The Long-Acting Phosphodiesterase Inhibitor Tadalafil does not Influence Athletes' V·O2max, Aerobic, and Anaerobic Thresholds in Normoxia

Whereas experimental studies showed that in healthy trained subjects, the phosphodiesterase-5 inhibitor (PDE-5i) sildenafil improves exercise capacity in hypoxia and not in normoxia, no studies on the effects of the long half-life PDE-5i tadalafil exist. In order to evaluate whether tadalafil influences functional parameters and performance during a maximal exercise test in normoxia, we studied 14 healthy male athletes in a double-blind cross-over protocol. Each athlete performed two tests on a cycle ergometer, both after placebo or tadalafil (at therapeutic dose: 20 mg) administration. Oxygen consumption (VO2), blood lactate, respiratory exchange ratio, rate of perceived exertion, arterial blood pressure (BP), heart frequency (HR) and oxygen pulse (VO2/HR) were evaluated before exercise, at individual ventilatory and anaerobic thresholds (IVT and IAT), at VO2max and during recovery. Compared to placebo, a single tadalafil administration significantly reduced systolic BP before and after exercise (p < 0.05), decreased VO2/HR at IVT (13.3 +/- 1.8 vs. 14.5 +/- 2.1 mL . beat (-1); p = 0.03), but did not modify individual VO2max, IVT, or IAT. In healthy athletes, 20 mg of tadalafil does not substantially influence physical fitness-related parameters, exercise tolerance, and cardiopulmonary responses to maximal exercise in normoxia; it remains to be verified if higher doses/prolonged use influence health and/or sport performance in field conditions.

Testicular function in boys previously treated with recombinant-human growth hormone for non-growth hormone-deficient short stature

Data on the effects of recombinant human GH (hGH) therapy during male puberty on future testis function are still inconclusive. The aim of this study was to investigate the long-term effects of recombinant hGH treatment on reproductive function in non-GH-deficient short stature boys. Eight boys with non-GH-deficient short stature, affected by constitutional delay of puberty or idiopathic short stature, were retrospectively studied after recombinant-hGH treatment to verify gonadal development, hormone production and semen quality. Auxological data, endocrinological/ andrological parameters and laboratory evaluation (GH, IGF-I, FSH, LH, testosterone, inhibin B) were assessed before treatment; after completion of pubertal development, the same parameters plus SHBG levels were evaluated and a seminal fluid examination was conducted (ejaculate volume, pH, sperm concentration, total sperm count, forward and total motility, morphology). All patients showed normal testicular volume at the final pubertal stage, with regular androgenization. Hormonal levels were within the normal adult range in all boys. Considering the immature reproductive system of these patients in comparison with adults, semen parameters (sperm count, motility, and morphology) were within almost normal limits, except in one patient. Although patients showed the wide fluctuation of semen values frequently observed at the end of puberty, the hypophysis-gonadal axis hormones were in the normal range in all adolescents. Pathological measurements of some seminal parameters were found in one patient only. This study suggests that recombinant hGH treatment has no detrimental effects on the development and maturation of male gonadal function in non- GH deficient short stature young patients.

Expression of Fas and Fas ligand in human testicular germ cell tumours

In the present study, we analysed the expression of Fas ligand (FasL) and its cognate receptor Fas in 14 seminomatous testicular germ cell tumours (TGCT) and six normal testicular tissues obtained following orchiectomy. Tissue samples have been processed to prepare either total RNA or protein extracts or fixed and embedded in paraffin for immunohistochemistry (IHC) experiments. Quantitative RT-PCR experiments demonstrated in TGCT a significant (p < 0.01) increase of the FasL mRNA expression of 21.1 +/- 5.4 fold, with respect to normal tissues. On the contrary, in the same cancer tissues, the levels of Fas mRNA were significantly (p < 0.01) reduced to 0.27 +/- 0.06 fold. These observations were confirmed in western blot experiments showing a significant increase of FasL and a concomitant decrease of Fas proteins in testicular cancer tissues, with respect to normal testis. Moreover, IHC experiments showed a strong FasL immuno-reactivity in six out of eight TGCT samples analysed, while Fas immuno-positivity was found in cancer cells of only two TGCT tissues. In addition, in all tumour samples, infiltrating lymphocytes were Fas positive. However, no correlation could be observed between Fas or FasL mRNA variations and clinical parameters such as patient's age, TNM stage or tumour size. We also compared the serum levels of soluble FasL (sFasL) of 15 patients affected by seminomatous TGCT, of four patients with non-seminomatous TGCT and six age-matched healthy males. No significant differences in sFasL serum level could be identified. In conclusion, our data demonstrated that the majority of seminomas are characterized by an increased expression of FasL and a concomitant reduction of Fas, with respect to human normal testis, and that sFasL serum level is not a tumour marker for patients affected by TGCT.

HIV-1 viral DNA is present in ejaculated abnormal spermatozoa of seropositive subjects

BACKGROUND

Semen is the major vehicle for HIV-1 infection as it contains free and cell-associated virions and infected cells. However, the presence of HIV-1 in spermatozoa has been a matter of debate, since the sperm cell fraction may contain somatic infected cells that jeopardize the attribution of the detected virus to the spermatozoa.

METHODS

Spermatozoa from 12 HIV-1 seropositive subjects were purified by multilayered Percoll gradient followed by osmotic shock. Residual presence of non-seminal cells (NCS) in purified spermatozoa, was then evaluated by cytometric and molecular analysis. HIV-1 DNA was revealed by nested PCR and in situ PCR after sperm chromatin decondensation. DNA-fragmented ejaculated spermatozoa in semen of infected subjects were detected by terminal deoxynucleotidyl transferase-mediated dUDP nick-end labeling (TUNEL) analysis.

