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Forstenpointner J, Maallo AMS, Elman I, Holmes S, Freeman R, Baron R, Borsook D. The Solitary Nucleus Connectivity to Key Autonomic Regions in Humans MRI and Literature based Considerations. Eur J Neurosci 2022; 56:3938-3966. [PMID: 35545280 DOI: 10.1111/ejn.15691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
The nucleus tractus solitarius (NTS), is a key brainstem structure relaying interoceptive peripheral information to the interrelated brain centers for eliciting rapid autonomic responses and for shaping longer-term neuroendocrine and motor patterns. Structural and functional NTS' connectivity has been extensively investigated in laboratory animals. But there is limited information about NTS' connectome in humans. Using MRI, we examined diffusion and resting state data from 20 healthy participants in the Human Connectome Project. The regions within the brainstem (n=8), subcortical (n=6), cerebellar (n=2) and cortical (n=5) parts of the brain were selected via a systematic review of the literature and their white matter NTS connections were evaluated via probabilistic tractography along with functional and directional (i.e., Granger-causality) analyses. The underlying study confirms previous results from animal models and provides novel aspects on NTS integration in humans. Two key findings can be summarized: (i) the NTS predominantly processes afferent input and (ii) a lateralization towards a predominantly left-sided NTS processing. Our results lay the foundations for future investigations into the NTS' tripartite role comprised of interoreceptors' input integration, the resultant neurochemical outflow and cognitive/affective processing. The implications of these data add to the understanding of NTS' role in specific aspects of autonomic functions.
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Affiliation(s)
- Julia Forstenpointner
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anne Margarette S Maallo
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Igor Elman
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Scott Holmes
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA.,Department of Radiology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Vieira-Baptista P, Lima-Silva J, Preti M, Xavier J, Vendeira P, Stockdale CK. G-spot: Fact or Fiction?: A Systematic Review. Sex Med 2021; 9:100435. [PMID: 34509752 PMCID: PMC8498956 DOI: 10.1016/j.esxm.2021.100435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/07/2021] [Accepted: 08/10/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction The G-spot, a putative erogenous area in the anterior vaginal wall, is a widely accepted concept in the mainstream media, but controversial in medical literature. Aim Review of the scientific data concerning the existence, location, and size of the G-spot. Methods Search on Pubmed, Pubmed Central, Cochrane, clinicaltrials.gov and Google Scholar from inception to November 2020 of studies on G-spot's existence, location and nature. Surveys, clinical, physiological, imaging, histological and anatomic studies were included. Main Outcome Measure Existence, location, and nature of the G-spot. Results In total, 31 eligible studies were identified: 6 surveys, 5 clinical, 1 neurophysiological, 9 imaging, 8 histological/anatomical, and 2 combined clinical and histological. Most women (62.9%) reported having a G-spot and it was identified in most clinical studies (55.4% of women); in 2 studies it was not identified in any women. Imaging studies had contradictory results in terms of its existence and nature. Some showed a descending of the anterior vaginal wall, that led to the concept of clitourethrovaginal complex. In anatomic studies, one author could systematically identify the G-spot, while another group did not find it. Studies on innervation of the vaginal walls did not systematically identify an area with richer innervation. Conclusion The different studies did systematically agree on the existence of the G-spot. Among the studies in which it was considered to exist, there was no agreement on its location, size, or nature. The existence of this structure remains unproved. Vieira-Baptista P, Lima-Silva J, Preti M, et al. G-spot: Fact or Fiction?: A Systematic Review. Sex Med 2021;9:100435.
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Affiliation(s)
- Pedro Vieira-Baptista
- Hospital Lusíadas Porto, Porto, Portugal; Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal; LAP, a Unilabs Company, Porto, Portugal.
| | - Joana Lima-Silva
- Hospital Lusíadas Porto, Porto, Portugal; Lower Genital Tract Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Mario Preti
- Department of Surgical Sciences University of Torino, Torino, Italy
| | - Joana Xavier
- Gynecology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Pedro Vendeira
- Urology Department, Saúde Atlântica - Clínica do Dragão, Porto, Portugal
| | - Colleen K Stockdale
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Blanke EN, Holmes GM, Besecker EM. Altered physiology of gastrointestinal vagal afferents following neurotrauma. Neural Regen Res 2021; 16:254-263. [PMID: 32859772 PMCID: PMC7896240 DOI: 10.4103/1673-5374.290883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The adaptability of the central nervous system has been revealed in several model systems. Of particular interest to central nervous system-injured individuals is the ability for neural components to be modified for regain of function. In both types of neurotrauma, traumatic brain injury and spinal cord injury, the primary parasympathetic control to the gastrointestinal tract, the vagus nerve, remains anatomically intact. However, individuals with traumatic brain injury or spinal cord injury are highly susceptible to gastrointestinal dysfunctions. Such gastrointestinal dysfunctions attribute to higher morbidity and mortality following traumatic brain injury and spinal cord injury. While the vagal efferent output remains capable of eliciting motor responses following injury, evidence suggests impairment of the vagal afferents. Since sensory input drives motor output, this review will discuss the normal and altered anatomy and physiology of the gastrointestinal vagal afferents to better understand the contributions of vagal afferent plasticity following neurotrauma.
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Affiliation(s)
- Emily N Blanke
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Gregory M Holmes
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Emily M Besecker
- Department of Health Sciences, Gettysburg College, Gettysburg, PA, USA
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Alkatout I, Wedel T, Pape J, Possover M, Dhanawat J. Review: Pelvic nerves - from anatomy and physiology to clinical applications. Transl Neurosci 2021; 12:362-378. [PMID: 34707906 PMCID: PMC8500855 DOI: 10.1515/tnsci-2020-0184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/30/2022] Open
Abstract
A prerequisite for nerve-sparing pelvic surgery is a thorough understanding of the topographic anatomy of the fine and intricate pelvic nerve networks, and their connections to the central nervous system. Insights into the functions of pelvic nerves will help to interpret disease symptoms correctly and improve treatment. In this article, we review the anatomy and physiology of autonomic pelvic nerves, including their topography and putative functions. The aim is to achieve a better understanding of the mechanisms of pelvic pain and functional disorders, as well as improve their diagnosis and treatment. The information will also serve as a basis for counseling patients with chronic illnesses. A profound understanding of pelvic neuroanatomy will permit complex surgery in the pelvis without relevant nerve injury.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, Building 24, 24105 Kiel, Germany
| | - Thilo Wedel
- Department of Anatomy, Institute of Anatomy, Center of Clinical Anatomy, University Hospitals Schleswig-Holstein, Campus Kiel, Otto-Hahn-Platz 8, 24118 Kiel, Germany
| | - Julian Pape
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, Building 24, 24105 Kiel, Germany
| | - Marc Possover
- Possover International Medical Center, Zürich, Switzerland
- Department of Gynecology, University of Aarhus, Aarhus, Denmark
| | - Juhi Dhanawat
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, Building 24, 24105 Kiel, Germany
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Non-invasive neuromodulation for bowel, bladder and sexual restoration following spinal cord injury: A systematic review. Clin Neurol Neurosurg 2020; 194:105822. [DOI: 10.1016/j.clineuro.2020.105822] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 01/30/2023]
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van Hoorn AC. Could affect regulation via vagal nerve self- stimulation be a maintaining factor in non-suicidal self-harm? Med Hypotheses 2019; 136:109498. [PMID: 31759305 DOI: 10.1016/j.mehy.2019.109498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a serious and common phenomenon which has been linked with emotion or affect regulation. The capacity for top-down emotion regulation has also been linked to vagal tone. Vagal tone is known to be low in groups with a propensity to engage in NSSI. HYPOTHESIS Some forms of NSSI, both direct and indirect, may result in vagal stimulation. The resulting increase in vagal tone may be linked to activation of prefrontal areas and improved top-down emotion regulation. This may be a maintaining factor in NSSI. EVALUATION Cutting with the sight of blood, the use of ligatures, eating disorders and risky sexual behaviour, behaviours that could be considered direct or indirect forms of NSSI, are all plausible methods of vagal self-stimulation. CONCLUSION NSSI may increase vagal tone. This may result in improved top down emotion regulation and result in a calmer emotional state. These vagal effects may be important maintaining factors in self-harm. This has important implications for the study and possible management of a common and serious issue.
