bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful treatment of relapsing disseminated coccidioidomycosis with cutaneous involvement with posaconazole
Authors: Wollina Uwe , Hansel Gesina , Vennewald Irina , Schönlebe Jacqueline , Tintelnot Kathrin , Seibold Michael , Kittner Thomas
Published: October 2008

A 52‐year‐old woman with pulmonary sarcoidosis on immunosuppressive therapy developed pulmonary infiltrates and cutaneous granulomatous abscesses after a trip to the USA in April 2005. A hyphomycete was identified, further characterized by a gene probe as Coccidioides spp. and then definitively identified as Coccidioides posadasii by polymerase chain reaction and sequencing. Antibodies towards Coccidioides spp. were detected. The infection was successfully treated with posaconazole (Noxafil®), 2 x 400 mg/d.
Wrong diagnosis erysipelas: hypodermitis – case series and review of literature
Authors: Reich‐Schupke Stefanie , Kreuter Alexander , Altmeyer Peter , Stücker Markus
Published: October 2008

Background: Patients with an advanced chronic venous insufficiency (CVI) often show inflammatory changes of their legs. Often erysipelas is diagnosed and systemic antibiotic therapy initiated. Frequently this approach is not successful.

Patients and Methods: During the last 6 months 5 patients with an outside diagnosis of erysipelas presented to our clinic. All had a painful erythema of the medial part of one or both calves and all failed numerous antibiotic regimens.

Results: In all patients a sharply demarcated, tender indurated erythema of the medial part of one or both calves was seen. Inguinal lymphadenopathy, fever and other systemic signs and symptoms were absent. In 4 of 5 patients normal laboratory inflammatory parameters were normal. We diagnosed hypodermitis in all. They were treated with compression therapy and topical corticosteroids. In addition, their underlying CVI was addressed. Conclusions: Dermatosclerosis is often seen in patients with advanced CVI. An acute inflammatory phase (hypodermitis) and a chronic phase of the disease can be differentiated. The acute hypodermitis can imitate erysipelas clinically, with systemic signs and symptoms, as well as laboratory evidence of inflammation generally being absent.
Hypercapnia and the neonate
Authors: Jankov Robert P , Tanswell A Keith
Published: October 2008

‘Permissive hypercapnia’ is a familiar term in neonatal intensive care, given the widespread adoption of low‐tidal‐volume ventilation strategies applied with the goal of decreasing respiratory morbidity. Recent evidence suggesting that hypercapnic acidosis may itself have protective effects on the lung and other organs has led to the coining of a new phrase, ‘therapeutic hypercapnia’, which also encompasses the use of supplemental inspired CO2.

Conclusion: Experimental evidence suggests that mild‐moderate hypercapnia can improve tissue oxygenation and perfusion, which may ameliorate injury to the immature lung and brain. However, hypercapnia may also be associated with adverse outcomes, and the range of PaCO2 levels that are both safe and effective for specific subsets of neonates has yet to be determined.
Effects of Testosterone Undecanoate Administered Alone or in Combination with Letrozole or Dutasteride in Female to Male Transsexuals
Authors: Meriggiola Maria Cristina , Armillotta Francesca , Costantino Antonietta , Altieri Paola , Saad Farid , Kalhorn Thomas , Perrone Anna Myriam , Ghi Tullio , Pelusi Carlotta , Pelusi Giuseppe
Published: October 2008

Introduction

Testosterone undecanoate (TU) has potential as androgen therapy for ovariectomized female to male (FtM) transsexual subjects; however, the long-term physiologic effects of TU treatment, the significance of testosterone (T), and the T metabolites dihydrotestosterone (DHT) and estradiol (E) on specific outcome parameters are currently unknown.

Aim

The aim of this study was to investigate the long-term treatment of TU with regard to bone metabolism, body composition, and lipid profile in FtM subjects, and to evaluate the relationship between observed effects and circulating levels of T, E, and DHT.

Main Outcome Measures

Circulating follicle-stimulating hormone, luteinizing hormone, T, E, DHT, and lipid concentrations were measured, as well as bone metabolism, body composition, and insulin resistance.

Methods

This was a 1-year, randomized treatment, open-label, uncontrolled safety study. Fifteen ovariectomized FtM subjects from an outpatient clinic were divided into three groups to receive TU 1,000 mg alone or in combination with oral administration of letrozole (L) 2.5 mg/die or dutasteride (D) 0.5 mg/die for a period of 54 weeks.

Results

TU alone and TU + D treatments were successful in terms of hormone adjustment, did not result in any adverse effects, and were well-tolerated. Bone mineral density decreased by an average of 0.9 g/cm2 in the TU + L group, and the addition of D resulted in a failure to gain lean mass.

Conclusion

This study confirmed that TU is a successful and safe treatment for FtM subjects. These data indicate that E has an important role in bone metabolism and that DHT may play a role in muscle metabolism.
Penile Injection with Silicone: Case Report and Review of the Literature
Authors: Silberstein Jonathan , Downs Tracy , Goldstein Irwin
Published: October 2008

Introduction

Liquid injectable silicone (LIS) has been used for soft tissue augmentation in excess of 50 years. Until recently, all literature on penile augmentation with LIS consisted of case reports or small cases series, most involving surgical intervention to correct the complications of LIS. New formulations of LIS and new methodologies for injection have renewed interest in this procedure.

Aim

We reported a case of penile augmentation with LIS and reviewed the pertinent literature.