RESULTS

Purification procedure adopted allowed complete removal of NCS. On purified sperm cells, HIV-1 DNA was detected in 5 out of 12 subjects by nested-PCR. On crude semen of 10 out of 12 subjects, HIV-1 DNA was in situ detected in a small percentage of abnormal spermatozoa with a wide range of structural alterations. TUNEL analysis revealed an increased percentage of DNA-fragmented ejaculated spermatozoa in semen of infected subjects.

CONCLUSIONS

We report molecular evidence demonstrating that HIV-1 infected subjects can ejaculate small amounts of HIV-1 DNA-positive abnormal spermatozoa. Their possible role in HIV-1 sexual transmission remains to be clarified.

[Ageing and male sexuality]

Visceral, hormonal and neuroendocrine changes after the sixth decade of life result from slowing down and alteration in metabolic, hormonal, protein, lipid and glucose turnover, progressive receptor insensitivity, degenerative processes--primarily arteriosclerosis--of the endocrine and non endocrine tissues. Unlike menopause, andropause has no biological speed; it is neither rapid nor marked by macroscopically evident psychobehavioral change, as occurs in women. Because of its indistinct and widely variable nosographic contours, the male climacterium is more complex. The challenge to the clinical sexologist, therefore, is to identify appropriate treatment approaches for an ageing population with an increasingly longer life expectancy and the right to a sexually satisfying life.

Cortisol, dehydroepiandrosterone sulphate and dehydroepiandrosterone sulphate/cortisol ratio responses to physical stress in males are influenced by pubertal development

To evaluate the influence of chronological age and pubertal development on the hypothalamus-pituitary-adrenal (HPA) axis response to stress, we studied the possible correlations between male pubertal characteristics and salivary cortisol (C), DHEAS and the DHEAS/C ratio before (pre-stress) and after acute exercise-stress in young male volunteers (no. 87; 13.3+/-2.1 yr). In our overall study population, the mean pre-stress salivary C and DHEAS concentrations, significantly increased after exercise-related stress, whereas the DHEAS/C ratio significantly decreased. Pre-stress salivary C was positively correlated with chronological age, and after-stress salivary C concentration variations were negatively correlated with pubertal stage, mean testis volume and pre-stress salivary DHEAS. Furthermore, salivary DHEAS concentrations and the DHEAS/C ratio, before and after exercise stress, were positively correlated with chronological age, pubertal stage, pre-stress salivary testosterone (T), testis volume and body mass index (BMI). In contrast with late pubertal stages (P4, P5), young individuals at early stages of puberty (P1 to P3) showed higher C increase and lower DHEAS/C ratio after exercise-related stress. In conclusion, since C is also a mediator of stress-related negative effects on health and the DHEAS/C ratio has been hypothesized as an index for the degree to which an individual is buffered against the negative effects of stress, these data might suggest potentially increased stress-related risks at early stages of male puberty.

Salivary Steroids at Rest and After a Training Load in Young Male Athletes: Relationship with Chronological Age and Pubertal Development

Puberty influences both the performance and the hormonal responses to exercise-related stress. We evaluated the distribution and the correlation between pubertal characteristics and the salivary cortisol (sC) and testosterone (sT) responses to acute physical exercise in young male athletes (13.4 +/- 2.1 yr, n = 110). The mean pre-exercise nmol . L (-1) sC and sT concentrations were 19.08 +/- 4.32 and 0.34 +/- 0.15 and increased to 21.27 +/- 5.51 and 0.41 +/- 0.16 after a 90-min training session (p < 0.01). The sC concentration at rest was positively correlated with chronological age (p < 0.01) and negatively correlated with fat % (p < 0.05), whereas significant negative correlations of DeltasC and DeltasC% after exercise with age, pubertal stage and mean testis volume (p < 0.05) were observed. The sT increase after exercise was correlated with chronological age, pubertal stage and pre-exercise sT levels (p < 0.01), whereas the DeltasT and DeltasT% of increase were negatively correlated with chronological age and resting sT levels (p < 0.05 and p < 0.01). In the present study, we observed the presence of high inter-individual variability of different biological parameters (anthropometry, pubertal stage, hormones, etc.) within athletes selected by chronological age in the same class and the presence of significant correlations between chronological age, puberty and the steroid hormone responses to physical exercise. Our data suggest the need for different criteria in exercise prescription and selection of young athletes and in the evaluation of stress reactivity at puberty.

Cryopreservation and Sperm DNA Integrity

Cryopreservation of sperm is an extremely important issue in the field of male infertility as freezing can have detrimental effects on a variety of sperm functions, some of them not accessible to the traditional semen quality analysis. In this study, chromatin structure variations in human spermatozoa in semen were studied with the sperm chromatin structure assay (SCSA), both before and after cryopreservation. Samples were divided into two aliquots: the first was analysed without further treatment, while the second was stored in liquid nitrogen at -196 degrees C using standard cryopreservation techniques. The fresh and thawed aliquots were also assessed by light and fluorescence microscopy (after Acridine Orange staining, AO), and computer-assisted semen analysis (CASA) of motility. Overall sperm quality was found to deteriorate after cryopreservation. When thawed spermatozoa were subjected to an extra swim-up round, a general improvement in nuclear maturity was seen in post-rise spermatozoa.

