Opposed hemispheric specializations for human hypersexuality and orgasm?

Sexual dysfunction after surgery for primary sporadic cranial meningiomas: prevalence and risk factors

BACKGROUND

Although postoperative quality of life (QoL) has been studied in relation to a variety of aspects following meningioma resection, the impact of meningiomas on sexual life has not been investigated. The aim of this study is to determine the impact of cranial meningioma surgery on patients' postoperative sexual life.

METHODS

A standardized questionnaire, anonymous and based on the Arizona Sexual Experiences Scale (ASEX), was sent to 87 patients who had been selected for participation in the study based on the following criteria: a postoperative Karnofsky performance of ≥ 80 and below 60 years of age at diagnosis.

RESULTS

53 patients (53/87; 61%) responded to the survey. The study identified eleven patients (20.8%) who reported sexual dysfunction (SD) according to ASEX criteria. Six of these patients were women (55%) and five were men (45%). Univariable analysis revealed that SD was observed with greater frequency in patients with non-skull base tumors (p = 0.006) and in those with a left-hemispheric meningioma (p = 0.046). Multivariable analysis revealed that non-skull base tumor location is the only independent factor being associated with SD (OR = 5.71, 95% CI = 1.02-31.81, p = 0.047).

CONCLUSION

This first investigation of sexual functioning post-surgery for cranial meningiomas indicates that SD is a prevalent issue among non-skull base meningioma patients. Consequently, we recommend that pre- and postoperative sexual health should be further addressed in future QoL investigations of cranial meningioma patients.

Efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in anejaculation: A randomized controlled trial

BACKGROUND

Anejaculation represents significant psychological distress and sexual and reproductive challenges among male individuals and couples. Effective fertility management options are available to address the reproductive challenges associated with anejaculation. However, there is a lack of methods to reverse the condition itself.

OBJECTIVES

This study aims to assess the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in patients suffering from anejaculation.

METHODS

A total of 94 patients with anejaculation individuals were randomly assigned to receive high-frequency (HF) stimulation on the left dorsolateral prefrontal cortex (DLPFC), low-frequency (LF) stimulation on the right DLPFC, and sham stimulation for 4 weeks, with daily sessions of stimulation occurring on five consecutive weekdays each week.

RESULTS

After 4 weeks of rTMS treatment, the patients in both the HF and LF groups exhibited a similar reduction in their male sexual health questionnaire for ejaculatory dysfunction bother/satisfaction score, Hamilton Anxiety Scale score, Hamilton Depression Scale score, and Pittsburgh Sleep Quality Inventory score, which were statistically significant compared with sham treatment. Additionally, there were no significant differences observed in erectile function and cognitive function across the three groups. However, there were notable disparities in the cure rates between HF- and LF-group patients (16.1% vs. 54.8%, p = 0.001). Additionally, it is worth noting that only two HF group patients and one LF group patient experienced spontaneously resolving minor adverse effects during the treatment process. At the 8-week follow-up, among patients who initially responded to the treatment, only one from the HF group experienced a relapse.

DISCUSSION AND CONCLUSION

The findings of this study demonstrate that rTMS represents a secure and efficacious remedy for anejaculation patients.

Topological differences of striato-thalamo-cortical circuit in functional brain network between premature ejaculation patients with and without depression

INTRODUCTION

Premature ejaculation (PE), a common male sexual dysfunction, often accompanies by abnormal psychological factors, such as depression. Recent neuroimaging studies have revealed structural and functional brain abnormalities in PE patients. However, there is limited neurological evidence supporting the comorbidity of PE and depression. This study aimed to explore the topological changes of the functional brain networks of PE patients with depression.

METHODS

Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired from 60 PE patients (30 with depression and 30 without depression) and 29 healthy controls (HCs). Functional brain networks were constructed for all participants based on rs-fMRI data. The nodal parameters including nodal centrality and efficiency were calculated by the method of graph theory analysis and then compared between groups. In addition, the results were corrected for multiple comparisons by family-wise error (FWE) (p < .05).

RESULTS

PE patients with depression had increased degree centrality and global efficiency in the right pallidum, as well as increased degree centrality in the right thalamus when compared with HCs. PE patients without depression showed increased degree centrality in the right pallidum and thalamus, as well as increased global efficiency in the right precuneus, pallidum, and thalamus when compared with HCs. PE patients with depression demonstrated decreased degree centrality in the right pallidum and thalamus, as well as decreased global efficiency in the right precuneus, pallidum, and thalamus when compared to those without depression. All the brain regions above survived the FWE correction.

