Aphrodisiac Research Articles

Idiopathic recurrent ischemic priapism: a review of current literature and an algorithmic approach to evaluation and management

BackgroundStuttering priapism is characterized by recurrent, self-limited episodes of penile erection lasting from a few minutes to a maximum of three hours, often resolving spontaneously. These episodes can occur with or without sexual stimulation. If not treated promptly and effectively, stuttering priapism can severely impact a patient’s quality of life, leading to significant psychological distress and anxiety related to sexual performance. Although it has been associated with various hematological disorders and pharmacological treatments, many cases of stuttering priapism remain idiopathic, meaning they have no identifiable cause. Currently, no conclusive randomized clinical trials exist on the management of idiopathic stuttering priapism. This study aims to review the existing literature on the pathophysiology and management of idiopathic stuttering priapism and propose an algorithm to assist physicians in its evaluation and treatment.ResultsA systematic literature review was conducted using the PubMed database, focusing on the terms “idiopathic,” “stuttering,” “ischemic,” and “priapism.” The search identified 23 relevant references published between 1991 and 2022. The selection and analysis of these studies adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and results were described qualitatively. Recent research into the effectiveness, sustainability, tolerability, and side effects of various treatments for idiopathic stuttering priapism has enhanced the understanding of its underlying molecular mechanisms. Various treatments, targeting different mechanisms, have been identified that can potentially reduce the frequency and severity of episodes and improve patient outcomes.ConclusionCurrent research predominantly addresses the acute treatment of idiopathic stuttering priapism rather than strategies to alter the disease’s overall course. The limited number of treatment reviews, case reports, and the low level of evidence available, combined with the absence of randomized clinical trials, prevent the establishment of a consensus on treatment protocols. As a result, idiopathic stuttering priapism remains under-recognized and under-treated. This review proposes a management framework to help clinicians access and apply the available literature effectively, minimizing the reliance on extensive case reports and review articles.

Sympathetic hypoactivity leads to hypocontractility of the corpus cavernosum in sickle cell mice: a mechanism contributing to priapism.

Priapism, a prevalent complication in sickle cell disease (SCD) patients, manifests as prolonged and painful erections unrelated to sexual arousal. The detailed mechanisms contributing to this condition, especially regarding sympathetic function in the corpus cavernosum that maintains penile flaccidity, remain to be elucidated. In this study, it was hypothesized that the pathways of the sympathetic nervous system would be down-regulated, thereby contributing to the development of ischemic priapism in sickle cell disease. This study aimed to investigate the contractions induced by stimulation of sympathetic terminals and the expression of tyrosine hydroxylase in the corpora cavernosa of Berkeley SCD mice. C57BL/6 mice (wild-type, WT) and Berkeley SCD mice were used. A total of 22 mice were used in this study, with 11 allocated to the WT group and 11 to the SCD group. Mice corpus cavernosum was dissected free and mounted in 7-mL organ baths containing Krebs solution. Noradrenergic contractions were obtained using electrical-field stimulation (4-32 Hz) in corpus cavernosum strips from WT and SCD mice. Measurements of tyrosine hydroxylase phosphorylated at Ser-31 and total tyrosine hydroxylase protein expressions in cavernosal tissues were also measured by western blot. The neurogenic contractions were significantly lower (P < 0.05) in the SCD group compared to WT group at all tested frequencies. The protein expression of both total tyrosine hydroxylase and tyrosine hydroxylase phosphorylated at Ser-31 was significantly decreased by approximately 46.28% (P = 0.01) and 55.32% (P = 0.03) in cavernosal tissues from the SCD group compared to the control group, respectively. In conclusion, sympathetic hypoactivity characterized by the downregulation of tyrosine hydroxylase contributes to the hypocontractility of the corpus cavernosum in Berkeley SCD mice. This suggests an impairment in the mechanism responsible for maintaining penile flaccidity, potentially predisposing to erections without sexual stimulation, similar to those observed in ischemic priapism. Pharmacological treatments aiming to restore sympathetic tone in the penis might hold promise for addressing ischemic priapism in SCD.