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Affiliation(s)
- Alje C van Hoorn
- University of Exeter Medical School Stocker Road, Exeter EX4 4PY, United Kingdom; Falmouth University Woodlane, Falmouth TR11 4RH, United Kingdom.
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Ostrzenski A. G-Spot Anatomy and its Clinical Significance: A Systematic Review. Clin Anat 2019; 32:1094-1101. [PMID: 31464000 DOI: 10.1002/ca.23457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 11/07/2022]
Abstract
The discovery of the G-spot and verification of its anatomy and histology paved the way to better understanding. Until 2012, the G-spot was defined as a physiological sexual response phenomenon with no identifiable anatomical correlate. The weakness of this definition is that a physiological response cannot exist without an anatomical basis, so the question motivating the present study was formulated: Are current scientific-clinical data sufficient to resolve the controversy about the anatomical existence of a G-spot? It is important to stipulate that no systematic review of the G-spot has hitherto been published. Manual and electronic searches revealed postmortem and in vivo studies describing the G-spot and findings reported within PRISMA-IPD guidelines. The objective of the present review was to provide evidence-based information related to the G-spot. Articles were quality-assessed using validated instruments. Publications on the G-spot from 1950 to May 2019 were reviewed. Of the 279 full-text articles examined, 30 met the eligibility criteria. The findings indicate that there are reliable scientific-clinical data to support the existence of an anatomical G-spot structure. Transient anterior-distal vaginal wall engorgement is caused by blood entrapment within the G-spot structure. Histological examination effectively ruled out the G-spot as the organ cannot be responsible for female ejaculation since no glandular tissue was identifiable. Finally, the results of this study could assist in developing new therapeutic, surgical interventions to treat secondary G-spot dysfunction. Additionally, this review indicates ample opportunities for further scientific-clinical investigations and has thereby moved the field forward. Clin. Anat. 32:1094-1101, 2019. © 2019 Wiley Periodicals, Inc.
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Assessment of sexual function in women with neurological disorders: A review. Ann Phys Rehabil Med 2018; 61:235-244. [DOI: 10.1016/j.rehab.2017.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/29/2017] [Indexed: 11/21/2022]
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Levin RJ, Both S, Georgiadis J, Kukkonen T, Park K, Yang CC. The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A). J Sex Med 2017; 13:733-59. [PMID: 27114190 DOI: 10.1016/j.jsxm.2016.02.172] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The article consists of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, and the pathophysiology of female sexual dysfunction but excluding hormonal aspects. AIM To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations according to the Oxford Centre for evidence based medicine (2009) "levels of evidence" wherever relevant. CONCLUSION Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.
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Affiliation(s)
- Roy J Levin
- Reader in Physiology (Retired), Department of Biomedical Science, University of Sheffield, Sheffield, UK: Section 2.
| | - Stephanie Both
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands: Section 3
| | - Janniko Georgiadis
- Department of Neuroscience, University Medical Center, Groningen, University of Groningen, The Netherlands: Section 4
| | - Tuuli Kukkonen
- College of Social and Applied Human Science, University of Guelph, Guelph, ON, Canada: Section 6
| | - Kwangsung Park
- Department of Urology, Chonnan National University Medical School, Gwangju, Korea: Section 5
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, WA, USA: Section 1
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Stanton AM, Pulverman CS, Meston CM. Vagal Activity During Physiological Sexual Arousal in Women With and Without Sexual Dysfunction. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:78-89. [PMID: 26735491 DOI: 10.1080/0092623x.2015.1115793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Recently, heart rate variability (HRV) level has been found to be a risk factor for female sexual dysfunction. Low HRV was a significant predictor of female sexual arousal dysfunction and overall sexual dysfunction. Building upon this finding, the present study examined whether differences in vagal activity between sexually functional and sexually dysfunctional women may be driving the association between low HRV and female sexual dysfunction. Specifically, respiratory sinus arrhythmia (RSA) was assessed before, during, and after physiological sexual arousal in 84 women, aged 18 to 47, to examine potential differences in vagal activity between sexually functional and sexually dysfunctional women. Significant differences in vagal activity between these two groups were observed (p =.02). These findings provide additional specificity to the recently established relationship between HRV and female sexual function while also proposing a mechanism to target during treatments for sexual dysfunction.
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Affiliation(s)
- Amelia M Stanton
- a The University of Texas at Austin , Department of Psychology , Austin , Texas , USA
| | - Carey S Pulverman
- a The University of Texas at Austin , Department of Psychology , Austin , Texas , USA
| | - Cindy M Meston
- a The University of Texas at Austin , Department of Psychology , Austin , Texas , USA
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Parish SJ, Goldstein AT, Goldstein SW, Goldstein I, Pfaus J, Clayton AH, Giraldi A, Simon JA, Althof SE, Bachmann G, Komisaruk B, Levin R, Spadt SK, Kingsberg SA, Perelman MA, Waldinger MD, Whipple B. Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions—Part II. J Sex Med 2016; 13:1888-1906. [DOI: 10.1016/j.jsxm.2016.09.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/09/2016] [Accepted: 09/25/2016] [Indexed: 01/23/2023]
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Pfaus JG, Quintana GR, Mac Cionnaith C, Parada M. The whole versus the sum of some of the parts: toward resolving the apparent controversy of clitoral versus vaginal orgasms. SOCIOAFFECTIVE NEUROSCIENCE & PSYCHOLOGY 2016; 6:32578. [PMID: 27791968 PMCID: PMC5084726 DOI: 10.3402/snp.v6.32578] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/26/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The nature of a woman's orgasm has been a source of scientific, political, and cultural debate for over a century. Since the Victorian era, the pendulum has swung from the vagina to the clitoris, and to some extent back again, with the current debate stuck over whether internal sensory structures exist in the vagina that could account for orgasms based largely on their stimulation, or whether stimulation of the external glans clitoris is always necessary for orgasm. METHOD We review the history of the clitoral versus vaginal orgasm debate as it has evolved with conflicting ideas and data from psychiatry and psychoanalysis, epidemiology, evolutionary theory, feminist political theory, physiology, and finally neuroscience. RESULTS A new synthesis is presented that acknowledges the enormous potential women have to experience orgasms from one or more sources of sensory input, including the external clitoral glans, internal region around the "G-spot" that corresponds to the internal clitoral bulbs, the cervix, as well as sensory stimulation of non-genital areas such as the nipples. CONCLUSIONS With experience, stimulation of one or all of these triggering zones are integrated into a "whole" set of sensory inputs, movements, body positions, autonomic arousal, and partner- and contextual-related cues, that reliably induces pleasure and orgasm during masturbation and copulation. The process of integration is iterative and can change across the lifespan with new experiences of orgasm.
