Tooth-brushing epilepsy with ictal orgasms

We report a 41-year-old woman with complex reflex epilepsy in which seizures were induced exclusively by the act of tooth brushing. All the attacks occurred with a specific sensation of sexual arousal and orgasm-like euphoria that were followed by a period of impairment of consciousness. Ictal EEG demonstrated two events of epileptic seizure that were provoked after tooth brushing for 38 and 14 seconds, respectively. The interictal EEG showed epileptiform discharges over the right anterior temporal region and interictal single photon emission computed tomography (SPECT) scan showed relative hypoperfusion in the uncus of right temporal lobe. Brain magnetic resonance imaging (MRI) revealed right hippocampal atrophy. We suggest that tooth-brushing epilepsy, especially with sexual ictal manifestations, may provide insight into the cerebral pathophysiology at the right temporolimbic structure.

Complex demodulation of cardiac interbeat intervals: increased cardiac sympathovagal interaction during human sexual activity

In this study, we analyzed heart rate variability during sexual activity using complex demodulation, which is a useful technique to study continuous changes in different frequency bands over short periods of time. Complex demodulation has the advantage of having higher time resolution compared to spectral analysis. We quantified the low frequency (LF: 0.04-0.15 Hz) and high frequency (HF: 0.15-0.5 Hz) amplitudes, and the LF/HF ratio before, during, and after the occurrence of orgasm. LF power is dually mediated by cardiac sympathetic and parasympathetic systems while HF power is mainly influenced by cardiac vagal function. We found a significant increase of cardiac sympathovagal interaction (LF/HF ratios) during the phase of orgasm. These findings are discussed in light of normal sexual physiology and the effect of sex on cardiac autonomic function in patients with heart disease, such as myocardial infarction.

Effects of sexual arousal on lymphocyte subset circulation and cytokine production in man

OBJECTIVE

Sexual arousal and orgasm induce an increase in sympathetic activity as well as in catecholamine and prolactin plasma concentrations. However, the effects of sexual arousal and orgasm on immune functions in man are unknown. Thus, this study investigated the effects of masturbation-induced orgasm on lymphocyte circulation and cytokine production in healthy young males.

METHODS

In a crossover design, 11 volunteers completed an experimental condition in which they were asked to masturbate until orgasm and to participate in a control condition without sexual activity. Blood was drawn continuously for determination of endocrine parameters. In addition, leukocyte and lymphocyte subsets were analyzed via flow cytometry, and the production of lipopolysaccharide-induced interleukin 6 and tumor necrosis factor alpha was measured before and then 5 and 45 min after the orgasm.

RESULTS

The results confirmed transient increases in adrenaline and prolactin plasma concentrations. Sexual arousal and orgasm increased the absolute number of leukocytes, in particular natural killer cells (CD3-CD16+CD56+), in the peripheral blood. In contrast, T cell (CD3+) and B cell (CD3-CD20+) subpopulations as well as the production of interleukin 6 and tumor necrosins factor alpha remained unaffected by sexual activity.

CONCLUSION

These findings demonstrate that components of the innate immune system are activated by sexual arousal and orgasm.

Update on central function relevant to sex: remodeling the basis of drug treatments for sex and the brain

Sexual function draws on a complex network of peripheral and central neural pathways. The standard focus on erectile difficulties and peripheral therapies has been highly successful clinically but there are many unresolved issues in men and newly discussed issues in women that will likely benefit from improved understanding of the central nervous system and sexual function. The spectrum of future therapies, based on evolving central neurophysiological understanding, will include the management of problems related to orgasm, ejaculation, desire, motivation, anxiety, and pleasure. This new range of therapies will employ old and new neurochemicals and pathways singly or in combination. The capability of hormones to modulate many of the sexual pathways will also contribute to the rise of multiagent therapy. The expanded understanding, in combination with enhanced imaging technologies, will renew the role of diagnosis and cause-specific treatment.