Erectile dysfunction after COVID-19 infection: A cross-sectional study in a male sample from Brazil

Introduction: COVID-19 infection may cause erectile dysfunction due to local viral infection and impairing mental health. Objective: To analyze the erectile function in Brazilian sample patients during pandemics with and without COVID-19 infection and compare with results from a sample obtained before the pandemic. Methods: Internet survey with epidemiologic questions, data on COVID-19 infection, and the International Index for Erectile Function (IIEF). Patients were divided into those with and without infections. A control group with results obtained before the pandemic was also included. Results: Four hundred twenty-two males were studied 210 with data obtained before the pandemic; 208 with data obtained during the pandemic (84 with COVID-19 infection and 124 without). Patients with COVID-19 infection had worse results of IIEF than those without (in the pandemics and before pandemics) with p=0.01 and used more sexual stimulants (p=0.02). The results were worse in the first month after the infection. Conclusion: Patients with COVID-19 infection had impairment in erectile function that is more severe in the first month after infection.

The Concept of Innate Sexual Priors in the Brain: A Theory on Why We Are Attracted to What We Are Attracted to

AbstractSexuality is an integral part of human nature, yet we know little about its origins and underlying mechanisms. Understanding how the brain processes sexual stimuli is crucial for advancing our knowledge of the origins of sexuality and its variations. Only if a stimulus was internally evaluated as ‘attractive’ the information can progress to evoke sexual desire or arousal. Importantly, such evaluation processes require an internal reference against which external information is compared. These processes, however, remain largely unexplored, and hence we still do not understand why we are attracted to what we are attracted to. By synthesizing the existing literature and integrating existing models, this narrative review proposes a novel neuroscientific framework on sexuality, addressing key theoretical gaps. As a result, the concept of sexual priors in the brain is introduced. Within this framework, sexual priors refer to mental ‘images’ representing a collection of internally stored information of what we regard as sexually attractive. Such mental representations act as reference in early internal evaluation processes of sexual stimuli. It is suggested that sexual priors are (partly) innate and sex-specific, contributing to heterosexuality. Evolutionary aspects that could explain the development of these priors are discussed. Furthermore, the framework provides possible explanations for variations in sexual orientation through potential cross-sex shifts in sexual prior content. The refinement of sexual prior content over time may explain the diversity of sexual interests and attraction patterns among humans. Moreover, the concept can be applied to a variety of psychiatric conditions related to atypical and maladaptive sexual behaviors. A proposition is put forward regarding brain areas and networks that may be involved in the formation of sexual priors, serving as potential targets for future research. In summary, by integrating sexual priors into models of sexual stimuli processing, this article fills theoretical gaps while inspiring further research. This work aims to enhance understanding of sexuality, which ultimately could increase social awareness, foster tolerance, and promote psychological well-being.

Erectile dysfunction as a common complication of radical prostatectomy

Prostate cancer is a widespread disorder among older men cured in most cases by radical prostatectomy. Erectile dysfunction, among other sexual disabilities, following a prostatectomy, plays an important role in the quality of life of these patients. Due to the high prevalence of this problem, the knowledge about health aspects leading to postoperative erectile dysfunction should be extended, enabling better prevention of this disorder. This study aims to assess the risks and benefits of preoperative sexual stimulation in patients undergoing different types of prostatectomy on erectile dysfunction by analysing available data from articles found on several internet archives such as PubMed, Google Scholar or Embase. This research shows that erectile function in patients undergoing radical prostatectomy depends both on protective factors of ED, risk factors of ED preoperatively, active sexual rehabilitation before and after surgery, and finally on the type of procedure itself. Patients benefit from good sexual conditions before the surgery, few risk factors such as obesity or cardiovascular diseases, having undergone one of nerve-sparing techniques and active sexual rehabilitation in the postoperative period.

Virtual reality exposure therapy for sexual aversion: a proof-of-concept study on acceptability, adequacy, and clinical effects.