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Affiliation(s)
- James G Pfaus
- Department of Psychology, Center for Studies in Behavioral Neurobiology, Concordia University, Montréal, QC, Canada;
| | - Gonzalo R Quintana
- Department of Psychology, Center for Studies in Behavioral Neurobiology, Concordia University, Montréal, QC, Canada
| | - Conall Mac Cionnaith
- Department of Psychology, Center for Studies in Behavioral Neurobiology, Concordia University, Montréal, QC, Canada
| | - Mayte Parada
- Department of Psychology, McGill University, Montréal, QC, Canada
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Marson L, Giamberardino MA, Costantini R, Czakanski P, Wesselmann U. Animal Models for the Study of Female Sexual Dysfunction. Sex Med Rev 2015; 1:108-122. [PMID: 27784584 DOI: 10.1002/smrj.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Significant progress has been made in elucidating the physiological and pharmacological mechanisms of female sexual function through preclinical animal research. The continued development of animal models is vital for the understanding and treatment of the many diverse disorders that occur in women. AIM To provide an updated review of the experimental models evaluating female sexual function that may be useful for clinical translation. METHODS Review of English written, peer-reviewed literature, primarily from 2000 to 2012, that described studies on female sexual behavior related to motivation, arousal, physiological monitoring of genital function and urogenital pain. MAIN OUTCOMES MEASURES Analysis of supporting evidence for the suitability of the animal model to provide measurable indices related to desire, arousal, reward, orgasm, and pelvic pain. RESULTS The development of female animal models has provided important insights in the peripheral and central processes regulating sexual function. Behavioral models of sexual desire, motivation, and reward are well developed. Central arousal and orgasmic responses are less well understood, compared with the physiological changes associated with genital arousal. Models of nociception are useful for replicating symptoms and identifying the neurobiological pathways involved. While in some cases translation to women correlates with the findings in animals, the requirement of circulating hormones for sexual receptivity in rodents and the multifactorial nature of women's sexual function requires better designed studies and careful analysis. The current models have studied sexual dysfunction or pelvic pain in isolation; combining these aspects would help to elucidate interactions of the pathophysiology of pain and sexual dysfunction. CONCLUSIONS Basic research in animals has been vital for understanding the anatomy, neurobiology, and physiological mechanisms underlying sexual function and urogenital pain. These models are important for understanding the etiology of female sexual function and for future development of pharmacological treatments for sexual dysfunctions with or without pain. Marson L, Giamberardino MA, Costantini R, Czakanski P, and Wesselmann U. Animal models for the study of female sexual dysfunction. Sex Med Rev 2013;1:108-122.
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Affiliation(s)
- Lesley Marson
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | | | - Peter Czakanski
- University of Alabama at Birmingham-Departments of Anesthesiology and Obstetrics & Gynecology, Birmingham, AL, USA
| | - Ursula Wesselmann
- University of Alabama at Birmingham-Departments of Anesthesiology and Neurology, Birmingham, AL, USA
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Krhut J, Tintera J, Bilkova K, Holy P, Zachoval R, Zvara P, Blok B. Brain activity on fMRI associated with urinary bladder filling in patients with a complete spinal cord injury. Neurourol Urodyn 2015; 36:155-159. [PMID: 26445209 DOI: 10.1002/nau.22901] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/16/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patients with complete spinal cord injury (SCI) may maintain some perception of bladder fullness. The aim of the study was to evaluate brain activation arising from anticipated extraspinal sensory pathways. METHODS Fourteen patients ages 24-54 years were enrolled, all having experienced a complete SCI (ASIA A) at C7 to T5 an average of 17 months before study entry. Urodynamic equipment was used for repeated bladder filling and detrusor activity evaluation. All functional magnetic resonance imaging measurements were performed using a Siemens Trio 3T scanner with the GRE-EPI sequence (field of view = 192 × 192 mm, voxel 3 × 3 × 3 mm, TR/TE = 3000/30 ms, 45 slices). Nine hundred dynamic scans were acquired over 45 min. Statistical analysis was done in SPM8 using a general linear model. Statistics using t-tests were thresholded at P = 0.001. RESULTS We excluded results from two patients because of activation artifacts. In 8 of 12 patients, significant brain activity was observed during urinary bladder filling. We found significant activation clusters at the nucleus of the solitary tract (NTS) (3/8), parabrachial nucleus (PBN) (4/8), hypothalamus (4/8), thalamus (6/8), amygdala (7/8), insular lobe (5/8), anterior cingulate gyrus (5/8), and prefrontal cortex (8/8). Activations in nuclei involved in afferents likely from the vagal nerve (NTS and PBN) correlated significantly with reported bladder sensations. CONCLUSIONS These data suggest that extraspinal sensory pathways may develop following SCI and that vagal nerve may play a role in re-innervation of the urinary bladder. Neurourol. Urodynam. 36:155-159, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic.,Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic
| | - Jaroslav Tintera
- Radiodiagnostis and Interventional Radiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Karolina Bilkova
- Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic
| | - Petr Holy
- Department of Urology, Thomayer Hospital and 1st and 3rd Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, Thomayer Hospital and 1st and 3rd Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Peter Zvara
- Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.,Division of Urology, University of Vermont, Burlington, Vermont
| | - B Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, the Netherlands
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Vitale SG, Caruso S, Rapisarda AMC, Valenti G, Rossetti D, Cianci S, Cianci A. Biocompatible porcine dermis graft to treat severe cystocele: impact on quality of life and sexuality. Arch Gynecol Obstet 2015; 293:125-131. [DOI: 10.1007/s00404-015-3820-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/13/2015] [Indexed: 01/23/2023]
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Courtois F, Charvier K. Sexual dysfunction in patients with spinal cord lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:225-45. [PMID: 26003247 DOI: 10.1016/b978-0-444-63247-0.00013-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many aspects of sexuality can be disrupted following a spinal cord lesion (SCL). It can alter an individual's self-esteem and body image, interfere with positioning and mobility, introduce unexpected problems with incontinence and spasticity, decrease pleasure, and delay orgasm. Sexual concerns in men can involve erectile function, essential for intercourse, ejaculation function, necessary for fertility, and the ability to reach orgasm. In women they can involve concerns with vaginal lubrication, genital congestion, and vaginal infections, which can all go unnoticed, and orgasm, which may be lost. All of these concerns must be addressed during rehabilitation as individuals with SCL continue to live an active sexual life, and consider sexuality among their top priority for quality of life. This chapter describes the impact of SCL on various phases of men's and women's sexual responses and on various aspects of sexuality. Treatments are described in terms of what is currently available and what is specific to the SCL population. New approaches in particular for women are described, along with tips from sexual counseling which consider an overall approach, taking into account the primary, secondary, and tertiary consequences of the SCL on the individual's sexuality. Throughout the chapter, attempts are made to integrate neurophysiologic knowledge, findings from the literature on SCL, and clinical experience in sexual rehabilitation.
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Affiliation(s)
- Frédérique Courtois
- Department of Sexology, Université du Québec à Montréal, Montreal, Quebec, Canada.