CONCLUSION

The results suggested that increased and decreased functional connectivity, as well as the capability of global integration of information in the brain, might be related to the occurrence of PE and the comorbidity depression in PE patients, respectively. These findings provided new insights into the understanding of the pathological mechanisms underlying PE and those with depression.

The effects of sex and handedness on masturbation laterality and other lateralized motor behaviours

Masturbation is a common human behaviour. Compared to other unimanual behaviours it has unique properties, including increased sexual and emotional arousal, and privacy. Self-reported hand preference for masturbation was examined in 104 left-handed and 103 right-handed women, and 100 left-handed and 99 right-handed men. Handedness (modified Edinburgh Handedness Inventory, EHI), footedness, eyedness, and cheek kissing preferences were also measured. Seventy nine percent used their dominant hand (always/usually) for masturbation, but left-handers (71.5%) were less consistently lateralized to use their dominant hand than right-handers (86.5%). Hand preference for masturbation correlated more strongly with handedness (EHI), than with footedness, eyedness, or cheek preference. There was no difference in masturbation frequency between left- and right-handers, but men masturbated more frequently than women, and more women (75%) than men (33%) masturbated with sex aids. For kissing the preferred cheek of an emotionally close person from the viewer's perspective, left-handers showed a left-cheek preference, and right-handers a weaker right-cheek preference. The results suggest that hemispheric asymmetries in emotion do not influence hand preference for masturbation but may promote a leftward shift in cheek kissing. In all, masturbation is lateralized in a similar way to other manual motor behaviours in left-handed and right-handed men and women.

Opposed attentional hemi-bias on a visuoconstructive task in children with severe hyperactivity versus severe inattention

Twenty six empirical investigations have now established that children and adults with DSM-defined Attention deficit/Hyperactivity disorder (ADHD) of the Hyperactive type (ADHD-H) or, more commonly, Combined Hyperactive/Inattentive types (ADHD-C) manifest a small but significant visual attentional bias to the right side (left subclinical neglect), consistently suggesting the existence of a subtle right hemisphere dysfunction or hemispheric imbalance in hyperactive people. Only one research team has investigated and compared the DSM-defined Inattentive subtype (ADHD-I) to the Hyperactive subtype (ADHD-H), confirming that line bisection is biased to the right in ADHD-H and discovering that it is biased to the left in ADHD-I. We aimed to test whether a similar crossed double dissociation would extend to Rey's Complex Figure Copy Task (RCF-CT), a simple visuospatial-constructive task. Clinical files of 205 juvenile clients from 6 to 16 years of age from a neuropsychological private clinic specialized in ADHD were analysed. Extreme scores on the Connors-3 Hyperactivity vs Inattention Parent Rating scales associated, respectively, with significant rightward and significant leftward emplacement of the drawing on the page on the RCF-CT. These results replicate previous findings and extend the "energetics" model of hemispheric specialization.

The Neurology of Acquired Pedophilia

The clinicoanatomic cases of acquired pedophilia that have been published in the medical and forensic literature up to 2019 are reviewed. Twenty-two cases fit our inclusion criteria. All but one were men, and in only one case the injury was localized to the left hemisphere. Hypersexuality was present in 18 cases. The damaged areas fell within the frontotemporoinsular cortices and related subcortical nuclei; however, the anterior hypothalamus was spared. Damage to parts of the right frontotemporoinsular lobes with sparing of the anterior hypothalamus seems to be critical for the emergence of acquired pedophilia.

Positive Correlation between Left Hemisphere Lesion and Erectile Dysfunction in Post-Stroke Patients

BACKGROUND:

Stroke is a serious health condition and the leading cause of disability, including erectile dysfunction (ED). The mechanisms and factors that predict ED in stroke are not fully elucidated. Several studies have shown a relationship between the location of the lesion in stroke with the onset of ED. The left hemispheric lesion was believed to disrupt the parasympathetic nervous system which is responsible for the regulation of erection. Stroke attack in this region therefore can be the underlying reason for ED. However, there are still contradictory findings in this area, and very few studies attempted to look at this problem, particularly among Asian male.