Methods

Comprehensive literature review was performed using PubMed. We performed additional searches based on references from relevant review articles.

Results

Injection of medical grade silicone for soft tissue augmentation has a role in carefully controlled study settings. Historically, the use of LIS for penile augmentation has had poor outcomes and required surgical intervention to correct complications resulting from LIS.

Conclusions

We currently discourage the use of LIS for penile augmentation until carefully designed and evaluated trials have been completed.
Cortisol, Sexual Arousal, and Affect in Response to Sexual Stimuli
Authors: Hamilton Lisa Dawn , Rellini Alessandra H. , Meston Cindy M.
Published: October 2008

Introduction

Theoretically, the physiological response to stress should inhibit the sexual response. This has been demonstrated experimentally in animal models, and correlationally in studies of human reproduction. It is reasonable to expect, then, that the stress response would be blunted during sexual arousal, and several researchers have found a pattern of decreasing cortisol during sexual arousal.

Aim

In the present study, we explored individual differences in women's cortisol response to sexual arousal in a laboratory setting. We also examined how cortisol response in the laboratory related to a validated measure of sexual arousal functioning in real life.

Main Outcome Measures

Cortisol levels were measured in saliva via enzyme immunoassay. Subjective arousal was measured by a self-report questionnaire, and genital arousal was measured by a vaginal photoplethysmograph.

Methods

Subjective and physiological responses to an erotic film were assessed in 30 women. Saliva samples were taken at baseline and following the film.

Results

The majority of women (N = 20) showed a decrease in cortisol; nine women showed an increase in response to an erotic film. The women who showed an increase in cortisol had lower scores on the Arousal, Desire, and Satisfaction domains of the Female Sexual Function Index. Genital arousal in the laboratory was not related to cortisol change.

Conclusions

Women who show an increase in cortisol in response to sexual stimuli in the laboratory have lower levels of functioning in certain areas of their sexual life compared with women who show a decrease in cortisol. Stress related to sexual performance may interfere with sexual arousal.
The Associations Between Serum Sex Hormones, Erectile Function, and Sex Drive: The Olmsted County Study of Urinary Symptoms and Health Status Among Men
Authors: Gades Naomi M. , Jacobson Debra J. , McGree Michaela E. , St. Sauver Jennifer L. , Lieber Michael M. , Nehra Ajay , Girman Cynthia J. , Klee George G. , Jacobsen Steven J.
Published: October 2008

Introduction

Testosterone replacement therapy has been used in the treatment of sexual dysfunction; however, its use remains controversial, and the effectiveness and long-term health implications are unknown.

Aim

To evaluate the association between sex hormone serum levels, erectile function, and sexual drive in a population-based sample of men.

Methods

A stratified random sample of men residing in Olmsted County, Minnesota, completed a questionnaire containing questions from the Brief Male Sexual Function Inventory (BMSFI), and participated in a clinical exam, which included serum hormone measurements.

Main Outcome Measures

Levels of sexual drive (libido) and erectile function as assessed by the BMSFI and serum testosterone, bioavailable testosterone, and estradiol measurements.

Results

Out of 414 men, 294 had a regular sexual partner and androgen measurements at the 14th year of follow-up. Total testosterone and erectile function were significantly correlated even after adjustment for age (r = 0.12, P = 0.04). Conversely, total testosterone was not significantly correlated with sex drive (r = 0.08, P = 0.17). Bioavailable testosterone was significantly correlated with both erectile function and sex drive (r = 0.16, P = 0.01 and r = 0.20, P = 0.001, respectively). However, these associations disappeared after age adjustment (r = 0.04 and r = 0.09).

Conclusions

These cross-sectional results suggest the relationship between sex hormones and sexual function is complex, and that the age-related decline in sexual function may be due to age-related declines in levels of bioavailable testosterone rather than total testosterone levels.
Sexual Counseling in Elderly Couples
Authors: Bitzer Johannes , Platano Giacomo , Tschudin Sibil , Alder Judith
Published: October 2008

Introduction

Sexual health of the elderly has long been either a taboo or a non-medical life style luxury issue. Increasing longevity of women and men, reconceptualization of sexual health as part of general health, and the development of drugs aiming at improvement of sexual function have contributed to a change in the attitude of the elderly and the medical community, thus increasing the demands for help.

Aims

To respond to these demands, caregivers need to be informed about the statistics concerning the sex life of the elderly, need to understand the biological, psychological, interaction and social factors that determine the sexual health of the aging population, need a comprehensive diagnostic and therapeutic approach, taking into account the specific characteristics of the aging male, female, and the couple.

Main Outcome Measures

Diagnostic and therapeutic algorithm integrating the biopsychosocial profile of the aging male and female and the interaction characteristics of the couple.

Methods

Review of the literature, analysis of cases, and review of multidisciplinary case discussions of elderly couples with sexual problems consulting the Division of Sexual Medicine at the University Hospital of Basel.

Results

Sexual dysfunction is highly prevalent in the aging population, with hypoactive sexual desire disorder and pain disorders being the most frequent in women, and premature ejaculation and erectile dysfunction being the most frequent in men. The specific characteristics of the sexual ill health in elderly couples are the interactions of physical and mental morbidity including therapies, multidimensional sexual dysfunctions in both partners, dyssynchrony in personal development and sexual scripts, and a longstanding fixed interactional pattern with rigid “sexual roles.” The diagnostic approach has to integrate sexological descriptive diagnoses of both partners, their biopsychosocial profile, and the couple's history and interactional pattern. From this diagnostic framework, caregivers must design specific, multidisciplinary therapeutic strategies for the elderly couple, which include biomedical, individual psychotherapeutic, and systemic interventions in various combinations.

