Psychogenic Impotence Research Articles

ROLE OF ASHWAGANDHA ON HEMATOLOGICAL, BIOCHEMICAL, SEMINAL PARAMETERS AND ON SERUM DHEAS IN PSYCHOGENIC ERECTILE DYSFUNCTION PATIENTS

Ashwagandha ( Withania somnifera Dunal) has been known for its capability to improve endurance against stress, general resistance a gainst infections, to slow down the ageing process, improvement of male sexual health and useful in disorders such as psychogenic impotence and unexplai ned infertility. T he roots of which have been used as anti - stress agent, aphrodisiac and male sexual sti mulant. Erectile dysfunction has been defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual intercourse . The clinical study on Ashwagandha in Psychogenic Erectile Dysfunction (PED) earlier reported negative results and concluded that, Ashwagandha didn’t provide relief in PED on various scales . The present article deals with the laboratory findings of this clinical study sample; to evaluate the efficacy of Ashwagandha on various hematological, bio che mical, seminal parameters and on serum DHEA - S (which were in normal range) in PED patients . Blood samples were collected and assayed for serum concentrations of DHEA - S, RBS, TC, TG, HDL, total protein, SGOT, SGPT , Hemoglobin, total RBC count, TLC and DLC. Semen samples were collected and measured on parameters like, liquefaction time, volume, motility and count. Patients found to have any abnormalities in the reports of above parameters were excluded from the study (to rule out organic pathology) . All of th ese investigations were done two times, before and after the treatment. Paired and unpaired‘t’ test were used for statistical analysis. Ashwagandha didn’t improve various hematological, biochemical, seminal parameters and serum DHEA - S which were already in normal range in the patients of psychogenic erectile dysfunction. The results were consistent with that of the clinical study which was also reported negative results earlier.

Male Infertility: Integrating an Old Psychoanalytic Story with the Research Literature

Male infertility, different from female infertility, is characterized by anxiety about sexual adequacy, potency, and manliness. This assault on a man's sense of self revives feelings of competition, castration, and experiences of developmental trauma. In this article we review the literature on male factor infertility and its relationship to psychogenic impotence and to psychological fertility in the larger sense. We also discuss spermatogenesis, sperm donation, and the emotional implications for men of the new reproductive technologies. Finally, we consider the effect on the couple relationship and the value of psychological treatment.

Experience with the Jonas penile prosthesis in the treatment of impotence.

The penile prosthesis has become established as a mode of therapy for organic and chronic psychogenic impotence. The Jonas type of penile prosthesis has been implanted into 10 patients and has achieved both functional success and excellent acceptance by the partner. Mechanical and pathological complications have a very low incidence. This penile prosthesis should be made available to carefully selected impotent patients who are deemed psychologically suitable candidates and in whom medical treatment has failed or is not indicated. It represents an important advance in the treatment of the male with erectile impotence.

T03-O-07 Gender stereotypes in sexology and sexual dysfunction research

Major changes have occurred in male and female dysfunction research. Male erectile dysfunction has been re-conceptualized as an organic dysfunction, which marks a dramatic shift from previous conceptions of psychogenic impotence developed during the 60’ and the 70s. The release of sildenafil in 1998 was the corner stone of a new paradigm of treatments focusing on male penile activity, far remote from any psychological approaches. More recently, medical sexologists started to reconsider Female Sexual Dysfunction using the same organic biological model of sexual function. New pharmaceutical products are currently under trial for the treatment of this new category of female sexual disorder. But as opposed to the absence of public adverse reaction to the development of this approach of male function, many voices raised to oppose this new conception of female function. A major discussion took place in the British Medical Journal (2003) stating that female sexual function was not organically driven, but rather determined by the social, psychological and interpersonal context of female sexual activity and relations. One of the major dimension of this discussion opposed the so-called simplicity of male sexual function to the complexity of female sexual function. The presentation, which takes place in the field of scientific history will present evidence of the permanence of traditional social scripting of male and female sexuality and their influence in the most advanced scientific research in this field. Does sexology science also consider that men come from Mars and women from Venus?

