Loss Of Erection Research Articles

The impact of CAPD on sexual life of renal patients

Uremia and dialysis are notorious to have adverse effect on the sexual life of renal patients. To assess the magnitude of this impact in patients on continuous ambulatory peritoneal dialysis (CAPD), married couples with one of the partner on CAPD aged less than 50 years old were studied by questionnaires. Fifty-six questionnaires returned from 28 spouses. Out of 28 patients, 53.6% indicated a decrease in satisfaction to sexual life, 71.4% had decrease in libido and 78.6% had decrease in frequency of sexual intercourse upon commencement of CAPD. Out of 11 male patients, 10 had perceived deterioration in sexual potency, seven indicated a decrease in the ease of achieving orgasm and three had complete loss of morning erection. Up to 50% of patients attributed the decrease in their libido to the fear of pulling the peritoneal dialysis (PD) catheters. Of all couples, 21.4% and 14.3% agreed to the notion that normal sexual life jeopardizes the health of male and female CAPD patients respectively; 28.6% agreed that sexual life could accelerate the deterioration of residual renal function; 14.3% felt that having sex with renal patients would be deleterious to the health of spouse. Another 16.1% thought that patients on CAPD should not have sexual life while 30.4% believed that end-staged renal failure (ESRF) would inevitably lead to loss of sexual function. Couples with complete cessation of sexual activities after CAPD tend to agree with or being uncertain about the above-mentioned notions. In conclusion, we confirmed that CAPD patients were adversely affected in various aspects of their sexual life. Misconception concerning the negative impact of sexual activities on the health of renal patients is common. Education and counseling should have definite role in the removal of myths and improvement of sexual rehabilitation amongst patients on CAPD.

Treatment of Erectile Dysfunction by an External Ischiocavernous Muscle Stimulator

Objective: The aim of the present study was to evaluate the therapeutic potency of an electrotherapy of striated ischiocavernous muscles in patients with erectile dysfunction. Patients and Methods: Transcutaneous electrostimulation of striated ischiocavernous muscles by self-adhesive penile or perineal skin electrodes was performed in 48 patients with erectile dysfunction. 6/48 patients (R) responded to intracavernous pharmacotherapy while 42/48 (NR) did not show significant penile rigidity even to intracavernous papaverine/phentolamine/PGE₁ triple drug medication. Results: Within the observation time of 3 months, 10/48 patients dropped out. 22/38 patients reported a penile rigidity for sufficient sexual intercourse whereby 3/22 NR required additional intracavernous pharmacotherapy. Penile rigidity could be objectivated by triple drug medicaton in 12/14 NR after ischiocavernous muscle stimulation (EIS) therapy. 5/6 R were treated successfully for premature erection loss. During EIS treatment neither discomfort nor complications could be observed. Conclusion: Transcutaneous electrostimulation of ischiocavernous muscles is a new, noninvasive therapy for the improvement of penile rigidity. The clinical results underline the importance of the striated ischiocavernous muscles for penile rigidity.

Erectile dysfunction following Nd-YAG visual laser-assisted prostatectomy (VLAP)

We investigated if side fire Nd-YAG visual laser prostatectomy (VLAP) causes erectile dysfunction (ED) in patients who were sexually active prior to the procedure. The 36 study patients gave a detailed medical/sexual history: physical examination included bulbo-cavernous reflex (BCR) on rectal examination and routine blood tests. Lasing time, power of the applied laser beam (in watts), coagulation site and energy intensity were recorded. Patients with new onset ED during the one year study period underwent pudendal nerve conduction (PNC), color duplex Doppler ultrasonography, and NPT/RigiScan testing. In 6 out of 36 (16.7%) patients reporting significant post-operative ED, there was a tendency towards higher energy applied and longer lasing time but no correlation between prostate size or the site of energy application. Patients reported loss of night and/or morning erections (n = 5), retrograde ejaculations (n = 2), loss of ejaculate (n = 2), and decreased sensation of orgasm (n = 3). Three had abnormal PNC, duplex Doppler showed abnormal blood supply in four, and all six had abnormal NPT/RigiScan. We believe this is the first demonstration that VLAP may be associated with a high rate of ED and that the lasing time and intensity of applied laser energy may play a role in this outcome.