Conclusion

The increasing demand for help of elderly couples with sexual dysfunction requires a multidisciplinary approach in diagnosis and therapy combining the knowledge and skills of urologists, gynecologists, internists, and various mental health professionals to provide individualized age-related care.
Effects of Natriuretic Peptides on Intracavernous Pressure and Blood Pressure in Conscious Rats
Authors: Aizawa Naoki , Ishizuka Osamu , Ogawa Teruyuki , Mizusawa Hiroya , Igawa Yasuhiko , Nishizawa Osamu , Andersson Karl-Erik
Published: October 2008

Introduction

Natriuretic peptides activate particulate guanylyl cyclases and have been shown to induce penile erection in rats, rabbits, and humans.

Aim

We investigated the effects of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP) on intracavernous pressure (ICP) and systemic blood pressure (BP) in conscious, free-moving rats.

Methods

ICP and BP were measured in male Sprague–Dawley rats after catheters were inserted into the crus corpus cavernosum and carotid artery, respectively. Natriuretic peptides were given by intravenous bolus (3, 10, and 30 nmol/kg) or continuous (0.1 and 1 nmol/kg/minute) administration.

Main Outcome Measures

The number of animals with increases in ICP were determined. Amplitudes and durations of ICP responses and changes in BP were also evaluated.

Results

More animals had multiple transient increases of ICP in response to ANP and BNP than to CNP. The increases in ICP were transient and appeared to be an “all or none” response. ANP and BNP decreased BP more than CNP, especially with bolus administration.

Conclusion

These findings show that in rats, erectile responses can be initiated by ANP, BNP, and less effectively, by CNP. ANP and BNP have a high affinity for the natriuretic peptide receptor-A, suggesting that this receptor is involved in the responses.
A VEGF Trap Inhibits the Beneficial Effect of bFGF on Vasoreactivity in Corporal Tissues of Hypercholesterolemic Rabbits
Authors: Xie Donghua , Findley Clarence M. , Greenfield Jason M. , Pippen Anne M. , Kontos Christopher D. , Donatucci Craig F. , Annex Brian H.
Published: October 2008

Introduction

Hypercholesterolemia causes a decrease in normal corporal tissue vasoreactivity in a preclinical model of erectile dysfunction. Previous studies have shown that intracorporal injection (ICI) of basic fibroblast growth factor (bFGF) reverses some of the detrimental vasoreactivity effects of hypercholesterolemia and increases vascular endothelial growth factor (VEGF) expression.

Aim

We sought to determine whether the beneficial effects of bFGF are VEGF-mediated.

Methods

A total of 32 New Zealand white rabbits were fed a 1% cholesterol diet for 6 weeks and randomly divided into four groups (N = 8/group). Group 1 received a 2.5 µg bFGF ICI and 2.5 × 1011 viral particle unit (vpu) of adenovirus encoding β-galactosidase (Adβ-gal) ICI, 10 days later. Group 2 received a 2.5 µg bFGF ICI and 2.5 × 1011 vpu of adenovirus encoding soluble VEGF receptor (VEGFR) (AdsVEGFR, a VEGF trap) ICI, 10 days later. Group 3 received phosphate buffered saline solution (PBS) ICI and 2.5 × 1011 vpu Adβ-gal ICI, 10 days later. Group 4 received PBS ICI and 2.5 × 1011 vpu AdsVEGFR ICI, 10 days later.

Main Outcome Measures

The corpus cavernosum was harvested for vasoreactivity studies 10 days post viral injection. The effective dose of 50% maximum relaxation was determined. VEGF levels were assessed by enzyme-linked immunosorbent assay. Total and phoshorylated Akt and endothelial nitric oxide were analyzed by Western blot.

Results

Endothelium-dependent vasoreactivity was significantly greater in Group 1 vs. all other groups. The VEGF trap eliminated the beneficial effects of bFGF on endothelium-dependent vasoreactivity and decreased Akt and nitric oxide phosphorylation.

Conclusions

These data demonstrate that VEGF activity contributes much of the therapeutic modulation of bFGF-mediated vasoreactivity in corporal tissue.
Sexual Function, Dysfunction, and Sexual Distress in a Prospective, Population-Based Sample of Mid-Aged, Australian-Born Women
Authors: Dennerstein Lorraine , Guthrie Janet R. , Hayes Richard D. , DeRogatis Leonard R. , Lehert Philippe
Published: October 2008

Introduction

Previous, population-based studies investigating the risk factors for sexual distress have not drawn on longitudinal data.

Aims

Determine the prevalence of sexual distress and dysfunction, explore factors associated with/predictive of sexual distress, and describe changes in sexual function over a decade in a population-based sample of mid-aged women.

Methods

Eleven-year prospective study of Australian-born women, aged 45–55 years, and menstruating at baseline. Short Personal Experiences Questionnaire (SPEQ) was completed in years 1 to 8 and 11 of follow-up. Female Sexual Distress Scale (FSDS) was completed in the 11th year of follow-up.

Main Outcome Measures

Validated outcome measures were the SPEQ (total sex score ≤7 indicates low sexual function) and FSDS (score ≥15 indicates sexual distress).