The Role Of Bulbo Cavernosus Reflex Latency (Bcr- L) In The Etiology Of Patients With Erectile Dysfunction

Introduction: The aim of the study was to determine the role of bulbocavernosus reflex latency (BCRL) in patients with erectile dysfunction (ED) who underwent physical examination, history, invasive and non invasive tests and revealed no psychogenic or organic pathology. Material and methods:A total of 60 patients with ED (mean age ± SD, range, 43,1 ± 10,7 years, 23-59) and 14 patients without any sign and symptom of ED (mean age ± SD, range, 35,6 ± 8 years, 25-49) were included to the study. Patients with a history of diabetes mellitus, multiple sclerosis, cranial, spinal and pelvic trauma or previous surgery were excluded from the study. Patients were evaluated for the etiology of ED by a detailed history, physical examination, blood chemistry, hormone profile, papaverine test, penile color doppler ultrosonography and BCRL. Results: Of the patients 17 (28,3%) showed psychogenic impotence whereas, 7 (11,7%) had arterial insufficiency and 4 (6,7%) revealed venous leak. In two (3,3%) patients hormone (testesterone) deficit was determined. In 30 (50%) patients with unexplained etiology, BCR test was performed by same neurology specialist(TY). Of the 30 patients, 5 (16,6 %) showed distal latency of 39 ms or more. This group of patients had higher level of test results compared to the patients in control group and the difference was statistically significantly (p < 0,05). Conclusion: Erectile dysfunction is a failure of multiple physiological systems and in patients suffering from ED with no identified etiology, neurogenic mechanisms may be a cause in the pathogenesis. Thus, in this group of patients BCRL measurement may be an assisted diagnostic technique in the evaluation.

The role of oxytocin and the paraventricular nucleus in the sexual behaviour of male mammals

The paraventricular nucleus of the hypothalamus contains the cell bodies of a group of oxytocinergic neurons projecting to extrahypothalamic brain areas and to the spinal cord, which are involved in the control of erectile function and copulation. In male rats, these neurons can be activated by dopamine, excitatory amino acids, nitric oxide (NO), hexarelin analogue peptides and oxytocin itself to induce penile erection and facilitate copulation, while their inhibition by gamma-aminobutyric acid (GABA) and GABA agonists and by opioid peptides and opiate-like drugs inhibits sexual responses. The activation of paraventricular oxytocinergic neurons by dopamine, oxytocin, excitatory amino acids and hexarelin analogue peptides is apparently mediated by the activation of nitric oxide (NO) synthase. NO in turn activates, by a mechanism that is as yet unidentified, the release of oxytocin from oxytocinergic neurons in extrahypothalamic brain areas. Paraventricular oxytocinergic neurons and mechanisms similar to those reported above are also involved in the expression of penile erection in physiological contexts, namely, when penile erection is induced in the male by the presence of an inaccessible receptive female, which is considered a model for psychogenic impotence in man, as well as during copulation. These findings show that paraventricular oxytocinergic neurons projecting to extrahypothalamic brain areas and to the spinal cord and the paraventricular nucleus play an important role in the control of erectile function and male sexual behaviour in mammals.

Role of urologists in evaluation of male erectile dysfunction with emphasis on ultrasound

