Psychogenic Erectile Dysfunction Research Articles

(115) Utility of Thermography as a Screening Tool for Erectile Disorder

Abstract Introduction Ultrasonography remains the gold standard for the evaluation of penile vasculature in men with erectile disorder. Despite its value, ultrasound assessment can be costly for patients, and requires an intracavernosal injection prior to imaging. With estimates of psychogenic ED being up to 40% or more in clinical populations, a less invasive method of quantifying penile vascular response would be beneficial in directing patients for further assessment and treatment. One such method that has potential is thermography as it requires no genital contact, can indirectly measure blood flow through temperature change, and has been validated in self-reported clinical non-clinical populations for the measurement of sexual response. Objective To determine whether thermography could be used to differentiate psychogenic from organic erectile disorder by comparing thermography to penile doppler ultrasound in men being assessed for erectile disorder. Methods 81 patients (m age = 43 years) recruited through a hospital Urology clinic completed penile vascular assessment across two different sessions: 1) thermographic measurement during a 15-minute baseline neutral and 15-minute sexually explicit film; 2) standard penile ultrasound assessment with an ICI of Prostaglandin E1. Demographic and sexual functioning questionnaires were completed, and urologist diagnosis following ultrasound assessment was used to classify patients as having psychogenic or organic ED. Results 45 patients had PSV values consistent with organic ED, while 36 patients were classified into the psychogenic ED group. Men with organic ED were significantly older than those in the psychogenic ED group (p < .05), and more likely to have concurrent health conditions (p < .05). A Repeated Measures ANOVA on temperature change measured through thermal imaging demonstrated that men with psychogenic ED had significantly greater penile temperature (m = 32.45°C, SD = 1.34) during sexual arousal than those with organic ED (m = 31.73°C, SD = 1.34; p <. 05), and also had a significantly (p < .01) stronger correlation between their self-reported and physical sexual response during thermographic assessment (psychogenic ED mean r =.49; organic ED mean r = .27). Furthermore, a hierarchical cluster analysis of thermography measures grouped patients into three distinct categories (high, medium and low temperature change), with significantly more of the psychogenic ED group being classified into the highest temperature cluster (82%). The medium and low temperature clusters were less sensitive at differentiating organic and psychogenic ED. Conclusions Thermography could provide a less costly and less invasive way to screen out patients presenting with ED who have a high degree of temperature change during sexual response. While thermography has been shown to differentiate between self-reported and clinical populations, this is the first evaluation of this instrument as a tool to differentiate within ED diagnostic groups. Although men with psychogenic ED were more likely to be classified in the highest temperature change cluster, thermography was less sensitive at differentiating organic and psychogenic ED in the middle and lower temperature groupings. Further research with larger samples would be beneficial in exploring potential clinical cutoffs for penile temperature change. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Biosciences, Initiator Pharma.

(012) Sexual Dysfunction in Men After Failed Hypospadias Repair

Abstract Introduction Hypospadias is commonly treated in childhood, and future sexual function of such patients is sometimes overlooked. Some published reports reveal excellent sexual function following hypospadias repair at long term, while other authors state high prevalence of sexual dysfunction which depends on original position of urethral meatus. Patients with complications of primary hypospadias repair are one of the most difficult subpopulations to evaluate. This is a unique subset of patients who should be described separately from men who underwent successful hypospadias repair. Objective To describe the spectrum of sexual dysfunction in patients with sequelae of failed hypospadias repair and our experience in its management. Methods We evaluated 112 patients with a history of failed hypospadias repair, defined as presence of voiding symptoms or cosmetic problems remaining despite previous surgery or caused by it. Patients’ median age was 29.5 years (range: 18–62). There were no intersex cases. Only 9.8% (11/112) underwent single attempt at surgical reconstruction, the median number of attempts was 3.5 (range: 1–9). Patients with IIEF-EF score ≤ 25 were considered to have erectile dysfunction; those with IIEF-EF ≤ 16 underwent penile doppler ultrasound, penile electromyography and endocrine assessment. Results 64.2% of patients (72/112) were dissatisfied with penile appearance, 40.2% (45/112) had ED, 71.4% (80/112) had ejaculation disorders. Psychogenic ED was diagnosed in 21 patients with preserved non-coital erections and no evidence of organic ED. Median IIEF-EF in ED patients was 20 (range: 8–25). Asthenic ejaculation, delayed ejaculation and anejaculation were present in 63.4% (71/112), 7.1% (8/112) and 3.5% (4/112) patients, respectively. Premature ejaculation was present in 28.6% (32/112) patients, but its association with hypospadias or previous surgery is unlikely. On univariate analysis only the number of previous attempts at surgical repair was a significant predictor of sexual dysfunction following definitive surgery (p = 0.033). Rate of normal sexual function was 37.5%, 23.5% and 9.1% among patients with history of ≤ 3, 4–6 and ≥ 7 procedures, respectively. Conclusions Failed hypospadias repair may lead to a wide spectrum of sexual dysfunction, involving sexual desire, erection and ejaculation. Repeated surgery leads to increased risk of sexual dysfunction which may be devastating for patient’s quality of life. Disclosure No.