Results

Two hundred fifty-seven women were interviewed in the 11th year of follow-up. All domains of sexual function declined significantly in the decade studied. Women using hormone therapy in year 11 had significantly greater responsivity and higher frequency of sexual activities than nonusers. Two hundred four women completed both the FSDS and SPEQ questionnaires. One hundred sixty-six (81%) women had an SPEQ score ≤7 of whom 34 (17% of the total sample) had an FSDS score ≥15, and were classified as having female sexual dysfunction. The multiple logistic regression analysis found that female sexual distress was concurrently associated with higher depression scores (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.10, 1.56) and more negative feelings for partner (OR 0.49, 95% CI 0.32, 0.76) and predicted by prior negative feelings for partner (OR 0.31, 95% CI 0.14, 0.70), and a greater decline in total sex score (OR 0.77, 95% CI 0.59, 0.99).

Conclusion

By the end of the sixth decade, women have low levels of sexual function. Hormone therapy may help these women maintain sexual function. A minority of these mostly postmenopausal women are significantly distressed about low sexual function. Sexual distress is associated with depression and relationship factors.
Sildenafil and a Compound Stimulating Endothelial NO Synthase Modify Sexual Incentive Motivation and Copulatory Behavior in Male Wistar and Fisher 344 Rats
Authors: Chu Xi , Zhavbert Ekaterina S. , Dugina Julia L. , Kheyfets Irina A. , Sergeeva Svetlana A. , Epstein Oleg I. , Ågmo Anders
Published: October 2008

Introduction

Earlier studies have shown that sildenafil may modify some aspects of male rat sexual behavior and sexual incentive motivation. Stimulation of endothelial nitric oxide synthase (eNOS) has also been reported to affect sexual motivation in old rats.

Aim

To determine the effects of sildenafil and a compound stimulating eNOS on copulatory behavior and sexual incentive motivation in young adult Fisher 344 and Wistar male rats.

Methods

The rats were selected for a low intromission ratio, and then treated with Impaza (stimulator of eNOS), sildenafil, or Impaza + sildenafil for 28 days. Tests for copulatory behavior and sexual incentive motivation were performed before the beginning of treatment and at days 7, 14, and 28 of treatment.

Main Outcome Measures

Standard parameters of copulatory behavior and sexual incentive motivation. Measurements of penis length at mount, intromission, and ejaculation.

Results

The Fisher 344 rats displayed a higher level of sexual incentive motivation than the Wistar rats, while the copulatory behavior was similar in both strains. Impaza and sildenafil enhanced the sexual incentive motivation after 28 days of treatment in the Wistar rats, but failed to do so in the Fisher 344 rats. The copulatory behavior was unaffected in the Wistar strain, while the Fisher 344 males had an enhanced intromission ratio after treatment with Impaza and sildenafil for 28 days.

Conclusions

The nitric oxide-guanylyl cyclase pathway seems to be of importance for sexual incentive motivation in animals with a modest baseline level. The different drug effects in the Wistar and Fisher 344 rats can be attributed to baseline differences. The importance of eNOS for sexual functions should not be overlooked.
Comparative Efficacy Assessment of Tamsulosin vs. Tamsulosin Plus Tadalafil in the Treatment of LUTS/BPH. Pilot Study
Authors: Bechara Amado , Romano Salomon , Casabé Adolfo , Haime Sergio , Dedola Pablo , Hernández Cecilia , Rey Horacio
Published: October 2008

Introduction

The high incidence of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in aging men and the same pathophysiology make probable to treat both disorders with the same treatment. Numerous authors evaluated the actions of PDE5i in improving the LUTS/(benign prostate hyperplasia) BPH.

Aim

To assess the efficacy and safety of tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus tadalafil 20 mg/day in patients with LUTS in a crossover design study.

Main Outcomes Measures

International Prostate Symptoms Score (IPSS), IPSS Quality of Life (IPSS-QOL), maximum flow rate (Qmax), post-void residual volume (PVR), International Index of Erectile Function-Erectile Function Domain (IIEF-EF), Global Assessment Quality (GAQ). For the statistical analysis, a Tukey-Kramer multicomparison test was used.

Methods

A randomized, double-blind, crossover study was conducted from September 2007 to February 2008 in one center. Thirty men, older than 50 years old, with a history of LUTS/BPH of at least 6 months, were randomized into two groups to receive tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus tadalafil 20 mg/day for 45 days, and then switched to the other treatment mode for other 45 days.

Results

Twenty-seven patients completed the study. Improvements of IPSS score and IPSS-QOL were significant with both treatments but greater with the drug combination. Both regimens similarly improved the Qmax and decreased the PVR volume from baseline (P < 0.001) with no significant differences between tamsulosin alone vs. tamsulosin and tadalafil (P > 0.05).

The IIEF improved with tamsulosin plus tadalafil (P < 0.001) but not with tamsulosin alone (P > 0.05). The GAQ showed that all patients preferred the combination scheme. Both treatments were well tolerated.

Conclusion

Tamsulosin 0.4 mg/day plus tadalafil 20 mg/day was more effective than tamsulosin 0.4 mg/day alone to improve LUTS and erectile dysfunction and was also well tolerated. Large-scale, randomized, placebo-controlled studies are needed to further assess the long-term safety and effectiveness of these agents in treating LUTS/BPH with or without ED.
Surgical Correction of Peyronie's Disease via Tunica Albuginea Plication or Partial Plaque Excision with Pericardial Graft: Long-Term Follow Up
Authors: Taylor Frederick L. , Levine Laurence A.
Published: October 2008

Introduction

Limited publications exist regarding long-term outcomes of surgical correction for Peyronie's Disease (PD).