Effects of acute prolactin manipulation on sexual drive and function in males

The neuroendocrine response to sexual activity in humans is characterized by a pronounced orgasm-dependent increase of plasma levels of prolactin. In contrast to the well-known inhibitory effects of chronic hyperprolactinemia on sexual drive and function, the impact of acute prolactin alterations on human sexual physiology is unknown. Therefore, this study was designed to investigate the effects of acute manipulation of plasma prolactin on sexual behavior. Ten healthy males participated in a single-blind, placebo-controlled, balanced cross-over design. Prolactin levels were pharmacologically increased to high levels (protirelin, 50 micro g i.v.) or reduced to low physiological concentrations (cabergoline, 0.5 mg p.o.). Sexual arousal and orgasm were then induced by an erotic film and masturbation. In addition to continuous neuroendocrine and cardiovascular recordings, the quality and intensity of the acute sexual drive, arousal, orgasm and refractory period were assessed by extensive psychometric measures. Administration of cabergoline decreased prolactin levels and significantly enhanced all parameters of sexual drive (P<0.05), function (P<0.01) and positive perception of the refractory period (P<0.01). Administration of protirelin increased prolactin concentrations and produced small, but not significant reductions of sexual parameters. The sexual effects observed from cabergoline were completely abrogated by coadministration of protirelin. Although different pharmacological sites of action of prolactin-altering drugs have to be considered, these data demonstrate that acute changes in prolactin plasma levels may be one factor modulating sexual drive and function. Therefore, besides a neuroendocrine reproductive reflex, a post-orgasmic prolactin increase may represent one factor modulating central nervous system centers controlling sexual drive and behavior. These findings may offer a new pharmacological approach for the treatment of sexual disorders.

Acute neuroendocrine response to sexual stimulation in sexual offenders

BACKGROUND

Several pharmacotherapeutic approaches have confirmed the influence of neuroendocrine parameters on sexual desire, function, and fantasies in men; however, the relevance of acute neuroendocrine changes in mediating heightened sexual drive remains unknown. We recently demonstrated that plasma prolactin substantially increases following orgasm in healthy men, suggesting a feedback mechanism for peripheral prolactin in the control of acute sexual arousal. Because prolactin appears to play a regulatory role in acute sexual drive, we initiated this study to see whether sexual offenders with a high sexual drive have a different neuroendocrine response to sexual arousal. This study compares the prolactin response to orgasm of sexual offenders with high sexual drive and that of healthy subjects with average sexual drive.

METHODS

From a subject pool of 150 inpatients held because of sexual crimes, we recruited 10 volunteers, based on their high sexual drive according to an intensive, semistructured clinical interview. We defined sexual drive by a short refractory period and strong sexualization, or a high frequency of sexual stimulation. We analyzed the acute psychoneuroendocrine response to sexual arousal and orgasm continuously before, during, and after masturbation-induced orgasm in patients and control subjects.

RESULTS

Sexual offenders demonstrated higher sexual desire (P < 0.001) and function (P < 0.001) and a more positively perceived refractory period (P < 0.05). Both groups displayed a prolonged, significant increase in prolactin plasma levels after orgasm (P < 0.001). Sexual offenders did not differ from control subjects in neuroendocrine response to sexual arousal and orgasm.

CONCLUSIONS

These data demonstrate that sexual offenders with a high sexual drive do not differ from control subjects in the postorgasmic neuroendocrine response, particularly in prolactin release. This study confirms that factors other than peripheral hormones influence deviant sexual behaviour.

Sexual dysfunction in men undergoing infertility evaluation: a cohort observational study

OBJECTIVE

To study psychosexual problems in men undergoing infertility evaluation.

DESIGN

A cohort observational study.

SETTING

Male infertility diagnostic center.

PATIENT(S)

Four hundred twelve men undergoing infertility evaluation between 1999 and 2001.

INTERVENTION(S)

Baseline and follow-up data on sexual functions. Semen analysis for samples collected by masturbation. A second analysis was requested in 2 weeks upon finding an abnormality of semen parameters. Penile vibratory stimulation to help men who failed to collect semen on their second or subsequent appointments.

MAIN OUTCOME MEASURE(S)

Sexual functions (erection and orgasm) during the time of infertility evaluation.

