The Penile Sensitivity Ratio: A Novel Application of Biothesiometry to Assess Changes in Penile Sensitivity

Differences between the glans and shaft of the penis: a review

INTRODUCTION

The penis serves as a vital receptor in men, playing a significant role in sexual intercourse. While there are discernible disparities between the glans penis and the penile shaft, a comprehensive and detailed analysis of these distinctions is currently lacking.

OBJECTIVES

This study aimed to review the existing literature on the variances between the glans penis and the penile shaft, providing a systematic examination of their anatomical and histological dissimilarities.

METHODS

Our investigation encompassed a thorough search of the published literature, including original articles, reviews, letters to the editor, and case reports focused on the penis. We conducted a comprehensive review of the anatomical and histological dissimilarities between the glans penis and the penile shaft.

RESULTS

The following key differences were identified. First, regarding innervation, the glans penis and the penile shaft possess distinct neural pathways. The glans penis exhibits a 3-dimensional structure, while the penile shaft exhibits a 2-dimensional distribution. Notably, the nerves of the penile shaft extend penetrating branches into the corpus cavernosum. Furthermore, there are variations in nerve-specific antibodies between the 2 regions. Second, regarding composition, the glans penis and the penile shaft consist of dissimilar cavernous bodies. The glans penis contains unique epithelial structures and receptors, setting it apart from the penile shaft. Third, regarding the veins, there are disparities in the venous systems of the glans penis and the penile shaft. Fourth, regarding biothesiometry, variances in biothesiometry research have been observed between the 2 regions.

CONCLUSION

There are differences between the glans and the shaft. To further advance our understanding, future research should delve deeper into the discrepancies between the glans penis and the penile shaft. Additionally, a more specialized subdivision of the glans penis and the penile shaft would facilitate more precise and tailored treatments.

Heart Failure and Erectile Dysfunction: a Review of the Current Evidence and Clinical Implications

PURPOSE OF REVIEW

Heart failure (HF) and erectile dysfunction (ED) are two common conditions that affect millions of men worldwide and impair their quality of life. ED is a frequent complication of HF, as well as a possible predictor of cardiovascular events and mortality. ED deserves more attention from clinicians and researchers.

RECENT FINDINGS

The pathophysiology of ED in HF involves multiple factors, such as endothelial dysfunction, reduced cardiac output, neurohormonal activation, autonomic imbalance, oxidative stress, inflammation, and drug side effects. The diagnosis of ED in HF patients should be based on validated questionnaires or objective tests, as part of the routine cardiovascular risk assessment. The therapeutic management of ED in HF patients should be individualized and multidisciplinary, considering the patient's preferences, expectations, comorbidities, and potential drug interactions. The first-line pharmacological treatment for ED in HF patients with mild to moderate symptoms (NYHA class I-II) is phosphodiesterase type 5 inhibitors (PDE5Is), which improve both sexual function and cardiopulmonary parameters. PDE5Is are contraindicated in patients who use nitrates or nitric oxide donors for angina relief, and these patients should be advised to avoid sexual activity or to use alternative treatments for ED. Non-pharmacological treatments for ED, such as psychotherapy or couples therapy, should also be considered if there are significant psychosocial factors affecting the patient's sexual function or relationship. This review aims to summarize the most recent evidence regarding the prevalence of ED, the pathophysiology of this condition with an exhaustive analysis of factors involved in ED development in HF patients, a thorough discussion on diagnosis and management of ED in HF patients, providing practical recommendations for clinicians.

The self-assessment of genital anatomy, sexual function, and genital sensation (SAGASF-M) questionnaire in a Belgian Dutch-speaking male population: A validating study

INTRODUCTION

Penile and genital surgery for congenital or acquired conditions is daily practice in reconstructive urology. These procedures, which carry the risk of disrupting nerves and blood vessels, may impair the genital sensation, and affect the capacity for sexual pleasure. Self-reported tools are needed to systematically assess the male genitalia before and after reconstructive surgeries in terms of genital sensation and sexual experience.