(202) Comparative Study of the Efficacy of Avanafil and Atorvastatin Daily Dose in Management of Vasculogenic Erectile Dysfunction

Abstract Introduction Erectile dysfunction (ED) is defined as the “consistent inability to attain or maintain a penile erection, or both, sufficient for adequate sexual relations”. ED is not only a medical problem but affects the marital relations and patient's self-esteem and causes the quality of life to decrease. which in turn causes the patient to go into depression or develop anxiety. In the past, erectile dysfunction was considered, in most cases, to be a purely psychogenic disorder, but current evidence suggests that more than 80% of cases have an organic aetiology. Causes of organic erectile dysfunction can now be broadly divided into nonendocrine and endocrine. Of the nonendocrine aetiologies, vasculogenic (affecting blood supply) is the most common and can involve arterial inflow disorders and abnormalities of venous outflow (corporeal veno-occlusion). Avanafil is a second-generation phosphodiesterase type 5 inhibitor approved for erectile dysfunction by the FDA on 2012 and by EMA in 2013. With a high selectivity for phosphodiesterase type 5 isoform AND faster onset of action compared with other PDE5 inhibitors, it offers more tolerability and less adverse events. Atorvastatin is 3-hydroxy-methylglutaryl (HMG)-CoA reductase inhibitor act on the rate-limiting step in cholesterol biosynthesis (the conversion of HMG-CoA to mevalonate) and are effective in treating dyslipidemia. statins reverse endothelial dysfunction by decreasing the action of oxidized low-density lipoprotein (LDL) on endothelial cells, resulting in an increase of NO activity. Objective is to evaluate and compare the efficacy of avanafil and atorvastatin daily dose in management of patients with vasculogenic erectile dysfunction. Methods A 60 adult heterosexual males complaining of vasculogenic erectile dysfunction proven by penile duplex were collected from outpatient andrology clinics of Al-Azhar University Hospitals. The patients were divided into two treatment groups: (Group A): 30 patients received daily dose of 100 mg avanafil. (Group B): 30 patients received daily dose of 40 mg atorvastatin, The main outcome measures and the difference in penile duplex ultrasound results and IIEF-EF scores between the two groups are evaluated and compared at the end of the study, Age of patients between 20 and 50 years, established diagnoses of Vasculogenic erectile dysfunction, Normal lipid profile, Normal Total and Free testosterone levels and No contraindications to the study medications were included criteria. However patients who failed to fulfill any of the inclusion criteria, psychogenic or neurogenic erectile dysfunction, dyslipidemia Patients with Renal or Hepatic insufficiency and Patients with advanced cardiovascular diseases such as heart failure and coronary artery disease on antianginal drugs especially nitrates were excluded. Results Our study revealed statistically significant improvement in Penile Doppler ultrasonography parameters (PSV, EDV& RI) and IIEF-EF scores in avanafil group compared to atorvastatin group. Conclusions avanafil 100 mg daily dose leads to significant improvement in men with vasculogenic erectile, while atorvastatin 40 mg caused no significant differences, neither positively nor adversely. In summary, avanafil at dose of 100 mg can be a therapeutic appropriate choice in cases of vasculogenic ED. Disclosure No.