Sexual Dysfunction in Peyronie's Disease: An Analysis of 222 Patients Without Previous Local Plaque Therapy

We obtained an objective evaluation of erectile function in patients with Peyronie's disease. Sexual dysfunction was analyzed in 222 patients with Peyronie's disease without previous local plaque therapy using a standardized protocol. Of the 222 patients 70 (31.5%) complained of not being able to perform intercourse. In 4 men (1.8%) standardized diagnostic procedure demonstrated only a severe angulation making coitus impossible, and in 3 men (1.4%) intercourse became unsatisfactory due to pain. Seven men (3.1%) reported distal penile flaccidity, including 4 in whom dynamic pharmacocavernosometry and pharmacocavernosography revealed veno-occlusive dysfunction. Of 56 men who complained of a complete loss of erection 51 did not respond to intracavernous pharmacological injection with prostaglandin E1, and 27 (48.2%) had abnormal arterial blood flow as shown by duplex sonography of the cavernous arteries, 47 (83.9%) had evidence of veno-occlusive dysfunction based on cavernosometric criteria and 33 (58.9%) also had cavernosographic evidence of the condition. Plaque associated venous drainage was evident in 15 of the 56 impotent patients (26.8%), equivalent to 45.5% of all cases with abnormal cavernosographic findings. Sexual dysfunction was evaluable in 31.5% of patients, and the main cause of impotence and loss of erection was veno-occlusive dysfunction.

Capsular perforation localization and adenoma size as prognostic indicators of erectile dysfunctional after transurethral prostatectomy.

The incidence of impotence following transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) was investigated, as well as its correlation with the localization of peroperative capsular perforations and the amount of prostate tissue resected. Patients underwent an interview questioning their potency before and after TURP. For each patient, the TURP technique was reviewed: the localization of eventual capsular perforations was noted and the amount of tissue resected was recorded. Of the 100 patients assessed, 83 were anamnestically potent prior to TURP. Of these, 27 (##%) reported complete loss of erections after operation. Peroperative capsular perforations adjacent to the neurovascular bundles and small-size adenomas correlated significantly with postoperative impotence. The results suggest that capsular perforations adjacent to the neurovascular bundles may be a cause of impotence after TURP, and that patients with small-size adenomas bear a higher risk of post-TURP erectile dysfunction.

Peyronie's Disease: Surgical Treatment Based on Penile Rigidity

Operative treatment of Peyronie's disease has the risk of penile shortening and/or loss of erection. To avoid these complications, we used plaque incision together with polytetrafluoroethylene (Gore-Tex) graft insertion in men with preserved penile rigidity and only implanted a penile prosthesis in men with erectile failure. Between August 1986 and July 1992, 24 men 36 to 72 years old (mean age 53 years) underwent surgery. Of the men 16 with adequate penile rigidity by history and/or RigiScan study, and severe curvature underwent plaque incision and polytetrafluoroethylene graft insertion. Eight men had erectile failure, including 4 with distal flaccidity as demonstrated by RigiScan study. These 8 men received a penile prosthesis (semirigid in 6 and inflatable in 2). In addition, 2 of these men also required plaque incision because of persistent curvature. With a mean followup of 47 months (range 20 to 92), all 16 men with incision and a polytetrafluoroethylene graft had excellent erections with satisfactory intercourse. Minimal curvature away from the plaque incision site, not causing any difficulty with sexual performance, occurred in 7 patients. The men with a penile prosthesis engage in normal intercourse without residual or recurrent curvature. Incision of Peyronie's plaque and polytetrafluoroethylene graft insertion is associated with an excellent functional result in men with normal preoperative penile rigidity. A penile prosthesis should be reserved for men with erectile failure.