AIM

This study validated the Dutch translation of the "self-assessment of genital anatomy and sexual functioning in male" (SAGASF-M) questionnaire and investigated the perceptions of healthy men regarding their genital anatomy and sensory function.

METHODS

Eight hundred and eight sexually active men with a median age of 39 years (18-79 years) and no history of genital procedures other than circumcision filled out an online version of the questionnaire. Twenty-four participants were randomly recruited to confirm the responses of the "self-assessment of genital anatomy and sexual functioning in male" questionnaire by a clinical evaluation.

MAIN OUTCOME MEASURES

The "self-assessment of genital anatomy and sexual functioning in male" questionnaire comprises of multiple-choice questions and clarifying illustrations asking men to rate their genital appearance, overall sexual sensitivity, and pain perception as well as the intensity and the effort to reach orgasm. Prespecified regions of the glans, penile shaft, scrotum, perineum, and anus are evaluated through this questionnaire.

RESULTS

Only slight variability in anatomical ratings was observed. Overall discrimination between different genital areas in terms of genital sensation was significant. The bottom of the glans or frenular area was rated the highest contributor to "sexual pleasure," followed by the other regions of the glans and shaft. The same distribution was found for "orgasm intensity" and "orgasm effort." The anal region was generally rated the lowest. "Discomfort/pain" was rated lower than any of the other sensory function indicators and the top of the glans and anal region were rated most likely to perceive this unpleasant sensation. Participants reported significantly more sexual pleasure and intense orgasms when stimulated by a sexual partner than self-stimulation. Homosexual and bisexual men reported a higher contribution of the perineal and anal regions in sexual pleasure and orgasm. No significant difference between circumcised and uncircumcised individuals regarding overall genital sensation could be found.

CONCLUSION

The Dutch translation of the SAGASF-M questionnaire is a valuable and reliable tool for self-assessment of genital anatomy and sensation, providing a site-specific attribution of a patient's perceived sexual function. Further prospective research with this questionnaire could aid in the patient-centered improvement of genital surgery.

A Review on Penile Doppler and Ultrasonography for Erectile Dysfunction

PURPOSE OF REVIEW

Herein, we seek to review the clinical applications of penile duplex Doppler ultrasound (PDDU) in sexual medicine practices and discuss the indications, protocols, advantages, and limitations of this diagnostic modality. Other more outdated diagnostic tests, such as cavernosometry, are briefly discussed to provide the reader a background of understanding on the evolution of diagnostic testing within the realm of sexual medicine.

RECENT FINDINGS

PDDU has become a key diagnostic tool in the clinical evaluation of both erectile dysfunction (ED) and Peyronie's disease (PD). With the assistance of intracavernosal injections such as alprostadil, clinicians can utilize ultrasound technology to produce a detailed description of the hemodynamics of the patient's erection cycle. This information plays a pivotal role in establishing an accurate diagnosis and creating a sensible management plan for the patient. This review aims to provide a better understanding regarding the technique and interpretation of PDDU as it pertains to male sexual function.

Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review

BACKGROUND

Congenital penile curvature (CPC) is corrected surgically by various corporoplasty or tunica albuginea plication techniques, but the optimal surgical approach is not well-defined.

AIM

To provide a comprehensive evaluation of the published literature pertaining to outcomes with penile plication and corporoplasty techniques for surgical management of CPC. To determine if plication or corporoplasty offers superior outcomes in surgical correction of CPC.

METHODS

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist. The following databases were queried from inception to March 18, 2020 to search for studies describing surgical treatment of CPC: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus.

OUTCOMES

Objective and subjective postoperative outcomes including penile straightening, shortening, penile sensory changes, and reoperation rates for both corporoplasty and tunica albuginea plication were summarized.

RESULTS

Fifty-five articles comprising 2,956 patients with CPC who underwent a plication procedure (n = 1,375) or corporoplasty (n = 1,580) were included. The definition of "treatment success" varied widely and most often involved subjective patient reporting (22 studies; 40%) or objective assessment (15 studies; 27%). We considered curvature correction to be satisfactory if there was self-reported patient satisfaction or residual curvature after correction of <20˚. Reported rates of successful straightening ranged from 75 to 100% and 73 to 100% for plication and corporoplasty, respectively. A comprehensive and accurate assessment of surgical outcomes for CPC correction, such as satisfactory penile straightening, reoperation rates, glans sensory changes, and other complications was limited by significant inter-study heterogeneity with respect to the reporting of treatment outcomes.