Aim

To report on long-term postoperative parameters including rigidity, curvature, length, sensation, function, and patient satisfaction in men with PD treated surgically via Tunica Albuginea Plication (TAP) or Partial Plaque Excision with Tutoplast® Human Pericardial Grafting (PEG).

Main Outcome Measures

Objective and subjective data regarding patients who underwent either TAP or PEG.

Methods

We report on 142 patients (61 TAP and 81 PEG) with both objective data and subjective patient reports on their postoperative experience. Patients underwent either TAP or PEG following our previously published algorithm. Data was collected via chart review and an internally generated survey, in which patients were asked about their rigidity, straightness, penile length, sensation, sexual function and satisfaction.

Results

Average follow up for TAP patients was 72 months (range 8–147) and 58 months (range 6–185) for PEG patients. At survey time, 93% of TAP and 91% of PEG patients reported curvatures of less than 30o. Rigidity was reportedly as good as or better than preoperative in 81% of TAP and 68% of PEG patients, and was adequate for coitus in 90% of TAP and 79% of PEG patients with or without the use of PDE5i. Objective flaccid stretched penile length measurements obtained pre and postoperatively show an average overall length gain of 0.6 cm (range −3.5–3.5) for TAP and 0.2 cm (range −1.5–2.0) for PEG patients. Sensation was reportedly as good as or better than preoperative in 69% of both TAP and PEG patients; 98% of TAP patients and 90% of PEG are able to achieve orgasm. 82% of TAP patients and 75% of PEG patients were either very satisfied or satisfied.

Conclusion

Our long-term results support both TAP and PEG as durable surgical therapy for men with clinically significant PD.
Genetic Factors Increase Fecundity in Female Maternal Relatives of Bisexual Men as in Homosexuals
Authors: Ciani Andrea Camperio , Iemmola Francesca , Blecher Stan R.
Published: October 2008

Introduction

Recent studies on male homosexuals showed increased fecundity of maternal female relatives of homosexual probands, compared to those of heterosexual controls. We have suggested that these data could be explained by the transmission, in the maternal line, of an X-linked genetic factor that promotes androphilic behavior in females and homosexuality in males.

Aim

Our original studies were on relatives of male subjects who declared themselves to be exclusively homosexual. However, the relationship between homosexuality and bisexuality, including the possibility of shared genetic factors, is complex and largely unexplored. To cast light on this issue, in the present study we examined whether relatives of bisexuals show the same indirect fitness advantage as previously demonstrated for homosexuals.

Main Outcome Measures

Subjects completed a questionnaire on their sexual orientation, sexual behavior, and their own and their relatives’ fecundity.

Methods

We studied 239 male subjects, comprising 88 who were exclusively or almost exclusively heterosexual (pooled to comprise our “heterosexual” group), 86 who were bisexual, and 65 exclusively or almost exclusively homosexual individuals (pooled in our “homosexual” group). Bisexuals were here defined on the basis of self-identification, lifetime sexual behavior, marital status, and fecundity.

Results

We show that fecundity of female relatives of the maternal line does not differ between bisexuals and homosexuals. As in the previous study on homosexuals, mothers of bisexuals show significantly higher fecundity, as do females in the maternal line (cumulated fecundity of mothers, maternal grandparents, and maternal aunts), compared to the corresponding relatives of heterosexual controls.This study also shows that both bisexuals and homosexuals were more frequently second and third born. However, only homosexuals had an excess of older male siblings, compared to heterosexuals.

Conclusions

We present evidence of an X-chromosomal genetic factor that is associated with bisexuality in men and promotes fecundity in female carriers.
Efficacy and Safety of Mirodenafil, A New Oral Phosphodiesterase Type 5 Inhibitor, for Treatment of Erectile Dysfunction
Authors: Paick Jae-Seung , Ahn Tai Y. , Choi Hyung K. , Chung Woo-Sik , Kim Je J. , Kim Sae C. , Kim Sae W. , Lee Sung W. , Min Kweon S. , Moon Ki H. , Park Jong K. , Park Kwangsung , Park Nam C. , Suh Jun-Kyu , Yang Dae Y. , Jung Hyung-Gi
Published: October 2008

Introduction

Mirodenafil is a newly developed oral phosphodiesterase type 5 inhibitor, currently under investigation as a treatment for erectile dysfunction (ED).

Aim

We investigated the efficacy and safety of on demand mirodenafil therapy at fixed doses (50 and 100 mg) in Korean men with a broad range of ED.

Methods

A multicenter, randomized, double-blind, placebo-controlled, parallel-group, fixed-dose study was conducted with 223 subjects who were randomized to placebo or mirodenafil at fixed doses of 50 or 100 mg for 12 weeks on an “as needed” basis.

Main Outcome Measures

Primary efficacy measures were scores on the International Index of Erectile Function (IIEF) Question 3 (Q3) and Question 4 (Q4). Secondary efficacy measures included all domain scores of the IIEF, Sexual Encounter Profile Question 2 (SEP2), Sexual Encounter Profile Question 3 (SEP3), the Global Assessment Question (GAQ), and the Life Satisfaction Checklist (LSC). Safety assessments included laboratory tests, vital signs, physical examination, 12-lead electrocardiogram recordings, and patients’ reporting of adverse events.

