Nocturnal Tumescence Research Articles

Нормативные показатели мониторинга ночных пенильных тумесценций: результаты собственных наблюдений и апробация разработанных нормативных критериев

Clinical approbation of previously obtained normative criteria for evaluating erectograms using the Androscan MIT hardware complex, as well as comparing the monitoring indicators of nocturnal penile tumescence (NPT) with the results of the standard questionnaire International Index of Erectile Function-15 (IIEF-15).The study included 120 patients aged 19 to 72 years. Erectile function was assessed using the IIEF-15 questionnaire and the Androscan MIT hardware complex. To assess erectile function, previously developed normative criteria for the relative increase in the diameter of the penis (OP) and the duration of NTP were used. Statistical data processing was carried out using the STATISTICA 12 software. A systematic literature search on the normative criteria for monitoring NTP was carried out in the Medline database.After performing androscanning, patients were divided according to the degree of ED: there were 12 patients without ED, 58 patients with grade 1 ED, 27 patients with grade 2 ED, and 23 patients with grade 3 ED. According to the results obtained, a positive correlation was found between the OD value and the results of the IIEF-15 questionnaire.The obtained data on the correlation between the results of the IIEF -15 questionnaire and the NTP monitoring parameters are consistent with most of the currently available foreign data.

Adam sensor: a novel nocturnal penile tumescence wearable device - technology overview & applications

We present a novel, low-cost interconnected wearable device, called ADAM sensor, that measures the Nocturnal Penile Tumescence (NPT) in male patients suffering from Erectile Dysfunction (ED) and the new clinical and research applications that emerge from this technology. Given the consistent, and autonomic nature of nocturnal erections, NPT testing and monitoring can be a valuable clinical and research tool in the diagnosis and progress monitoring of ED. Rigiscan, the device currently used to measure NPTs, is bulky, uncomfortable and disrupts sleep. It was developed 30 years ago and it's not compatible with modern IT hardware and is usually physician-owned and lent to patients overnight or testing is carried out in a sleep clinic, resulting in a very high cost. Consequently, NPT measurement is rarely performed anymore in clinical practice. This is a technical note presenting a novel NPT measuring sensor, which is a ring-like device that users wear around their penis and detects changes in penile tumescence throughout the night. The data is continuously transmitted via bluetooth to the user's mobile phone and analysed by a dedicated mobile app, which reports three key metrics i) Number of erection episodes; ii) Total erection time and iii) Tumescence Activity Units. The advantages of the device are that it is easy to use, does not disrupt users sleep, low cost and the data analysis is continuously improving since it is performed in the cloud. This allows each patient to have their own sensor and continuously monitor NPTs over an extended period of time thus creating new applications of NPT testing, both for research and clinical purposes. The ADAM sensor is a novel, low cost, easy to use and non-obstructing device that can re-establish NPT monitoring as a useful clinical and research tool. None

Adam sensor: a novel nocturnal penile tumescence wearable device - technology overview & applications

We present a novel, low-cost interconnected wearable device, called ADAM sensor, that measures the Nocturnal Penile Tumescence (NPT) in male patients suffering from Erectile Dysfunction (ED) and the new clinical and research applications that emerge from this technology. Given the consistent, and autonomic nature of nocturnal erections, NPT testing and monitoring can be a valuable clinical and research tool in the diagnosis and progress monitoring of ED. Rigiscan, the device currently used to measure NPTs, is bulky, uncomfortable and disrupts sleep. It was developed 30 years ago and it's not compatible with modern IT hardware and is usually physician-owned and lent to patients overnight or testing is carried out in a sleep clinic, resulting in a very high cost. Consequently, NPT measurement is rarely performed anymore in clinical practice. This is a technical note presenting a novel NPT measuring sensor, which is a ring-like device that users wear around their penis and detects changes in penile tumescence throughout the night. The data is continuously transmitted via bluetooth to the user's mobile phone and analysed by a dedicated mobile app, which reports three key metrics i) Number of erection episodes; ii) Total erection time and iii) Tumescence Activity Units. The advantages of the device are that it is easy to use, does not disrupt users sleep, low cost and the data analysis is continuously improving since it is performed in the cloud. This allows each patient to have their own sensor and continuously monitor NPTs over an extended period of time thus creating new applications of NPT testing, both for research and clinical purposes. The ADAM sensor is a novel, low cost, easy to use and non-obstructing device that can re-establish NPT monitoring as a useful clinical and research tool. None

Erectile dysfunction after COVID-19 recovery: A follow-up study.