(144) The Use of Virtual Reality Systematic Desensitization for the Treatment of Psychogenic Erectile Dysfunction: A Pilot Study

Abstract Introduction Erectile dysfunction (ED) is a sexual dysfunction that affects the sexual health of millions of men around the world. In recent years, the evidence indicates an increase in cases of ED among individuals under 40 years old. In most cases, the etiology is of psychogenic origin. Cognitive-behavioral therapy (CBT) has been proven effective and remains one of the most widely used treatments for ED in these cases although controlled studies are lacking. One of the most effective CBT techniques is a set of activities performed by a couple, known as systematic desensitization (SD). SD involves gradually exposing the patient to feared intimacy-related activities with their partner. However, many patients do not have a stable partner or do not want their partner to participate in the treatment. Technological advances are helping to create virtual SD programs which are able to reproduce the sights, sounds, and other sensations of the feared situation. Objective Our goal is to determine the potential usefulness of a new virtual reality-based SD program for the treatment of psychogenic ED (pED). Methods Six sexually active men diagnosed with pED based on criteria for Erectile Disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) completed virtual SD over 8 weeks. The program consisted of one educational session and five different virtual reality audio exercises which were completed at home using a masturbation aid device called Myhixel ED01, that is connected to a smartphone. The five-item Spanish version of the International Index of Erectile Function (IIEF-5) questionnaire was used to assess symptoms before and after the treatment and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used for evaluating satisfaction with treatment. Results Patients enrolled had a mean age of 34.83 years (range 27–39) and experienced an improvement in erectile function, mean IIEF-5 score pretreatment was 11(range 9–13) mean posttreatment IIEF score was 18 (range 14–21). The mean EDITS index score at the end of the treatment was 64.70 (range 59–70.25). No adverse effects were reported during the treatment. Conclusions This case series suggests that the use of a virtual reality-based SD could be a potentially effective and safe therapeutic option for men with pED. This new treatment would facilitate greater access of men with pED to one of the most commonly used strategies of sexual therapy, as it would no longer require the participation of a partner. Studies with adequate sample sizes, control groups, randomization, and follow-up are needed to determine the effectiveness of this new treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: NEW WELLNESS CONCEPT SL.

(141) Can a Nocturnal Penile Tumescence and Rigidity Test Detect Organic Aetiology of Erectile Dysfunction? A Peripheral and Penile Vascular Study

Abstract Introduction In the diagnostic workup of erectile dysfunction (ED) the Nocturnal Penile Tumescence and Rigidity test (NPTR) is being used less and less because of its inconvenience but also in part because of the intrinsic limits of this test. In particular, the NPTR has been considered very useful to diagnose psychogenic ED when it is positive (normal) but less informative when it is negative (pathological) because of the high incidence of false negatives. Other tests have been suggested to better diagnose an organic ED, especially the dynamic Penile Colour-Doppler Ultrasound (PCDU) to study the penile vascular response and detect a vasculogenic ED. Objective The purpose of the study was to explore the value of a pathological NPTR by investigating relationship between the NPTR result and the peripheral vascular health at the carotid, brachial and cavernous arteries. Methods We conducted an observational study involving patients with ED who had undergone a NPTR as part of their ED diagnostic workup. We assessed their peripheral vascular health through (1) the measurement of the intima-media thickness at the carotid arteries (cIMT), (2) the measurement of the flow-mediated dilation at the brachial artery (FMD), and (3) performing a PCDU. Results Globally, our patients presented with a normal cIMT, FMD and Peak Systolic Value (PSV) in the PCDU. The group with pathological NPTR were significantly older than patients with normal NPTR (55.6 vs 44.1 years, p=0.002), had a higher prevalence of hypertension (50.0 vs 6.8%, p=0.001), longer hypertension duration (8.0 vs 1.3 years, p=0.035), a higher prevalence of diabetes mellitus (42.9 vs 6.8%, p= 0.004), higher blood glucose (111 vs 92 mg/dl, p=0.004) and higher blood triglycerides levels (188 vs 96 mg/dl, p=0.002). Furthermore, they showed lower PSV (46.2 vs 71.0 cm/s, p=0.002) while we did not find significant differences as regards cIMT and FMD between the two groups. Interestingly, the prevalence of patients with pathological PSV (<35 cm/s) was higher among patients with a pathological NPTR but without reaching the statistical significance. However, when adopted an age-dependant cut-off described in the literature (PSV < age x 0.7 + 6.73) the difference between the two groups became significant (50.0 vs 11.4%, p=0.005). Finally, the correlation analysis showed a significant correlation between PSV and the cIMT (-0.352, ρ=0.009), the maximum number of events in the RPTR record (+0.344, ρ=0.012), and the mean tip tumescence (+0.303, ρ=0.036). When corrected for age, these associations lost their statistical significance. Conclusions This study demonstrates the diagnostic value of a pathological NPTR which suggests an organic aetiology of the ED and associates with pathological findings in the PCDU. Age appears to be one of the most important risk factors for ED, even when other risk factors are present. Finally, when using a PCDU to diagnose vasculogenic ED, a cut-off of 35 cm/s might be less sensitive than an age-dependent cut-off to detect early impairments of penile endothelial function. Disclosure No.