The discovery that penile erection was a vascular phenomena associated with clinical risk factors (advancing age, hypertension, atheroslcerotic vascular disease, diabetes mellitus, and smoking) coincided with the advent of non-invasive imaging technologies, specifically duplex Doppler ultrasound. The eighties and nineties saw the development of multiple penile diagnostics; of these technologies, color duplex Doppler ultrasound was the least invasive and most informative. In those practices where Doppler technology was not available, a vasoactive penile injection administered in the office permitted the physician to roughly distinguish between severe arterial disease and psychogenic impotence. Whether the agent was papaverine, prostaglandin E1, or a combination of vasoactive medications, the addition duplex Doppler ultrasound provided greater objective criteria for evaluating penile responses, permitting subclassification of erectile dysfunction as: arterial, veno-occlusive, or mixed vascular insufficiency. Subsequently, color Doppler enhanced diagnostics by speeding the acquisition of data. The introduction of Sildenafil in 1998 dramatically changed practice patterns, by increasing the number of patients acknowledging the complaint, and shifting the burden of evaluation and management away from the urologist and toward the family practitioner. The next few years will see the development of multiple oral agents for the management of erectile dysfunction. The role of erection diagnostics will be: 1) to predict which drug or combination of drugs (oral, cutaneous, urethral, intracavenosal) will effectively restore erection, 2) to spare patients the frustration and the potential side effects of empiric trials, and 3) to determine whether patients would best be served by a mechanical/surgical solution. This lecture will highlight patient selection for specialist referral and the techniques of erection diagnostics based on color duplex Doppler ultrasound. The discovery that penile erection was a vascular phenomena associated with clinical risk factors (advancing age, hypertension, atheroslcerotic vascular disease, diabetes mellitus, and smoking) coincided with the advent of non-invasive imaging technologies, specifically duplex Doppler ultrasound. The eighties and nineties saw the development of multiple penile diagnostics; of these technologies, color duplex Doppler ultrasound was the least invasive and most informative. In those practices where Doppler technology was not available, a vasoactive penile injection administered in the office permitted the physician to roughly distinguish between severe arterial disease and psychogenic impotence. Whether the agent was papaverine, prostaglandin E1, or a combination of vasoactive medications, the addition duplex Doppler ultrasound provided greater objective criteria for evaluating penile responses, permitting subclassification of erectile dysfunction as: arterial, veno-occlusive, or mixed vascular insufficiency. Subsequently, color Doppler enhanced diagnostics by speeding the acquisition of data. The introduction of Sildenafil in 1998 dramatically changed practice patterns, by increasing the number of patients acknowledging the complaint, and shifting the burden of evaluation and management away from the urologist and toward the family practitioner. The next few years will see the development of multiple oral agents for the management of erectile dysfunction. The role of erection diagnostics will be: 1) to predict which drug or combination of drugs (oral, cutaneous, urethral, intracavenosal) will effectively restore erection, 2) to spare patients the frustration and the potential side effects of empiric trials, and 3) to determine whether patients would best be served by a mechanical/surgical solution. This lecture will highlight patient selection for specialist referral and the techniques of erection diagnostics based on color duplex Doppler ultrasound.

Erectile Dysfunction in Patients with Chronic Obstructive Pulmonary Disease

Background : Recent discoveries on the physiology of an erection have demonstrated that the organic causes of impotence are more common, and psychogenic impotence is correspondingly less common than was formally believed. The incidence of sexual dysfunctions in chronic obstructive pulmonary disease (COPD) patients is largely unknown or may be perfunctorily attributed to the associated illness or to aging. This study investigated whether or not the impotence was related to the COPD itself as well as whether or not it may stem from organic causes in a notable proportion of such patients. Methods : The sexual function was evaluated in 10 COPD patients and 10 normal control subjects. A nocturnal Rigi Scan was performed to evaluate the erectile function of each group. The level of hormones such as the free testosterone, prolactin and thyroid stimulating hormone (TSH) was measured, and a pulmonary function test and arterial blood gas analysis was performed. Results : The time duration and frequency of a penile erection were significantly lower in COPD patients than the controls (p<0.05). In addition, the PaO2 levels correlated with the time duration of the penile erection. Conclusion : These results suggest that COPD is one of the causes of organic erectile dysfunction.

Central oxytocinergic neurotransmission: a drug target for the therapy of psychogenic erectile dysfunction.