Several studies confirm multiple complications after COVID-19 infection, including men's sexual health, which is caused by both physical and psychological factors. However, studies focusing on long-term effects among recovered patients are still lacking. Therefore, we aimed to investigate the erectile function at three months after COVID-19 recovery along with its predicting factors. We enrolled all COVID-19 male patients, who were hospitalized from May to July 2021, and declared to be sexually active within the previous two weeks. Demographic data, mental health status, and erectile function were collected at baseline and prospectively recollected three months after hospital discharge. To determine changes between baseline and the follow-up, a generalized linear mixed effect model (GLMM) was used. Also, logistic regression analysis was used to identify the associating factors of erectile dysfunction (ED) at three months. One hundred fifty-three men with COVID-19 participated. Using GLMM, ED prevalence at three months after recovery was 50.3%, which was significantly lower compared with ED prevalence at baseline (64.7%, P = 0.002). Declination of prevalence of major depression and anxiety disorder was found, but only major depression reached statistical significance (major depression 13.7% vs. 1.4%, P < 0.001, anxiety disorder 5.2% vs. 2.8% P = 0.22). Logistic regression, adjusted for BMI, medical comorbidities, and self-reported normal morning erection, showed a significant association between ED at three months and age above 40 years and diagnosis of major depression with adjusted OR of 2.65, 95% CI 1.17-6.01, P = 0.02 and 8.93, 95% CI 2.28-34.9, P = 0.002, respectively. Our study showed a high ED prevalence during the third month of recovery from COVID-19. The predicting factors of persistent ED were age over 40 years and diagnosis of major depression during acute infection.

A Proposal of a New Nomogram to Predict the Need for Testosterone ReplACEment (TRACE): A Simple Tool for Everyday Clinical Practice.

International guidelines suggest to use testosterone therapy (TTh) in hypogonadal men presenting symptoms of testosterone deficiency (TD), even if there is no fixed threshold level of T at which TTh should be started. We aimed to develop and validate a nomogram named TRACE (Testosterone ReplACEment) for predicting the need of TTh in patients with “low–normal” total testosterone levels. The following nomogram variables were used: serum T level; serum LH level; BMI; state of nocturnal erections; metabolic comorbidities; and IPSS total score. The nomogram has been tested by calculating concordance probabilities, as well as assaying the calibration of predicted probability of clinical testosterone deficiency and need for TTh, together with the clinical outcome of the TTh. A cohort of 141 patients was used for the development of the nomogram, while a cohort of 123 patients attending another institution was used to externally validate and calibrate it. Sixty-four patients (45.3%) received TTh. Among them, sixty patients (93.7%) reported a significant clinical improvement after TTh. The nomogram had a concordance index of 0.83 [area under the ROC curve 0.81 (95% CI 0.71–0.83)]. In conclusion, the TRACE nomogram accurately predicted the probability of clinical impairment related to TD, and resulted in a simple and reliable method to use to select hypogonadal patients with not clearly pathological testosterone values who will benefit from TTh.

Efficacy of Laparoscopic Management of Posterior Urethral Diverticulum in Anorectal Malformations

BackgroundA posterior urethral diverticulum (PUD) is a serious postoperative complication after anorectal malformation correction. Complete resection is technical demanding because of limited retrourethral working space deep in the pelvis. ObjectiveWe pioneered the single-incision laparoscopic approach for PUD excision and evaluated the efficacy. Design, setting, and participantsTwenty-six PUD patients undergoing redo surgeries between June 2011 and June 2021 were reviewed. Surgical procedureA series of transabdominal retraction sutures were placed through the PUD to facilitate dissection. The contents were evacuated to create a working space. Distal PUD dissection was carried along the submucosal layer to prevent injury of the urethra/pelvic nerve complex. The rectal mucosa was peeled off from the junction site for complete PUD excision. The muscular cuff of the distal rectum was then oversewn. MeasurementsOperative time, postoperative recovery, and complications were assessed. Results and limitationsThe mean age of redo surgery was 2.46 yr. The average operative duration was 2.35 h. The mean postoperative hospital stay, resumption of full diet, and bowel movement were 10.23, 2.15, and 1.54 d, respectively. The median follow-up period was 46 mo (12–132 mo). No remnant of PUD, recurrent fistula, or urinary leak was detected. None of the patients had difficulty in urination, urinary dribbling, urinary tract infection, constipation, or soiling. All patients retained morning erection, and two postpubertal patients had ejaculations. ConclusionsOur single-incision laparoscopic redo surgery provides an effective approach for PUD excision. It minimizes complications. It also preserves urinary and bowel continence and sexual function. Patient summaryComplete resection of a posterior urethral diverticulum (PUD) in anorectal malformation is technically demanding because of limited retrourethral working space in the deep pelvis. The outcomes of single-incision laparoscopic PUD excision were satisfactory.