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Veening JG, de Jong TR, Waldinger MD, Korte SM, Olivier B. The role of oxytocin in male and female reproductive behavior. Eur J Pharmacol 2014; 753:209-28. [PMID: 25088178 DOI: 10.1016/j.ejphar.2014.07.045] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/30/2014] [Accepted: 07/24/2014] [Indexed: 01/01/2023]
Abstract
Oxytocin (OT) is a nonapeptide with an impressive variety of physiological functions. Among them, the 'prosocial' effects have been discussed in several recent reviews, but the direct effects on male and female sexual behavior did receive much less attention so far. As our contribution to honor the lifelong interest of Berend Olivier in the control mechanisms of sexual behavior, we decided to explore the role of OT in the present review. In the successive sections, some physiological mechanisms and the 'pair-bonding' effects of OT will be discussed, followed by sections about desire, female appetitive and copulatory behavior, including lordosis and orgasm. At the male side, the effects on erection and ejaculation are reviewed, followed by a section about 'premature ejaculation' and a possible role of OT in its treatment. In addition to OT, serotonin receives some attention as one of the main mechanisms controlling the effects of OT. In the succeeding sections, the importance of OT for 'the fruits of labor' is discussed, as it plays an important role in both maternal and paternal behavior. Finally, we pay attention to an intriguing brain area, the ventrolateral part of the ventromedial hypothalamic nucleus (VMHvl), apparently functioning in both sexual and aggressive behavior, which are at first view completely opposite behavioral systems.
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Affiliation(s)
- J G Veening
- Department of Psychopharmacology, Division of Pharmacology, University of Utrecht, Utrecht, The Netherlands; Department of Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - T R de Jong
- Department of Behavioral and Molecular Neurobiology, University of Regensburg, 93053 Regensburg, Germany
| | - M D Waldinger
- Department of Psychopharmacology, Division of Pharmacology, University of Utrecht, Utrecht, The Netherlands
| | - S M Korte
- Department of Psychopharmacology, Division of Pharmacology, University of Utrecht, Utrecht, The Netherlands
| | - B Olivier
- Department of Psychopharmacology, Division of Pharmacology, University of Utrecht, Utrecht, The Netherlands
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Cramp J, Courtois F, Connolly M, Cosby J, Ditor D. The Impact of Urinary Incontinence on Sexual Function and Sexual Satisfaction in Women with Spinal Cord Injury. SEXUALITY AND DISABILITY 2014. [DOI: 10.1007/s11195-014-9354-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cramp JD, Courtois FJ, Ditor DS. Sexuality for women with spinal cord injury. JOURNAL OF SEX & MARITAL THERAPY 2014; 41:238-253. [PMID: 24325679 DOI: 10.1080/0092623x.2013.869777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors conducted a review of the literature on women's sexuality after spinal cord injury, including studies from 1990 to 2011 retrieved from PubMed. Several facets of a woman's sexuality are negatively affected by after spinal cord injury, and consequently, sexual satisfaction has been shown to decrease, which also negatively affects quality of life. Neurogenic bladder is common after spinal cord injury, and the resulting urinary incontinence is a top therapeutic priority of this population. To improve sexual satisfaction and quality of life for women with spinal cord injury, future research needs to explore the effects of urinary incontinence on various aspects of sexuality.
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Affiliation(s)
- Jackie D Cramp
- a Department of Kinesiology , Brock University , St. Catharines , Ontario , Canada
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Brody S, Costa RM, Hess U. “Standard Operating Procedures for Female Orgasmic Disorder” is not Based on Best Evidence. J Sex Med 2013; 10:2606-9. [DOI: 10.1111/jsm.12159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Georgiadis JR, Kringelbach ML, Pfaus JG. Sex for fun: a synthesis of human and animal neurobiology. Nat Rev Urol 2012; 9:486-98. [PMID: 22926422 DOI: 10.1038/nrurol.2012.151] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Sex is a fundamental pleasure, and crucial to the survival of our species. Though not many people would disagree with the proposition that sexual behaviour depends on the brain, the neuroscientific study of human sex is still relatively taboo and much remains to be discovered. On the contrary, excellent experimental animal models (mostly rat) are available that have uncovered major behavioural, neurochemical, and neuroanatomical characteristics of sexual behaviour. Restructuring sexual behaviour into broader terms reflecting behavioural states (wanting, liking, and inhibition) facilitates species comparison, revealing many similarities between animal and human sexual pleasure cycles, some of which can serve as potential avenues of new human sex research. In particular, behavioural and brain evidence clearly shows that motivational and consummatory phases are fundamentally distinct, and that genitally-induced sexual reward is a major factor in sexual learning mechanisms.
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Affiliation(s)
- Janniko R Georgiadis
- Department of Neuroscience (Section Anatomy), University Medical Centre Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands.
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Matarazzo MG, Cianci S, Rampello L, Presti LL, Caruso S. Urethral sphincter innervation and clitoral blood flow after the transobturator (TOT) approach. Int Urogynecol J 2012; 24:621-5. [PMID: 22855114 DOI: 10.1007/s00192-012-1891-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 07/02/2012] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the study was to exclude neurovascular damage due to prosthetic mini-invasive surgery using transobturator tape (TOT) by pre- and postoperative electromyography (EMG) of the striated urethral sphincter and a color Doppler ultrasonography evaluation of clitoral blood flow. METHODS A total of 25 women affected by clinical stress urinary incontinence (SUI) were enrolled. After undergoing urodynamic assessment, pelvic organ prolapse quantification, urine culture, Q-tip test, and stress test, each subject underwent color Doppler ultrasonography to record clitoral blood flow and EMG of the urethral sphincter with a needle electrode inserted through the mucosa into the muscle tissue before surgery. A single urogynecologist performed the TOT surgical technique for the treatment of all patients. Urogynecologic examination, EMG, and color Doppler ultrasound follow-up were performed at 1 and 6 months after surgery. RESULTS At the urogynecologic examination performed 1 and 6 months after the TOT approach the stress test was negative, urethral hypermobility was reduced, and sling exposure was not observed for each patient. There was no statistically significant difference in electromyographic values (p > 0.05) in both the follow-ups with regard to baseline values. Pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) values increased during the first follow-up (p < 0.01); PI and RI values increased during the second follow-up with respect to baseline values (p < 0.01) CONCLUSIONS TOT prosthesis surgery, avoiding denervation and devascularization of pelvic structures, does not damage the urethral sphincter.
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Affiliation(s)
- M G Matarazzo
- Department of Medical-Surgical Specialties, University of Catania, Catania, Italy
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Georgiadis JR, Kringelbach ML. The human sexual response cycle: brain imaging evidence linking sex to other pleasures. Prog Neurobiol 2012; 98:49-81. [PMID: 22609047 DOI: 10.1016/j.pneurobio.2012.05.004] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 04/21/2012] [Accepted: 05/08/2012] [Indexed: 12/30/2022]
Abstract
Sexual behavior is critical to species survival, yet comparatively little is known about the neural mechanisms in the human brain. Here we systematically review the existing human brain imaging literature on sexual behavior and show that the functional neuroanatomy of sexual behavior is comparable to that involved in processing other rewarding stimuli. Sexual behavior clearly follows the established principles and phases for wanting, liking and satiety involved in the pleasure cycle of other rewards. The studies have uncovered the brain networks involved in sexual wanting or motivation/anticipation, as well as sexual liking or arousal/consummation, while there is very little data on sexual satiety or post-orgasmic refractory period. Human sexual behavior also interacts with other pleasures, most notably social interaction and high arousal states. We discuss the changes in the underlying brain networks supporting sexual behavior in the context of the pleasure cycle, the changes to this cycle over the individual's life-time and the interactions between them. Overall, it is clear from the data that the functional neuroanatomy of sex is very similar to that of other pleasures and that it is unlikely that there is anything special about the brain mechanisms and networks underlying sex.