A group of oxytocinergic neurons originating in the paraventricular nucleus of the hypothalamus and projecting to extrahypothalamic brain areas (e.g. hippocampus, medulla oblongata and spinal cord) control penile erection. Activation of these neurons by dopamine and dopamine agonists, excitatory amino acids (N-methyl-D-aspartic acid) or oxytocin itself, or by electrical stimulation leads to penile erection, while their inhibition by GABA and GABA agonists or by opioid peptides and opiate-like drugs inhibits this sexual response. The activation of oxytocinergic neurons in the paraventricular nucleus by dopamine, oxytocin and excitatory amino acids is apparently secondary to the activation of nitric oxide (NO) synthase. NO in turn activates, by a mechanism that is as yet unidentified, the release of oxytocin from oxytocinergic neurons in extrahypothalamic brain areas. Several peptide analogues of hexarelin, a growth hormone releasing peptide, also induce penile erection when injected into the paraventricular nucleus and, to a lesser extent, systemically, apparently by acting on a specific receptor to activate oxytocinergic neurons as shown for the above drugs and oxytocin. Paraventricular oxytocinergic neurons and mechanisms similar to those reported above are also involved in the expression of penile erection in physiological contexts, namely when penile erection is induced in the male by the presence of an inaccessible receptive female, which is considered a model for psychogenic impotence in man, as well as during copulation. These findings show that paraventricular oxytocinergic neurons projecting to extra-hypothalamic brain areas and to the spinal cord are a likely target for the treatment of erectile dysfunction of central origin.

Colour duplex Doppler ultrasonography evaluation of non-vasculogenic male erectile dysfunction: An Indian perspective.

We present the study of colour duplex Doppler ultrasonography on Indian patients with non-vasculogenic erectile dysfunction. Patients with a history suggestive of psychogenic impotence along with a normal clinical response to intracavernosal papaverine were presumed to have non-vasculogenic erectile dysfunction. In our patients, the incidence of psychogenic impotence was much higher and the mean age of patients presenting with erectile dysfunction was lower as compared to patients from developed countries reported in research. The Doppler flowmetry showed much higher mean peak systolic velocities (PSVs) with a negative correlation between age and PSV. End diastolic velocity, resistive index and acceleration time values conformed to the literature.

New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: is it a useful test?

The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno-occlusive dysfunction. Eighty-seven consecutive patients were allocated into three groups as psychogenic, arterial and venous erectile dysfunction after investigations. Nocturnal penile tumescence recording parameters between psychogenic and vascular erectile dysfunction and arterial and veno-occlusive dysfunction were compared. Mann-Whitney U-test, Pearson's chi2 test and correlation coefficient tests were used for statistical analysis. Depending on intracavernous injection, penile Doppler ultrasonography and cavernosometry tests, 37 patients (43%) had psychogenic impotence while 50 (57%) had organic pathologies. Of the 50 patients diagnosed with vascular impotence, 29 (48%) had arterial failure and 21 (42%) had veno-occlusive dysfunction. Nocturnal penile tumescence recording revealed psychogenic erectile dysfunction in 34 patients (39%) and vascular erectile dysfunction in 53 patients (61%). Nocturnal penile tumescence recording has been regarded as the gold standard and, in our series, it showed 90.6% sensitivity and 88.2% specificity in differentiating the cause of erectile dysfunction. Values of rigidity activity unit and tumescence activity unit were significantly higher in patients with psychogenic impotence (P < 0.001), when compared with vascular impotence. In patients with a vascular cause, no difference was found between arterial failure and veno-occlusive dysfunction with regard to tip tumescence activity unit, base tumescence activity unit, tip rigidity activity unit, base rigidity activity unit and erection time (P > 0.001). However, patients with arterial failure had less erection than patients with veno-occlusive dysfunction (P < 0.001). New recording parameters of nocturnal penile tumescence can differentiate organic and psychogenic erectile dysfunction more precisely. However, these recording parameters cannot distinguish subgroups with a vascular cause of erectile dysfunction.

Are normal hemodynamic responses invariably associated with normal penile rigidity and potency?

The existence and importance of patients with low penile buckling pressure and normal penile hemodynamic status have been recently recognized. We assessed the ratio of inadequate erection for vaginal penetration (low buckling pressure) in patients with normal penile vascular system proved with penile Doppler ultrasonography. A total of 101 patients with normal penile vascular status were retrospectively scrutinized dependent on penile axial rigidity (buckling pressure). Ninety patients had sufficient penile axial rigidity (> or = 550 g) whereas in the remaining 11 patients (11%) inadequate penile buckling pressure for vaginal penetration (< 550 g) was determined. Penile geometric and mechanical properties should not be overlooked during the evaluation of penile vascular system lest the patient be incorrectly diagnosed as having psychogenic impotence.