RESULT(S)

Seven of 412 men were excluded from the analysis due to a past history of sexual dysfunction. Of the remaining 405 men, 46 (11%) failed to collect semen by masturbation for a second semen analysis after repeated (2-4 times) attempts at 2- to 3-day intervals. Nine of these men (20%) were able to collect semen using vibratory stimulation. All 46 men experienced problems with erection or orgasm and had severe anxiety during attempts to masturbate and during sexual contact with their partners.

CONCLUSION(S)

Our study indicates that some men may experience sexual dysfunction of a psychogenic nature in response to the diagnosis of infertility.

Specificity of the neuroendocrine response to orgasm during sexual arousal in men

We have demonstrated that sexual activity produces transient sympathoadrenal activation and a pronounced, long-lasting increase in prolactin in men and women. However, by analyzing endocrine alterations at 10-min intervals, a precise assignment of these changes to the pre-, peri- and postorgasmic periods was not possible. Thus, the current study aimed to accurately differentiate the endocrine response to sexual arousal and orgasm in men using an automatic blood collection technique with 2-min sampling intervals. Blood was drawn continuously before, during and after orgasm over a total period of 40 min in 10 healthy subjects and were compared with samples obtained under a control condition. Sexual activity induced transient increases of plasma epinephrine and norepinephrine levels during orgasm with a rapid decline thereafter. In contrast, prolactin levels increased immediately after orgasm and remained elevated throughout the experiment. Although oxytocin was acutely increased after orgasm, these changes were not consistent and did not reach statistical significance. Vasopressin, LH, FSH and testosterone plasma concentrations remained unaltered during sexual arousal and orgasm. These data confirm that prolactin is secreted after orgasm and, compared with oxytocin, seems to represent a more reliable and sustained marker for orgasm in man. The results further reinforce a role for prolactin either as a neuroendocrine reproductive reflex or as a feedback mechanism modulating dopaminergic systems in the central nervous system that are responsible for appetitive behavior.

A journey through two lumens!

This account describes studies from the Institute of Medical Physiology in the University of Copenhagen, starting in the mid 1970's, which included some of the earliest European laboratory investigations on human female genital function. The measurements involved vaginal pH, pO2, blood flow, motility, fluid and its ionic concentrations, amino-acid concentrations and electrical activity (transvaginal potential difference) usually in both the basal and sexual aroused states. The blood flow monitoring pioneered the use of the heated oxygen electrode. Other studies examined the effects of arousal to orgasm on cervical secretion, on the heart rate as an objective indicator of orgasmic excitement and investigated the actions of TRH and the cholinergic antagonist atropine on a number of vaginal parameters. The work was part of the scientific watershed that divided the previous descriptive era of human genital mechanisms from the now prevalent quantitative assessments.

Chronic illness and sexual functioning

Chronic illness and its treatments can have a negative impact on sexual functioning. The mechanism of interference may be neurologic, vascular, endocrinologic, musculoskeletal, or psychologic. Patients may mistakenly perceive a medical prohibition to the resumption of sexual activity, or they may need advice on changes in sexual activity to allow satisfactory sexual functioning. Family physicians must be proactive in diagnosing and managing the alterations in sexual functioning that can occur with chronic illness. Patient education and reassurance are essential. Before sexual activity is resumed, patients with cardiovascular disease should be stratified according to risk. Patients with musculoskeletal disease should be educated about positional changes that may improve comfort during sexual activity. Psychosocial concerns should be addressed in patients with human immunodeficiency virus infection or acquired immunodeficiency syndrome. In patients with cancer, it is important to discuss sexual problems that may arise because of negative body image and the effects of chemotherapy. Patients who have disabilities can benefit from the use of muscle relaxants, technical adaptations, and expansion of their sexual repertoire.