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Affiliation(s)
- J R Georgiadis
- Department of Neuroscience/Section Anatomy, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
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Jannini EA, Rubio‐Casillas A, Whipple B, Buisson O, Komisaruk BR, Brody S. Female Orgasm(s): One, Two, Several. J Sex Med 2012; 9:956-65. [DOI: 10.1111/j.1743-6109.2012.02694.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Borrow AP, Cameron NM. The role of oxytocin in mating and pregnancy. Horm Behav 2012; 61:266-76. [PMID: 22107910 DOI: 10.1016/j.yhbeh.2011.11.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 10/10/2011] [Accepted: 11/01/2011] [Indexed: 12/23/2022]
Abstract
The hormone oxytocin (OT) is released both centrally and peripherally during and after mating. Although research in humans suggests a central role in sexuality, the most reliable findings to date involve peripheral activation. This review will discuss these results and will particularly focus on understanding the most recent findings from fMRI data and the effects of exogenous peripheral OT administration. We will then consider hypotheses of the roles played by central and systemic OT release as well as their control and modulation in the female, summarizing recent findings from animal research. Finally, we will discuss the contribution of OT to the initiation of pregnancy in rodents. This article is part of a Special Issue entitled Oxytocin, Vasopressin, and Social Behavior.
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Affiliation(s)
- Amanda P Borrow
- Center for Development and Behavioral Neuroscience, Psychology Department, Binghamton University-SUNY, Binghamton, NY 13902-6000, USA
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Brody S, Costa RM, Hess U, Weiss P. Vaginal Orgasm Is Related to Better Mental Health and Is Relevant to Evolutionary Psychology: A Response to Zietsch et al. J Sex Med 2011; 8:3523-5. [DOI: 10.1111/j.1743-6109.2011.02444.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Courtois F, Charvier K, Vézina JG, Morel Journel N, Carrier S, Jacquemin G, Côté I. Assessing and conceptualizing orgasm after a spinal cord injury. BJU Int 2011; 108:1624-33. [DOI: 10.1111/j.1464-410x.2011.10168.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Clyde LA, Lechuga TJ, Ebner CA, Burns AE, Kirby MA, Yellon SM. Transection of the pelvic or vagus nerve forestalls ripening of the cervix and delays birth in rats. Biol Reprod 2010; 84:587-94. [PMID: 21106964 DOI: 10.1095/biolreprod.110.086207] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Innervation of the cervix is important for normal timing of birth because transection of the pelvic nerve forestalls birth and causes dystocia. To discover whether transection of the parasympathetic innervation of the cervix affects cervical ripening in the process of parturition was the objective of the present study. Rats on Day 16 of pregnancy had the pelvic nerve (PnX) or the vagus nerve (VnX) or both pathways (PnX+VnX) transected, sham-operated (Sham) or nonpregnant rats served as controls. Sections of fixed peripartum cervix were stained for collagen or processed by immunohistochemistry to identify macrophages and nerve fibers. All Sham controls delivered by the morning of Day 22 postbreeding, while births were delayed in more than 75% of neurectomized rats by more than 12 h. Dystocia was evident in more than 25% of the PnX and PnX+VnX rats. Moreover, on prepartum Day 21, serum progesterone was increased severalfold in neurectomized versus Sham rats. Assessments of cell nuclei counts indicated that the cervix of neurectomized rats and Sham controls had become equally hypertrophied compared to the unripe cervix in nonpregnant rats. Collagen content and structure were reduced in the cervix of all pregnant rats, whether neurectomized or Shams, versus that in nonpregnant rats. Stereological analysis of cervix sections found reduced numbers of resident macrophages in prepartum PnX and PnX+VnX rats on Day 21 postbreeding, as well as in VnX rats on Day 22 postbreeding compared to that in Sham controls. Finally, nerve transections blocked the prepartum increase in innervation that occurred in Sham rats on Day 21 postbreeding. These findings indicate that parasympathetic innervation of the cervix mediates local inflammatory processes, withdrawal of progesterone in circulation, and the normal timing of birth. Therefore, pelvic and vagal nerves regulate macrophage immigration and nerve fiber density but may not be involved in final remodeling of the extracellular matrix in the prepartum cervix. These findings support the contention that immigration of immune cells and enhanced innervation are involved in processes that remodel the cervix and time parturition.
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Affiliation(s)
- Lindsey A Clyde
- Department of Physiology, Pathology, and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Ortigue S, Bianchi-Demicheli F, Patel N, Frum C, Lewis JW. Neuroimaging of love: fMRI meta-analysis evidence toward new perspectives in sexual medicine. J Sex Med 2010; 7:3541-52. [PMID: 20807326 DOI: 10.1111/j.1743-6109.2010.01999.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Brain imaging is becoming a powerful tool in the study of human cerebral functions related to close personal relationships. Outside of subcortical structures traditionally thought to be involved in reward-related systems, a wide range of neuroimaging studies in relationship science indicate a prominent role for different cortical networks and cognitive factors. Thus, the field needs a better anatomical/network/whole-brain model to help translate scientific knowledge from lab bench to clinical models and ultimately to the patients suffering from disorders associated with love and couple relationships. AIM The aim of the present review is to provide a review across wide range of functional magnetic resonance imaging (fMRI) studies to critically identify the cortical networks associated with passionate love, and to compare and contrast it with other types of love (such as maternal love and unconditional love for persons with intellectual disabilities). METHODS Retrospective review of pertinent neuroimaging literature. MAIN OUTCOME MEASURES Review of published literature on fMRI studies of love illustrating brain regions associated with different forms of love. RESULTS Although all fMRI studies of love point to the subcortical dopaminergic reward-related brain systems (involving dopamine and oxytocin receptors) for motivating individuals in pair-bonding, the present meta-analysis newly demonstrated that different types of love involve distinct cerebral networks, including those for higher cognitive functions such as social cognition and bodily self-representation. CONCLUSIONS These metaresults provide the first stages of a global neuroanatomical model of cortical networks involved in emotions related to different aspects of love. Developing this model in future studies should be helpful for advancing clinical approaches helpful in sexual medicine and couple therapy.
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Esho T, Enzlin P, Van Wolputte S, Temmerman M. Female genital cutting and sexual function: in search of an alternate theoretical model. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/14725843.2010.491614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Quality of life and sexual changes after double transobturator tension-free approach to treat severe cystocele. Eur J Obstet Gynecol Reprod Biol 2010; 151:106-9. [PMID: 20430511 DOI: 10.1016/j.ejogrb.2010.03.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 03/12/2010] [Accepted: 03/25/2010] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To study the quality of life and sexual function changes of women affected by severe cystocele and treated with the double transobturator tension-free approach. STUDY DESIGN 23 women (mean age 60.6) with third and fourth degree cystocele (according to Baden and Walker classification) were monitored by Short Form-36 (SF-36) and Pelvic Organ Prolapse/Urinary Incontinenece Sexual Questionnaire (PISQ-12) before and 12 months after surgical treatment. Each woman also underwent translabial color Doppler ultrasonography to measure the Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV), and End-Diastolic Velocity (EDV) of the clitoral arteries, before surgery and 12 months postoperatively. RESULTS SF-36 showed a considerable increase in all of the categories (physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, and mental health) compared to those obtained at baseline (P<0.05). PISQ-12 also showed a considerable increase in the behavioural emotive factor score, in the physical factor score, in the partner-related factor score and, consequently, in the total score compared to that obtained at baseline (P<0.05). Color Doppler measurement showed that the mean Pulsatility Index, Peak Systolic Velocity, Resistance Index and End-Diastolic Velocity were not significantly lower to those obtained at baseline (P=NS). CONCLUSIONS Double transobturator tension-free approach to treat severe cystocele considerably improves quality of life and sexual function, and does not significantly influence clitoral blood flow. Our data could add new information about sexual behaviour after prolapse treatment, particularly about the impact on clitoral blood flow changes.