Multicenter study of the treatment of erectile dysfunction with transurethral alprostadil (MUSE) in Korea

A Korean multicenter study was conducted to assess the effectiveness of transurethral alprostadil with MUSE in 334 subjects with chronic erectile dysfunction (ED) who were enrolled in 21 clinical centers. Patients with psychogenic impotence comprised about 30% of subjects. Intraurethral alprostadil was titrated in a stepwise fashion in the clinics from 250 to 500 or 1000 mcg based on erectile response and tolerability. The erectile responses were evaluated using an erection assessment scale (score of 1-5). The dose that produced a maximal penile response of score 5 (full rigid erection) or 4 (full tumescence, partial rigidity) was selected for home treatment. Patients who showed partial erection (score of 3) with 1000 mcg were also included in the home-treatment group. In-clinic phase: 198 men (59.3%) had maximal penile responses of score 4 or 5. The rate of maximal responses was not related to patient age, etiology or duration of the ED. A total of 228 (68.3%) men progressed to home treatment. The overall level of comfort of the transurethral alprostadil was rated as uncomfortable or very uncomfortable in 12%. Home phase: During the two-month period of home treatment, 178 (78.1%) men had successful sexual intercourse at least once, and 78.2% of administrations (1976) resulted in successful intercourse. The main causes of drop-out were insufficient erectile response in 27 men (11.8%), adverse reactions (mostly penile or urethral pain) in 7 (3.1%) or both in 7 (3.1%). In conclusion, transurethral alprostadil could be a suitable treatment option for patients with ED regardless of age and etiology of ED. Efficacy in an Asian population (Korea) is comparable to that reported previously in Caucasians.

Interdisciplinary assessment and follow-up of patients with erectile dysfunction--psychiatric aspects.

The objectives of this investigation were to assess the psychiatric comorbidity and patients' satisfaction with treatment in a sample of 73 men with erectile dysfunction (ED) who were consecutively admitted to an andrologic outpatient centre. After comprehensive interdisciplinary assessment, 49% of these patients were assigned an organic etiology, 33% had psychogenic impotence, and in 18% somatic and psychogenic factors seemed to be relevant. 63% of all patients received a psychiatric diagnosis (according to ICD-9). Depressive disorders were found in 25%. Organic psychosyndromes (nonpsychotic) were prominent in the somatic group. In a follow-up after 29.4 +/- 5.0 months, 41 out of 73 patients could be reevaluated, of which 85% of organic patients had received some kind of therapy, but 65% were not satisfied with the chosen treatment. These results underline the importance of close interdisciplinary co-operation in the assessment and therapy of patients with erectile importance. Potential reasons for drop-out and limited acceptance of the offered treatments are discussed.

Short term use of intracavernous vasoactive drugs in the treatment of persistent psychogenic erectile dysfunction.

The objective of this retrospective study is to evaluate the effectiveness of short term intracavernous pharmacotherapy in the treatment of persistent psychogenic impotence. The study included 153 patients evaluated within an Andrology clinic in a general hospital working in close relation to three psychiatry clinics in three hospitals. Patients underwent an average of two office sessions of intracavernous injections for the selection of the appropriate intracavernous agent and dose, and for self injection training. Of the 153 patients included in our study 98 (64%) needed the injection for less than three months, only 18 (12%) patients needed the injections up to one year. We concluded that intracavernous self injection of vasoactive drugs is an effective alternative in the treatment of men with persistent psychogenic impotence when sex therapy is unsuccessful.