Sexual dysfunctions impair theintimate relationships of up to one-third of the population. Virtual reality (VR) offers innovative treatment options for both mental and sexual disorders, such as female orgasmic disorder and erectile disorder. Sexual aversion disorder (SAD)-the anxiety, disgust, and avoidance of sexual contexts-is a chronic condition commonly treated with anxiety-reducing strategies, such as exposure-based therapy. Despite exposure's efficacy in reducing SAD symptoms, VR exposure therapy's (VRET) effectiveness remains unexplored for this condition. This proof-of-concept study examines the acceptability, adequacy, and clinical effects of a VRET's simulation protocol for SAD. In the laboratory, 15 adults suffering from SAD (Mage = 35.00; SD = 11.36) viewed 15 virtual sexual scenarios of increasing intensity (eg, flirting, nudity, genital stimulation) adjusted to their sexual preferences and gender identities. Levels of anxiety, disgust, and catastrophizing beliefs were measured throughout the scenarios using standard self-report measures. Participants also completed validated questionnaires on sexual presence and simulation realism, as well as open-ended questions on scenarios' representativeness and adequacy immediately after immersion. Six months after the laboratory visit, participants completed a negative effects questionnaire and were screened for SAD symptoms again. Repeated-measures ANOVAs and descriptive analyses were performed. Levels of anxiety and disgust significantly increased with the intensity of sexual scenarios. Catastrophizing levels were high and tended to augment with increasing exposure levels. A significant reduction in symptoms of SAD was found from pre-simulation to the 6-month follow-up assessment. Sexual presence and realism scores were moderate. Qualitative assessment revealed that all participants reported the sexual scenarios were representative of real-life situations that tend to elicit SAD symptoms for them. Reported negative effects were generally mild. This proof-of-concept study suggests that VRET may have the potential to elicit self-reported emotional and cognitive manifestations of SAD (sex-related anxiety, disgust, and catastrophizing), while also hinting at its acceptability, adequacy, and benefits in alleviating SAD symptoms. While this study marks the first exploration of the clinical relevance of gender-inclusive virtual sexual scenarios for SAD, its design and sample composition may impact observed effects and the generalizability of findings. This study invites future clinical trials to assess VRET efficacy for SAD.

Penile circumference in the Chinese population measured by Rigiscan

Background: This study aimed to assess the penile circumference in its flaccid and erect states using a Rigiscan monitoring device and Audiovisual Sexual Stimulation (AVSS) within a large Chinese male cohort to establish an objective standard. Methods: 1,134 men participated between January 2019 and June 2021. 803 men, achieving a hardness of 80% or more, were included. Circumferences of the penis’ base and tip in its flaccid and erect states were documented, and averages were compared across age groups and Chinese regions. Age-related correlations were explored. Results: Flaccid penile base and tip averaged 7.25 ± 0.60 cm and 7.20 ± 0.71 cm. At 80% erection, they were 9.70 ± 0.65 cm and 9.65 ± 0.75 cm. The increase in circumference from flaccid to 80% erect for the base and tip was approximately 25.31% and 25.47%, respectively. Correlations between flaccid and erect states were significant (tip: R = 0.807, base: R = 0.828, both p < 0.01). No significant age or regional variations in penile circumference were found. Conclusion: Our data on 803 subjects measured with Rigiscan showed that penile circumferences in flaccid and erect states show a strong correlation, in Chinese population. Penile size does not seem significantly influenced by age or region.

Novel eco-friendly HPTLC method using dual-wavelength detection for simultaneous quantification of duloxetine and tadalafil with greenness evaluation and application in human plasma

A novel, environmentally friendly, and sensitive HPTLC method has been developed and validated for simultaneous quantification of duloxetine (DLX) and tadalafil (TDL) in their pure state, laboratory-prepared mixtures, and spiked human plasma. This method is particularly important for patients dealing with depression and sexual issues, as it allows for the measurement of these co-administered antidepressant and sexual stimulant drugs in biological fluids. The separation process employed a stationary phase of pre-coated silica gel 60 F254 and a mobile phase consisting of ethyl acetate, acetonitrile, and 33% ammonia (8:1:1, v/v). The optimized mobile phase resulted in well-defined bands for DLX and TDL, with Rf values of 0.3 and 0.8, respectively with dual-wavelength detection at 232 nm for DLX and 222 nm for TDL. Polynomial regression analysis revealed exceptional linearity for both drugs, with correlation coefficients of 0.9999 over concentration ranges of 10–900 ng/band for DLX and 10-1200 ng/band for TDL. The quantitation limits were 8.2 ng/band for DLX and 8.6 ng/band for TDL, while the detection limits (LOD) were 2.7 ng/band for DLX and 2.8 ng/band for TDL. The validation of this method followed the guidelines set by the International Council for Harmonization (ICH). Additionally, the suggested method’s greenness was assessed by means of four up-to-date ecological tools, namely the Eco-Scale, the National Environmental Method Index (NEMI), the Green Analytical Procedure Index (GAPI), and the Analytical Greenness metric approach (AGREE). The proposed method was also assessed using the Blue Applicability Grade Index (BAGI), a recently developed metric for assessing the practicality (blueness) of procedures.