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McCallum RW, Dusing RW, Sarosiek I, Cocjin J, Forster J, Lin Z. Mechanisms of symptomatic improvement after gastric electrical stimulation in gastroparetic patients. Neurogastroenterol Motil 2010; 22:161-7, e50-1. [PMID: 19719511 DOI: 10.1111/j.1365-2982.2009.01389.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aims were to investigate the effects of gastric electrical stimulation (GES) on autonomic function, gastric distention and tone, and central control mechanisms in gastroparetic patients. Ten gastroparetic patients refractory to standard medical therapy participated in this study and data were collected at baseline, within two weeks before surgery for implantation of GES system, and at follow-up sessions between 6 and 12 weeks after GES therapy was initiated. In each session, electrocardiogram, electrogastrogram (EGG) and gastric barostat measurements were conducted before and after a caloric liquid meal. Positron Emission Tomography (PET) brain scans were performed on a separate day. During GES therapy there was a significant increase in the discomfort threshold for mean pressure from 21 mmHg at baseline to 25 mmHg at follow-up, and for mean volume from 561 mL to 713 mL. A significant increase in the postprandial EGG power (amplitude) was observed between baseline and follow up. The sympathovagal balance was significantly decreased after GES therapy, indicating a significant increase in vagal activity. The cumulative PET data showed an increase in quantitative radioactive counts relative to the standardized data base in both the thalamic and caudate nuclei after chronic GES therapy. We conclude that our data suggest that the symptomatic improvement achieved by GES in gastroparesis is best explained by activation of vagal afferent pathways to influence CNS control mechanisms for nausea and vomiting accompanied by enhanced vagal efferent autonomic function and decreased gastric sensitivity to volume distention which enhances postprandial gastric accommodation.
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Affiliation(s)
- R W McCallum
- Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
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Sexuality and reproductive health in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2010; 33:281-336. [PMID: 20737805 PMCID: PMC2941243 DOI: 10.1080/10790268.2010.11689709] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Su TH, Lau HH, Huang WC, Chen SS, Lin TY, Hsieh CH, Yeh CY. Short term impact on female sexual function of pelvic floor reconstruction with the Prolift procedure. J Sex Med 2009; 6:3201-7. [PMID: 19627464 DOI: 10.1111/j.1743-6109.2009.01399.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Prolift system is an effective and safe procedure using mesh reinforcement for vaginal reconstruction of pelvic organ prolapse (POP), but its effect on sexual function is unclear. AIM To evaluate the impact of transvaginal pelvic reconstruction with Prolift on female sexual function at 6 months post-operatively. METHODS Thirty-three sexually active women who underwent Prolift mesh pelvic floor reconstruction for symptomatic POP were evaluated before and 6 months after surgery. Their sexual function was assessed by using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and after surgery. The quality of life was also evaluated with the short forms of the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) as a control for efficacy of the procedure. The Pelvic Organ Prolapse Quantification system was used to evaluate the degree of prolapse. MAIN OUTCOME MEASURES PISQ-12 scores at 6 months post-operatively. RESULTS The total PISQ-12 score decreased from 29.5 +/- 9.0 to 19.3 +/- 14.7 (P < 0.001), indicating worsening of sexual function 6 months post-operatively. The behavioral, physical, and partner-related domains of PISQ-12 were each significantly reduced (5.2 +/- 3.7 vs. 2.9 +/- 3.7, P = 0.016; 15.4 +/- 4.7 vs. 10.4 +/- 8.6, P = 0.001; 8.9 +/- 3.8 vs. 6.4 +/- 5.5, P = 0.01, respectively). UDI-6 and IIQ-7 scores were significantly improved at the 6-month follow-up, as was anatomic recovery. Of the 33 subjects, 24 (73%) had worse sexual function 6 months after the procedure. CONCLUSION The Prolift procedure provided an effective anatomic cure of POP, but it had an adverse effect on sexual function at 6 months after surgery.
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Affiliation(s)
- Tsung-Hsien Su
- Mackay Memorial Hospital-Division of Urogynecology, Department of Obstetrics and Gynecology, Taipei, Taiwan 92, Chung-San North Road, Section 2, Taipei 104, Taiwan.
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Courtois F, Charvier K, Leriche A, Côté M, Lemieux A. L’évaluation et le traitement des troubles des réactions sexuelles chez l’homme et la femme blessés médullaires. SEXOLOGIES 2009. [DOI: 10.1016/j.sexol.2007.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Woodard TL, Diamond MP. Physiologic measures of sexual function in women: a review. Fertil Steril 2008; 92:19-34. [PMID: 19046582 DOI: 10.1016/j.fertnstert.2008.04.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 04/15/2008] [Accepted: 04/20/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To review and describe physiologic measures of assessing sexual function in women. DESIGN Literature review. SETTING Studies that use instruments designed to measure female sexual function. PATIENT(S) Women participating in studies of female sexual function. INTERVENTION(S) Various instruments that measure physiologic features of female sexual function. MAIN OUTCOME MEASURE(S) Appraisal of the various instruments, including their advantages and disadvantages. RESULT(S) Many unique physiologic methods of evaluating female sexual function have been developed during the past four decades. Each method has its benefits and limitations. CONCLUSION(S) Many physiologic methods exist, but most are not well-validated. In addition there has been an inability to correlate most physiologic measures with subjective measures of sexual arousal. Furthermore, given the complex nature of the sexual response in women, physiologic measures should be considered in context of other data, including the history, physical examination, and validated questionnaires. Nonetheless, the existence of appropriate physiologic measures is vital to our understanding of female sexual function and dysfunction.