Correlation between ejaculatory and erectile dysfunction

Summary Premature ejaculation (PE) and erectile dysfunction (ED) are different sexological issues. However, they have many little-known links. PE is the most common male sexual dysfunction, but ED is undoubtedly the most common reason that medical help is sought. As a consequence, PE is largely under-diagnosed and under-treated, while ED has received great scientific and clinical attention in recent years. There are plenty of reasons for this: (i) PE is classically considered as psychogenic in nature; (ii) it is traditionally treated with behavioural psychotherapies; (iii) clear and accepted clinical definition(s) are lacking; (iv) the aetiologies are largely unknown; (v) the pathogenesis is still obscure - there is a lack of awareness and acknowledgement of PE as a symptom of medical disease; (vi) lacking a medical presence in the field and requests for help from patients are low. Finally, erectile dysfunctions (ED) and ejaculatory dysfunctions frequently overlap. The aim of this review article is to propose a new taxonomy of PE, which considers ED as an important factor of PE and vice versa.

Diagnosing erectile dysfunction: instruments for endocrine diagnosis

Endocrine factors represent an important and potentially treatable cause of sexual dysfunction. The availability of a correct endocrinological diagnosis allows correct identification of most cases of sexual dysfunction in which the endocrine apparatus is involved. Not only the most frequent causes of endocrine sexual dysfunction, such as hypogonadism and hyperprolactinaemia, but almost all extra-gonadal endocrinopathies (hyper-and hypothyroidism, hyper- and hypocortisolism, steroidal secreting tumours, etc.) may have importance to a greater or lesser extent in sexual function. It is, therefore, necessary that the diagnostic process for sexual dysfunctions of an endocrine nature be as integrated and wide as possible, especially as such pathologies are normally extremely responsive to medical or surgical therapy.

The andrologist from medicine of reproduction to sexual medicine: the Italian experience

The main andrological areas of interest, male reproductive and - more recently - sexual dysfunctions are most appropriately viewed as symptoms of the couple with medical, psychological and behavioural components that cannot be treated in a mechanical, purely medicinal manner (sexual medicine). The patient and his sexual partner must be active participants in a full continuum of care (medical sexology), the new challenge for the renewed and enriched field of andrology. In this field, the cooperation between basic researchers (such as geneticists, neurophysiologists, pharmacologists, ethologists) and a wide group of clinicians (such as endocrinologists, psychologists and psycho-sexologists, psychiatrists, urologists and gynaecologists) is of paramount importance for the andrologist at the dawn of the new field of medical sexology, which will be full of scientific gratification in the years to come.

Presence of membrane and soluble forms of Fas ligand and of matrilysin (MMP-7) activity in normal and abnormal human semen

BACKGROUND

The aim of this study is to shed some light on the role of the Fas system in human semen, by investigating whether there is an association between the expression of the molecules regulating the Fas system [membrane-bound Fas ligand (mFasL), soluble Fas ligand (sFasL) and matrilysin, the metalloprotease cleaving mFasL to sFasL] and sperm parameters.

METHODS

We investigated, by flow cytometric analysis, the presence of FasL on spermatozoa from normozoospermic and teratozoospermic subjects and, by western blot, the presence of sFasL and matrilysin in the seminal plasma of the same samples as well as on samples from azoospermic subjects. The enzymatic activity of matrilysin was examined by gel zymography.

RESULTS

We observed that sperm cells expressed mFasL in 22% of normozoospermic men, whereas it was absent from spermatozoa from teratozoospermic patients. Higher levels of sFasL and augmented enzymatic activity of matrilysin were found in azoospermic samples.

CONCLUSIONS

The presence of mFasL on sperm from normozoospermic men and its absence in pathological samples emphasize the role of the Fas system in human semen. Moreover, the presence of both sFasL and matrilysin in seminal plasma implies a fine regulation of the function of the Fas system and, consequently, of the apoptotic process in the human genital tract.

Changes in serum inhibin B during normal male puberty

OBJECTIVE

In adult men, inhibin B (InhB) regulates FSH secretion by a negative feedback. The aims of this study were to evaluate the changes of InhB during puberty in the male and the relationship between InhB and FSH, LH, testosterone and testicular volume.

DESIGN

Cross-sectional study.

METHODS

InhB was measured using a two-site ELISA in 100 healthy boys subdivided by their pubertal development according to Tanner into five groups of 20.

RESULTS

During puberty we observed an increase of InhB level (G1 = 84.3 pg/ml, G3 = 132.2 pg/ml, G5 = 206.1 pg/ml). In G1, InhB correlated positively with FSH (P = 0.0001), LH (P = 0.005), testosterone (P = 0.001) and testicular volume (P = 0.007); in G5, InhB correlated inversely with FSH (P = 0.001) and LH (P = 0.045) and directly with testicular volume (P = 0.013). The multivariate analysis demonstrated that: in G1, FSH is the most important, and testosterone the second most significant, stimulus for InhB increase; in G2 only FSH has a positive effect on InhB variation; in G3 only mean testicular volume fits the model (G1-G3: InhB dependent variable); considering the FSH dependent variable, in G4, InhB is the most important stimulus for FSH decrease and mean testicular volume is a secondary directly proportional variable; in G5, only InhB shows a significant inverse relationship with FSH.

CONCLUSIONS

During puberty there is a regular increase of InhB. In the first phases of gonadal maturation, InhB and FSH correlate positively, while in mid-late stages the relationship is inverse. We found that in mid-puberty (G3-G4), the serum concentration of InhB increases, as its inverse relationship with FSH is being established and hence spermatogenesis.