(226) Wearable Devices for Monitoring Sexual Encounter Physiology in Patients with Psychogenic Erectile Dysfunction

Abstract Introduction Understanding the physiological changes during sexual arousal and function in males with psychogenic erectile dysfunction remains an area of limited comprehension, despite a well-established understanding of erection physiology. To bridge this gap, we conducted a prospective study employing both qualitative and quantitative methods, to investigate the utility of wearable devices in measuring and identifying the physiological changes among males diagnosed with psychogenic sexual dysfunction. Objective This study aims to leverage wearable device technology to precisely measure and analyze physiological parameters, including heart rate, during sexual encounters in individuals diagnosed with psychogenic erectile dysfunction. Methods Individuals diagnosed with psychogenic erectile dysfunction were asked to wear a FitBit Versa 3 for a period of six weeks. Encrypted, de-identified data from the Fitbit was sent via the Fitbit app on subject’s smartphones to a single member of the research team. Subjects were asked to log the number, type (penetrative/oral/erogenous touch/masturbation), and timing of sexual encounters. Subjects also logged whether orgasm was achieved, and their satisfaction with the encounter. Results Over the course of the study, data from twenty unique sexual encounters were analyzed. Patients’ heart rate during both masturbation and sexual intercourse were recorded and normalized to their resting heart rate. During both sexual intercourse and masturbation, patterns of heart rate variability emerged, with an excitement phase (initial rise in heart rate), plateau phase, orgasm (peak heart rate), and resolution phase (decrease back to baseline heart rate), in line with our previous findings in individuals without sexual dysfunction. The data also indicate that these physiologic responses are similar regardless of if the patient is engaging in intercourse with a partner, or engaging in masturbation via self-stimulation. Conclusions We have previously shown that wearable device technology can be used to delineate patterns of heart rate variability during sexual encounters in healthy patients without sexual dysfunction. Data from our current study further highlights the feasibility of wearable device technology for conveniently and accurately measuring physiological parameters during sexual activity in patients with psychogenic erectile dysfunction. Furthermore, our data is the first to show that heart rate variability is consistent between masturbation and sexual activity with a partner in patients diagnosed with psychogenic erectile dysfunction. These findings contribute to the limited existing literature on objective physiologic measurements during sexual activity and emphasize the potential of wearable technology in monitoring physiological changes in sexual encounters. This study has further implications for both research and clinical settings for psychogenic erectile dysfunction. In research, Fitbits and other wearable devices may provide a convenient and non-invasive method for studying sexual satisfaction and further characterizing psychogenic erectile dysfunction, while in a clinical setting these devices may help healthcare professionals Disclosure No.

(366) Potential Effectiveness of Focused Vibration Treatment for Psychogenic Erectile Dysfunction: A Case Series

Abstract Introduction The current non-pharmacological treatment of psychogenic erectile dysfunction (pED) is based on cognitive-behavioral interventions that often involve the participation of the partner, such as desensitization procedures, sensory focusing, and couples counseling. However, it is important to note that in many cases, patients may not have a stable partner or their partner cannot participate in the treatment. The application of local mechanical vibration has shown promising results in increasing skin blood flow and nitric oxide production in healthy young adults. The relaxation of smooth muscle in the penis initiates and maintains an erection. The local release of nitric oxide from autonomic dilator nerves and vascular endothelium is crucial in initiating and sustaining this process. Technological advances have allowed the design of vibrating devices that men can use during sexual encounters. Objective To determine if the on-demand use of a focused vibration device can increase blood flow and promote relaxation of erectile tissue to improve erectile function in patients with pED. Methods Seven sexually active men diagnosed with pED based on criteria for Erectile Disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and without a stable partner, were instructed to use a vibrating device called TENUTO II during their sexual encounters for duration of 8 weeks. This device generates focal vibrations on the penis and the perineal area in intervals of 10 seconds of vibration followed by 10 seconds of pause, with a frequency of 50Hz and an amplitude of 2mm. The five-item Spanish version of the International Index of Erectile Function (IIEF-5) questionnaire was used to assess symptoms before and after the procedure and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire was used for evaluating satisfaction with treatment. Results After the using the device, all patients enrolled with a mean age of 36.1 years (range 28-45) experienced an improvement in erectile function, mean IIEF-5 score pretreatment was 11(range 5–13) mean posttreatment IIEF score was 20 (range 18-27). No adverse effects were reported during the treatment. Conclusions This case series suggests that use of an on-demand focused vibration device could be a potentially effective and safe therapeutic option for men with pED. However, further studies with a larger number of participants and a more rigorous research design are needed to confirm these preliminary findings. Disclosure Yes, this is sponsored by industry/sponsor: MysteryVibe. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Mysteryvibe.