CLINICAL IMPLICATIONS

While both plication and corporoplasty appear to be safe and effective options in the treatment of CPC, definitive conclusions cannot be drawn with respect to treatment superiority due to low-quality study design, methodology flaws, and significant heterogeneity in reporting.

STRENGTH & LIMITATIONS

This report represents the most comprehensive review of CPC surgical management. However, there is a significant lack of standardization in the reporting of treatment outcomes for CPC, thereby limiting the reliability of the published data summarization encompassed by our review.

CONCLUSION

Both plication and corporoplasty demonstrate high success rates and relatively low complication rates in the treatment of CPC, albeit with low-level evidence available in most research publications. Robust comparison of the surgical techniques used to correct CPC is limited by significant variation in reporting methods used in the literature. C. J. Britton, F. A. Jefferson, B. L. Findlay, et al. Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review. J Sex Med 2022;19:364-376.

Complete study for erectile dysfunction (CompED) improving diagnosis and treatment decision-making

Erectile dysfunction is a condition associated with increasing age. Patient evaluation and management should follow a comprehensive, stepwise approach. The aim of this article was to report our experience with the complete study for erectile dysfunction, including intracavernous injection rigidity test, biothesiometry and colour duplex Doppler ultrasound. Data were collected and analysed prospectively. The primary end point was to determine whether treatment decision-making was eased by the CompED test. Secondary end points were to establish which clinical variables prior to the study could impact the results of the CompED test, to finally improve patient selection for the study. 187 patients were recruited, 31.2% of the patients had an axial rigidity below 50%, 28.5% had a peak systolic velocity <25 cm/s, 13.2% had an end-diastolic velocity >5cm/s and 27.5% had an abnormal biothesiometry. The factors that best predicted an abnormal result in any of the tests were age >70 years, IIEF domain A < 14 points, and previous radical prostatectomy or radiotherapy. The CompED test stands as a new alternative for the evaluation of patients with erectile dysfunction, being less time consuming, aiding in a more accurate determination of the aetiology and guiding treatment decision-making.

Persistent Genital Arousal Disorder (PGAD): A Clinical Review and Case Series in Support of Multidisciplinary Management

INTRODUCTION

Persistent genital arousal disorder (PGAD) is an uncommon condition resulting in intrusive, unwanted and distressing symptoms of genital arousal. Presentation can vary and most cases do not have an immediately identifiable etiology.

OBJECTIVES

To present evaluation and treatment recommendations for PGAD from a multidisciplinary perspective and provide case examples.

METHODS

A focused review of the literature on diagnosis, workup, and treatment of PGAD was completed. A case series of 3 varying presentations of PGAD is offered.

RESULTS

PGAD results in high levels of patient distress and is best managed with a multidisciplinary treatment approach. Identification and management of co-occurring symptoms or disease states is imperative, particularly psychologic and psychiatric comorbidities. With appropriate intervention, patients may achieve improvement of their physical symptoms and a decrease in associated psychological distress.

CONCLUSION

PGAD is an uncommon and highly distressing condition that requires thoughtful evaluation for appropriate diagnosis and treatment. Multidisciplinary treatment approaches provide the best opportunity to address the needs of patients and optimizing treatment response. Pease ER, Ziegelmann M, Vencill JA, et al. Persistent Genital Arousal Disorder (PGAD): A Clinical Review and Case Series in Support of Multidisciplinary Management. Sex Med Rev 2021;XX:XXX-XXX.