The interplay of genetic and environmental factors on the morphology of the limbic cortex and hippocampal subfields: Insights from an MRI twin study

IntroductionThe limbic system and the hippocampus are complex brain structures with key roles in memory, emotions, sexual stimulation and learning, with subregion abnormalities associated with a range of disorders and psychopathologies. Our study aimed to explore the heritability of specific subfield structures within the limbic system and hippocampus first in a Caucasian twin sample with volBrain pipeline. Materials and Methods59 healthy adult Caucasian twin pairs from the Hungarian Twin Registry without any history of previous neurodegenerative or cerebrovascular diseases underwent brain MRI on a 3.0 T scanner (43 monozygotic, MZ and 16 dizygotic, DZ pairs, with a median age of 50±+27 years). The volBrain automated volumetry pipeline was used to calculate the subcortical and general brain volumes from three-dimensional T1-weighted images. Based on age- and sex-adjusted MZ and DZ intra-pair correlations, the univariate ACE model was applied to calculate additive genetic, shared and unshared environmental influences. ResultsAdjusting for age and sex, moderate to strong heritability (A: 59.7 to 73.1 %) was found for most limbic cortex volumes, except for the volumes of entorhinal area and posterior cingulate gyrus where common environmental contribution was detected (C: 56.6 % and 65.0 %, respectively). A substantial heritability (A: 67.0 to 79.4 %) was estimated for the overall hippocampus and most subfield volumes, except for the CA2-CA3 region which was determinated by common environmental factors (C: 45.7 %). Unique environmental variance was a minor to moderate contributor across all variables (E: 20.6 to 54.3 %). ConclusionsAlbeit most limbic cortex, overall hippocampus and most subfield volumes are under substantial genetic influence in healthy adult twins, the volumes of entorhinal area, posterior cingulate gyrus and the CA2-CA3 region of the hippocampus are influenced common environmental factors. The findings underline the importance of unique environmental factors which may play a role in the prevention of disorders related to limbic cortex and hippocampus.

Women's experiences of female ejaculation and/or squirting: a Swedish cross-sectional study.

Women's experiences of the expulsion of fluids during sexual stimulation, commonly referred to as female ejaculation/squirting, are not well comprehended in the existing literature. To investigate women's knowledge about and experiences of female ejaculation/squirting. Data from 1568 women (aged 18 to 69) were collected using a cross-sectional online-based questionnaire (in Swedish). The study focused on descriptive features of knowledge about, reactions to, occurrence of, and sensations around female ejaculation/squirting. Among the participants, 58% had experienced ejaculation/squirting (significantly more often among non-heterosexuals). Among women without such experience, only one-third would like it to happen. Among women with such experience, ejaculation/squirting occurred consistently during sexual practice for a small percentage (7%) and on a few occasions for about half (52%). Despite most (77%) rating it as primarily a positive sensation, many reacted with shock/shame (28%) or thought they had urinated (26%) the first time it occurred. Many (61%) reported orgasm occurring close to, or simultaneously, with ejaculation/squirting, and these women were more likely to report it as a positive sensation (P < .001). Despite overall positive aspects, 58% had wanted to avoid it at some point, mainly because it got too wet or due to insecurities about the content of the fluid. Having wanted to avoid it at some point was more likely among those who sensed the fluid as being expelled from the urethra (P < .001) or whose partner reacted negatively to it (P < .001). This study contributes with a nuanced understanding of women's experiences of ejaculation/squirting and related challenges. This study is the first to explore women's desire for ejaculation/squirting, their initial reactions, and reasons for avoidance. There are limitations due to the nature of the data collection, such as missing data and potential overrepresentation of women who are informed and open-minded about ejaculation/squirting. Ejaculation/squirting is a common occurrence among women and, despite being perceived predominantly positively, particularly when linked with an orgasm, initial reactions, and avoidance underscore complexities related to excessive wetness and insecurities about the fluid's content.