Results

Mirodenafil 50 and 100 mg groups showed a significantly greater increase in IIEF Q3 (P = 0.0001, P < 0.0001, respectively) and Q4 scores (both P < 0.0001) at the end point compared with the placebo group. And mirodenafil in both doses significantly improved the scores of all five domains of the IIEF, SEP2, and SEP3 as well as the percentages of patients responding positively to the GAQ compared with the placebo group. As for LSC scores, the two mirodenafil groups showed significantly greater improvements in items regarding life as a whole, sexual life, and partner relationship than the placebo group. Most treatment-associated adverse events were of mild intensity, resolving spontaneously.

Conclusions

Mirodenafil, in doses of 50 or 100 mg, significantly improved erectile function and were well tolerated in a representative population of Korean men with broad-spectrum ED of various etiologies and severities.
The Effect of Korean Red Ginseng Extract on the Relaxation Response in Isolated Rabbit Vaginal Tissue and Its Mechanism
Authors: Kim Sun-Ouck , Kim Min Kyung , Lee Hyun-Suk , Park Jong Kwan , Park Kwangsung
Published: October 2008

Introduction

Ginseng is an herbal medicine with a variety of biological activities.

Aim

The purpose of this study was to investigate the effect of Korean red ginseng (KRG) extract on the relaxation response in isolated rabbit vaginal tissue and its mechanism as a potential therapeutic agent for female sexual dysfunction.

Method

Strips of rabbit vagina were mounted in organ chambers to measure isometric tension. After the strips were precontracted with phenylephrine, the contractile responses to KRG extract (1–20 mg/mL), nitric oxide inhibitor (N[omega]-nitro-L-arginine methyl ester [L-NAME]), an inhibitor of soluble guanylate cyclase (methylene blue), an inhibitor of Ca2+-activated K+ channels (tetraethylammonium [TEA]), and an adenosine triphosphate (ATP)-sensitive K+ channel blocker (glybenclamide) were examined.

Main Outcome Measures

The relaxation of the vaginal tissue strip was assessed after treating KRG extract or other chemicals.

Results

KRG (1–20 mg/mL) extract relaxed the vaginal tissue strip in a dose-dependent manner up to 85%. The relaxation effect was significantly inhibited by L-NAME (30 µM) and methylene blue (30 µM) (P < 0.05). In addition, KRG inhibited the contraction induced by depolarization with 10, 20, and 40 mM KCl. The KRG-induced relaxation effect was significantly inhibited by TEA (300 µM) (P < 0.05), and not by glybenclamide (30 µM).

Conclusions

These data show that KRG extract has a relaxing effect on rabbit vaginal smooth muscle tissue. These effects might be mediated partly through the NO pathway and hyperpolarization via Ca2+-activated K+ channels.
Systemic Vascular Endothelial Dysfunction in Peyronie's Disease
Authors: Agrawal Vineet , Ellins Elizabeth , Donald Ann , Minhas Suks , Halcox Julian , Ralph David J.
Published: October 2008

Introduction

Many patients with Peyronie's disease (PD) have one or more risk factors (RFs) for atherosclerosis and endothelial dysfunction. It is well recognized that such RFs commonly lead to the development of systemic vascular abnormalities. While not necessarily so, this may implicate vascular dysfunction in its pathogenesis. The cause of PD remains obscure despite intense research over the years and investigating the role of vascular dysfunction in the pathogenesis of PD is a novel approach worth undertaking.

Aim

To test our hypothesis that PD is associated with systemic vascular changes even in the absence of RFs for atherosclerosis and endothelial dysfunction.

Methods

Vascular function was assessed using high-resolution brachial artery ultrasound in 23 PD patients (aged 30–65 years) without RFs for endothelial dysfunction and atherosclerosis, and 23 age-matched healthy controls. Endothelium-dependent, flow-mediated brachial artery dilation was measured in response to increased shear stress (reactive hyperemia induced by 5 minutes of forearm ischemia). This response was contrasted with that of 400 µg sublingual glyceryl trinitrate, an endothelium-independent vasodilator. Anthropometric characteristics, blood pressure, fasting lipids, and glucose were also measured.

Main Outcome Measure

Endothelium-dependent, flow-mediated brachial artery dilation and glyceryl trinitrate-induced endothelium-independent vasodilation.

Results

Endothelium-dependent flow-mediated dilation (FMD) was impaired in PD patients compared to controls (5.62 ± 0.58% vs. 7.46 ± 0.56%, P = 0.03). In contrast, responses to glyceryl trinitrate were similar in PD patients and controls as were blood pressure, lipid, and glucose values. FMD remained impaired after multivariable adjustment for potential confounders.

Conclusion

Patients with Peyronie's disease have evidence of systemic vascular changes in the way of systemic conduit artery endothelial impairment even in the absence of RFs for atherosclerosis and endothelial dysfunction. These wider vascular abnormalities in PD are likely to be of clinical relevance and require further study.
Sacral Neuromodulation for Lower Urinary Tract Dysfunction and Impact on Erectile Function
Authors: Lombardi Giuseppe , Mondaini Nicola , Giubilei Gianluca , Macchiarella Angelo , Lecconi Filippo , Del Popolo Giulio
Published: October 2008

Introduction

The first sacral nerve stimulators were for urinary urgency incontinence, urgency-frequency, and nonobstructive urinary retention. Since then, observations have been made for benefits beyond voiding disorders.

