seven of ten pedophiles in hospital completed a double-blind, placebo-controlled two-dose comparison of medroxyprogesterone acetate and cyproterone acetate. Sequential measures during the 28 week study were: patient self-reports, nurses' observations, phallometry, hormone levels and side-effects. The drugs, which performed equivalently, reduced sexual thoughts and fantasies, the frequency of early morning erections on awakening, the frequency and pleasure of masturbation, and level of sexual frustration. Penile responses were also reduced but to a lesser degree and were more variable. Serum testosterone FSH and LH all declined during drug administration, but by the end of the final placebo phase had essentially returned to (or exceeded) pre-drug values. Our experience suggests that only a minority of pedophiles are likely to accept libido-reducing drugs.

The Predictive Significance of Patient-Reported Sexual Functioning in Rigiscan Sleep Evaluations

We evaluated the relevance of patient reported sex history information in predicting erectile functioning as measured by the RigiScan† monitor. A total of 46 male veterans who presented with erectile dysfunction completed an extensive medical and psychological evaluation including a sexual history, and then underwent 2 consecutive nights of inhospital RigiScan sleep evaluation performed under supervision. Multivariate analyses indicated a significant relationship among patient reported sex history information, and RigiScan measurements of tip and base duration, and rigidity. The sex history item with the greatest predictive power was the question regarding early morning erections. The results of this study highlight the importance of patient reported information, and the significance of obtaining a detailed sex history in the evaluation of older, primarily chronically ill patients who present with erectile dysfunction.

Use of sexual history to differentiate organic from psychogenic impotence.

The use of sexual symptomatology to differentiate psychogenic from organogenic impotence was studied. All patients were independently classified based on the evaluation of a minimum of one night of nocturnal penile tumescence recording, a sleep lab technician's rating of penile turgidity of erections, Doppler determination of penile blood flow, determination of serum prolactin and testosterone levels. Three aspects of symptomatology significantly discriminated the criterion groups. The single best predictor was the presence or absence of early morning erections as reported by the patient.

Serum testosterone and prolactin levels in erectile dysfunction.

Serum testosterone and prolactin levels were determined in 52 impotent patients. Fifteen percent were found to have abnormally low testosterone levels. Low testosterone levels were related to clinical ratings of decreased libido and the absence of early morning erections. Suggestive relationships between testosterone levels and scales on the Derogatis Sexual Functioning Inventory were noted.