Why do condoms break or slip off in use? An exploratory study.

Men attending 3 sexually transmissible disease clinics and a university health clinic in Sydney, Australia, were invited to complete a questionnaire on their use of condoms. Respondents were 108 male condom user volunteers aged 18 to 62 years; in the last five years 47 had had sex with men, 18 with both men and women and 43 only with women. They reported using a total of 4809 condoms in the previous 12 months (condoms worn by a male partner were not included). The overall breakage rate was 4.9% (including condoms breaking during application), while 3.1% of condoms reportedly slipped off. On a multivariate analysis, condom breakage correlated with: (1) male sexual partner(s), (2) infrequent condom use, (3) rolling the condom on as per conventional instructions (modified application methods appeared protective) and (4) having trouble with condoms partially slipping. Factors associated with condoms slipping off were (1) young age, (2) being circumcised, (3) having less life-time condom experience, (4) rolling the condom on conventionally, and (5) having trouble with condoms partially slipping. Few men used inappropriate lubricants and no association between lubricant type and breakage was found. Though common among our respondents, negative attitudes towards condoms, loss of erection during condom application or use, finding condoms uncomfortable, and prolonged sexual intercourse were not related to success in use. Almost half (49%) of the men reported having deliberately removed a condom after the beginning of intercourse; 17% had done so 3 or more times. Counselling protocols should acknowledge the complexity of condom use.(ABSTRACT TRUNCATED AT 250 WORDS)

Patient-Partner Satisfaction with Semirigid Penile Prostheses for Peyronie’s Disease: A 5-Year Followup Study

The long-term acceptance of and satisfaction with penile prostheses were assessed in patients with Peyronie’s disease and their partners. From 1985 to 1987, 50 men with advanced Peyronie’s disease and associated erectile dysfunction were treated with a semirigid penile implant without additional plaque surgery. A total of 48 patients and 29 partners was reassessed at a followup of at least 60 months. Only 23 patients (48%) and 12 partners (40%) were totally satisfied with the long-term functional result and would repeat the same operation. Among the 25 dissatisfied patients (52%) loss of complementary erection resulting in a pencil-like penis, decrease in penile sensitivity, poor concealment and persistence of penile deviation were the major complaints. Of the partners 17 (60%) were dissatisfied due to poor penile girth, sensation of a cold glans penis, sensation of unnatural intercourse and dyspareunia. Eight patients (16%) chose to substitute the semirigid implant with a 3-component inflatable prosthesis. On a long-term basis, placement of a semirigid penile prosthesis for Peyronie’s disease is associated with a significant patient-partner dissatisfaction rate.

Intracavernous papaverine for impotence in spinal cord injured patients.

The majority of the spinal cord injury patients in our centre are young healthy males aged between 20 and 40 years. Loss of erection and inability to have coitus and father children have been responsible for inadequate sociosexual rehabilitation. In 1985, under urologist supervision, intracavernosal papaverine injection treatment was started in 101 volunteers, 65 paraplegics and 36 tetraplegics. Satisfactory erection sufficient for coital penetration was possible in 98 patients. Three had prolonged erection lasting beyond 4 hours. Only one required irrigation of the corpus with saline to achieve detumscence. One patient developed cavernosal fibrosis necessitating discontinuing the injection. Administration was under medical supervision so that possible complications of priapism/systemic effects could be promptly managed.