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

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

Trends in psychogenic erectile dysfunction research: a bibliometric and visualized study

Trends in psychogenic erectile dysfunction research: a bibliometric and visualized study

Efficacy of acupuncture for psychogenic erectile dysfunction: a randomized, sham-controlled trial

BackgroundPsychogenic erectile dysfunction (pED) is a common sexual dysfunction often accompanied by psychosomatic factors. Its treatment includes oral medications, psychotherapy, and behavioral therapy. Acupuncture’s effect on erectile function in pED patients remains to be investigated. This randomized study evaluated the effects of acupuncture and sham acupuncture in pED patients. Altogether, 66 men with pED were randomized to the acupuncture (n = 33) or sham acupuncture group (n = 33). Both groups have a 6-week treatment with 18 sessions. Primary outcome was the International Index of Erectile Function-5 (IIEF-5) at 6 weeks. Secondary outcomes were IIEF-5 (weeks 2, 4, and 10), erection hardness score (EHS), sexual encounter profile-2 (SEP-2), SEP-3, self-rating anxiety scale (SAS), and self-rating depression scale (SDS).ResultsAmong the 66 participants, 64 completed the outcome measurements at week 10. Both acupuncture and sham acupuncture groups had improved IIEF-5 and EHS and decreased SAS and SDS post-treatment (p < 0.05). The acupuncture group had significantly better improvement in IIEF-5, EHS, and SEP-3 and significantly reduced SAS and SDS than the sham acupuncture group (p < 0.05). The improvement in SEP-2 post-treatment was not significantly different between the two groups (p > 0.05). There were no serious adverse events.ConclusionsThe 6-week acupuncture treatment significantly improved the erectile capacity and psychosomatic status of pED patients.Trial registrationChiCTR2200064345 (Chinese Clinical Trial Registry) (https://www.chictr.org.cn/showproj.html?proj=174873).

Effect of internet pornography use frequency on psychogenic erectile dysfunction severity in young Turkish men: the mediating role of dyadic adjustment.

This cross-sectional study aimed to investigate the effect of the frequency of using pornography on psychogenic erectile dysfunction severity after controlling for other psychological factors. It then evaluated the mediating role of dyadic adjustment regarding this. This study included 66 young married heterosexual male patients who were diagnosed with psychogenic erectile dysfunction after organic causes were excluded. The patients filled out the form about demographics, the age of onset of pornography use, and the frequency of pornography use. All participants were evaluated using a comprehensive data form, the International Index of Erectile Function, the Dyadic Adjustment Scale, the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms, the Perceived Stress Scale, and the Rosenberg Self-Esteem Scale. A significant strong negative correlation was determined between the International Index of Erectile Function scores and pornography use frequency (r = -0.535 and p < 0.001). Pornography use frequency and Dyadic Adjustment Scale scores were found to have a significant predictive effect on erectile dysfunction scores in hierarchical regression analysis after controlling for somatization, depression, and perceived stress, which are typically correlated with erectile dysfunction scores (Beta = -0.28, and 0.34 respectively, p = 0.02, and 0.01 respectively). The Sobel test conducted to evaluate the mediating effect of dyadic adjustment revealed that dyadic adjustment played a mediating role in the correlation between pornography use frequency and erectile dysfunction scores (z = -1.988 and p = 0.047, respectively). The most significant observation of this study was the specific causative effect of pornography use frequency on erectile dysfunction severity through dyadic adjustment, especially considering that the frequency of using pornography is a modifiable factor.

Altered White Matter Structural Network Connectivity Associated with Cognitive Declines in Psychogenic Erectile Dysfunction.