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Affiliation(s)
- Terri L Woodard
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, 3750 Woodward Avenue, Detroit, MI 48201, USA
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Nicholas A, Brody S, De Sutter P, De Carufel F. A Woman's History of Vaginal Orgasm is Discernible from Her Walk. J Sex Med 2008; 5:2119-24. [DOI: 10.1111/j.1743-6109.2008.00942.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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40
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Sensations éjaculatoires chez l’homme paraplégique et tétraplégique durant la stimulation par vibromassage avec et sans Gutron®. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s11608-008-0192-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Courtois F, Charvier K, Leriche A, Vézina JG, Côté I, Raymond D, Jacquemin G, Fournier C, Bélanger M. Perceived physiological and orgasmic sensations at ejaculation in spinal cord injured men. J Sex Med 2008; 5:2419-30. [PMID: 18466272 DOI: 10.1111/j.1743-6109.2008.00857.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With the advances in penile vibrator stimulation (PVS), most spinal cord injured (SCI) men can self-ejaculate. Oral midodrine may further increase ejaculation success, while maintaining autonomy. Since most SCI men attempt ejaculation for sexual rather than reproductive purposes, self-ejaculation should be emphasized and sensations explored. AIMS Explore (i) self-ejaculation success rate in SCI men; (ii) vascular parameters indicative of autonomic dysreflexia (AD) during sexual stimulation and ejaculation; and (iii) sensations associated with ejaculation. METHODS Ejaculation was assessed on 81 SCI men with complete ASIA A (49%) and incomplete B to D lesions (51%), subdivided into tetraplegics (C2-T2), paraplegics sensitive to AD (T3-T6), paraplegics not sensitive to AD (T7-T10), paraplegics with lesions to the emission pathway (T11-L2), and paraplegics with lesions interrupting the emission-ejaculation pathways (L3-below). Natural stimulation was attempted first followed, if negative, by PVS followed, if again negative, by PVS combined with oral midodrine (5-25 mg). MAIN OUTCOME MEASURES Ejaculation success, systolic and diastolic blood pressure, and perceived physiological and orgasmic sensations. RESULTS Overall 91% reached ejaculation, 30% with natural stimulation, 49% with PVS and 12% with midodrine plus PVS. Midodrine salvaged up to 27% depending upon the lesion. Physiological and orgasmic sensations were perceived significantly more at ejaculation than sexual stimulation. Tetraplegics did not differ from paraplegics sensitive to AD on perceived cardiovascular and muscular sensations, but perceived significantly more autonomic sensations, and generally more physiological sensations than lower lesions unsensitive to AD. CONCLUSION Most SCI men can self-ejaculate and perceive physiological and orgasmic sensations. The climactic experience of ejaculation seems related to AD, few sensations being reported when AD is not reached, pleasurable climactic sensations being reported when mild to moderate AD is reached, and unpleasant or painful sensations reported with severe AD. Sexual rehabilitation should emphasize self-ejaculation and self-exploration and consider cognitive reframing to maximize sexual perceptions.
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Affiliation(s)
- Frédérique Courtois
- Departement of Sexology, Université du Québec à Montréal, Québec, Montreal, Quebec, Canada.
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Wietek BM, Baron CH, Erb M, Hinninghofen H, Badtke A, Kaps HP, Grodd W, Enck P. Cortical processing of residual ano-rectal sensation in patients with spinal cord injury: an fMRI study. Neurogastroenterol Motil 2008; 20:488-97. [PMID: 18298436 DOI: 10.1111/j.1365-2982.2007.01063.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Eleven paraplegic patients with complete traumatic spinal cord injuries (SCI) [according to American Spinal Injury Association (ASIA) criteria] at different levels (Th3-L3) were investigated during non-painful stimulation of the distal rectum and anal canal, using event related functional magnetic resonance imaging. Although a complete lesion was clinically diagnosed in all, four of them experienced reproducible sensations during anal and/or rectal stimulation. In six patients, individual data analysis revealed significant activation in the right secondary somatosensory cortex SII, the posterior cingular gyrus, the prefrontal cortex, and the left posterior cerebellar lobe during either anal or rectal stimulation or both. A Region of interest analysis using a data mask from healthy controls confirmed that SCI patients demonstrate cortical activation in areas similar to those activated in healthy volunteers, but to a less extensive degree. This supports the notion that the diagnosis of complete spinal cord transsection by ASIA criteria alone may be insufficient for assessment of 'completeness' of cord lesions, and that visceral sensitivity testing may be required in addition.
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Affiliation(s)
- B M Wietek
- Section on Experimental Radiology, Department of Diagnostic Radiology, University Hospital Tübingen, Tübingen, Germany.
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Brody S, Costa RM. Vaginal orgasm is associated with less use of immature psychological defense mechanisms. J Sex Med 2008; 5:1167-1176. [PMID: 18331263 DOI: 10.1111/j.1743-6109.2008.00786.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Freud implied a link between inability to have a vaginal orgasm and psychosexual immaturity. Since Kinsey, many sexologists have asserted that no such link exists. However, empirical testing of the issue has been lacking. AIM The objective was to determine the relationship between different sexual behavior triggers of female orgasm and use of immature psychological defense mechanisms. METHODS Women reported their past month frequency of different sexual behaviors and corresponding orgasm rates and completed the Defense Style Questionnaire (DSQ-40). MAIN OUTCOME MEASURE The association between ability to have vaginal intercourse orgasm (versus clitoral orgasm) and the use of DSQ-40 immature psychological defense mechanisms (associated with various psychopathologies) was examined. RESULTS In a sample of 94 healthy Portuguese women, vaginal orgasm (triggered solely by penile-vaginal intercourse) was associated with less use of DSQ-40 immature defenses. Vaginal orgasm was associated with less somatization, dissociation, displacement, autistic fantasy, devaluation, and isolation of affect. Orgasm from clitoral stimulation or combined clitoral-intercourse stimulation was not associated with less use of immature defenses, and was associated with more use of some immature defenses. In one regression analysis, more masturbation and less vaginal orgasm consistency made independent contributions to the statistical prediction of immature defenses. In another regression analysis, any use of extrinsic clitoral stimulation for intercourse orgasm, and lack of any vaginal orgasm, made independent contributions to the statistical prediction of immature defenses. Vaginally anorgasmic women had immature defenses scores comparable to those of established (depression, social anxiety disorder, panic disorder, and obsessive-compulsive disorder) outpatient psychiatric groups. Results were not confounded by social desirability responding or relationship quality. CONCLUSIONS The results linking penile-vaginal orgasm with less use of immature psychological defense mechanisms are consistent with both early psychoanalytic personality theory and recent advances in sexual physiology. Implications for diagnosis and sex therapy are noted.
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Affiliation(s)
- Stuart Brody
- Division of Psychology, School of Social Sciences, University of the West of Scotland, UK;.
| | - Rui Miguel Costa
- CEDEMA-Associação de Pais e Amigos dos Deficientes Mentais Adultos, Lisbon, Portugal
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Caruso S, Rugolo S, Bandiera S, Mirabella D, Cavallaro A, Cianci A. Clitoral Blood Flow Changes After Surgery for Stress Urinary Incontinence: Pilot Study on TVT Versus TOT Procedures. Urology 2007; 70:554-7. [PMID: 17905114 DOI: 10.1016/j.urology.2007.04.045] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 03/09/2007] [Accepted: 04/30/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To study the effects of mini-invasive surgery using the tension-free vaginal tape (TVT) procedure and the transobturator tape (TOT) procedure in modifying clitoral blood flow in women affected by stress urinary incontinence. METHODS The setting of the prospective open clinical study was the Urogynecologic Service of the Department of Microbiological and Gynecological Science, University of Catania School of Medicine (Catania, Italy). A total of 105 women underwent surgery; 42 (mean age 52.8 years) and 63 (mean age 53.9 years) were treated with TVT and TOT, respectively. Each woman underwent translabial color Doppler ultrasonography to measure the resistance index, pulsatility index, peak systolic velocity, and end-diastolic velocity of the clitoral arteries, before and 6 months postoperatively. RESULTS In the TVT group, the mean pulsatility index and mean peak systolic velocity were significantly lower and the mean resistance index was significantly greater compared with the pretreatment values (P <0.5). In the TOT group, each color Doppler measurement was similar to that obtained at baseline (P = NS). CONCLUSIONS The different vaginal approach for these two surgical methods influenced clitoral blood flow. Our data could add new information about sexual behavior after incontinence treatment, particularly the impact of clitoral blood flow changes.
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Affiliation(s)
- Salvatore Caruso
- Department of Microbiological and Gynecological Science, University of Catania School of Medicine, Catania, Italy.