The relationship between serum 25-hydroxy vitamin D and arteriogenic erectile dysfunction.

This study aimed to assess the relationship between 25(OH) levels and erectile dysfunction (ED), particularly arteriogenic ED (A-ED). From September 2020 to January 2022, 150 patients diagnosed with ED by the International Index of Erectile Function-5 (IIEF-5) questionnaire were included. All patients were classified as organic ED and psychological ED by nocturnal penile tumescence and rigidity (NPTR) examination. Organic ED patients were divided into A-ED and NA-ED by penile doppler ultrasound (PDU) examination. Finally, 150 patients complaining of ED were enrolled in our study. 25(OH)D levels were significantly lower in patients with organic ED (18.24 ± 6.04 ng/ml) than in patients with psychogenic ED (20.90 ± 8.79 ng/ml) (p=0.032). In A-ED and NA-ED, the mean of peak systolic flow velocity (PSV) values was 18.94 ± 5.28 cm/s and 51.57 ± 15.42 cm/s (p < 0.001), and the mean of 25(OH)D was 15.66 ± 5.86 ng/ml and 20.48 ± 5.90 ng/ml, respectively (p < 0.001). The results showed that 25(OH)D levels were positively correlated with IIEF-5 scores and the PSV values in A-ED patients. The 25(OH)D cut-off value differentiating between A-ED and NA-ED was 15.05 ng/ml. Low 25(OH)D levels may be an independent risk factor for ED, especially A-ED. ED patients should routinely undergo serum 25(OH)D level measurement, and 25(OH)D replacement therapy is necessary for patients with low vitamin D levels.

Patient with hypogonadism and infertility successfully treated with clomiphene citrate

We described 59-year-old men with history of secondary/tertiary hypogonadism, without primary hypothyroidism, elevated prolactin or hemochromatosis with structurally intact hypothalamo- hypophyseal (HT-HP) axis who was diagnosed in 2017. He was treated by different physicians with Testosterone intramuscular injections, hCG intramuscular injections and combination of hCG and FSH intramuscular injections. The patients wanted to have another child and this is why his therapy was changed from testosterone to hCG and later on to hCG and FSH injections three times a week by his urologist. Although his testosterone levels increased his semen analysis showed oligospermia. The patient was not very compliant with his Testosterone, hCG/hCG and FSH injections, because of the discomfort of intramuscular injections. This is why we started the patient from the therapy with hCG and FSH intramuscularly to Clomiphene citrate (CC) 25 mg per mouth every other day in 2021. After eight months therapy with CC the patient semen analysis normalized, Total and Free testosterone levels normalized, LH and FSH increased, his libido, morning erections improved and his erectile dysfunction resolved. Most importantly for the patient his wife become pregnant. With this case we emphasize the role of Clomiphene citrate in treating male hypogonadism if the patients desire fertility.

An objective correlation of specific haematological parameters with ED severity.

This study aims to investigate the role of nocturnal penile tumescence and rigidity (NPTR) and laboratory features in patients with mild, moderate and severe ED and then explored the correlation between ED severity with certain blood count parameters such as WBC and NLR. A total of 86 ED patients (age 29.8 ± 7.09 years) were enrolled. Classification of ED severity according to IIEF-5 scores was as follows: mild ED, 43.02% (37/86); moderate ED, 27.91% (24/86) and severe ED, 29.07% (25/86). Patients with moderate and severe ED had declined IIEF-5 scores and increased GAD-7 and PHQ-9 scores compared with mild ED. The mean NLR value of the mild, moderate and severe ED groups was 1.43 ± 0.39, 1.74 ± 0.45 and 2.0 ± 0.58, respectively. Stratification analysis according to NPTR results indicated that there was a significant difference in WBC and NLR between the two groups. Patients with abnormal NPTR had increased WBC and NLR levels compared with the normal groups. Multivariate logistic regression analysis suggested that severe ED (OR [95% CI]: 5.736 [1.248-26.354]), WBC (OR [95% CI]: 1.676 [1.094-2.567]) and NLR (OR [95% CI]: 5.595 [1.478-21.178]) were identified as independent risk factors for severe ED (abnormal NPTR results). In conclusion, this study indicates a significant difference in NLR, PLR, PDW, MPV and HDL between the mild, moderate and severe ED groups. The WBC and NLR are significantly increased in patients with severe ED (abnormal NPTR results) and it can be available as a quick, easy and cheap investigation compared with the RigiScan to evaluate the severity of ED with good sensitivity and specificity, which is important for the diagnosis and evaluation of ED.

