Retinal vascular findings and penile cavernosal artery blood flow

Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction

INTRODUCTION

Male and female sexual dysfunction (SD) is considered a multifactorial condition. Numerous studies have shown the involvement of inflammatory processes in this pathological condition. Sexual intercourse requires healthy and functioning vessels to supply the pelvic region in both males and females, generating penile erection and clitoral and vaginal lubrication, respectively. Cardiovascular diseases and associated risk factors may contribute negatively to pelvic blood flow, possibly through immune system activation.

AIM

The study aimed to address the correlation between vascular inflammation driven by immune system activation and SD in males and females.

METHODS

A literature review was performed to identify articles addressing male and female SD and vascular inflammation. Key words included "male and female sexual dysfunction," "vascular inflammation," "iliac and pudendal arteries dysfunction," "genitourinary tract," and "blood flow."

MAIN OUTCOME MEASURES

Management of systemic and local inflammation may be a useful alternative to improve SD and reduce the risk of cardiovascular diseases in the future.

RESULTS

Increased levels of cytokines and chemokines have been detected in humans and animals with hypertension, obesity, and diabetic conditions. Chronic activation of the innate immune system, especially by pathogen- or damage-associated molecular patterns, and metabolic-related disorders may act as triggers further contributing to an increased inflammatory condition. Due to the reduced size of vessels, SD and retinal vascular impairments have been shown to be predictive factors for cardiovascular diseases. Therefore, considering that blood flow to the genitalia is essential for sexual function, endothelial dysfunction and vascular remodeling, secondary to chronic immune system activation, may be implicated in male and female vasculogenic SD.

CONCLUSIONS

Several conditions appear to play a role in SD. In the present review, we have identified a role for the immune system in generating vascular and tissue impairments contributing to erectile dysfunction and female SD. Calmasini FB, Klee N, Webb RC, et al. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019;7:604-613.

Correlation between penile cavernosal artery blood flow and retinal vascular findings in arteriogenic erectile dysfunction

Objectives:

Arteriogenic erectile dysfunction (ED) is a target organ disease of atherosclerosis, and therefore might be a predictor of systemic atherosclerosis. Being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. We investigated the possible correlation between penile cavernosal artery blood flow and retinal vascular findings in patients with arteriogenic ED.

Patients and methods:

Sixty patients with ED were divided according to the peak systolic velocity (PSV) in their penile cavernosal arteries into two groups; Group A included 30 patients with PSV less than 25 cm/sec, and Group B included 30 patients with PSV more than 35 cm/sec. Blood flow in the penile cavernosal artery was measured with color Doppler ultrasonography. All patients were assessed by ocular fundus examination under amydriatic conditions to evaluate retinal vascular atherosclerotic changes using Hyman’s classification.

Results:

Evidence of retinal vascular atherosclerotic changes was found in 19 patients (63.3%) in Group A and in 10 patients (33.3%) in Group B.

Conclusions:

Our study confirms the possibility of predicting penile arterial vascular status in patients with ED from their retinal vascular findings by using amydriatic simple, practical funduscopy.

Small-vessel lower extremity arterial disease and erectile dysfunction: The Rancho Bernardo study

OBJECTIVE

Although erectile dysfunction (ED) has been associated with heart disease risk factors and large-vessel lower extremity arterial disease (LEAD), no community-based studies have reported the association between ED and small-vessel LEAD, despite the similar size of the arteries affected. We examined whether small-vessel LEAD is associated with ED, and whether this association is independent of cardiovascular risk factors and medications.

METHODS AND RESULTS

Community-dwelling men, average age 71, completed the International Index of Erectile Function-5 questionnaire and had measurements recorded of toe-brachial index (TBI), a measure of small-vessel LEAD. TBI, 12 cardiovascular risk factors, and medications were used as categorical predictors in age-adjusted bivariate analyses, and as continuous covariates in multivariable linear regression analyses, to determine their independent association with severity of ED. In the age-adjusted categorical model, the level of TBI (low, medium, high) was associated with the severity of ED (beta=0.364; 95% CI: 0.102, 0.625). In the final multivariable linear regression model, which controlled for age and systolic blood pressure, lower TBI (i.e., more severe small-vessel LEAD) was significantly and independently associated with more severe ED (beta=0.422; 95% CI: 0.019, 0.826).

CONCLUSIONS

The severity of small-vessel LEAD is significantly and independently associated with the severity of ED. The mechanism for this association remains to be determined, but these data are compatible with the hypothesis that concurrent ED and small-vessel LEAD signify a diffuse microvascular process involving multiple small-vessel arterial beds.

Peak systolic velocity in patients with arterial erectile dysfunction and peripheral arterial disease

The aim of this study is to evaluate whether penile peak systolic velocity (PSV) varies in patients with erectile dysfunction (ED) due to artery insufficiency associated with abnormalities in other arterial districts or not. To accomplish this, cavernous artery PSV was determined 10, 20 and 30 min after intracavernously administering alprostadil by means of echo-color Doppler to a total of 65 consecutive patients (age range 52-78 years). In all, 18 patients had ED alone (group A) and served as controls, 15 had ED plus atheroma plaques and/or marked intima-media thickness of the common carotid artery (group B); 17 had ED plus lower limb artery abnormalities; 17 had ED plus carotid and lower limb artery abnormalities (group D). Group B and C patients had a similar PSV, which turned out to be significantly lower than that in group A. Group D patients had the lowest PSV, which proved to be significantly lower than that in groups A, B and C. This study shows that a more generalized peripheral atherosclerotic process is associated with a severer penile artery insufficiency. Therefore, ED patients with a severe arterial insufficiency should undergo an extensive echo-duplex examination.