Androgens and fertility

Androgens play a pivotal role in the development of the male reproductive tract. The spermatogenesis requires high levels of intratesticular testosterone secreted by the Leydig cells. Testosterone exerts its action through the androgen receptor (AR), which is located both in the cytoplasm and in the nucleus of cells in the target tissue. Severe defects of the AR may result in abnormal male sexual development, while more subtle modifications can be a potential cause of male infertility. Low circulating levels of testosterone can be found in 20-30% of infertile men, but administration of testosterone or gonadotropins does not result in improved sperm production. Abuse of anabolic steroids is a frequent cause of male infertility, and substances such as endocrine disruptors can alter male fertility through an anti androgenic action.

Androgenic-anabolic steroids abuse in males

Androgenic-anabolic steroids (AAS) is an official definition for all male sex steroid hormones, their synthetic derivatives and their active metabolites. AAS are drugs with specific therapeutic indications, yet they are popularly known because of their worldwide non-therapeutic use in a large number of healthy individuals. Doping with AAS has become so widespread in athletics that it affects the outcome of sports contests. Furthermore, AAS non-therapeutic use is increasing particularly among adolescents and females, becoming one of the main causes of iatrogenic diseases due to drug abuse. All physicians must be aware about the large diffusion and side effects related to AAS non-therapeutic use, in order to discover clinical signs of AAS abuse and/or to start adequate preventive and/or therapeutic actions.

Psychosocial issues of ART in aging male

The role of androgens in human sexuality as regards the mechanism of erection and the pathogenesis of impotence is under debate. In addition, it is difficult to define the psychosocial impact of both hypogonadism and androgen replacement. However, sexual hormones largely influence mood, well-being, and quality of life. For this reason, despite the methodological difficulties of assessment, testosterone replacement has a deep impact on the social, psychological and sexual life of the treated patient. Considering the obvious characteristic of testosterone as an hormone, it appears evident that the endocrinologist is the unique experienced specialist able to diagnose and treat the hypogonadal men, monitoring potential side effects and following the psychosocial issues of androgen therapy.

Risk factors for androgen decline in older males: lifestyle, chronic diseases and drugs

The aging process in men is accompanied by a progressive decline in serum testosterone levels. In addition to chronological aging, the various illnesses occurring in mid- to late-adult life and the medications used to treat them further contribute to lowering circulating testosterone levels. Any acute severe illness produces hypogonadotrophic hypogonadism; but also chronic illnesses, such as diabetes, cardiovascular disease and hypertension, lifestyle habits, such as tobacco and alcohol intake, and nutritional factors, from malnutrition to obesity, account for and accentuate the age-related decline in serum androgen levels. These issues are reviewed in a clinical perspective.

Might erectile dysfunction be due to the thermolabile variant of methylenetetrahydrofolate reductase?

Hyperhomocysteinemia is considered one of the most important cardiovascular risk factors increasing considerably the risk of stroke and myocardial infarction. With respect to endothelial function, direct effects of hyperhomocysteinemia on vascular endothelial cells have been demonstrated through the reduction of endothelial nitric oxide production. In this paper, we report the case of a young man with homozygote genotype mutated with 5-methylenetetrahydrofolate reductase (MTHFR) thermolabile variant who, in the absence of relational stress, developed an erectile dysfunction (ED) refractory to the vasoactive type-V phosphodiesterase (PDE5) inhibitor therapy. After one month of treatment with 5 mg/day folic acid and 1000 microg/day cyanocobalamin, the patient restarted the assumption of 50 mg sildenafil, obtaining satisfying erections during sexual intercourse. We suggest that hyperhomocysteinemia may interfere with penile blood supply and, thus, be responsible for ED. If this relationship is confirmed, plasma levels and urinary homocysteine (HCy) should be evaluated in selected young patients with vascular ED. Furthermore, careful attention should be given to the risk of ED when dealing with this metabolic disturbance.

Are subjects with erectile dysfunction aware of their condition? Results from a retrospective study based on an Italian free-call information service

The aim of the study was to analyse the socio-demographic and epidemiological characteristics of the Italian male population affected by sexual disturbances. Men complaining of erectile dysfunction (ED) who called the Pfizer program "Man and Woman in Health" between April 18th 2001 and May 27th 2002 and asked for information about their medical condition, were interviewed by trained doctors using a computer-assisted questionnaire. 16007 out of 25018 calls were considered for statistical analysis. Mean age of callers was 48.8+/-14.2 yr, reporting ED in 83% of cases. In the majority of men ED was severe (58%) and lasting more than 3 yr (25%). Multivariate analysis revealed that diabetes, depression, prostate surgery, heart disease, neurological disorders, liver and renal diseases were all significant and independent contributors to the degree of erectile impairment adjusted for age (p<0.001). The principal concomitant medications were anti-hypertensive (23%), antidiabetic (9%) and cardiovascular agents (6%). Cigarette smoking was present in 24%. On directed questioning of the caller, anxiety and distress were perceived as the most frequent causes of ED (42%) across all age groups, followed by the presence of concomitant disease/s (26%) especially in aging men. Also, a large number of men (41 %) with severe ED waited for more than 3 yr before looking for medical referral. Interestingly, only 19% had ever tried any specific medication for ED. These data indicate that 5 yr after worldwide approval and release of sildenafil, ED is still largely undiagnosed and under-treated, possibly because it is still perceived as a condition mainly due to distress or advancing age and therefore not deserving medical referral. Effective prevention of ED commences with better awareness of the pathological causes by the population and modification of risk factors by the doctors.