Aim

To evaluate if sacral neuromodulation (SNM) using the InterStim system (Medtronic Inc., Minneapolis, MN, USA) improves erectile function.

Methods

From January 1999 to January 2007, 54 males, mean age 42.8, underwent a permanent SNM for lower urinary tract symptoms (LUTS). Pre-SNM only subjects with concomitant erectile impairment according to the five-item version of the International Index of Erectile Function (IIEF-5), with normal blood sexual hormonal status, and responding to an intracavernous injection test 10 µg were enrolled in our study. Three months after permanent implantation, the IIEF-5 was completed again. Those who benefited significantly in erectile function completed the IIEF-5 semiannually. A final checkup was performed in July 2007.

Main Outcome Measures

A score of IIEF-5 equal to or higher than 25% compared to baseline indicated remarkable clinical enhancement.

Results

Presurgery, two patients were excluded. Overall, 22 subjects (42.3%) showed erectile impairment (14 were neurogenic). In the first visit post-SNM, five retentionists of neurogenic origin and two with overactive bladder syndrome of idiopathic origin achieved noticeable erectile improvement. Their median IIEF-5 score shifted from 14.6 to 22.2, and 15.5 to 22.5, respectively. During follow-up, two neurogenics lost the benefits concerning voiding and erection and recovered them after a new implant in the controlateral sacral S3 root. In the final visit, the seven responders reached an IIEF-5 score of at least 22.

Conclusions

Our study showed a clinically important benefit of sexual function mainly for neurogenic retentionists. Future research should test SNM in a larger sample of subjects, exclusively with sexual dysfunctions, in order to better understand the mechanism of action of SNM on erectile function.
Aging Male Questionnaire in Normal and Complaining Men
Authors: Raynaud Jean-Pierre , Tichet Jean , Born Catherine , Taieb Charles , Igigabel Philippe , Giton Franck , Fiet Jean
Published: October 2008

Introduction

Detection of androgen deficiency is at least, based on specific questionnaires, defined by sexual, psychological, and somatic variables. Their relationships with sexual hormone levels are poorly understood.

Aim

To assess the Aging Male Symptoms (AMS) score and sex hormone levels in normal and complaining men in order to define the relationship between the key parameters related to androgen deficiency.

Methods

Nine hundred and three men were interviewed via phone by a trained interviewer who completed the questionnaire; 539 men consulting for a checkup in a health center and 471 complaining men, who completed the AMS scale in clinical setting, were selected, after excluding subjects with major and/or chronic diseases, endocrine disorders, psychological dysfunctions, and metabolic syndrome.

Main Outcome Measures

Total AMS score and psychological, somatic and sexual subscores, as a function of age.

Results

The AMS questionnaires the were completed in a clinical setting or via calling-up line were comparable. In both cases, total AMS scores and subscores were significantly dependent of age and were correlated to income. In normal men, the only two parameters that significantly changed with age were the AMS sexual subscore and bioavailable testosterone (BT). Complaining men aged more than 50 years old had a significantly higher total AMS scores, subscores, and BT level than normal men up to 60 years old, and these differences weakened with increasing age. In normal and complaining men, whatever the AMS sexual subscore, any variation in testosterone (T) and BT levels was observed.

Conclusions

The AMS scale could be defined as a screening test for androgen deficiency symptoms in men between 50 and 65 years of age. The sexual AMS subscore and BT level are the key variables to identify those symptoms; the severity of sexual symptoms can not be explained by a BT level decrease.
The Current Outlook for Testosterone in the Management of Hypoactive Sexual Desire Disorder in Postmenopausal Women
Authors: Kingsberg Sheryl A. , Simon James A. , Goldstein Irwin
Published: October 2008

Introduction

Hypoactive sexual desire disorder (HSDD) is a common clinical problem in women, especially those who have experienced surgical menopause. Because androgen levels decline with age and drop dramatically following bilateral oophorectomy, it has been hypothesized that reduced levels of testosterone are related to diminished desire.

Aim

As presented at a continuing medical education satellite symposium during the 2008 annual meeting of the International Society for the Study of Women's Sexual Health, to review the current state of knowledge about the physiologic effects of testosterone in postmenopausal women, the effects of transdermal testosterone delivery in surgically menopausal women with HSDD, and ongoing studies of a transdermal testosterone gel.

Methods

A review of the pertinent literature, including recent presentations.

Main Outcome Measures

Results from the Women's International Study of Health and Sexuality; and studies utilizing the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and validated instruments that assess female sexual function: the Sexual Activity Log©, the Profile of Female Sexual Function©, and the Personal Distress Scale©.

Results

Surgically menopausal women receiving testosterone experience significant increases in total satisfying sexual activity vs. women receiving placebo, significant improvement in all domains of sexual function, and decreases in personal distress, with a favorable safety profile.

Conclusion

Testosterone deficiency may be considered among the underlying causes of HSDD. Currently, testosterone is available to women in the United States only via off-label prescribing or by unregulated compounding of testosterone preparations. New safety trials will examine the long-term safety of testosterone gel in surgically menopausal women with HSDD who are at high risk of cardiovascular disease or breast cancer.
Assessing Sexual Function in Well Women: Validity and Reliability of the Monash Women's Health Program Female Sexual Satisfaction Questionnaire
Authors: Davison Sonia L. , Bell Robin J. , La China Maria , Holden Samantha L. , Davis Susan R.
Published: October 2008

Introduction

A validated questionnaire to assess the nature and quality of the recent female sexual experience and that can be employed to evaluate acute therapeutic effects does not exist.