Cyber pornography use and masturbation outburst. Considerations on 150 italian patients complaining erectile dysfunction and trying to solve it.

We aimed to verify the rate of masturbation (Mst) in a group of 150 Italian patients complaining Erectile Dysfunction (ED). Our diagnostic protocol for penile and sexual problems included the collection of the patient's history, general and local clinical examination, and metabolic and hormonal analyses. Selected patients were also submitted to nocturnal penile tumescence test (Rigiscan), Duplex ultrasound of the penis, Magnetic Resonance Imaging, neurological tests and cardiological examination. A group of 150 Italian males (aged between 20 and 86 years) who complained ED and who presented to our Andrological Center to research the possibility of correcting their ED and being able to recover adequate sexual erectile activity were included in this study. In this group of patients suffering from ED we decided to evaluate the practice of Mst by asking specific questions: 1. Do you sometimes practice Mst? 2. How often in a week? 3. Is Mst hidden or known by the partner? 4. What do you use as a masturbatory sexual stimulus? The frequency of Mst was assessed according to a Likert scale as follow: a: No Mst; b:1-2/week; c: 2-3/week; d: > 3/week; e: daily or more. We also asked if it was possible to have penetrative marital intercourse on the same day as Mst (1-10 hours). We also asked what they used as a triggering sexual stimulus: press magazines, TV movies, the WEB. Only 5/150 patients did not report Mst while 27/145 pts (aged 20-30 years) reported it more than 3 times a week; 44/145 (aged 31-50 years) 1-3 times a week and 27/145 (51-86 years) 1-2 times a week. Almost all patients used WebPorn as a stimulus for Mst. A group of patients over the age of 50 said they were quite satisfied with the physical results of Mst even though they would prefer to have sex as part of a couple relationship. The outburst of Mst in this web-dominated era could affect the sexual activity of individual males and couples.

P-014 Thermal Male Contraception: A Study Of Users’ Motivation, Experience And Satisfaction

Abstract Study question What are the motivations, experience, and acceptability of thermal male contraception (TMC) in men using TMC as the only couple contraceptive ? Summary answer Men wished to share the role of providing contraception in a couple and to avoid the use of hormones. Sexual satisfaction was significantly improved. What is known already Two male contraceptive methods inducing spermatogenesis suppression have achieved contraceptive efficacy, on a large population for hormonal contraception and a smaller one for thermal contraception (TC). The suppression of sperm counts to below 1 million/mL results in fertility rates commensurate with female pills. TC is obtained by wearing 15 hours/day a contraceptive underwear (CU) inducing a 2°C increase in testicular temperature (Mieusset &amp; Bujan 1994). As no commercially available male thermal contraceptive exists, little information regarding the acceptability of this approach to men has been reported and only one publication analysed the hypothetical acceptability of TMC (Amouroux et al. 2018). Study design, size, duration We contacted 72 men who had started the CU testing phase between June 2011 and September 2019. The participants completed an anonymous online survey of 93 questions exploring population characteristics, contraceptive histories, motivations for choosing TC, patient experience at the successive phases of use, relations with partner and environment, and satisfaction with TC. Sexual life was evaluated by rating (1 to 4): frequency and pleasure of sexual intercourse, sexual desire, morning and intercourse erections. Participants/materials, setting, methods Among men who had reached the contraception use phase, the quality ratings of sexual life were compared over time, from the contraceptive method used before TC (“N-1” method) to the 2 previous methods (“N-2” and “N-3”)): “N-3” versus “contraception use phase”, “N-3” versus “CU testing phase,” and “CU testing phase” versus “contraception use phase.” These comparisons were made for all 5 sexual life parameters by a paired samples Wilcoxon signed rank test. Main results and the role of chance Sixty-seven men responded (93% response rate);63 participated in the survey (94% participation rate). The median age was 31 [21-52], 30 men (48%) had a Master’s degree or more, 49 (78%) had no child and 24 (38%) no parental project. Among the men whose couple's contraception method immediately before TC (N-1) was a female method (n = 36/63, 57%), the 2 main reasons for switching to a male method were the wish to share the role of providing contraception in a couple (n = 31/36, 86%) and the willingness to take responsibility for contraception (n = 21/36, 58%). The main motivations for choosing TC were “not using hormones” (n = 59/63, 94%) and using a method regarded as “natural” (n = 49/63, 78%). Most of men (68%) adopted the method in less than 2 weeks. During the contraception use phase (n = 59 men), they described: i) significantly improved sexual satisfaction (3,49±0,29/4) compared to that experienced with previous contraceptive methods (3,27±0,58/4;p&amp;lt;0,01); ii) high female partner confidence (100% rather/totally confident partner) and support (88% rather/totally supporting partner); iii) improved self-esteem (n = 35/59, 59%). The main negative point was discomfort, reported by 24% of the men. The overall satisfaction score of using TC was 3.78±0.46/4, and 100% would recommend TC to other men. Limitations, reasons for caution The study population may seem small (63 men). However, it is not different from that of the previously pubished studies on men using hormonal contraception, which included 20, 38, 79 and 57 men, respectively. Our study also lacked a similar questionnaire for the female partners. Wider implications of the findings Men using TC successfully assumed the responsibility for and performed a daily task to provide couple contraception. This positive evaluation of TC together with its previously published contraceptive efficacy and reversibility on a small population, should encourage the development of this method. Trial registration number IRB No. 2020-09-10-005