Technetium-99m-Labelled RBC Erection Penogram to Differentiate Psychogenic from Vasculogenic Impotence

The ^99mTc-labelled RBC erection penogram (Tc-RBC penogram) coupled with intracavernosal injection of prostaglandin E₁ (PGE₁) was used to evaluate the penile hemodynamic changes during tumescence. As expected, the method is useful to differentiate organic from psychogenic impotence, and arteriogenic from venogenic impotence. Thirty-four patients with psychogenic impotence, 23 patients with arteriogenic impotence, and 27 patients with venogenic impotence were included in the study. A Tc-RBC penogram was performed on each patient after intracavernosal injection of PGE₁. Several parameters calculated from the time-radioactivity curve of the Tc-RBC penogram were used to evaluate hemodynamic changes of the penis. They included (1) the arterial phase: slope and time to peak (TTP), and (2) the venous phase: washout index (WOI). During the arterial phase, the patients with psychogenic and venogenic impotence had higher slope and shorter TTP than those of patients with arteriogenic impotence (p < 0.01). During the venous phase, the patients with psychogenic and arteriogenic impotence had a lower WOI than that of patients with venogenic impotence (p < 0.01). We conclude that the Tc-RBC penogram is a simple, noninvasive, and valuable method for the objective differentiation among psychogenic, arteriogenic, and venogenic impotence.

Changes in Erectile Response to Repeated Audiovisual Sexual Stimulation

Objectives: To determine changes in erectile response to repeated audiovisual sexual stimulation in patients with psychogenic impotence and normal men. Methods: The same erotic video was shown to 45 men (20 patients with psychogenic impotence and 25 normal men) for 3 consecutive days. Their erectile responses during the audiovisual stimulation were monitored using RigiScan (Dacomed, Minneapolis, Minn., USA), and the maximal rigidity of erection, sustained for more than 5 min, was measured. The rigidities on the first, second and third days were comparatively analyzed. Whether previous multiple viewings of the erotic movie and previous exposure to the same or a similar movie influenced the erectile response were also evaluated. Results: Rigidity on the third day was significantly decreased compared to that on the first day in both patients with psychogenic impotence and normal controls (p < 0.05), regardless of the frequency of previous viewings and the previous exposure to a similar movie. Rigidity on the first day was significantly lower in the group with multiple viewings than in the group with fewer viewings (p < 0.05). Conclusions: Real-time monitoring of penile erection during audiovisual sexual stimulation may result in false-negative responses when patients are repeatedly exposed to the stimulation.

Comparison between plasma concentrations of testosterone, nitric oxide and endothelin 1–2 in penile and brachial venous blood: preliminary results in men with psychogenic impotence

In the present study venous plasma concentrations of testosterone (T), nitric oxide (NO) and endothelin 1-2 (ET1-2) in the flaccid penis and brachial blood were measured in men with psychogenic impotence. T and NO were significantly lower in the penile venous blood, while ET1-2 showed no statistical difference. These data support the hypothesis of testosterone dependence of penile nitric oxide synthesis (NOS).

Import Catheter in Erectile Dysfunction

Purpose We propose an alternative technique for intracavernous self-injection of sodium nitroprusside for erectile dysfunction by inserting a Medtronic ImPort * * Medtronic PS Medical/IPI, Minneapolis, Minnesota. catheter with a valved tip. Materials and Methods A silicone catheter was implanted in 3 patients with psychogenic impotence. The reservoir, which is used for vasoactive agent injection, was implanted laterally to the anterosuperior iliac spine and the distal tip of the catheter was inserted into the corpora cavernosa via a subcutaneous tunnel. The injection technique was taught to the patient and the initial injection was performed 1 week later. Results All patients and partners were satisfied with the technique and quality of erections at a mean followup of 14 months. There were no major local complications due to catheter implantation and no systemic complications due to sodium nitroprusside injection. Conclusions An alternative technique for intracavernous pharmacotherapy of inserting an ImPort catheter prevented the complications of intracavernous injections in patients with erectile dysfunction.

Sildenafil: an oral drug for impotence

Sildenafil, an oral drug for men with erectile dysfunction, produced satisfactory erections in almost 90% of men in a large European trial. The drug is effective and welltolerated both in men with organic and in those with psychogenic impotence, according to results from European and US phase III trials. Sildenafil may be useful in treating female sexual dysfunction as well, reported researchers at the Annual Meeting of the American Urological Association (AUA) [New Orleans, Orleans, US; April 1997]. The drug also improves sexual satisfaction and orgasm in men, said a researcher, based on patient reports in his clinic.