The effect of hysterectomy on sexual functioning

The effect of hysterectomy on sexual function is an issue of debate. There are reasons to believe that removal of the uterus can have adverse effects on female sexual functioning by disrupting the anatomical relations in the pelvis. In this article, we review the literature on the impact of hysterectomy (without oophorectomy and for benign conditions) on the sexual functioning of premenopausal women. There is evidence that women for whom there is a clinical indication for hysterectomy are often experiencing a decreased quality of life. After successful treatment of dysfunctional uterine bleeding, either by hysterectomy or uterus-saving alternatives, the majority of women report experiencing improved sexual functioning. Nonetheless, the research on the effect of hysterectomy on female sexual functioning is not conclusive. Prehysterectomy sexual functioning and psychosocial state are significant predictors for posthysterectomy sexual dysfunction and depression. A minority of women report developing sexual dysfunctions as a result of hysterectomy. The nature and extent of these dysfunctions have not been adequately investigated. Many investigations in this area are flawed by methodological imperfections. For example, qualitative changes in sexual functioning and changes in the physiology of sexual function often were not adequately addressed. In the future, researchers should include both objective measures of physiological functioning and use standardized and validated self-report questionnaires. A critical attitude towards the indications of hysterectomy remains mandatory.

Concordance between women's physiological and subjective sexual arousal is associated with consistency of orgasm during intercourse but not other sexual behavior

Many studies have found a discordance between women's genital (vaginal pulse amplitude) and subjective sexual arousal responses to erotica. We hypothesized that the association between the physiological and subjective domains would be greater for women with greater orgasmic consistency during penile-vaginal intercourse but not for orgasm consistency during other sexual behaviors. We confirmed this specific hypothesis in a sample (N = 38) of postmenopausal women. In addition, we discovered that the correlation between the domains was unrelated to social desirability responding, that orgasm consistency was not less for intercourse than for other sexual activity, and that orgasm consistency during intercourse was uncorrelated with orgasm consistency during masturbation. We discuss the results in terms of the unique nature of penile-vaginal intercourse, our study's implications for sex therapy, and orgasm consistency during intercourse being an operational measure of functional vaginal sensitivity and sexual pleasure integration and organization.

[Sexual function in patients with spinal cord injuries]

A spinal cord lesion (SCL) changes most functions below the level of lesion, including sexual function. Most women had sexual intercourse after the lesion, but describe practical problems. Many of them are capable of achieving organism, and are normally fertile. During pregnancy there is an increased risk of urinary tract infection. Delivery can take place vaginally. In the case of lack of progression or severe autonomic dysreflexia, cesarean section may be necessary. For erectile dysfunction in men with SCL, oral sildenafil may be used, alternatively intracavernous injection with prostaglandin E1. To obtain ejaculation penile vibratory stimulation (PVS) is used, and if this fails then electroejaculation. Impaired sperm quality with low motility is observed. Vaginal insemination at home with sperm obtained by PVS is possible. The fertility potential may be enhanced with assisted reproduction techniques, like intrauterine insemination and in vitro fertilisation.

The physiology of sexual arousal in the human female: a recreational and procreational synthesis

Changes induced by human sexual arousal serve reproductive and recreational functions. The current sexual phase model (desire, excitation, orgasm, and resolution) conveys little about this duarchy. Lack of spontaneous sexual desire in a third of nonclinic females indicates that the D phase needs splitting into D1 (the spontaneous [endogenous] activation of desire) and D2 (desire activated by sexual excitation at and during the E phase). Attempts to link D1 with reproduction by studies monitoring it over the menstrual cycle revealed a D1 peak just before or at ovulation, but its reliability is criticized because of the poor identification of the time of ovulation. Sexual arousal initiates enhanced genital blood flow, leading to the formation of a neurogenic transudate, lubricating the vagina, partly buffering its acidity, and increasing its oxygen tension all features that enhance spermatozoal function and survival. Orgasm occurs with vaginal and uterine contractions. The latter have been misinterpreted as powering rapid sperm transport to facilitate fertilization, but such fast transport would lead to the tubal deposition of noncapacitated, incompetent spermatozoa. Vagino-cervico elevation, however, delays rapid sperm transport and allows the initiation of decoagulation and sperm capacitation before the elevation resolves. The fastest transport of spermatozoa from cervix to the fallopian tubes occurs in the nonaroused female by uterine/subendometrial smooth muscle peristalsis. There is some evidence that even this may be reduced for a time after coitus, adding to the transport delay. If a number of the changes induced by sexual arousal are inadequately expressed, sexual as well as reproductive dysfunctions could arise.

