ORIGINAL RESEARCH—COUPLES' SEXUAL DYSFUNCTIONS: The Effects of Treating Male Hypogonadism on Couples’ Sexual Desire and Function

Sexual incentive motivation, sexual behavior, and general arousal: Do rats and humans tell the same story?

Sexual incentive stimuli activate sexual motivation and heighten the level of general arousal. The sexual motive may induce the individual to approach the incentive, and eventually to initiate sexual acts. Both approach and the ensuing copulatory interaction further enhance general arousal. We present data from rodents and humans in support of these assertions. We then suggest that orgasm is experienced when the combined level of excitation surpasses a threshold. In order to analyze the neurobiological bases of sexual motivation, we employ the concept of a central motive state. We then discuss the mechanisms involved in the long- and short-term control of that state as well as those mediating the momentaneous actions of sexual incentive stimuli. This leads to an analysis of the neurobiology behind the interindividual differences in responsivity of the sexual central motive state. Knowledge is still fragmentary, and many contradictory observations have been made. Nevertheless, we conclude that the basic mechanisms of sexual motivation and the role of general arousal are similar in rodents and humans.

Sexual functions of females married to males with semi-rigid penile implant: A cross-sectional study

Erectile dysfunction is a highly prevalent disorder. It is estimated that more than 50% of men who ranged in age from 40 to 70 years old suffer from erectile dysfunction to some degree. We aimed in this pilot cross-sectional study to determine female sexual function and social satisfaction before and 6 months after penile prosthesis implant. This study was carried on 50 consecutive married women whose husbands underwent malleable penile prosthesis implant in our department from July 2015 to July 2016. Our results showed significant increase in desire, lubrication, orgasm, and satisfaction scores after 6 months of penile prosthesis operation compared to scores before penile prosthesis implant (p < 0.001). Moreover, our study demonstrated significant increase in lubrication score in non-female genital mutilation after penile prosthesis implant (p 0.049). In addition, the results showed inverse correlations between age and female genital mutilation and female sexual function index scores after penile prosthesis implant. On the contrary, there were no correlations between number of offsprings and residence and duration of marriage and different domains of female sexual function index scores. Finally, penile prosthesis operation for patients with erectile dysfunction has a great impact on sexual functions of their female partners. We recommend preoperative and postoperative female partner involvement as a part of the treatment strategy for men undergoing penile prosthesis implant.

Sexual Dysfunction in Type 2 Diabetes at Diagnosis: Progression over Time and Drug and Non-Drug Correlated Factors

Aims

To present the longitudinal data of the SUBITO-DE study, a prospective survey involving male patients with new or recently diagnosed type 2 diabetes mellitus (T2DM) (<24 months).

Materials and Methods

Sexual function was assessed in male patients with T2DM at baseline (phase 1) and after a mean follow-up of 18 months (phase 2). Standard metabolic parameters and sexual and depressive symptoms were evaluated.

Results

Six of the 499 enrolled patients died of different causes during phase 1. Of the 493 surviving men invited to participate in phase 2, 450 (mean age 59.0±9.0 years) (90.2%) accepted and 43 (8.2%) were lost to follow-up. As compared to baseline, the proportion of the men who reported improvement in erectile dysfunction (ED) at follow-up was nearly double that of the men who reported worsening of ED (22.6% vs. 12.8%). The increase in frequency of sexual activity the men reported at follow-up assessment indicates that many never treated before baseline were taking an ED drug during the study period (106 subjects). Phosphodiesterase type 5 inhibitors (PDE5i) were the ED drugs most commonly taken at both baseline and follow-up. An overall improvement over baseline values was observed in metabolic targets for T2DM and depressive symptoms. Conversely, no change in lifestyle behaviors was recorded during the study.

Conclusions

Sexual dysfunction is a major concern in men with T2DM. The SUBITO-DE study demonstrates that, when combined with adequate counseling and tailored PDE5i therapy, an integrated approach to achieving metabolic targets in men with T2DM can improve sexual function as well as depressive symptoms.

Endocrine function over time in patients with myotonic dystrophy type 1

BACKGROUND AND PURPOSE

Patients with myotonic dystrophy type 1 (DM1) have an increased incidence of endocrine dysfunction. In this study, the temporal evolution of endocrine dysfunction in patients with DM1 was investigated.

METHODS

Endocrine function was assessed in 68 patients with DM1, in whom endocrine function had been followed, on average, for 8 years. The endocrine function was assessed by measuring the concentration of hormones and metabolites in blood and by validating libido with questionnaires.

RESULTS

At baseline, 30 of the 68 patients presented with at least one hormonal dysfunction. When re-evaluated after 8 years, 57 of 68 patients had endocrine dysfunction. Diabetic patients had increased from one to four. At follow-up, hyperparathyroidism occurred in 25% and abnormal thyroid-stimulating hormone in 21%, compared with 14% and 9% at baseline. Sixteen of 33 men had increased luteinizing hormone levels compared with seven at baseline.

