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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pudenal somatosensory evoked potential (PSEP) and bulbocavernosus reflex (BCR) testing have been reported to be useful in the evaluation of erectile dysfunction and neurogenic bladder. 461 patients with sexual dysfunction were studied to determine the usefulness of the above tests. Abnormality of PSEP was found significantly in upper motor neuron (UMN) type spinal cord patients and average prolonged P1 latency was 47.4 +/- 9.8 msec. Lower motor neuron (LMN) type spinal cord patients revealed great abnormality in BCR latency with an average value of 44.9 +/- 14.5 msec on the right and 44.2 +/- 15.6 msec on the left. Additionally significant differences were obtained in patients with diabetes mellitus, pelvic trauma and spinal cord lesion of the UMN type in the study of PSEP. There was also a significant difference in the patients with diabetes mellitus, pelvic trauma and spinal cord lesion of the LMN type in the BCR study. The findings of our study suggest that PSEP together with BCR study is useful in assessing the integrity of the sacral reflex arc and the central afferent pathway, in differentiating the lesion site and in providing basic data for the management plan in sexual rehabilitation. Furthermore, because erection is under the influence of both the somatic and autonomic nervous system, BCR study and PSEP combined with currently studied electrical activity of the corpus cavernosum would provide a more accurate evaluation of the neurogenic erectile dysfunction patients.
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PMID:Pudendal somatosensory evoked potential and bulbocavernosus reflex testing in erectile dysfunction. 837 85

Seventy-eight male diabetics with sexual dysfunction were evaluated by a thorough history, general physical, psychological, neurological and urological examinations, routine laboratory tests, and a duplex ultrasound scan with intracavernous injection of prostaglandin E1 (PGE1). The mean patient age was 55.9 years, and the average onset of sexual dysfunction was 10.0 years after the diagnosis of diabetes. Sixty-eight patients (87.2%) had moderate or severe cavernous arterial insufficiency. Older patients and those having a longer duration of diabetes had a higher incidence of cavernous arterial insufficiency. Cigarette smoking, hypertension, and alcohol abuse were also related to cavernous arterial insufficiency. There was no significant difference in cavernous arterial insufficiency between the insulin-dependent and the insulin-nondependent groups. There were significant differences of diameters and peak blood flow velocities of cavernous arteries between 78 diabetic impotent patients and 10 controls. These findings strongly suggest that the cavernous arterial insufficiency is closely related to the diabetic impotence. In addition, the prevalence of cavernous arterial insufficiency increases with age, duration of diabetes, cigarette smoking, hypertension and alcohol abuse, but it is not definitely correlated with the type of diabetes management.
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PMID:Penile blood flow study in diabetic impotence. 850 92

It is well known that diabetes mellitus is accompanied by complications of sexual dysfunction and it is believed that diabetic neuropathy may cause impotence. In our study, we found that not all the patients who visited our center with the chief complaint of diabetic impotence were suffering from organic impotence, and diabetes mellitus per se served as a means of psychological stress in a substantial number of cases. Probably because no method has been available to provide precise information on the state of the penile-controlling nerves, we found that a larger number of patients than expected were suffering from a vascular disorder.
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PMID:Is diabetic neuropathy responsible for diabetic impotence? 918 40

Erectile dysfunction or impotence is a very common complication in diabetic male patients; the prevalence of which may be more than that of retinopathy. The cause of diabetic impotence has been thought to be neuropathy or angiopathy or both of them. The diagnosis of diabetic impotence is based on the exclusion of other causes of impotence including psychological, iatrogenic, endocrinological impotence. The treatment options for diabetic impotence such as vacuum device, intracavernous self-injection or surgical procedures are available and useful at present. In this article, other sexual dysfunction; retrograde ejaculation and female sexual dysfunction in diabetes mellitus are also discussed.
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PMID:[Sexual dysfunction in diabetes mellitus]. 939 1

This was a primary health care (PHC) study aiming at the investigation of the prevalence and nature of sexual dysfunction among a sample of type II diabetic men, in comparison with the control groups of hypertensive men and apparently healthy men with no chronic medical illness. Subjects were assessed by PHC physicians using a sexual dysfunction semistructured questionnaire and a questionnaire designed for medical history and sociodemographic data. Clinical assessments for peripheral vascular disease and peripheral neuropathy were carried out for the diabetic group only. The estimated high prevalence rate of sexual dysfunction among the diabetic group (89.2%) was significantly greater than the hypertensive group (43.6%), and the apparently healthy group (16.7%). The commonest clinical presentations of sexual dysfunction among the diabetic men were impaired morning and spontaneous erections, erectile weakness, and ejaculatory disturbances. Lesser common presentations were reduced sexual interest and complete erectile failure. There were no significant associations between the sexual dysfunction and clinically obvious physical complications of diabetes, or factors that might affect sexual functioning (i.e., alcohol or drug misuse or marital disharmony). However, the validity of these results is questioned due to the small numbers used for statistical analysis.
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PMID:Sexual dysfunction among type II diabetic men: a controlled study. 943 73