Priapism in South West Nigeria—Short and Intermediate-Term Outcomes

Abstract Background: Priapism is usually defined as penile erection that lasts more than 4 h beyond sexual stimulation and orgasm or is unrelated to sexual stimulation. The overwhelmingly more common low-flow priapism is typically painful, while high-flow priapism is typically painless. Interventions are varied depending on the aetiology and timing of the presentation. The outcome in most cases depends on the timing of the intervention. Objective: This study aimed to review the presentation and short- and intermediate-term outcomes of treatment of priapism in patients in Southern Nigeria. Materials and Methods: This was a retrospective 10-year study conducted from 2010 to 2019 of all adult patients diagnosed with priapism who were admitted to the adult urology units in two Government University Teaching hospitals in South West Nigeria. Results: The records of 61 patients were analysed. The mean age was 27.54 years ± 6.22 with a range of 15–56 years. The median duration of symptoms before presentation was 36 h with a range of 2 to 336 h. Eleven patients (18%) presented within 24 h of onset of symptoms. Sickle cell disease (SCD) and idiopathic aetiology were the most common causes of priapism, accounting for 44 (72.1%) and 8 (13.1%) respectively. Corporal aspiration resolved the priapism in 22 (36.1.%), while corpora–glandular shunt was the final treatment in 36 (59.1%). Fifty-seven per cent had erectile dysfunction (ED), while penile gangrene with autoamputation was observed in one patient (1.6%). Sixty-six per cent and 62% of patients who presented within &lt; 36 h and 36–72 h, respectively, experienced normal erection at 6 months after surgery. Erectile function got progressively worse after 72 h, with all patients with ischemic priapism lasting more than 1 week developing ED. There was no statistically significant relationship between the variants of SCD and the risk of ED in patients who presented within 72 h. Conclusion: The incidence of ischemic priapism was high, with sickle cell disease being the most common cause. The risk of ED was significantly worse after 72 h. The aetiology of priapism did not significantly influence the risk of ED.

Application of Kaempferia parviflora: A Perspective Review

Kaempferia parviflora, also known as black ginger, is a popular medicinal plant among the Southeast Asian community. Recently, there has been increased interest in further exploring the potential health benefits and therapeutic applications of K. parviflora in Malaysia, Thailand's neighboring country. This review provides an overview of current literature regarding K. parviflora's traditional use and literature on efficacy and safety. We found that, traditionally, K. parviflora was used for gastrointestinal disorders, allergies, as sexual stimulants, and body nourishment. K. parviflora demonstrated antioxidant, anti-inflammatory, antiobesity, anticancer, vascular relaxation, and antimicrobial effects. In humans, there is evidence of its general benefits on physical fitness. In conclusion, K. parviflora is a plant with significant potential for various pharmacological applications. The rhizome is most popularly used and investigated, with polymethoxyflavones as the main bioactive phytoconstituent.

168 - Dorsal Genital Nerve stimulation in patients with overactive bladder syndrome. A feasibility study with the novel UCon neurostimulator

168 - Dorsal Genital Nerve stimulation in patients with overactive bladder syndrome. A feasibility study with the novel UCon neurostimulator

Non-penetrative sexuality and sexual satisfaction among partners of prostatectomy candidates

Curative surgery for localized prostate cancer can lead to iatrogenic erectile dysfunction (ED), affecting couples. Sexuality remains influenced by social norms, often requiring men to provide pleasure through rigid erections. However, iatrogenic ED does not prevent male orgasm, although it can disrupt body image and self-esteem. This study aims to describe couples’ sexual repertoire and partners’ sexual satisfaction post-radical prostatectomy at the Centre Hospitalier Universitaire de Martinique. A monocentric retrospective observational study was conducted with data collected from January 2021 to March 2024. The Valentin and ASEX questionnaires were administered to the partners of future vesiculo-prostatectomy patients at the start of the sex-rehabilitation program. Responses were analyzed anonymously using the Sphinx iQ2 application. The characteristics of the population were described in terms of proportions and means, with a significance threshold set at 0.05 for statistical tests. Of the 152 couples identified, 65 Valentine questionnaires were available. Respondents were heterosexual women, with an average age of 59, and their partners had an average age of 64. Non-penetrative sex was already part of the sexual repertoire for 52% of couples prior to prostate cancer diagnosis. After surgery, 32% of partners resumed penetrative sex, while 43% had not yet resumed sexual intimacy, and 14% had resumed non-penetrative sex. Mutual fondling (85%), vaginal penetration (70%), female oro-genital sex (70%) and male oro-genital sex (52%) were the most popular sexual stimuli. Surgery was therefore no obstacle to sexual satisfaction for our respondents, with a satisfaction level of 90% before and 86% after total prostatectomy. The same applies to orgasm before and after total prostatectomy. The results show that erectile dysfunction is not an obstacle to partners’ sexual satisfaction, with couples able to reinvent their sexuality around non-penetrative practices. Sexual satisfaction indicators before and after RA show a strong correlation, confirming that surgery does not negatively affect sexual satisfaction. The results show that men suffering from post-RP ED can free themselves from the dogma of penile erection by exploring female sexual pleasure to a greater extent. Couples practicing non-penetrative sexuality report satisfying, more playful, complicit and varied sexuality. Finally, ED has less of an impact on partners than future operators believe.