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.

Dutch Sexologist perceptions on monitoring nocturnal erectile function

Background: There has been a long-standing interest in assessing male sexual function over the past number of decades. Erectile Dysfunction (ED) is commonly classified as organic, psychogenic, or mixed. Aim: The principal aim of this questionnaire was to determine the ways in which Dutch healthcare professionals (sexologists) define the type of ED in their daily practice. The second aim was to evaluate sexologists’ opinions regarding their experiences with the Rigiscan and the desired aspects of a yet-to-be-developed successor. Methods: We performed an anonymous survey study. A questionnaire with 21 items was mailed to all participants of the Dutch Association of Sexology. To obtain a higher response rate the survey was sent three times. The questionnaire was designed by two Dutch sexologists from the Sint Antonius Hospital. The survey questions were pre-tested, and after making changes to the questionnaire it was pilot tested. Outcomes: Eighty-eight people responded and sixty-six respondents completed the survey. Results: The majority of respondents reported that information obtained by a thorough sexual history, according to the biopsychosocial model, is sufficient to diagnose the cause of ED and enable them to provide the correct therapy. For additional diagnostics, respondents indicate to refer to a urologist for physical examination, basic laboratory tests, or, if necessary, advanced examinations such as a nocturnal penile tumescence measurement. 83% of respondents said to use a simple sensor to differentiate the cause of ED if this would be available. Features respondents mentioned of a future sensor where: validated, patient-friendly, and easy to use at home. Clinical implications: The data provide information to develop a new sensor to measure nocturnal erections. Strengths &amp; limitations: Study strengths include: The first report among Dutch sexologists about usage and needs for nocturnal erections measurements. Study limitations include a non-validated questionnaire. A diverse group of Dutch sexologists, not many medical sexologists. Low response rate. Conclusion: The participating sexologists indicate a need for more clarity regarding the different tools which could be useful for the differentiation between primary organic and primary psychogenic ED. A new validated, patient-friendly sensor that can be used by patients in their home setting was appointed to be helpful.

Spontaneous nocturnal erections and masturbation in captive male chimpanzees (Pan troglodytes)

Abstract Nocturnal penile tumescence (NPT) has been reported for males of only a few mammalian species, including humans, albeit this scarcity might be an artefact of the difficulty of documenting it. We investigated NPT in 12 adult male chimpanzees living in an all-male group at Kumamoto Sanctuary, Japan. Recorded non-invasively with infrared video cameras across 72 nights (6 per individual), we observed NPT in two thirds of the individuals (8/12), with events in total. More than three quarters occurred during a transition from sleep to wakefulness, suggesting NPT may be associated with rapid eye movement sleep, similar to humans. Masturbation occurred in conjunction with NPT, including the likely consumption of ejaculate, in 4–6 individuals. While detailing nocturnal erections in chimpanzees may help us to better understand this robust physiological phenomenon in humans, further comparative research is necessary to reconstruct its phylogenetic history. At present, our findings support hypothetical functional explanations such as the facilitation of nocturnal emissions in order to increase ejaculate quality or an increase in tissue oxygenation to prevent erectile dysfunction.