Sexual function and behavior in social phobia

BACKGROUND

Social phobia is a type of performance and interpersonal anxiety disorder and as such may be associated with sexual dysfunction and avoidance. The aim of the present study was to evaluate sexual function and behavior in patients with social phobia compared with mentally healthy subjects.

METHOD

Eighty subjects participated in the study: 40 consecutive, drug-free outpatients with social phobia (DSM-IV) attending an anxiety disorders clinic between November 1997 and April 1999 and 40 mentally normal controls. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Liebowitz Social Anxiety Scale were used to quantitatively and qualitatively assess sexual function and behavior.

RESULTS

Men with social phobia reported mainly moderate impairment in arousal, orgasm, sexual enjoyment, and subjective satisfaction domains. Women with social phobia reported severe impairment in desire, arousal, sexual activity, and subjective satisfaction. In addition, compared with controls, men with social phobia reported significantly more frequent paid sex (p < .05), and women with social phobia reported a significant paucity of sexual partners (p < .05).

CONCLUSION

Patients with social phobia exhibit a wide range of sexual dysfunctions. Men have mainly performance problems, and women have a more pervasive disorder. Patients of both genders show difficulties in sexual interaction. It is important that clinicians be aware of this aspect of social phobia and initiate open discussions of sexual problems with patients.

Patient-reported sexual function after nerve-sparing radical retropubic prostatectomy

OBJECTIVE

Improved selection criteria have lead to an increasing number of nerve-sparing radical retropubic prostatectomies (RRP) in patients with clinically localised prostate cancer (PCA). Patient questionnaire based outcome analysis on post-operative erectile function after uni- or bilateral nerve-sparing RRP is described.

METHODS

Between January 1992 and March 1999, 366 patients (mean age 62.5 years) underwent uni- or bilateral nerve-sparing RRP at our institution. Indication for nerve-sparing procedure was based on the results of a multivariate classification and regression tree analysis (CART). For evaluation of post-operative patient-reported rates of sexual and erectile function non-validated and validated questionnaires (IIEF 5) were administered after a follow-up of 12 months. Data of five operation periods were analysed.

RESULTS

The unilateral procedure resulted in rates of 13-29% of erections sufficient for unassisted intercourse. Some degree of tumescence was reported by 37-73% of the remaining patients. Bilateral nerve-sparing procedures were almost exclusively performed in periods 3-5, only four patients of period 2 received the bilateral procedure. Here, rates of erections sufficient for intercourse were 25% (period 2), 61% (period 3), 50% (period 4), and 52% (period 5), respectively. Patients with grades 4 and 5 erections had IIEF scores of 19.2 and 20.2 and patients without rigidity or tumescence had scores of 5.7 and 7.0 after uni- and bilateral nerve-sparing procedure, respectively. Patients <60 years of age had better erections than those > or =60 (unilateral: 19% versus 13%, bilateral 45% versus 38%).

CONCLUSION

Compared to a unilateral nerve-sparing procedure, the bilateral nerve-sparing technique revealed much better results inasmuch as about 50% of the patients reported recovery of erections sufficient for sexual intercourse without use of sexual aids.

Sexual activity, orgasm and tampon use are associated with a decreased risk for endometriosis

OBJECTIVE

The purpose of the study was to determine if sexual behaviors, orgasm, tampon use, and douching during menstruation modify the risk of endometriosis.

METHODS

A case-control study was conducted. Subjects (n = 2,012) consisted of members of the Endometriosis Association and friends not affiliated with the organization who completed mailed surveys. Data were analyzed using chi(2), Fisher's exact test, t test, and regression analyses.

RESULTS

There was no difference between study groups concerning douching practices. However, cases were less likely than controls to report sometimes or often engaging in sexual behaviors during menstruation (p = 0.002, OR = 1.5), and sexual behaviors during menstruation that included orgasm (p = 0.001, OR = 1.5). Cases were also less likely than controls to report using only tampons (p < 0.0001, OR = 2.6).

CONCLUSION

Sexual activity, orgasm, and tampon use during menstruation may confer protection against endometriosis.