Full-term pregnancies achieved with ICSI despite high levels of sperm chromatin damage

BACKGROUND

Sperm DNA integrity is essential for the accurate transmission of genetic information. The clinical significance of this assessment lies in its association with not only natural conception rates, but also the success of assisted reproduction technology (ART). It has been reported that sperm chromatin structure assay (SCSA) identified thresholds for negative pregnancy outcome after ART when the DNA fragmentation index (DFI), previously known as COMPalphat, was >30%.

METHODS

In a prospective clinical study, we examined 34 male infertile patients, the husbands of women undergoing conventional IVF or ICSI. SCSA and ART were carried out on semen aliquots taken from the same ejaculate. Fertilization rate, embryo quality and pregnancy rates were correlated to SCSA parameters, DFI and highly DNA stainable (HDS) cells.

RESULTS

No differences were seen in SCSA parameter values between patients initiating pregnancies and not doing so in either ICSI or conventional IVF. Pregnancies and normal delivery were obtained even with high levels of DFI.

CONCLUSIONS

There is still controversy over whether analytical techniques currently in use are able to identify the level of damage to spermatozoa. Large-scale studies should be conducted in different clinical settings to determine the effects of sperm DNA damage on the outcome of ART.

Schwannoma of the tongue: one case report

The schwannomas are nervous tissue tumours that arise from Schwann cells; they are uncommon in peripheral nerves and rare in the tongue. After, a review of the literature, we present a case of schwannoma which arose in the ventral part of the body of the tongue. The tumour presented as a slowly growing mass producing few symptoms. The diagnosis of schwannoma is usually made post-operatively by histological identification although modern imaging techniques can provide useful indications. The treatment is exclusively surgical and usually enucleation of the mass is uncomplicated. There are no reports of malignant transformation.

Research and academic education in medical sexology

Advances in sexual pharmacology have stimulated the development of new analytical instruments in the management of sexual dysfunction, with increasing research in the area of basic mechanisms of human sexual response. However, the public is greatly interested and eager for new discoveries and pharmacological treatments to enhance sexual performance and relationships, and cure common sexual dysfunctions and symptoms. The need for sexology--in this case, a new "medical" sexology--to utilize scientific tools and be taught in medical schools is therefore evident.

Stress, sexual dysfunctions, and male infertility

Involuntary childlessness is considered to be a chronic stressor for couples suffering from infertility. Stress itself may interfere with spermatogenesis and fertility rate. The long period of diagnostic and treatment procedures may also have a negative impact on the sex life of the infertile couple. In fact, we observed in such patients a higher frequency of male sexual disturbances expressed as erectile dysfunction, ejaculatory disorders, loss of libido and a decrease in the frequency of intercourse. We tried to partially overcome these sexual symptoms by administration of 50 mg of a type-V phosphodiesterase inhibitor (sildenafil) to two selected groups: patients collecting semen for artificial insemination and male partners of couples before post-coital testing. The results of this uncontrolled pilot study suggest that sildenafil is effective in increasing compliance of male patients facing infertile couple management procedures, and also in improving some sperm parameters, above all the number of sperm penetrating the cervical mucus.

Endocrinological diagnosis in sexology

Endocrine factors represent an important and potentially treatable cause of sexual dysfunction. The availability of a correct endocrinological diagnosis allows correct identification of most cases of sexual dysfunction in which the endocrine apparatus is involved. Not only the most frequent causes of endocrine sexual dysfunction, such as hypogonadism and hyperprolactinemia, but almost all extra-gonadal endocrinopathies (hyper- and hypothyroidism, hyper- and hypocortisolism, steroidal secreting tumors, etc.) may play a role to a greater or lesser extent in sexual function. It is therefore necessary that the diagnostic process for sexual dysfunctions of an endocrine nature be as integrated and wide as possible, especially as such pathologies are usually extremely responsive to medical or surgical therapy.

Introduction to the integrated model: medical, surgical and psychological therapies for the couple

The integrated model is the interplay of behavioural, cognitive, medical, and surgical approach to sexual problems. Research demonstrates that prognosis and outcome of patients with sexual diseases dramatically improve when medical solutions are proposed along with the evaluation of the therapies' sexual impact on the couple's dynamics. Current classification of treatments for erectile dysfunction (here used as a paradigm of sexual disorder therapies) distinguishes between central and peripheral "initiators" and "conditioners" of erection. However, such a taxonomy does not take into account the impact on the couple, the final recipient of the treatment. For this reason, we propose here a new, couple-based sexological taxonomy which divides therapies into "harmonious" and "inharmonious". Pilot data are also presented on the use of a carnitine analogue as a model of an etiological, harmonious therapy for impotence. The integrated model suggests a strict collaboration between sexologists of different areas. Considering the growing complexity of therapies for sexual symptoms and diseases, there seems to be a need for the new professional figure of the medical sexologist.

Functional anatomy of the human vagina

Anatomy studies normally precede physiology. While the anatomy of the penis and the biochemical and molecular regulation of erection are largely known, the exact anatomical description of the human clitoris was produced in 1998, the taxonomy of female sexual dysfunctions classified in 1999, and biochemistry of female excitation described only in 2002. There are various reasons for this. Female sexual physiology is much more complex than that of the male, and cultural and religious considerations have discouraged the scientific study of female sexuality. However, it is now apparent that modern sexology cannot be truly 'medical' if female sexual anatomy and the physiology of female sexual response are unknown.