Application of micronised acellular dermal matrix for primary premature ejaculation: A preliminary study

This study aimed to explore the efficacy of injection of micronised acellular dermal matrix (MADM) particles for treating primary premature ejaculation. This study was a prospective single-arm clinical trial. Thirty patients who met the surgical indications were enrolled. MADM particles, mixed in platelet-rich plasma, were injected into Buck's fascia to spread over the dorsal penile nerve, suppress the influx of nerve impulses and, thus, reduce penis sensitivity. We evaluated the changes according to intravaginal ejaculation latency time using a stopwatch and a premature ejaculation diagnostic tool. Meanwhile, we also recorded sexual partner satisfaction and adverse events. All patients recovered well after surgery with no complications such as infections or allergies. The mean intravaginal ejaculation latency time before surgery was 0.72 ± 0.28 min, compared with 2.41 ± 0.54 min, 2.64 ± 0.41 min, 2.79 ± 0.25 min and 2.89 ± 0.35 min at, respectively, 4, 8, 16 and 20 weeks after surgery. The premature ejaculation diagnostic values and sexual partner satisfaction had significantly improved after treatment. Injection of MADM particles is an effective, safe and simple method for treating premature ejaculation.

A Population-Based Study of Peyronie's Disease in Turkey: Prevalence and Related Comorbidities

INTRODUCTION

Peyronie's disease (PD) prevalence varies between 0.39% and 20% and studies on PD prevalence are limited.

AIM

This study aims to determine the prevalence of PD in males aged ≥30 years in Turkey and to evaluate etiological factors associated with it.

METHODS

The study was conducted in 12 regions of Turkey according to the Eurostat Nomenclature of Territorial Units for Statistics 1 classification and included 1,208 patients. Survey questionnaires including questions about demographic features and basic health status as well as about diagnosis and etiology of PD were put forth to the volunteers who agreed to participate in the study. Diagnosis of probable PD was established by evaluating the questionnaires. Patients with a diagnosis of congenital penile curvature were excluded from the group with PD. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used.

MAIN OUTCOME MEASURE

The primary outcome analyzed in this article was the prevalence rate of PD in Turkey and the associated comorbidities.

RESULTS

The prevalence of PD was determined as 5.3%. The rates of participants with PD were found to be the highest in the 50-59 years group (27%) and in the North-East Region (20%). Compared with participants without PD, participants with PD were older (median: 52 interquartile range [41-64] vs 45 [37-55]; P < .001) and the rates of smokers (73% vs 60.9%; P = .036) and those having diabetes mellitus (17.5% vs 9.2%; P = .045), hypertension (14.3% vs 6.9%; P = .041), and heart failure were higher (7.9% vs 2.5%; P = .027). Male with PD symptoms preferred their partners on top during sexual intercourse (15.2% vs 34.1%; P < .001). This is the first study to evaluate premature ejaculation prevalence and related comorbidities with face-to-face interviews.

CONCLUSION

The prevalence of PD was 5.3% in Turkey. Besides advanced age, smoking, position of sexual intercourse, and presence of comorbidities especially diabetes mellitus, hypertension, and heart failure were the factors associated with PD prevalence. Kadioglu A, Dincer M, Salabas E, et al. A Population-Based Study of Peyronie's Disease in Turkey: Prevalence and Related Comorbidities. Sex Med 2020;8:679-685.

Amphetamine/Dextroamphetamine Salts for Delayed Orgasm and Anorgasmia in Men: A Pilot Study

OBJECTIVE

To describe our experience with amphetamine/dextroamphetamine salts (AMP) as a treatment for delayed orgasm/anorgasmia (DO/AO).

METHODS

We identified patients with DO/AO from September 2017 to September 2019. Baseline characteristics and patient-reported orgasmic latency time (OLT) were recorded. After extensive screening, patients were treated with AMP. Validated questionnaires were administered including International Index of Erectile Function, quantitative Androgen Deficiency in the Aging Male and Adult ADHD Self-Report Scale. OLT change, adverse effects, and patient satisfaction were assessed. Baseline characteristics were compared using chi-squared test. OLT changes were compared with one-way ANOVA. Multivariable logistic regression was performed to identify predictors of treatment success. P < 0.05 was statistically significant.