Type 2 diabetes mellitus, one of the most prevalent and disruptive diseases in our older population, occurs in approximately 10% of persons over age 65. Its cause is usually a combination of deficient insulin production and resistance to insulin. In approximately one-half of those with diabetes, symptoms occur slowly over time and escape diagnosis. Complications include cardiovascular disease with myocardial infarction and stroke, nephropathy, retinopathy, peripheral neuropathy, and sexual dysfunction. Risk factors include age, family history, obesity, and sedentary lifestyle. Screening and early diagnosis are important secondary means of prevention, but physicians should also think about primary prevention based on family history, diet, and physical activity.
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PMID:Type 2 diabetes: causes, complications, and new screening recommendations. I. 951 74

During the last decade there were extensive investigations in clinical and molecular andrology with emphasis on assisted reproduction, micromanipulation techniques of gametes, sperm/egg interaction, male contraception, diabetes mellitus, varicocele, andropause versus menopause, sexual dysfunction, associated hypertension/stress, prostatic carcinoma and molecular parameters of male reproduction. Sperm hyperactivation is a required step in capacitation sequence. Sperm motility is measured by videotape to evaluate the Straight Line Velocity (microm/s) (VSLI). Fertilization/embryonic development results from single sperm transfer (S-MIST) and multiple sperm transfer. Fertilization/embryo development is achieved by injection of immotile sperm into the perivitelline space. To assess sperm viability, a supravital stain suitable for use in combination with immunofluorescent assay, Hoeschst 33258, is used. The dye fluoresces with an intense blue when bound to DNA. To assess sperm plasma membrane integrity, a hypo-osmotic swelling test (HOST) is performed, using fluoresceinated D-mannose enriched albumin (FITC-DMA). The ability of sperm to swell under hypo-osmotic conditions indicates an intact membrane. A human protein, C-peptide, thought to be a useless byproduct of insulin may protect against devastating heart and nerve damage that diabetes causes. Human diabetics may benefit from the substance. Over 15 million Americans have diabetes, in which blood sugar levels rise out of control. There are two types of diabetics: Type I diabetics produce no insulin, the hormone that regulates blood sugar. Type II diabetics are unable to use their insulin properly. Diabetics are at great risk of heart disease and nerve damage, as arteries throughout the body leak and nerve-cell impulses fail. C-peptide is a byproduct of insulin production; it can be produced by the body or synthetically. Production of this protein is not induced by insulin, so diabetics who take insulin do not get C-peptide with it. Varicocele occurs unilaterally on the left side in 78% to 93% of men. Typically the presence of a varicocele is associated with an abnormal semen analysis (sperm density and morphology) and a decreased testicular volume on the affected side. Impaired sperm motility occurs in 89.5% of all varicocele patients. Varicocele ligation improves semen parameters in two thirds of patients. A few studies on andropause included sexual dysfunction, hormonal changes, medical/psychological correlates of impotence, ostenopenia/osteoporosis and bone loss; indices of bone remodeling, testosterone supplementation, androgen, negative feedback and hypothalamo-pituitary-testicular axis. Prostatic cancer is the second leading cause of cancer death for men between the ages of 60 and 80. Early detection involves a simple blood test for prostate specific antigen (PSA). Regular screening and early detection are essential. This is an important test because a high antigen count can be the only symptom. Since no screening is 100% accurate, physicians recommend both a PSA blood test and a physical examination. Although heredity plays a major role in whether a man will develop prostate cancer, men who lead healthy lives can dramatically reduce their chances of cancer: low-fat diet, eating plenty of fruits and vegetables and not smoking. Recent advances in molecular andrology include peptide hormone binding proteins; gonadotropin-releasing hormone (GnRH) agonists/antagonists analog; gonadotropins/their receptors; growth factors/reproduction; peptides as intratesticular regulators; molecular cloning of reproductive proteins/peptides. Gene cloning is applied for characterization/expression of genes coding. The interaction of gp120 with CD4 receptor plays a role in syncytium formation, apoptosis and CD4 cell deletion in human immunodeficiency virus (HIV) infection. The recombinant V3 peptide of fragment 307-330 of HIV-1 can induce sperm head agglutination. The generation process of react
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PMID:Recent advances in clinical/molecular andrology. 958 57