It has been reported that individuals with psychogenic erectile dysfunction (pED) potentially suffer from cognitive declines. Despite that increasing neuroimaging studies have demonstrated abnormalities of cerebral structural changes in pED, the association between altered white matter (WM) structural network and cognitive impairments remains unclear. Hence, this study aimed to explore the relationship between WM structural network connectivity and cognitive performance in patients with pED. Forty pED patients and 33 healthy controls (HCs) were recruited to perform cognitive assessments, and diffusion tensor imaging scans. We firstly constructed the WM structural network and applied the machine learning method to identify the important features. Then, we examined group differences in cognitive assessments, WM structural network connectivity within the identified features, and associations between altered WM structural network connectivity and cognitive scores in pED patients. From 26,896 features of DTI data, 24 important features were identified by K-Nearest Neighbor classification with a satisfactory accuracy (78%). Compared with HCs, we found that pED patients showed higher fractional anisotropy (FA) values between left transverse temporal sulcus and left supramarginal gyrus, and lower FA values between left suborbital sulcus and left para-hippocampal part of the medial occipito-temporal gyrus in pED patients. Furthermore, the increased FA between left transverse temporal sulcus and left supramarginal gyrus was observed to be negatively associated with impaired delayed memory. Overall, our findings provide new insights into WM network alterations associated with impaired cognitive functions in pED, which may unravel the potential neural mechanisms underlying the cognitive impairments of pED patients.

Altered Functional Connectivity of Large-Scale Brain Networks in Psychogenic Erectile Dysfunction Associated with Cognitive Impairments.

Several studies have demonstrated that psychogenic erectile dysfunction (pED) patients potentially suffer from cognitive dysfunction. Despite that previous neuroimaging studies have reported abnormal functional connections of brain areas associated with cognitive function in pED, the underlying mechanisms of cognitive dysfunction in pED remain elusive. This study aims to investigate the underlying mechanisms of cognitive dysfunction by analyzing large-scale brain networks. A total of 30 patients with pED and 30 matched healthy controls (HCs) were recruited in this study and scanned by resting-state functional magnetic resonance imaging. The Dosenbach Atlas was used to define large-scale networks across the brain. The resting-state functional connectivity (FC) within and between large-scale brain networks was calculated to compare pED patients with HCs. The relationship among cognitive performances and altered FC of large-scale brain networks was further explored in pED patients. Our results showed that the decreased FC within visual network, and between visual network and default mode network, visual network and frontoparietal network, and ventral attention and default mode network were found in pED patients. Furthermore, there was a positive correlation between immediate memory score and FC within visual network. The visuospatial score was negatively correlated with decreased FC between ventral attention network and default mode network. Taken together, our findings revealed the relationship between cognitive impairments and altered FC between large-scale brain networks in pED patients, providing the new evidence about the neural mechanisms of cognitive dysfunction in pED patients.

An Evaluation of Psychogenic Predictors of Non-Organic Erectile Dysfunction.

Background and Objectives: Erectile dysfunction is a significant problem, which diminishes the quality of life. The aim of this study was to investigate the relationship of childhood trauma and attachment styles in the aetiology of psychogenic erectile dysfunction. Materials and Methods: The study included 80 participants (40 patients who presented with the complaint of erectile dysfunction, were not determined with an organic pathology, and were diagnosed with erectile dysfunction according to the DSM-5 criteria; and a control group of 40 healthy subjects.) The structured clinical interview form for DSM-5 (SCID-5) was applied to all the participants, together with the International Erectile Function Index (IIEF), the Childhood Trauma Questionnaire (CTQ), the Relationship Scale Questionnaire (RSQ), and the Beck Depression Inventory (BDI). Results: The emotional abuse (p = 0.002), physical abuse (p = 0.049), emotional neglect (p = 0.004), physical neglect (p = 0.002), and total scale points of the CTQ were determined to be significantly higher in the patient group than in the control group. Secure (p = 0.022) and dismissive (p = 0.009) attachment styles were found to be higher in the control group. As the time together with the current sexual partner increased, so the severity of erectile dysfunction increased, and sexual function, orgasmic function, sexual satisfaction, and general satisfaction decreased. As emotional abuse, sexual abuse, and physical neglect increased, the severity of erectile dysfunction increased. Childhood trauma (β = -0.275, t (73) = -2.704, p = 0.009) and the duration together with the partner (β = -0.249, t (73) = -2.512, p = 0.014) were found to be predictive of erectile dysfunction. Conclusions: The results of this study demonstrated that childhood trauma and the time elapsed without treatment are predictors of psychogenic erectile dysfunction severity, and secure attachment style and self-esteem play an important role in the aetiology of psychogenic erectile dysfunction.