CONCLUSIONS

Our findings show that endocrine abnormalities amongst patients with DM1 increase over time. Based on these findings it is suggested that correctable endocrine abnormalities should be monitored periodically in this patient group.

Unconsummated marriage: can it still be considered a consequence of vaginismus?

Unconsummated marriage (UM) is the failure to perform successful sexual intercourse at the beginning of the marriage. Vaginismus has been traditionally reported as the leading cause. ED is also a leading cause for UM. This appears to be a significant problem in the conservative middle-Eastern societies and in the developing countries, where couples are strongly prevented by religious rules and cultural taboos from sexual experiences before wedding. One could think that according to major sexual freedom and information, in Western countries UM is now disappearing, but the number of observed cases by the authors in 2008-2012 was relevant. The aim of this study is to compare the literature data from non-Western countries with the features of UM in Western ones, focusing on cases observed by the authors, and to verify whether the etiology of UM proposed in the '70s is still relevant, outlining any changes that occur in current reality. In our series, traditional appearance of UM is no more effective, while the role of man is undervalued, because of his frailty, lack of self-confidence and ignorance, expressing a social and cultural change of man's role in the couple.

Emerging concepts in erectile preservation following radical prostatectomy: a guide for clinicians

Radical prostatectomy (RP) is a commonly performed procedure for the management of prostate cancer. While documented oncologic outcome for early stage disease is excellent, functional impairments such as incontinence and erectile dysfunction (ED) are common after the procedure. Recent evidence has implicated cavernous nerve damage and subsequent corporal oxygen deprivation, as well as corporal inflammation, in the pathogenesis of post-RP ED. Targeted therapies such as oral phosphodiesterase-5 inhibitors, mechanical vacuum erection devices, local alprostadil delivery and testosterone replacement (for hypogonal patients) have demonstrated some efficacy in the management of post-RP ED. This review aggregates much of the recent data in support of these therapies and critically reviews them. The article then presents tools to assess patients and partner sexual function to aid in identifying and monitoring post-RP ED. Finally, the article describes a protocol in use at Baylor College of Medicine as a guide toward the development of a protocol for erectile preservation (EP). The purpose of this work is to educate clinicians on emerging concepts in EP and provide an implementable protocol for use in practice.

Favorable female sexual function is associated with patient satisfaction after inflatable penile prosthesis implantation

INTRODUCTION

The interrelationship between male and female sexual function suggests that partner outcomes after inflatable penile prosthesis (IPP) implantation must be assessed.

AIM

We examined predictors of patient and partner satisfaction, and the relationship between patient satisfaction and female sexual function, after IPP implantation.

METHODS

We designed a questionnaire (scored 1-5) assessing satisfaction with various domains related to the IPP (e.g., overall satisfaction and satisfaction related to: length, width, ease of use, and partner perception). Scores ≥3 were classified as satisfied. The Female Sexual Function Index (FSFI) was administered to the female partners of patients that underwent an IPP.

MAIN OUTCOME MEASURES

Independent samples Students' t-test was used to compare various FSFI domain scores in relation to male and female satisfaction. Analysis of variance test was used to assess linear regression correlation between various continuous variables.

RESULTS

45 men and 32 partners with a mean follow-up of 2.2 years were contacted. Overall satisfaction for men and women was 3.60 and 3.62 (out of 5), respectively. Partner FSFI scores were higher, respectively, in men with higher implant satisfaction than those with lower implant satisfaction (25.09 ± 6.79 vs. 13.67 ± 12.70, P < 0.001). Regression analysis suggests a direct correlation between FSFI scores and the degree of patient (r = 0.50, r(2) = 0.23; P = 0.001) and partner (r = 0.70 r(2) = 0.50; P < 0.001) satisfaction with the IPP.

CONCLUSION

Patient satisfaction after IPP implantation implies favorable partner sexual function compared to that of unsatisfied patients. The correlation observed suggests that patients not satisfied with their IPP are likely to have female partners at high risk for female sexual dysfunction. Further interventions may be needed to improve patient and partner sexual function, particularly unsatisfied men and their female partners.

The female factor: predicting compliance with a post-prostatectomy erectile preservation program

INTRODUCTION

Early post-radical prostatectomy (RP) erectile preservation (EP) therapy may be critical to preserve erections after surgery.

AIM

To assess if pre-RP female sexual function predicts of partner compliance with an EP protocol.

MAIN OUTCOME MEASURES

Compliance, defined as use of localized penile EP therapy (intracavernosal injections [ICIs], vacuum erection device [VED], or alprostadil) at 3 and 6 months after RP.