The Influence of Hormone Treatment on Psychological Functioning of Transsexuals

The effects of hormone treatment of transsexuals on the emotional state and sexual feelings have been studied less extensively than the effects on physical appearance and functioning. Most of the research in the field of hormone-behavior relationships has been carried out in non-patient groups or in patient groups other than transsexuals. Results of the few available studies of transsexuals are generally consistent with this research. In the existing literature the following hormonal effects on sexuality are reported: an enhancement of sexual interest, fantasies and initiative after androgen administration in female-to-male transsexuals; a loss of sexual interest as well as a loss of erections and the capacity to reach orgasm in male-to-female transsexuals after the use of antiandrogens. Less thoroughly investigated are the effects of hormone treatment on moods. In transsexuals, the following effects are reported: in male-to-female transsexuals less feelings of tension and more feelings of relaxation afte...

Quality of Life in Long-Term Survivors of Nonseminomatous Germ Cell Testicular Tumors

A total of 109 survivors of curative therapy for nonseminomatous germ cell testicular tumor was interviewed an average of 9 years after treatment to assess long-term physical, emotional and sexual sequelae. An age-matched group of healthy men were interviewed similarly as controls. Of the physical sequelae loss of ejaculation was prominent (30% of the patients) and appeared directly related to retroperitoneal lymph node dissection surgery (p <0.01). Hypofertility was apparent among patients during the posttreatment period compared to controls (p <0.01). Other physical complications were present in 35% of the patients and 8% were severe. Laparotomy was associated with incisional hernia and radiotherapy with gastrointestinal complications (p <0.001). Psychoemotional status was similar among patients and controls before cancer diagnosis but 60% of the patients had obvious emotional problems during the treatment period, which were more severe in those who had a history of such problems. Anxiety, often with insomnia, affected 49% of the patients, while irritability and depression were noted in 34%. At the interview 30% of the patients versus 5% of the controls had psychoemotional dysfunction (p <0.001) but half of the affected patients had a history of problems preexisting the diagnosis of cancer. Sexual complaints were encountered in 19% of the patients before cancer diagnosis compared to only 7% of the controls (p <0.02). During cancer therapy 57% of the patients had sexual symptoms, primarily loss of erection and decreased frequency of intercourse. Residual problems were more prevalent among patients (38%) than controls (11%, p <0.001). Sexual impairment was associated with direct treatment effects and persisted more often when symptoms developed during the treatment period. Although direct treatment related effects should decrease with modern single modality therapy, appropriate attention should be placed on counseling to help avoid long-term psychoemotional and sexual complications of the disease process and its treatment.

Pre-operative assessment of Peyronie's disease using colour Doppler sonography.

Colour Doppler ultrasonography was used to assess 39 patients with Peyronie's disease with a suspected organic cause for their impotence. In 20 patients who complained of a uniform loss of erection, the impotence was likely to be functional in origin (90%) or occasionally venogenic (10%), the penile arterial blood flow being normal. However, patients who complained of distal flaccidity were likely to have an organic cause for their impotence (68%). This was due to proximal arterial disease (10%), plaque involvement of the distal vessels (37%), veno-occlusive dysfunction (5%) or to the soft glans syndrome (16%).

Venous surgery in veno-occlusive dysfunction: long-time results after deep dorsal vein resection.

Follow-up of patients 1 year after deep dorsal vein resection gives evidence of an approximate 50-60% success rate. A careful selection of only this small percentage of patients, in whom abnormal drainage through the penile dorsum is obvious, is mandatory. Men with an arterial cofactor have to be excluded or to be subsequently treated by intracavernosal autoinjection of vasoactive substances. Late results from our study demonstrate a further loss of sufficient erection, also in men considered as persistent success by us, in the subjective view of the patient and/or his sexual partner.