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Biologic basis for female orgasm: A retrospective report. CURRENT SEXUAL HEALTH REPORTS 2007. [DOI: 10.1007/s11930-007-0015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Park K, Jeong GW. The role of functional MRI in neural assessment of female sexual dysfunction. CURRENT SEXUAL HEALTH REPORTS 2007. [DOI: 10.1007/bf02938329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Bianchi-Demicheli F, Ortigue S. Toward an understanding of the cerebral substrates of woman's orgasm. Neuropsychologia 2007; 45:2645-59. [PMID: 17543356 DOI: 10.1016/j.neuropsychologia.2007.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 04/07/2007] [Accepted: 04/13/2007] [Indexed: 01/29/2023]
Abstract
The way women experience orgasm is of interest to scientists, clinicians, and laypeople. Whereas the origin and the function of a woman's orgasm remains controversial, the current models of sexual function acknowledge a combined role of central (spinal and cerebral) and peripheral processes during orgasm experience. At the central level, although it is accepted that the spinal cord drives orgasm, the cerebral involvement and cognitive representation of a woman's orgasm has not been extensively investigated. Important gaps in our knowledge remain. Recently, the astonishing advances of neuroimaging techniques applied in parallel with a neuropsychological approach allowed the unravelling of specific functional neuroanatomy of a woman's orgasm. Here, clinical and experimental findings on the cortico-subcortical pathway of a woman's orgasm are reviewed and compared with the neural basis of a man's orgasm. By defining the specific brain areas that sustain the assumed higher-order representation of a woman's orgasm, this review provides a foundation for future studies. The next challenge of functional imaging and neuropsychological studies is to understand the hierarchical interactions between these multiple cortical areas, not only with a correlation analysis but also with high spatio-temporal resolution techniques demonstrating the causal necessity, the temporal time course and the direction of the causality. Further studies using a multi-disciplinary approach are needed to identify the spatio-temporal dynamic of a woman's orgasm, its dysfunctions and possible new treatments.
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Affiliation(s)
- Francesco Bianchi-Demicheli
- Psychosomatic Gynaecology and Sexology Unit, Emergency and Liaison Services, Geneva University Psychiatric Centre, Switzerland
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Lammertse D, Dungan D, Dreisbach J, Falci S, Flanders A, Marino R, Schwartz E. Neuroimaging in traumatic spinal cord injury: an evidence-based review for clinical practice and research. J Spinal Cord Med 2007; 30:205-14. [PMID: 17684886 PMCID: PMC2031961 DOI: 10.1080/10790268.2007.11753928] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 02/28/2007] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To perform an evidence-based review of the literature on neuroimaging techniques utilized in spinal cord injury clinical practice and research. METHODS A search of the medical literature for articles on specific neuroimaging techniques used in SCI resulted in 2,302 published reports. Review at the abstract and full report level yielded 99 clinical and preclinical articles that were evaluated in detail. Sixty nine were clinical research studies subjected to quality of evidence grading. Twenty-three articles were drawn from the pre-clinical animal model literature and used for supportive evidence. Seven review articles were included to add an element of previous syntheses of current thinking on neuroimaging topics to the committee process (the review articles were not graded for quality of evidence). A list of clinical and research questions that might be answered on a variety of neuroimaging topics was created for use in article review. Recommendations on the use of neuroimaging in spinal cord injury treatment and research were made based on the quality of evidence. RESULTS Of the 69 original clinical research articles covering a range of neuroimaging questions, only one was judged to provide Class I evidence, 22 provided Class II evidence, 17 Class III evidence, and 29 Class IV evidence. RECOMMENDATIONS MRI should be used as the imaging modality of choice for evaluation of the spinal cord after injury. CT and plain radiography should be used to assess the bony anatomy of the spine in patients with SCI. MRI may be used to identify the location of spinal cord injury. MRI may be used to demonstrate the degree of spinal cord compression after SCI. MRI findings of parenchymal hemorrhage/ contusion, edema, and spinal cord disruption in acute and subacute SCI may contribute to the understanding of severity of injury and prognosis for neurological improvement. MRI-Diffusion Weighted Imaging may be useful in quantifying the extent of axonal loss after spinal cord injury. Functional MRI may be useful in measuring the anatomic functional/metabolic correlates of sensory-motor activities in persons with SCI. MR Spectroscopy may be used to measure the biochemical characteristics of the brain and spinal cord following SCI. Intraoperative Spinal Sonography may be used to identify spinal and spinal cord anatomy and gross pathology during surgical procedures. Further research in these areas is warranted to improve the strength of evidence supporting the use of neuroimaging modalities. Positron Emission Tomography may be used to assess metabolic activity of CNS tissue (brain and spinal cord) in patients with SCI.
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Affiliation(s)
- Daniel Lammertse
- Department of Physical Medicine and Rehabilitation, Univeristy of Colorado Denver Health Science Center, Denver Cororado, USA.
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Brody S. Blood pressure reactivity to stress is better for people who recently had penile–vaginal intercourse than for people who had other or no sexual activity. Biol Psychol 2006; 71:214-22. [PMID: 15961213 DOI: 10.1016/j.biopsycho.2005.03.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 03/12/2005] [Indexed: 10/25/2022]
Abstract
Penile-vaginal intercourse (PVI) but not other sexual behavior is associated with better psychological and physiological function. I examined the relationship of sexual behavior patterns to blood pressure (BP) and its reactivity to stress (public speaking and verbal arithmetic). For a fortnight, 24 women and 22 men used daily diaries to record PVI, masturbation, and partnered sexual behavior in the absence of PVI. Persons who reported PVI (but no other sexual activities) had better stress response (less reactivity and/or lower baseline levels) than persons reporting other or no sexual behaviors. Persons who only masturbated or had partnered sex without PVI had 14 mmHg more systolic BP reactivity than those who had PVI but not the other behaviors. Many variables were examined but failed to confound the observed relationships. The magnitude of the sexual behavior effect on BP reactivity is greater than of other factors in the literature. These findings add to the research corpus on the benefits of PVI (differentiated from other sexual activities).
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Affiliation(s)
- Stuart Brody
- Division of Psychology, School of Social Sciences, University of Paisley, Paisley PA1 2BE, Scotland, UK.
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Helström L, Nilsson B. Impact of vaginal surgery on sexuality and quality of life in women with urinary incontinence or genital descensus. Acta Obstet Gynecol Scand 2005; 84:79-84. [PMID: 15603572 DOI: 10.1111/j.0001-6349.2005.00668.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To study the effect of vaginal surgery for urinary incontinence and genital descensus on sexual function and quality of life. METHODS The day before surgery, 118 women, of whom 41 were admitted for urinary incontinence and 77 for genital descensus, accepted to complete a questionnaire containing questions of uterovaginal symptoms, quality of life, and sexuality. One year later, 101 women, of them 88 were sexually active, accepted to complete the same questionnaire by mail. RESULTS The women reported improvement in two different scales for quality of life, and there was no difference between surgery for genital descensus and that for urinary stress incontinence. The total score for sexual variables was deteriorated, and the mean frequency of sexual intercourse was reduced. Among women with genital descensus, 14% experienced more urinary incontinence and 13% more dyspareunia after the operation. CONCLUSION Although pelvic floor disorders are known to impair sexual function, there was no improvement in sexuality after surgery for urinary incontinence or genital descensus. On the contrary, it seems that sexual function might deteriorate and dyspareunia get worse after vaginal surgery. The explanation for this might be vulnerability to disturbance of vaginal nerve and blood supply of the vaginal wall resulting in impaired sexual arousal and lubrication.
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Affiliation(s)
- Lotti Helström
- Department of Women and Child Health, Karolinska Hospital, Stockholm, Sweden.
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