An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report.

Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED. The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges. Atypical ED, psychogenic ED not excluded; infertility. Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife. The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization. The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.

A Case Report of Psychogenic Erectile Dysfunction with Ego Dystonic Sexual Disorientation: Is Still Relevant to Treat?

A Case Report of Psychogenic Erectile Dysfunction with Ego Dystonic Sexual Disorientation: Is Still Relevant to Treat?

A Study Showing Importance of Nocturnal Penile Tumescence (Sleep Related Erections) to Differentiate between Psychogenic and Organic Erectile Dysfunction and Using NPT as Confidence Building Measure in Young Men Having Sexual Especially Performance Anxiety and Preference of Midnight/Early Morning Sex using REM Sleep Erections in Them

A Study Showing Importance of Nocturnal Penile Tumescence (Sleep Related Erections) to Differentiate between Psychogenic and Organic Erectile Dysfunction and Using NPT as Confidence Building Measure in Young Men Having Sexual Especially Performance Anxiety and Preference of Midnight/Early Morning Sex using REM Sleep Erections in Them

MP79-15 ERECTILE FUNCTION RECOVERY AMONG YOUNG MEN WITH ERECTILE DYSFUNCTION ON OaD TADALAFIL 5 MG: FINDINGS FROM A REAL-LIFE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP79-15 ERECTILE FUNCTION RECOVERY AMONG YOUNG MEN WITH ERECTILE DYSFUNCTION ON OaD TADALAFIL 5 MG: FINDINGS FROM A REAL-LIFE STUDY Edoardo Pozzi, Federico Belladelli, Giuseppe Fallara, Simone Cilio, Christian Corsini, Alessandro Bertini, Massimiliano Raffo, Fausto Negri, Ludovica Cella, Margherita Fantin, Francesco Lanzaro, Luigi Candela, Paolo Capogrosso, Luca Boeri, Alessia d'Arma, Francesco Montorsi, and Andrea Salonia Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Simone CilioSimone Cilio More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Luca BoeriLuca Boeri More articles by this author , Alessia d'Arma Alessia d'Arma More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Daily tadalafil 5 mg provides a valuable alternative to on-demand tadalafil for men who prefer spontaneous to scheduled sexual attempts. We investigated the rate of and the clinical factors associated with erectile function (EF) recovery after discontinuation of 5 mg tadalafil OaD in a cohort of young men seeking medical help for ED as primary complaint. METHODS: Data from 96 consecutive young patients (<50 yr) with ED and prescribed with 5 mg tadalafil OaD were analysed. All patients were diagnosed with psychogenic ED after a comprehensive clinical evaluation including penile duplex ultrasound and hormonal profile assessment. All completed the International IIEF at baseline. Length of treatment varied from 1 to 12 months according to clinical judgement. EF recovery was assessed after 2 weeks from treatment discontinuation and defined as IIEF-EF >21 after daily 5 mg tadalafil discontinuation. Patients without EF recovery were classified as tadalafil OaD non-responders. Cox-regression models tested the association between patients' baseline characteristics and the probability of EF recovery after treatment discontinuation. Kaplan-Meier analyses estimated the probability of EF recovery over time. RESULTS: Median (IQR) age was 39 (32-45) yr. Of all, 82 (85.4%) achieved EF recovery at treatment discontinuation, whilst 14 (14.6%) were identified as non-responders. Median treatment length was 3 (2-11) months. Most common treatment-related adverse effect was headache in 9 (9.4%) patients. Non-responders were older (43 vs. 38, p=0.03), with higher BMI (25.54 vs. 23.6, p=0.04) and depicted lower IIEF-EF scores at baseline (12 vs. 15, p=0.02) than responders. No differences in terms of comorbidities (CC≥1), smoking, alcohol consumption and regular physical exercise were detected. Kaplan Meier estimates of EF recovery at 3, 6 and 12 months, were 43% (95%CI: 41-62), 60% (95%CI: 49-69) and 75% (95%CI: 64-83), respectively (Figure 1). Younger age (HR: 0.95; 95% CI: 0.92-0.99, p=0.01) was associated with EF recovery after adjusting for baseline EF, BMI, smoking and CCI≥1. CONCLUSIONS: Almost one out of two young ED patients prescribed with tadalafil OaD achieved full EF recovery within 3 months of treatment. Younger patients have higher probability of EF recovery with daily 5 mg tadalafil therapy. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1147 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Giuseppe Fallara More articles by this author Simone Cilio More articles by this author Christian Corsini More articles by this author Alessandro Bertini More articles by this author Massimiliano Raffo More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Francesco Lanzaro More articles by this author Luigi Candela More articles by this author Paolo Capogrosso More articles by this author Luca Boeri More articles by this author Alessia d'Arma More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