Sexual function and testosterone levels in men with nonalcoholic liver disease

The effects of nonalcoholic liver disease on sexual desire, arousal, activity, orgasmic function and satisfaction and serum testosterone levels were studied in 75 men with nonalcoholic liver disease. Each man was interviewed about his sexual behavior and problems and was asked to comment on whether he felt liver disease affected his sexual function. The average age of the patients was 49 yr, and a wide variety of liver diseases was represented. Child-Pugh grading was A in 51 patients, B in 18 and C in 6; the mean duration of liver disease was 8 yr. Sexual desire, arousal and activity of patients with grade A disease were within the ranges observed in studies of healthy men of comparable age. Diminished sexual desire was reported by 2% of grade A patients and 35% of grade B and C patients (p less than 0.005). Arousal problems were noted by 16% of grade A patients, 60% of grade B patients and 67% of C patients (p less than 0.005). Loss of erection and inability to regain erection were noted by 7%, 40% and 67% of grade A, B and C patients, respectively (p less than 0.01). Premature and retarded ejaculation were more frequent in patients classed in Child-Pugh grades B and C. Frequency of coitus and orgasm were significantly higher in grade A patients than in grade B and C patients. Total and free testosterone levels were (in nanograms per milliliter) A, 677/1.78; B, 416/1.06; and C, 178/0.43 (p less than 0.002). We concluded that Child-Pugh grade A nonalcoholic liver disease in men does not affect sexual desire, function or performance. Men with disease grades B and C have significant sexual dysfunction and significant reduction of both total and free testosterone levels.

Detailed investigation of the cause of impotence in 20 diabetic men

To clarify the cause of their impotence, 20 diabetic patients underwent detailed assessments of: diabetic autonomic neuropathy (acetylcholine sweatspot test, pupil test-PD%, five cardiovascular tests); vascular disease (radioisotope phallogram, response to intracorporeal papaverine); nocturnal penile rigidity; psychiatric disturbance (General Health Questionnaire). Results suggested cause as: vascular 7/20 (35%), vascular and autonomic neuropathy 7/20 (35%), autonomic neuropathy 3/20 (15%), psychiatric disturbance 2/20 (10%), beta-blockers 1/20 (5%). The sweatspot test appeared to be the most sensitive assessment of autonomic neuropathy. Investigations suggested an alternative aetiology in all cases with a normal sweatspot test. In one patient with autonomic neuropathy, high deep-artery velocity on Doppler but loss of papaverine-induced erection, dynamic cavernosography revealed venous leakage; impotence was improved by surgical venous ligation. The results suggest that most impotence in diabetics has an organic basis. The sweatspot test (ideally in conjunction with cardiovascular tests and pupil test) and response to intracorporeal papaverine may identify and categorise most of these patients. Those with normal tests are unlikely to have organic disease and could be referred for psychosexual/psychiatric counselling. Doppler studies may identify those who need investigating for venous leakage. The others could then, in the first instance, be offered one of the recently described non-invasive devices for overcoming diabetic impotence. Self-administered intracorporeal papaverine may also be considered, but only a minority of diabetic patients seem to respond.

The incidence and correlates of erectile problems in patients with Alzheimer's disease

Loss of erection was reported in 53% of 55 male Alzheimer's disease patients with a mean age of 70.25. Loss of erection is not related to degree of cognitive impairment, age, or depression. Modal time of onset of erectile problems is concurrent with onset of Alzheimer's symptoms. Patients with erectile problems were not taking more medications overall than those without problems and had no greater overall incidence of concurrent physical problems. Thus, the evidence suggests that there may be an elevated incidence of erectile failure in patients with Alzheimer's disease as a primary problem not attributable to other age-related factors.

Zoladex vs. Zoladex Plus Cyproterone Acetate in the Treatment of Advanced Prostatic Cancer: A Multicenter Italian Study