Sexological approach to ejaculatory dysfunction

Ejaculatory disorders include premature, deficient (delayed ejaculation and anejaculation) and retrograde ejaculation. A rare symptom connected to ejaculatory disorders is male anorgasmia. In the past, ejaculatory disorders were considered as typical relational and psychological symptoms. For this reason, a number of behavioural and psycho-relational approaches have flourished from the first ideas of curing sexual problems with empirical therapy, focusing on the symptoms of sexual pathology. Such treatment includes assessment, behavioural and educational components, psychotherapy in the context of the relationship and sexual timetables. Recent advances in understanding the importance and frequency of ejaculatory disorders, insights into their organic and non-organic pathophysiology and the efficacy of a growing arsenal of pharmacological therapies lead to a new challenge which can be confronted only with the development of new, integrated therapeutic alternatives from a modern somato-psychic and holistic viewpoint.

Disorders of ejaculation

The physiology of ejaculation includes emission of sperm with the accessory gland fluid into the urethra, simultaneous closure of the urethral sphincters, and forceful ejaculation of semen through the urethra. Emission and closure of the bladder neck are primarily alpha-adrenergically mediated thoracolumbar sympathetic reflex events with supraspinal modulation. Ejaculation is a sacralspinal reflex mediated by the pudendal nerve. The most common ejaculation disorder is premature ejaculation, but there is little agreement regarding the definition of this disorder or its etiology, diagnosis, and treatment options. Premature ejaculation is in fact classically considered psychogenic in nature. However, recent data have demonstrated that prostatic inflammation/infection has been found with high frequency in premature ejaculation, suggesting a role of prostatic pathologies in the pathogenesis of some cases of failure of ejaculatory control. Rarer disorders are emission and ejaculation failure and urine contamination of semen. The new use of diagnostic procedures and the availability of pharmacological aids place this topic in the mainframe of medical sexology.

Sexual inactivity results in reversible reduction of LH bioavailability

We have recently documented significantly reduced serum testosterone (T) levels in patients with erectile dysfunction (ED). To understand the mechanism of this hypotestosteronemia, which was independent of the etiology of ED, and its reversibility only in patients in whom a variety of nonhormonal therapies restored sexual activity, we measured serum luteinizing hormone (LH) in the same cohort of ED patients (n=83; 70% organic, 30% nonorganic). Both immunoreactive LH (I-LH) and bioactive LH (B-LH) were measured at entry and 3 months after therapy. Based on outcome (ie number of successful attempts of intercourse per month), patients were categorized as full responders (namely, at least eight attempts; n=51), partial responders (at least one attempt; n=20) and non-responders (n=16). Compared to 30 healthy men with no ED, baseline B-LH (mean+/-s.d.) in the 83 patients was decreased (13.6+/-5.5 vs 31.7+/-6.9 IU/L, P<0.001), in the face of a slightly increased, but in the normal range, I-LH (5.3+/-1.8 vs 3.4+/-0.9 IU/L, P<0.001); consequently, the B/I LH ratio was decreased (3.6+/-3.9 vs 9.7+/-3.3, P<0.001). Similar to our previous observation for serum T, the three outcome groups did not differ significantly for any of these three parameters at baseline. However, outcome groups differed after therapy. Bioactivity of LH increased markedly in full responders (pre-therapy=13.7+/-5.3, post-therapy=22.6+/-5.4, P<0.001), modestly in partial responders (14.8+/-6.9 vs 17.2+/-7.0, P<0.05) but remained unchanged in non-responders (11.2+/-2.2 vs 12.2+/-5.1). The corresponding changes went in the opposite direction for I-LH (5.2+/-1.7 vs 2.6+/-5.4, P<0.001; 5.4+/-2.2 vs 4.0+/-1.7, P<0.05; 5.6+/-1.2 vs 5.0+/-1.2, respectively), and in the same direction as B-LH for the B/I ratio (3.7+/-4.1 vs 11.8+/-7.8, P<0.001; 4.2+/-4.3 vs 5.8+/-4.2, P<0.05; 2.1+/-0.7 vs 2.6+/-1.3, respectively). We hypothesize that the hypotestosteronemia of ED patients is due to impaired bioactivity of LH. This reduced bioactivity is reversible, provided that resumption of sexual activity is achieved regardless of the therapeutic modality. Because biopotency of pituitary hormones is controlled by the hypothalamus, LH hypoactivity should be due to the hypothalamic functional damage associated to the psychological disturbances which unavoidably follow sexual inactivity.

Polyunsaturated fatty acids of germ cell membranes, glutathione and blutathione-dependent enzyme-PHGPx: from basic to clinic

The lipid metabolism in sperm cells is important both for energy production and for cell structure. A special composition of membrane phospholipids, rich in polyunsaturated fatty acids (PUFA), and the different composition of sperm and immature germ cell membrane are described and discussed. Testis germ cells as well as epididymal maturing spermatozoa are endowed with enzymatic and non-enzymatic scavenger systems to prevent lipoperoxidative damage. Catalase, superoxide dismutase, and glutathione-dependent oxidoreductases are present in variable amounts in the different developmental stages. Phospholipid hydroperoxide glutathione peroxidase (PHGPx) activity and roles in caput and cauda epididymal sperm cells are discussed. Also seminal plasma has a highly specialized scavenger system that defends the sperm membrane against lipoperoxidation and the degree of PUFA insaturation acts to achieve the same goal. Systemic predisposition and a number of pathologies can lead to an anti-oxidant/pro-oxidant disequilibrium. Scavengers, such as glutathione can be used to treat these cases as they can restore the physiological constitution of PUFA in the cell membrane.