Motor-evoked potentials as biomarkers for sexual arousal?

Motor cortex excitability may represent the neuronal endpoint of motivational processes and was shown to be modulated by both sexual arousal and deceptive behavior. This is the first study to investigate the influence of lying and sex in heterosexual women and men based on motor-evoked potentials (MEPs) measured while viewing sexually arousing pictures. Sixteen heterosexual couples were shown 360 trials consisting of pictures displaying both almost naked females and males and neutral control images. In a subsequent forced-choice question about wanting to see the respective pictures fully naked, they were instructed to either answer in agreement with or opposite to their sexual preference. Participants went through 2 blocks of answering truthfully and 2 blocks of lying, with these 4 blocks being shown in a randomized alternating order. To measure cortical excitability, MEPs were used, evoked by single transcranial magnetic stimulation pulses between image presentation and response. In normalized MEPs, women and men showed higher amplitudes for preferred over non-preferred sexual stimuli, but only on a descriptive level. Planned contrasts showed higher non-normalized MEPs for lying in all picture categories. Direct comparisons to a preliminary study showed overall lower effect sizes. Both sexes tend to show higher MEPs in response to their sexually preferred stimuli. MEPs are not stable markers for willful volitionally controlled deception although lying does increase cortical excitability. The present experimental design does not seem valid enough to serve as a diagnostic marker for sexual preference or paraphilia and malingering. This is the first study investigating whether sexual motivational stimuli modulate MEPs in women, while also examining the influence of lying for both sexes. The sample was too small for some found effects to be significant. Also, the experimental setup may have been less suited for female participants in comparison to male ones. The operationalization of sexual motivation via MEPs seems to highly depend on different experimental factors including the sex of the participants, induced motivation, and lying.

Determinants of the expression of sexual behaviour in mammals

Abstract The article contains a literature review of facts and views on the strategies of sexual behaviour in mammals, taking into account the role of the animal’s species, sex, and position in the herd. The role of the senses, brain, and hormones in the expression of animals’ sexual behaviour is discussed, as well as the role of induction of the coitus reflex and social behaviour in the reproduction of present-day wild and domesticated animals. The analysis shows that the predominant strategy of sexual behaviour in females is to attract multiple potential partners to acquire the best male. The predominant strategies in the sexual behaviour of males of most mammalian species are aimed at fertilizing as many females as possible. Expression of sexual behaviour requires the generation of a set of characteristic sexual reflexes that indicate readiness to copulate and are sexually stimulating. Animals are differ in expressing their sexual behaviour. Some individuals react quickly and dynamically to sexual stimuli and immediately begin coitus, while others require longer preparation for successful coitus. Sexual behaviour influences the status of individuals in some species. Wild mammals with high expression of the sexual behaviour typical of a given species usually occupy a dominant position, which gives them an advantage in the search for breeding partners, access to food, and the expression of preferred social behaviour. Expression of sexual behaviour is stimulated by stimuli from potential sexual partners, which induce copulatory reflexes. These reflexes have been described in numerous animal species. They should be generated in the proper order and proceed without disruption for successful coitus and fertilization to occur.

Mad honey (wild honey) poisoning: clinical case series from Nepal.

Mad honey is commonly used for hypertension, and coronary artery disease, and as a sexual stimulant. Patients with mad honey poisoning present with dizziness, nausea, syncope, blurred vision, bradycardia, and hypotension with ECG findings of sinus bradycardia, complete AV block, and ST elevation. Here, the authors report five cases admitted to our tertiary care center following the consumption of mad honey. The amount of ingestion of honey varies from 1 to 2 teaspoons (~10-20ml). Most of the cases presented with chief complaints of nausea, dizziness, and vomiting, and all the cases had hypotension and bradycardia. Two cases were admitted to the ward and three of them were admitted to the ICU for further management. They were managed with intravenous fluid, injection atropine along with adjunctive vasopressor and oxygen whenever necessary. Mad honey contains grayanotoxin extracted from the nectar of Rhododendron species. This honey contains grayanotoxin, which binds to sodium channels in its open state causing hyperpolarization of the sodium channel predominantly causing gastrointestinal, neurological, and respiratory symptoms. Intravenous fluids and injection atropine are the mainstays of management in an ICU setup. Some also may require vasopressors. Mad honey poisoning is rare, and limited cases have been reported in Nepal. Physicians should consider mad honey poisoning in cases with ingestion history and clinical symptoms, as it may be a clinical diagnosis due to limited lab tests for grayanotoxin intoxication. Supportive management still forms the cornerstone for its management after diagnosis.