AIM:

We would like to evaluate the association between left hemisphere lesion after ischemic stroke and the subsequent risk of developing ED.

METHODS:

The study was conducted in the neurology polyclinic of Sanglah and Wangaya Hospital from February to August 2013. Subjects are all post-stroke patients who visited the neurology polyclinic of Sanglah and Wangaya Hospital that met inclusion and exclusion criteria.

RESULTS:

There is a significant positive correlation (p < 0.05) between left hemisphere lesions and ED in stroke patients with a correlation coefficient (r) = 0.361 which means weak correlation and p = 0.032.

CONCLUSION:

Left hemisphere lesions positively correlated with ED in stroke patients. Further longitudinal research is needed to see whether left hemisphere lesion in post-stroke patients is a risk factor for ED.

Brain Activity Unique to Orgasm in Women: An fMRI Analysis

BACKGROUND

Although the literature on imaging of regional brain activity during sexual arousal in women and men is extensive and largely consistent, that on orgasm is relatively limited and variable, owing in part to the methodologic challenges posed by variability in latency to orgasm in participants and head movement.

AIM

To compare brain activity at orgasm (self- and partner-induced) with that at the onset of genital stimulation, immediately before the onset of orgasm, and immediately after the cessation of orgasm and to upgrade the methodology for obtaining and analyzing functional magnetic resonance imaging (fMRI) findings.

METHODS

Using fMRI, we sampled equivalent time points across female participants' variable durations of stimulation and orgasm in response to self- and partner-induced clitoral stimulation. The first 20-second epoch of orgasm was contrasted with the 20-second epochs at the beginning of stimulation and immediately before and after orgasm. Separate analyses were conducted for whole-brain and brainstem regions of interest. For a finer-grained analysis of the peri-orgasm phase, we conducted a time-course analysis on regions of interest. Head movement was minimized to a mean less than 1.3 mm using a custom-fitted thermoplastic whole-head and neck brace stabilizer.

OUTCOMES

Ten women experienced orgasm elicited by self- and partner-induced genital stimulation in a Siemens 3-T Trio fMRI scanner.

RESULTS

Brain activity gradually increased leading up to orgasm, peaked at orgasm, and then decreased. We found no evidence of deactivation of brain regions leading up to or during orgasm. The activated brain regions included sensory, motor, reward, frontal cortical, and brainstem regions (eg, nucleus accumbens, insula, anterior cingulate cortex, orbitofrontal cortex, operculum, right angular gyrus, paracentral lobule, cerebellum, hippocampus, amygdala, hypothalamus, ventral tegmental area, and dorsal raphe).

CLINICAL TRANSLATION

Insight gained from the present findings could provide guidance toward a rational basis for treatment of orgasmic disorders, including anorgasmia.

STRENGTHS AND LIMITATIONS

This is evidently the first fMRI study of orgasm elicited by self- and partner-induced genital stimulation in women. Methodologic solutions to the technical issues posed by excessive head movement and variable latencies to orgasm were successfully applied in the present study, enabling identification of brain regions involved in orgasm. Limitations include the small sample (N = 10), which combined self- and partner-induced stimulation datasets for analysis and which qualify the generalization of our conclusions.

CONCLUSION

Extensive cortical, subcortical, and brainstem regions reach peak levels of activity at orgasm. Wise NJ, Frangos E, Komisaruk BR. Brain Activity Unique to Orgasm in Women: An fMRI Analysis. J Sex Med 2017;14:1380-1391.

Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review

BACKGROUND

Optimal anti-epileptic drug (AED) treatment maximises therapeutic response and minimises adverse effects (AEs). Key to therapeutic AED treatment is adherence. Non-adherence is often related to severity of AEs. Frequently, patients do not spontaneously report, and clinicians do not specifically query, critical AEs that lead to non-adherence, including sexual dysfunction. Sexual dysfunction prevalence in patients with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or mood states. This case reports lamotrigine-induced sexual dysfunction leading to periodic non-adherence.

AIMS

To report lamotrigine-induced sexual dysfunction leading to periodic lamotrigine non-adherence in the context of multiple comorbidities and concurrent antidepressant and antihypertensive pharmacotherapy.

METHOD

Case analysis with PubMed literature review.