How the roots contribute to the ability of Phaseolus vulgaris L. to cope with chilling-induced water stress

Intact plants and stem-girdled plants of Phaseolus vulgaris grown hydroponically were exposed to 5 degrees C for up to 4 d; stem girdling was used to inhibit the phloem transport from the leaves to the roots. After initial water stress, stomatal closure and an amelioration of root water transport properties allowed the plants to rehydrate and regain turgor. Chilling augmented the concentration of abscisic acid (ABA) content in leaves, roots and xylem sap. In intact plants stomatal closure and leaf ABA accumulation were preceded by a slight alkalinization of xylem sap, but they occurred earlier than any increase in xylem ABA concentration could be detected. Stem girdling did not affect the influence of chilling on plant water relations and leaf ABA content, but it reduced slightly the alkalinization of xylem sap and, principally, prevented the massive ABA accumulation in root tissues and the associated transport in the xylem that was observed in non-girdled plants. When the plants were defoliated just prior to chilling or after 10 h at 5 degrees C, root and xylem sap ABA concentration remained unchanged throughout the whole stress period. When the plants were chilled under conditions preventing the occurrence of leaf water deficit (i.e. at 100% relative humidity), there were no significant variations in endogenous ABA levels. The increase in root hydraulic conductance in chilled plants was a response neither to root ABA accretion, nor to some leaf-borne chemical signal transported downwards in the phloem, nor to low temperature per se, as indicated by the results of the experiments with defoliated or girdled plants and with plants chilled at 100% relative humidity. It was concluded that the root system contributed substantially to the bean's ability to cope with chilling-induced water stress, but not in an ABA-dependent manner.

Control and impairment of immune privilege in the testis and in semen

It has long been known that the testis is an immunologically privileged site in the body, and that human seminal plasma possesses a generalized immunosuppressive activity. Multiple factors participate in the establishment of immunotolerance in the testis: the blood-tubular barrier; the local production of immunosuppressive molecules by Sertoli cells; and the Fas system as regulator of immunological homeostasis in both physiological and pathological conditions. Cytokine-induced up-regulation of Fas as well as of integrin ligands, which are known to be specific binding molecules for lymphocytes on the Sertoli cell surface, indicates that the 'nursing' cells of seminiferous epithelium might be important in the impairment of immune privilege, causing autoimmune orchitis. In addition, the soluble form of Fas-ligand protein present in the seminal plasma of infertile patients might suggest a role for this immunomodulatory protein in male infertility. Finally, an understanding of the mechanisms underlying immune privilege in the testis and in semen might help to clarify how cells expressing 'non-self' antigens (such as male gametes) can escape the immune system in both the male and female genital tracts.

Phosphatidylinositol 3-kinase inhibition enhances human sperm motility

BACKGROUND

The number of spermatozoa with forward motility after capacitation procedures represents the limiting factor for application of IVF versus intracytoplasmatic sperm injection (ICSI) procedure in cases of oligoasthenozoospermia. The possibility of increasing this number may thus be of help to the patient. A complex array of signalling pathways is involved in the regulation of sperm motility and recent data pointed out an important role for kinase/phosphatase-regulated phosphorylation of proteins. Here, we investigated the role of phosphatidylinositol 3-kinase (PI3K), a lipid and protein kinase involved in the regulation of several biological aspects of somatic cells, on human sperm motility by using the specific PI3K inhibitor LY294002.

METHODS AND RESULTS

We demonstrated that in-vitro incubation of swim-up selected or unselected human spermatozoa with LY294002 determined an increase of percentage forward motility in all the treated samples. The effect was dose-dependent with an EC(50) of 1.09 +/- 0.54 micromol/l. LY294002 also increased sperm movement characteristics and hyperactivation as evaluated by computer-assisted motion analyser. The compound was also able to overcome the detrimental effect of hydrogen peroxide and lithium chloride on sperm motility.

CONCLUSIONS

Our results suggest a negative role for PI3K in the development and maintenance of sperm motility and suggest a possible use of PI3K inhibitors to enhance motility in cases of asthenozoospermia.

Antisperm immunity in natural and assisted reproduction

Research conducted in the last 40 years has provided evidence that antisperm antibodies (ASA) can impair the fertilizing capacity of human spermatozoa. It is established that ASA can be present at different sites, can act against different antigens and can impair fertility in various ways. In fact, in the past it was amply demonstrated that ASA can act negatively on sperm motility and on cervical mucus penetration. In recent years, owing to the improvement and spreading of IVF techniques, it has been possible to demonstrate the effect of antibody-bound spermatozoa at the level of in-vitro gamete interaction. The literature demonstrates that the various previously used treatments for immunological infertility, i.e. medical therapy, intrauterine insemination with husband's spermatozoa (AIH) and IVF, usually had poor success. The primary choice of treatment in immunological infertility, especially in the most severe cases and when the sperm head is involved, is ICSI. ASA evaluation in all couples who undergo the various techniques of insemination or IVF is imperative.

Chromosomal alterations and male infertility

Reduced male fertility can be caused by genetic factors affecting gamete formation or function; in particular, chromosome abnormalities are a possible cause of male subfertility as shown by their higher frequency in infertile men than in the general male population. Meiotic studies in a number of these males have shown spermatogenesis breakdown, often related to alterations in the process of chromosome synapsis. Indeed, any condition that can interfere with X-Y bivalent formation and X-chromosome inactivation is critical to the meiotic process; furthermore, asynapsed regions may themselves represent a signal for the meiotic checkpoint that eliminates spermatocytes with synaptic errors. We performed cytogenetic, hormonal and seminal studies in 333 infertile patients selected because azoospermic, severely oligozoospermic or normozoospermic with failure to fertilize the partner's oocytes in an in vitro fertilization (IVF) program. Our findings: 1) confirm the high incidence of chromosomal anomalies among infertile males; 2) highlight the relevance in male infertility of quantitative/positional modifications of the constitutive heterochromatin; and 3) underline the relevance of cooperation between andrologists and cytogenetists prior to every kind of assisted reproduction, above all prior to intracytoplasmic sperm injection, in which selective hurdles eliminating abnormal germ cells are bypassed.