Corporal aspiration and sympathomimetic injection for priapism: “Preprocedure preparation” and “procedural considerations”

Priapism is a prolonged and persistent erection that lasts more than 4 hours and is unrelated to sexual stimulation. Although uncommon, it requires expeditious treatment to prevent erectile function compromise. Corporal aspiration is the first-line treatment for patients with ischemic priapism. This article focuses on contemporary corporal aspiration techniques for the management of priapism. After obtaining informed consent and administering local anesthesia, corporal aspiration was initiated by inserting 2 large-bore butterfly needles into the penile shaft. Aspiration is then performed using 10-mL syringes to decompress the corporeal pressure, flush out clots, and restore the pH balance of the penis. Diluted phenylephrine (100–1000 μg/mL) is injected in 1 mL aliquots every 5 to 10 minutes until complete detumescence is achieved. The results show that the overall resolution rate using corporal aspiration followed by phenylephrine injection is 65% to 72%. Ninety percent of men experience detumescence success if aspiration and phenylephrine injection are performed within 12 hours. Conversely, 85% of patients with priapism may require penile shunt surgery if the priapism exceeds 24 hours, and in the majority of these patients, health care providers will consider placing a penile prosthesis if the priapism exceeds 36 hours. Corporal aspiration is the first-line treatment for priapism. When properly performed expeditiously, patients experience a high rate of detumescence. Ischemic priapism is a true urological emergency that requires prompt diagnosis and treatment. The advantages of using corporal aspiration as a first-line treatment include pain relief and the prompt restoration of circulation.

Efficacy of sexual stimulation in the treatment of distal ureteral stones: A meta-analysis

IntroductionThis study aimed to compare the clinical efficacy of sexual stimulation with that of placebo in the treatment of distal ureteral stones. MethodsWe searched PubMed, Web of Science, Cochrane Library, and Google Scholar from January 1, 2000 to December 31, 2022 for studies comparing the efficacy of sexual stimulus with that of placebo for the treatment of distal ureteral stones. RevMan 5.3 software was used to pool the data. The study protocol was registered on PROSPERO (Registration Number: CRD42023432408). ResultsA total of six randomized controlled trials comprising 535 cases of distal ureteral stones were included in this study. Among these, 273 cases were associated with sexual intercourse or masturbation 3–4 times a week, while 262 cases only received symptomatic treatment. The pooled results showed that the 2-week [risk ratios (RR) = 1.77, 95 % confidence interval (CI): 1.34, 2.33] and 4-week [RR = 1.48, 95 % CI: 1.29, 1.69] ureteral stone expulsion rates of the sexually stimulated group were significantly higher than those of the placebo group (ps < 0.01). Additionally, sexual stimulation was associated with a shorter ureteral stone expulsion time [weighted mean differences (WMD) = −3.74, 95 % CI: −6.27, −1.22, p < 0.01] and a decreased prevalence of renal colic attacks [WMD = −0.61, 95 % CI: −1.01, −0.22, p < 0.01] compared with those of the placebo group. ConclusionAppropriate sexual stimulation can enhance the spontaneous expulsion of distal ureteral stones in patients presenting with tolerable pain.

Homosexual and Heterosexual men present characteristic patterns of cortical synchronization in response to Visual Sexual Stimuli.

Since several cortical areas participate in the processing of sexual stimuli, this study characterized the electroencephalographic activity of prefrontal, temporal and parietal areas in men with different sexual orientation while observing erotic videos with homosexual (HOV) and heterosexual (HEV) content. The homosexual group presented lower absolute power of theta band in the right temporal cortex and higher right fronto-temporal correlation of beta band when observing the HOV. While the heterosexual group rated only the HEV as pleasant, also presented a higher left fronto-temporal correlation of beta band while watching the HEV, and a lower right fronto-parietal correlation of theta band during observation of the HOV. These results show a characteristic cortical functionality involved in the processing of sexually-relevant stimuli and its possible association with sexual orientation.