Electroacupuncture for psychogenic erectile dysfunction: A resting-state functional magnetic resonance imaging study exploring the alteration of fractional amplitude of low frequency fluctuation.

Psychogenic erectile dysfunction (PED) can seriously affect emotional and marital wellbeing. Electroacupuncture (EA) seems an effective method for treating PED. However, the central mechanisms underlying PED and the beneficial effects of EA treatment are unclear. The purpose of this study was to explore the central mechanisms of PED and to examine the impact of EA on erectile function. We recruited 14 PED patients and 14 matched normal controls (NCs). PED patients underwent twice rs-fMRI scans, respectively, pre- and post-treatment. The NCs only completed one rs-fMRI scan. We used the fractional amplitude of low frequency fluctuation (fALFF) to compare spontaneous neural activity between the PED patients and NCs, and to examine the differences between the pre- and post-EA treatment scans in the PED patients. Scores on the IIEF5, QEQ, and SEAR improved after EA treatment. Compared with the NCs, PED patients showed increased fALFF in the right posterior cingulate cortex (PCC), right dorsolateral prefrontal cortex (DLPFC), right supplementary motor area (SMA), and left middle occipital gyrus. Most of these regions are closely implicated in sexual inhibition. The results of the correlation analysis results indicated that the fALFF of the right PCC was negatively correlated with IIEF5 scores. After treatment, fALFF values were substantially lower in the left triangular part of the inferior frontal gyrus, right DLPFC, right SMA, bilateral PCC and the orbital part of the middle frontal gyrus, and higher in the left middle temporal gyrus and left caudate nucleus. These regions mainly belong to the default mode network (DMN), executive control network and primary sensory motor network. The results of the correlation analysis indicated a positive association between the changes in IIEF5 score and changes in the fALFF value in the right PCC after EA treatment. In conclusion, our study highlights that PED patients have abnormal patterns of activity in the right PCC, right DLPFC, and right SMA mainly involved in the DMN, executive central network, and sensory motor network which could lead to a higher levels of sexual inhibition. EA might regulate the process of sexual inhibition to improve erection function in PED patients probably by modulating spontaneous brain activity in the DMN, executive central network, and sensory motor network.

Hypothalamic-pituitary-adrenal axis activity and its relationship to the autonomic nervous system in patients with psychogenic erectile dysfunction.

Psychological stress and its two stress response systems, the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), are closely related to psychogenic erectile dysfunction (pED). However, the analyses of perceived stress and stress systems in pED patients need to be more in-depth, especially the interactions between them. Our study included 75 patients with pEDs and 75 healthy men. The International Index of Erectile Function-5 (IIEF-5) and the 10-item Perceived Stress Scale (PSS-10) were used for assessing the severity of ED and perceived stress. All participants collected saliva samples on three consecutive days at eight specific times with strict reference to the time of morning awakening for measuring cortisol parameters and wore electrocardiography for 24h to derive heart rate variability (HRV). The PSS-10 scores of pED patients were significantly higher than the control group (p<0.001). Although PSS-10 and IIEF-5 scores were negatively correlated in pED patients, there was no statistical significance between them (r=-0.049, p=0.677). Compared with the control group, the HRV parameters of pED patients were significantly increased in LF/HF ratio (p=0.014) but significantly decreased in LF, HF, and pNN50 (p<0.001). However, the two groups had no statistically significant differences in cortisol variables (all p>0.05). The interaction between sympathovagal modulation (HF, rMSSD) and cortisol awakening response (CAR AUCi) explained significantly greater variance in perceived stress than either stress system alone. Higher parasympathetic activity combined with a higher cortisol awakening response was associated with greater perceived stress. Our results suggested that the interrelation between ANS and HPA axis activity might enhance our comprehension of how stress affected the physical and mental health of pED patients.