Myth and reality of the decline in semen quality: an example of the relativity of data interpretation

Many hypotheses have been put forward to explain a suspected decline in semen quality. Up to now many sources of data were used but conflicting results are present in the literature. To study whether modifications of sperm parameters actually exist we used data from two groups of patients checked and two small groups of sperm bank donors selected at the beginning '80s and '90s. We tried to reduce bias to a minimum: all the semen analyses were carried out by the same biologist, using the same methods, groups were clinically evaluated by the same andrological team, the study groups were homogeneous for age, geographic-ethnic origin, residence, monthly-seasonal distribution and abstinence period. Comparing patients from the '80s and the '90s, sperm concentration and motility showed a significant reduction. Furthermore, the decrease in concentration and motility was mainly due to the higher age classes. In donors, no decline was observed. These results seem to indicate that sperm donors remain unaffected, while patients with lower levels of semen quality are experiencing a real decline. Unfortunately, many confounding variables, analyzed in detail in this review, still remain despite efforts at standardization.

Front-surface absorbance spectra of wheat flour: determination of carotenoids

Front-surface absorbance spectra of wheat flours in the 250-650 nm region can be obtained by measuring reflectance spectra with a conventional spectrofluorometer suitably set to detect light scattered from powder samples. The spectra recorded on flour samples, obtained from seeds of four bread and five durum wheats, show high-intensity absorption bands due to aromatic amino acids of wheat proteins and low-intensity bands due to chromophores bound to low-molecular-weight compounds. The intensity of these last bands is proportional to the concentration of the corresponding chromophores present in the flour; thus, it can be used to measure the content of the compounds containing the chromophore(s). In particular, a quantitative determination of the carotenoids actually present in the flours is made, obtaining information on the original content of the seeds. This determination is important, as, for example, xanthophylls are well-known antioxidants and free-radical scavengers involved in aging processes of seeds. Reflectance measurements on powder samples are far more economic in terms of time and materials consumption than methods such as extraction and HPLC analysis of extracts and, in addition, give an evaluation of the overall content of carotenoids with absorption bands in the spectral range 450-500 nm. Application of the technique to other food powders with low-intensity absorption bands in the near-UV and vis region is possible.

Psychosocial factors and male seminal parameters

The relationships between (a) alexithymia, (b) extroversion (E), neuroticism (N), psychoticism (P), (c) coping style towards stressors, and seminal parameters, were assessed in 132 males on their first seminal fluid examination by means of a multivariate approach. They were given the TAS-20, the EPQ, and the Coping Inventory for Stressful Situations (CISS). Seminal parameters were: (1) sperm concentration; (2) total sperm count; (3) forward motility; (4) atypical forms. Multiple regressions considering quantitative parameters of seminal status as criterion showed a negative relationship with P, difficulty describing feelings (DDF), while a positive relationship was found for N, and emotion-oriented coping. A discriminant analysis also showed that P, N and DDF distinguished between two groups of normozoospermic and oligozoospermic subjects with a high probability of correct classifications. Results confirm the hypothesis that biological and psychological variables are not completely independent or randomly related in people with an impaired seminal status, although the correlations between psychosocial and biological data are not very strong.

Study of apoptotic DNA fragmentation in human spermatozoa

The aim of our work was to define and better understand apoptosis in the spermatozoa of normal subjects, infertile patients and patients affected by specific tumoral diseases employing the method of the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling and confirming the results by electron microscopy. We studied 23 healthy, normozoospermic subjects (group A), 29 oligoasthenoteratozoospermic patients, affected by various andrological pathologies (group B), 28 patients with Hodgkin's disease (C1) and 30 patients with testicular cancer (C2). Our data demonstrate that the percentage of apoptosis in normozoospermic subjects (group A) is significantly lower than in all the other groups (B, C1, C2) (P < 0.001). This confirms that high DNA fragmentation is one of the characteristics of spermatogenetic failure. The induction of apoptosis, which can also be a basic response to neoplastic disease, can even act right up to the mature male gamete. Our results suggest that apoptosis could be the final result of various pathologies and of a deregulation of spermatogenesis control systems.

Fatty acid composition of spermatozoa and immature germ cells

A great deal of attention has recently been given to the essential role of polyunsaturated fatty acids (PUFA) of sperm membranes. We studied the fatty acid composition of the immature germ cells (IGC) and of the sperm populations separated by Percoll gradient in the ejaculate of normozoospermic patients. Fatty acid pattern was analysed by combined gas chromatography-mass spectrometry on a capillary column. In IGC, differences were found compared with mature spermatozoa, with a higher percentage of saturated fatty acids and of essential fatty acids. On the contrary, the long-chain PUFA were significantly lower in IGC. The highest concentration of n3 PUFA docohexaenoic acid (DHA) was detected in the spermatozoa deriving from 70-100% Percoll layers and a direct linear correlation was found between the increase of DHA and increased percentage of Percoll gradient. An inverse relationship between the percentage of atypical sperm forms in each layer and the percentage of DHA was also observed. This study demonstrates that the human germ cell line can elongate and desaturate essential fatty acids and that the percentage of long-chain PUFA is correlated with the normal morphology of sperm cells.