Evaluation of male sexual parameters in infertile couples with a history of abortion

IntroductionIt is thought that both individuals are affected psychologically and sexually in couples experiencing abortion. In addition to the stress caused by infertility, sexual life may also be negatively affected in couples who experience psychogenic wear, such as abortion and curettage. The aim of this study is to evaluate male sexual functions in infertile couples with a history of abortion and male infertility component. MethodsFive hundred forty-seven male patients’ data were evaluated retrospectively. Group 1 was the included the males of the couples without abortion history and the rest with abortion history was group 2. In addition to demographic data, abortion history, libido level, presence of morning erection and intercourse frequency were evaluated. Hormone levels of all patients were evaluated. After that we created sub-group 1 and sub-group 2 from these groups, respectively, due to whether the patients fulfilled the international index of erectile function (IIEF), Beck anxiety inventory (BAI) and Beck depression inventory (BDI). ResultsThere were not any significant differences between the groups regarding psychiatric scale scores, hormone levels, libido, intercourse frequency and IIEF scores. Only orgasmic dysfunction was significant in the males of the couples with abortion history. ConclusionMan is not affected from abortion process in which woman get involved. Men only have orgasmic dysfunction when there is one or more abortion history in couples.

Erectile dysfunction predicts mortality in middle-aged and older men independent of their sex steroid status.

erectile dysfunction is associated with mortality, whereas the association between low testosterone (T) and higher mortality remains controversial. Sexual dysfunction and low T often coexist, but the relative importance of sexual symptoms versus low T in predicting mortality is not known. We studied the interrelationships between sex steroids and sexual symptoms with all-cause mortality in a large prospective cohort of European men. survival status was assessed in 1,788 community-dwelling men, aged 40-79, who participated in the European Male Ageing Study (EMAS). Sexual symptoms were evaluated via a validated questionnaire (EMAS-SFQ). Sex steroids were measured by mass spectrometry. Cox proportional hazard models were used to study the association between hormones, sexual symptoms and mortality. about 420 (25.3%) men died during a mean follow-up of 12.6 ± 3.1years. Total T levels were similar in both groups, but free T was lower in those who died. Men with three sexual symptoms (erectile dysfunction, reduced morning erections and lower libido) had a higher mortality risk compared with men with none of these symptoms (adjusted hazard ratio (HR) and 95% confidence intervals: 1.75 (1.28-2.40, P = 0.001)). Particularly, erectile dysfunction and poor morning erections, but not lower libido, were associated with increased mortality (HR 1.40 (1.13-1.74, P = 0.002), 1.28 (1.04-1.59, P = 0.023) and 1.12 (0.90-1.39, P = 0.312), respectively). Further adjusting for total T, free T or oestradiol did not influence the observed risk. sexual symptoms, in particular erectile dysfunction, predict all-cause mortality independently of sex steroids and can be an early warning sign of a poor health status.

A rare case of penile schwannomatosis presenting with painful nocturnal penile tumescence

BackgroundPenile schwannoma is a rare tumor. They commonly present as an asymptomatic, painless and slow growing mass. Other presentations include sexual dysfunction, most commonly dyspareunia, followed by erectile dysfunction, abnormal penile curvature or pain with ejaculation.Case presentationA 26-year-old male presented atypically with painful nocturnal penile tumescence, along with multiple nodules over the dorsal penis. Excision of multiple penile tumors under general anaesthesia was performed and histopathologic examination revealed benign schwannoma.ConclusionOur hypothesis is that the schwannoma lies along the axis of the dorsal penile nerve, and compression of this nerve occurs during his erection causing pain. However, there are limited presentations of painful erections in penile schwannomas, and we hope that future studies can help confirm this theory.

Accurate and time-saving, two-step intracavernosal injection procedure to diagnose psychological erectile dysfunction.