Aim

To validate an instrument with which researchers can evaluate the nature and quality of the female sexual experience within 24 hours of a sexual event.

Methods

A cross-sectional questionnaire study in 349 sexually active community-based women, aged 20–65 years, who self-identified as being either satisfied or dissatisfied with their sexual life.

Main Outcome Measures

Scores from the Monash Women's Health Program Female Sexual Satisfaction Questionnaire (MFSSQ), completed within 24 hours of sexual activity, on two occasions.

Results

Participants were 349 women who were sexually active at least once per fortnight, but not necessarily partnered. Almost equal groups of self-identified satisfied, dissatisfied, premenopausal, and postmenopausal women participated. Three hundred forty-five women (99%) completed one MFSSQ, and 326 women (94%) completed two separate questionnaires, each within 24 hours of a sexual event. Missing responses were few, good inter-item correlation was seen, and excellent reliability was demonstrated for most items, based on test–retest data. The questionnaire was able to discriminate well between sexually satisfied and dissatisfied women.

Conclusions

The MFSSQ is a 12-item questionnaire specifically designed to assess the quality and nature of a recent sexual experience. It is easy and quick to administer, is reliable and valid, and has the potential to be used to assess the efficacy of acute interventions in the area of female sexual dysfunction.
Is the Relationship Between Cigarette Smoking and Male Erectile Dysfunction Independent of Cardiovascular Disease? Findings from a Population-Based Cross-Sectional Study
Authors: Chew Kew-Kim , Bremner Alexandra , Stuckey Bronwyn , Earle Carolyn , Jamrozik Konrad
Published: October 2008

Introduction

Cigarette smoking has been implicated in the pathophysiology of cardiovascular disease (CVD) and as a risk factor for erectile dysfunction (ED). However, various aspects of the associations between cigarette smoking, ED, and CVD need further elucidation.

Aim

We explored the relationship between cigarette smoking, ED, and CVD using data from a population-based cross-sectional study of 1,580 participants.

Methods

Postal questionnaires were sent to randomly selected age-stratified male population samples obtained from the Western Australia Electoral Roll.

Main Outcome Measures

In addition to items covering sociodemographic and self-reported clinical information and smoking habits, the 5-item International Index of Erectile Function was used to assess erectile function.

Results

Compared with never smokers, the odds of ED, adjusted for age, square of age, and CVD, were significantly higher among current smokers (odds ratio [OR] = 1.40; 95% confidence interval [CI] 1.02, 1.92) and ever smokers (OR = 1.57; 95% CI 1.02, 2.42). Similarly, the adjusted odds of severe ED were significantly higher among former smokers. Albeit not statistically significant, the age-adjusted odds of ED among current smokers increased with the number of cigarettes smoked. Among former smokers, the age-adjusted odds of ED were significantly higher 6–10 years following cessation of smoking than ≤5 or >10 years. Compared with never smokers without CVD, the age-adjusted odds of ED among former smokers and ever smokers without CVD were about 1.6. Regardless of smoking, these odds were significantly higher among participants with CVD.

Conclusions

Compared with never smokers, former smokers and ever smokers have significantly higher odds of ED. The relationship between smoking and ED is independent of that between smoking and CVD, and not because of confounding by CVD. Patterns of ED in former smokers suggest that there may be a latent interval between active smoking and symptomatic ED, involving a process initially triggered by smoking.
Menstrual Cycle-Related Morphometric and Vascular Modifications of the Clitoris
Authors: Battaglia Cesare , Nappi Rossella Elena , Mancini Fulvia , Cianciosi Arianna , Persico Nicola , Busacchi Paolo , Facchinetti Fabio , De Aloysio Domenico
Published: October 2008

Introduction

The evaluation of clitoral anatomy and function is of paramount importance to understand the physiology and pathology of clitoral function.

Aim

To prospectively evaluate the clitoral volumetric and vascular modifications during the menstrual cycle, and analyze their relationship with circulating hormones and nitric oxide levels.

Methods

Thirty healthy eumenorrheic women were studied in different phases of the menstrual cycle (day 3, 10, 14, 20, and 27). They were submitted to ultrasonographic (US) and Doppler analyses, and to hormonal and biochemical evaluations.

Main Outcome Measures

Transvaginal US evaluation of uterus, ovaries, and clitoris; Doppler analysis of uterine and dorsal clitoral arteries; and measurement of plasma luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, androstenedione, testosterone, and nitrites/nitrates concentration. Sex hormone binding globulin was assayed, and free androgen index was calculated.

Results

During the menstrual cycle, FSH, LH, and estradiol changed as expected, whereas androgens did not show any significant change. The US assessment of the clitoral body volume evidenced a progressive increase with significant modifications during the periovulatory phase, after which it remained stable until day 20. Subsequently, the clitoral body volume decreased into the premenstrual phase (day 27), reaching values similar to those observed on cycle day 3. A comparable trend was observed in the nitrite/nitrate circulating values. The uterine and clitoral arteries presented significant modifications with reduced resistances in the periovulatory period. Estradiol levels resulted positively correlated with the clitoral body volume and inversely correlated with the dorsal clitoral artery pulsatility index (PI). Furthermore, the dorsal clitoral artery PI was inversely and significantly correlated with the nitrite/nitrate circulating values and the clitoral body volume.

Conclusion

Clitoral anatomic and vascular modifications are observable during the normal menstrual cycle.