Do we need impotence testing? Yes, it is the clinician's obligation to establish the etiology of impotence: end organ vascular failure vs neurologic dysfunction vs psychosexual dysfunction, classify the severity of that dysfunction, and select a therapy that is not only acceptable to the patient but also addresses his pathology. The most commonly utilized diagnostic tests for erectile dysfunction are outlined in this monograph. Nocturnal erections are evaluated by tests commonly known as nocturnal penile tumescence (NPT) studies. NPT has been measured by each of the following methods: stamp test, Snap Gauges, strain gauges, NPTR (Rigiscan, Osbon Medical Systems), and sleep lab NPTR. Normal Nocturnal Penile Tumescence and Rigidity (NPTR) depends on both the integrity of the corticospinal efferents to the penis and vascular responsiveness of the penile tissues to those nerve signals. When nocturnal erections are of appropriate duration and strength the central and peripheral neuroeffectors and intra-corporal regulators of penile hemodynamics are intact. Unfortunately, abnormal NPTR is of little value in determining the etiology or classifying the severity of vascular impotence; the most prevalent kind of end organ failure. The sacral reflex arc of erection consists of somatosensory afferents via the dorsal and pudendal nerves and autonomic efferents via the pelvic and cavernous nerves. These afferents have been measured indirectly by somatosensory evoked potentials (SSEP) and bulbocavernosus reflex latency (BCR). Penile EMG's have recently been recorded, corporal cavernosal smooth muscle electrical activity: CC-EMG. This technology is far from standardized; computer-assisted interpretations of penile electrical potentials may eventually differentiate afferent nerve pathologies so long inferred in: diabetes, spinal cord injury and following radical pelvic surgery. Numerous diagnostic tests have been employed to evaluate penile hemodynamics: penile plethysmography, penile blood pressures, penile brachial index, selective internal pudendal pharmacoangiography, Doppler sonography, dynamic infusion cavernosometry/cavernosography, nuclear washout radiography, and color duplex Doppler ultrasound. Insufficient corporal veno-occlusion is implicated in up to 50% of patients. The diagnosis and demonstration of venous leakage requires complete smooth muscle relaxation. Veno-occlusive dysfunction is associated with poorly sustained erections; this pathology has traditionally been evaluated with Dynamic Infusion Cavernosometry and Cavernosography. DICC is an invasive test, and is now primarily reserved for patients considering the option of vascular reconstructive procedure. Pharmacotesting consists of intracavernous injection and visual rating of the subsequent erection; the test is the most commonly used office procedure for diagnosing erectile dysfunction. It is simple, minimally invasive, and performed without monitoring equipment. Hemodynamic investigations suggest that a positive injection test is associated with normal veno-occlusion, but not necessarily with normal arterial function. When the penile response to pharmacotesting is suboptimal or equivocal, diagnostic testing with duplex Doppler assessment should be performed. The penile blood flow study (PBFS) provides an objective, minimally invasive evaluation of a suboptimal/equivocal erectile response.
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PMID:Evidence based assessment of erectile dysfunction. 964 64

Sexual behavior involves the complex integration of higher intellectual function, such as associative memory and the experience of drives and motivations, with basic instinctual or reflexive physiological responses coordinated at the spinal level. Previous research in diabetic sexual dysfunction has largely focused on diabetic male erectile dysfunction, emphasizing a peripheral vasculopathy or neuropathy as etiologic factors, although ignoring the more complex neuropsychiatric components of sexual behavior. Following a review of the basic physiology of sexual behavior and evidence in support of a peripheral vasculopathy and/or a peripheral autonomic neuropathy in the cause of diabetic sexual dysfunction, emphasis will then shift to the role of a "central" neuropathy as a contributing component of diabetic sexual dysfunction. Evidence in support of such a view will come from a variety of studies, ranging from basic neuroscience research on forebrain mechanisms of sexual function to the functional brain imaging of human rapid eye movement (REM) sleep, a brain state known to be associated with the periodic occurrence of penile tumescence. An integrative perspective of this research will identify major candidate structures within the brain that may be dysfunctional in diabetic patients and may contribute to the profound sexual dysfunction that characterizes this condition. Major findings as well as deficits in our understanding of the effects of diabetes on female sexual dysfunction will also be highlighted, followed by suggestions for future research in this largely understudied area.
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PMID:Sexual Dysfunction in Patients with Diabetes Mellitus: The Role of a "Central" Neuropathy. 1032 Apr 41

Modern cardiac rehabilitation is a comprehensive program of secondary prevention for patients with heart disease. Moreover, it is an important context in which to broach issues of impaired sexual function. Sexual problems plague a large portion of our cardiac patient population. Unspoken+ concerns about impotence, now more correctly called erectile dysfunction (ED), are common, as are concerns about the safety of engaging in sexual activity, especially after major cardiac events or therapeutic interventions. A large proportion of patients do not return to normal sexual activity after a cardiac event. Many factors, including normal age-related changes in sexual response, medication-induced dysfunction, and vascular changes associated with risk factors (e.g., diabetes and dyslipidemia), as well as the emotional impact of symptomatic heart disease, may influence sexual function in these patients. These factors, occurring alone or in combination, probably explain the discouraging prevalence of sexual dysfunction in patients with manifest cardiac disease. Because so few patients have specific cardiac reasons for limiting sexual activity, a clear opportunity exists for cardiologists and their staff to help enhance the emotional well-being and overall quality of life of their cardiac patients.
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PMID:Sexual activity and the cardiovascular patient: guidelines. 1050 70


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