BackgroundThe recognition of the erectile dysfunction pathogenesis is essential to identify the appropriate erectile dysfunction management. As vascular erectile dysfunction could be a manifestation of a systemic arterial damage, the watershed in the erectile dysfunction diagnostic framework is the discrimination between psychological erectile dysfunction and vascular erectile dysfunction. However, reliable tools to directly diagnose psychological erectile dysfunction are currently lacking.ObjectiveTo identify which parameters could predict psychological erectile dysfunction. Moreover, we suggest a new intracavernosal injection procedure to optimize the erectile dysfunction diagnostic workup.Materials and methodsA retrospective, real‐world analysis was carried out including all men who underwent intracavernosal injection procedure at the Modena Andrology Unit from 2018 to 2021. A first intracavernosal injection procedure with 5 µg of prostaglandin E‐1 (PGE‐1) was performed. In the absence of a full drug‐induced erection (immediate or delayed), an echo‐color Doppler penile evaluation after administration of PGE‐1 10 µg was conducted, measuring intracavernosal blood flows, to document a possible vascular etiology. Hormonal evaluations were performed.ResultsOut of 179 enrolled patients, 70.4% showed psychological erectile dysfunction, 21.7% vascular erectile dysfunction, and 7.8% hormonal genesis. Multinomial logistic regression analysis identified absence of cardiovascular disease (p = 0.017), presence of spontaneous morning erections (p = 0.018), and normal penile erections with masturbation (p = 0.035) as predictors of psychological erectile dysfunction. Clinically, normal intracavernosal injection test response was detected in 86 patients and abnormal response in 93 subjects. Among the latter, 54 patients experienced a delayed response. The combination of intracavernosal injection test with late penile erections evaluation was able to diagnose psychological erectile dysfunction (sensitivity 97%, specificity 100%), avoiding unnecessary retesting.DiscussionWe propose a two‐step intracavernosal injection procedure that allows to recognize psychological erectile dysfunction with a high sensitivity/specificity, saving costs and time, and limiting adverse events. Moreover, the presence of spontaneous morning erections and valid penile erections after masturbation could guide the diagnostic workup, indirectly identifying those patients deserving of a deeper evaluation of vascular health.

Significance of hyperhomocysteinaemia as an effective marker for vasculogenic erectile dysfunction: a cross-sectional study.

BackgroundThe primary objective of this cross-sectional study aimed at evaluating serum levels of homocysteinemia (Hcy) in a cohort of erectile dysfunction (ED) patients, and at assessing the correlation between Hcy and vasculogenic ED.MethodsA total of 119 Chinese patients presenting with ED [International Index of Erectile Function (IIEF)-5≤21] were enrolled in this study. The whole cohort was asked to complete the IIEF-5 questionnaire and blood analysis. A detailed medical history, physical examination, nocturnal penile tumescence (NPT) tests and penile color Doppler ultrasonography (pDUS) were performed by a urologist. Based on the pDUS result, they were further categorized into 2 main groups: non-vasculogenic ED (n=79) and vasculogenic ED (n=40).ResultsAge and Hcy levels were significantly higher in the vasculogenic ED group compared to the non-vasculogenic ED group (38.45±8.51 vs. 32.29±7.57 and 22.91±5.85 vs. 16.31±5.23 µmol/L, respectively, P<0.01). Univariate and multivariable regression analyses showed that the incidence of vasculogenic ED raised significantly with the increase of Hcy level. After multivariable adjustment, ED patients with hyperhomocysteinaemia (HHcy) had 13.42 times the odds of vasculogenic ED compared with patients without HHcy (OR: 13.42, 95% CI: 3.78 to 47.64). Moreover, the risk of vasculogenic ED was 1.24 (95% CI: 1.04 to 1.48, P=0.01) per-unit increase in Hyc concentration for ED with HHcy. In addition, the smoothing curve revealed that Hcy levels were inversely correlated with peak-systolic velocity (PSV) (β: −0.48, 95% CI: −0.91 to −0.05, P=0.04) in vasculogenic ED patients by multivariate regression analysis. Furthermore, in the analysis of receiver operating characteristic curve, the area under curve for Hcy to predict vasculogenic ED was 0.81 (95% CI: 0.73 to 89) in patients with ED.ConclusionsThese findings suggest a dose-dependent association between Hcy and vasculogenic ED. HHcy was a risk factor for vasculogenic erectile dysfunction. Therefore, HHcy is likely to be a potential indicator to predict and diagnose vasculogenic ED when using pDUS.

Management of issues relating to marriage, mental illness, and Indian legislation.

Management of issues relating to marriage, mental illness, and Indian legislation.