RESULTS

Seventeen men received AMP - 6 of 17 (35.3%) for AO and 11 of 17 (64.7%) for DO, with median follow-up 1.0 year (interquartile range [IQR] 1.0 year). Amongst responders, AMP improved subjective experience of sex in 8 of 17 (47.1%) patients (2/6 with AO). Of those, 6 of 17 (35.3%; 1/6 with AO) experienced reduced OLT or increased frequency of orgasm. Non-responders were older than responders, with median age 69.5 (IQR 4.3) vs 61.0 years (IQR 12.3; P = 0.024). There were no other significant differences in baseline characteristics among responders. Of note, 6 of 8 (75%) responders and 8 of 9 (88.9%) non-responders failed other treatment modalities prior to AMP. Among responders with DO and improved OLT, mean OLT decreased by 72.3% (40.7 to 11.1 minutes, P = 0.049) during intercourse. Minimal side effects were noted including insomnia and jitters, each in one patient respectively.

CONCLUSION

AMP as a treatment for AO/DO merits further investigation. Measurable improvements in OLT or frequency of orgasm occurred in more than a third of patients. Larger prospective multicenter studies with strict inclusion and exclusion criteria are warranted.

Peyronie's disease: Contemporary evaluation and management

Peyronie's disease is a common yet poorly understood condition characterized by penile pain, curvature, sexual dysfunction and psychological bother. Peyronie's disease represents a penile wound healing disorder, and is thought to arise from exuberant scarring in response to penile trauma in genetically predisposed men. In the absence of active treatment, the majority of men experience stable or worsening symptoms, with few reporting spontaneous resolution in penile curvature or other deformity. In contrast, penile pain improves or resolves in the majority of men. Treatment options vary based on symptom severity and stability. Several oral therapies are commonly prescribed, although to date there are no strong data to support any oral agents as monotherapy for Peyronie's disease. Other options including penile traction therapy and intralesional injections result in modest improvements for many patients, particularly when used early after symptom onset. Penile straightening through approaches, such as penile plication and plaque incision or partial excision and grafting, represent the most rapid and reliable approach to correct penile curvature once the symptoms have stabilized. Side-effects vary based on the type of surgery carried out, and include penile shortening, sensation changes and erectile dysfunction in the minority of men. In patients with drug refractory erectile dysfunction and Peyronie's disease, placement of a penile prosthesis will address both issues, and is associated with high levels of patient satisfaction. The current review provides a practical approach to the modern evaluation and management of patients presenting with Peyronie's disease.

Evaluation of the Mistakes in Self-Diagnosis of Sexual Dysfunctions in 11,000 Male Outpatients: A Real-Life Study in An Andrology Clinic

Purpose: The aim of this study was to compare the initial request for sexual consultation with the final diagnosis and to evaluate the limits of the active andrological anamnesis concerning unclassified male sexual dysfunction. Methods: In this 12-year observational retrospective study, we collected data from patients referring to an andrological outpatient clinic, evaluating the requests, perceptions, needs, and self-diagnosis at their first visit and comparing them with the final diagnosis reached after a complete clinical, laboratory, and instrumental investigation. Results: A total of 11,200 patients were evaluated. The main request of andrological consultation was erectile dysfunction (ED) (52%), followed by premature ejaculation (PE) (28%), and low sexual desire (11.5%). Among the patients seeking help for ED, about 30% were ultimately found to have a different type of dysfunction and 24% were diagnosed with an “unmet need”, which included issues not present in the current nosography nonetheless affecting sexual and relational life. Among the patients referring for PE, the final diagnosis was lifelong PE for the large majority of them, regardless of whether initially they thought to have an acquired form. Several of those who sought consultation for acquired PE were frequently found to be able to compensate for lifelong PE by a subsequent coitus or were able to induce orgasm in the partner with different modalities. Among the patients referring for low sexual desire, only 57.5% were confirmed to have it; 23% had ED and 18.5% showed a raised threshold of penile sensitivity. Conclusions: The results of this study show that the reason for consultation is frequently misleading and raise the relevance of being aware of the so-called “unmet needs” and to discuss with the patient and the couple to explore the sexual history behind the self-diagnosis. These findings also suggest the need to expand the current taxonomy of male sexual dysfunctions.