RESULTS

A 56-year-old male patient with major depression, panic disorder without agoraphobia and post-traumatic stress disorder was well-controlled with escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid prn. Comorbid conditions included complex partial seizures, psychogenic non-epileptic seizures (PNES), hypertension, gastroesophageal reflux disease and hydrocephalus with patent ventriculoperitoneal shunt that were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam and lansoprazole 30 mg qam. He acknowledged non-adherence with lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg total daily dose, he described no libido with impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he described becoming libidinous with decreased erectile dysfunction but persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to maximise sexual functioning, he developed auras. Family confirmed patient's consistent monthly non-adherence for 2-3 days during the past year.

CONCLUSIONS

Sexual dysfunction is a key AE leading to AED non-adherence. This case describes dose-dependent lamotrigine-induced sexual dysfunction with episodic non-adherence for 12 months. Patient/clinician education regarding AED-induced sexual dysfunction is warranted as are routine sexual histories to ensure adherence.

DECLARATION OF INTEREST

No financial interests. K.R.K. is Editor of BJPsych Open; he took no part in the peer-review of this work.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Neurology of ecstatic religious and similar experiences: Ecstatic, orgasmic, and musicogenic seizures. Stendhal syndrome and autoscopic phenomena

All human experiences, including mystical and religious ones, are the result of brain functional activity. Thanks to the study of cases of ecstatic epilepsy with structural (MRI) and functional neuroimaging (fMRI, PET, SPECT) and neurophysiological technologies (recording and stimulation with intracranial electrodes), we now have a better knowledge of certain mental states which involve pleasant and affective symptoms and clarity of mind. These ecstatic experiences are thought to be caused by the activation of the anterior insular cortex and some neuronal networks (basically related to mirror neurons and salience) participating in introspection, social cognition, memory, and emotional processes. Thus, neuroscience could explain in a retrospective way some facts surrounding the situations of such relevant figures as Paul the Apostle, Teresa de Cepeda y Ahumada, and Dostoevsky, whose origin was previously considered paranormal or supernatural. Ecstatic epilepsy shares symptoms and mechanisms with orgasmic epilepsy (spontaneous orgasms in the course of epileptic seizures), musicogenic epilepsy (epileptic seizures triggered by listening to a certain musical piece), and also with Stendhal syndrome (neuropsychiatric disturbances caused when an individual is exposed to large amounts of art) and some autoscopic phenomena (out-of-body experiences that occasionally take place in imminent death situations). In all these events, there are pleasant and affective symptoms which have a great impact on patients.

Sexuality after surgery for diffuse low-grade glioma

BACKGROUND

Although neurological and neurocognitive outcomes have previously been studied after resection of diffuse low-grade glioma (DLGG), the impact of surgery on sexual life has not been investigated. Our aim was to assess whether DLGG surgery could have consequences on sexual experience.

METHODS

Anonymous standardized questionnaires concerning sexual functioning, including the Arizona Sexual Experiences Scale (ASEX) and a subjective statement, were completed by 32 patients who underwent surgery for DLGG. All patients returned to a normal social and professional life following resection, with neither neurological deficits nor depression. No radiotherapy was administered, and patients who received chemotherapy were without treatment for at least 1 year.

RESULTS

Seventeen patients (53%) reported a postoperative sexual change, with subjective deterioration in 15 (88%) and improvement in 2 (12%). Sexual dysfunction according to ASEX affected 9 of 15 women (60%) and 5 of 17 men (29%). Right-sided resections were associated with more difficulties in reaching orgasm than left-sided resections (P < .02). Men with temporal lobe resection displayed more reduction in sexual drive (P < .003) and sexual arousal (P < .004) than women, resulting in significant higher overall ASEX scores for temporal lobe resections in men (P = .01). Men remaining on antiepileptic drugs who underwent right-sided resection displayed higher overall ASEX scores than women (P = .031).

CONCLUSIONS

This first evaluation of sexual life after surgery for DLGG suggests that sexual dysfunction is common in this population. Therefore, we suggest that sexual health should consistently be addressed during routine pre- and postoperative examination of patients with DLGG.

Bilateral cortical representation of orgasmic ecstasy localized by depth electrodes

While sexual arousal had been evoked during direct electrical stimulation (DES) of the right mesial temporal lobe and basal forebrain, isolated orgasmic ecstasy (OE) evoked by DES is not reported in the literature. We present the first case of isolated bihemispheric reproduction of OE by stimulation via depth electrode in a patient implanted for epilepsy.