A collaborative multicenter trial was conducted by 17 Italian groups to verify whether the so-called total androgen blockade obtained with luteinizing hormone releasing hormone (LHRH) analogs combined with antiandrogens is more effective than conventional monotherapy in the treatment of advanced prostatic cancer. A total of 328 previously untreated patients were evaluated: 163 patients received Zoladex depot alone, 3.6 mg subcutaneously every 28 days, and 165 patients received Zoladex depot plus cyproterone acetate (CPA), 200 mg/day orally. The follow-up period ranged from 41-251 weeks. Treatment was well tolerated, and side-effects in both groups mainly comprised loss of libido and erections, hot flashes and breast swelling and tenderness. There was no significant difference in objective response after 6, 12 and 24 months of treatment between the 2 groups. Median time to disease progression was comparable in both groups: 55 weeks in the Zoladex group and 54 weeks in the Zoladex plus CPA group. The time to disease progression and the survival distribution was comparable in both groups. Although there were no significant differences in the overall subjective response to both treatments, a faster improvement, with respect to pain and performance status was noted in the Zoladex plus CPA group (8 weeks) compared to Zoladex alone (12 weeks). The addition of antiandrogen, by inhibiting the initial elevation of plasma testosterone, may prevent the disease flare-up which occurs in a small number of patients during the first few days of treatment with LHRH analogs alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of Groin and Mid-Thigh Flap in Reconstruction of Penis with Penile and Perineal Urethra and a Dorsal Skin-Lined Socket for a Removable Prosthesis

Absent or deformed genitalia give rise to profound psychological complexes. In such cases reconstruction of the phallus can help the patient return to leading a normal life. A reconstructed penis must have a normal appearance, feel, and function, which up to now has not been completely possible. Using the method described herein, the penis was reconstructed from a groin and mid-thigh flap. It has a skin-lined tube placed ventrally for urination and has a dorsal skin-lined socket for insertion of a removable prosthesis for artificial erection. Seven stages are required for reconstruction, including reconstruction of a perineal urethra. Appearance of the reconstructed organ is acceptable. The erection device is simple, stable, and not costly, and normal urination and procreation are possible. Part of this method is also applicable for loss of erection and in reconstruction of a perineal urethra only.

Vasculogenic Impotence: Role of the Pelvic Steal Test

A new dynamic pelvic flow test is described that measures differential right and left corporeal artery blood pressure changes with exercise. Previous penile blood flow measurements have been made at rest. It is well known that exercise may unmask vascular pathological conditions not apparent at rest. Furthermore, cases have been reported that document potency at rest and impotence following exercise. As a result exercise was used to stress the pelvic vasculature in 97 patients chosen from vascular and urology clinics. A decrease of 0.15 or more in penile-brachial index with exercise was found to be statistically abnormal. A total of 23 patients (27 per cent) fulfilled the criteria for positive pelvic steal testing. In this group there were high incidences of smoking (52 per cent), hypertension (52 per cent) and diabetes (30 per cent). Although 70 per cent of these patients had at least occasional morning erections 78 per cent complained of loss of erection with exercise. The pelvic steal test detected vascular pathological conditions in 17 patients (20 per cent) previously missed by resting penile-brachial index measurements. Nocturnal penile tumescence studies in these patients demonstrated poor quality erections and correlated with the intermediate penile-brachial index values. Angiographic data performed in 5 of 23 patients corroborated the pathophysiology of a pelvic steal condition in each case. The pelvic steal test is simple to perform and markedly improves the sensitivity and yield of penile blood pressure measurements. The test appears to have better results in patients with suspected vasculogenic impotence and intermediate resting penile-brachial index values.

Effects of demand for performance, self-monitoring of arousal, and increased sympathetic nervous system activity on male erectile response.

Clinical programs for the treatment of impotence generally have been successful but without experimental verification of their individual components or factors associated with the development of impotence. Twenty-four normal males participated in an investigation comparing factors believed to inhibit or facilitate penile tumescence. The effects of demand for performance, self-monitoring of erection, and increased SNS activity, were evaluated. Subjects were exposed to sexual stimuli under these conditions and measurements of penile responses were taken. Results indicated that there were no differential effects on penile responses between demand and no-demand or between self-monitoring and no self-monitoring. Increased SNS activity appeared to facilitate loss of erection, but only after, and not during, the sexual stimulus. The clinical and theoretical implications of these findings are discussed, and suggestions are made for future research.