METHODS

Records of patients enrolled in our EP program from April 2007 to June 2008 were reviewed. Before surgery, patients completed the Sexual Health Inventory for Men (SHIM) and their female partners completed the Female Sexual Function Index (FSFI) questionnaire. Prior to surgery, patients were advised to take sildenafil 25 mg every nightly and use a 250-µg alprostadil suppository three times/week. At 1 month, additional daily use of a VED was encouraged. All patients unable to achieve erections sufficient for penetration were encouraged to initiate ICI of Trimix (phentolamine, papaverine, and PGE1) twice weekly after 3 months following surgery. Data were analyzed using binary logistic regression analysis holding all input variables constant.

RESULTS

Twenty-nine patients had preoperative SHIM>7 and pre-RP partner FSFI data available. After a 4-week follow-up, compliance with alprostadil suppository declined and both ICI and VED usage increased. At 6 months, six (25.0%) patients had return of natural erectile function and 22 (91.7%) were achieving assisted erections. Higher preoperative partner FSFI scores were associated with greater compliance to the localized penile therapy component of our EP protocol (risk ratio 3.8, P=0.05).

CONCLUSIONS

Preoperative female sexual function correlated with greater partner compliance with the localized component of our EP protocol. Consideration of a female partner's preoperative sexual function in predicting patient erectile function recovery after RP is warranted. Future studies are necessary to determine the clinical significance of this factor.

Treatment of 161 men with symptomatic late onset hypogonadism with long-acting parenteral testosterone undecanoate: effects on body composition, lipids, and psychosexual complaints

INTRODUCTION

Elderly men may suffer from late-onset hypogonadism (LOH). The long-term effects of long-acting testosterone undecanoate (TU) in a large number of LOH men have not yet been reported. Aims.  We analyzed the effects of normalization of plasma testosterone (T) in LOH men.

METHODS

The records of 161 men with LOH (baseline T<300 ng/dL) were reviewed and 100 men had used parenteral TU for >12 months. The mean duration of treatment was 90.6 weeks (54 to 150 weeks).

MAIN OUTCOME MEASURES

Body mass index (BMI), waist circumference, percentage body fat, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, prostate-specific antigen (PSA), and hematocrit were measured. Further the Aging Male Symptoms' scale (AMS) and the International Index of Erectile Function (IIEF-5 and 15) were scored.

RESULTS

T therapy was associated with a significant decline in waist circumference (P=0.028) and percentage body fat (P<0.001), but no change of BMI. Total cholesterol and LDL cholesterol declined significantly (P=0.005 and P=0.024, respectively), with no significant changes of HDL cholesterol and triglycerides. The scores of sub-scales of AMS (psychological, somotovegetative and sexual factors) decreased (P=0.044, P=0.200 and P=0.071, respectively). The mean IIEF-5 (P=0.011) and IIEF-15 scores (P=0.021) improved significantly. Erectile function domain, orgasmic function domain, sexual desire domain, intercourse satisfaction domain, and overall satisfaction domain improved. Median PSA rose from 0.95 (0.640; 1.558) ng/mL to 1.480 (1.015; 2.275) ng/mL (P<0.001), with 11 patients >4 ng/mL (4.01-13.21). On biopsy there was no evidence for malignancy. The mean hematocrit level increased significantly from 42.3±3.4% to 47.1±3.8%.

CONCLUSIONS

Normalizing serum T in men with LOH resulted in improvement of the metabolic syndrome, mood and sexual functions and appeared acceptably safe.

Short term testosterone replacement therapy improves libido and body composition

OBJECTIVE

To assess the efficacy and safety of testosterone replacement in males with late-onset hypogonadism compared to hypogonadal men without replacement, and controls, during six months.

METHODS

We assessed, through ADAM, AMS, IIEF-5 and SF-36 questionnaires, and through clinical and laboratory examinations, 62 patients divided into three groups: 17 hypogonadal males (HR) used intramuscular testosterone every three weeks; 14 hypogonadal males (HV) and 31 non-hypogonadal males (CV) used oral vitamins daily.

RESULTS

When compared to others, HR group obtained libido improvement assessed by ADAM 1 (p = 0.004), and borderline sexual potency improvement assessed by IIEF-5 (p = 0.053), besides a decrease in waist circumference after eight weeks (p = 0.018). The remaining parameters did not differ between the groups. PSA and hematocrit remained stable in those using testosterone.

CONCLUSION

Six months of testosterone replacement improved sexuality and body composition, with prostatic and hematological safety.

Psychobiological correlates of women's sexual interest as perceived by patients with erectile dysfunction

INTRODUCTION

We have recently reported that the perceived loss of a partner's sexual desire is independently associated with an increased incidence of major cardiovascular events in patients with erectile dysfunction (ED). No study has ever evaluated the specific impact of men's perception of women's sexual desire on male sexual function and lifestyle attitudes in ED subjects.

AIM

To evaluate the clinical correlates of the perception of a partner's sexual desire [hypoactive sexual desire (HSD)] in a consecutive series of subjects seeking medical care for ED.

METHODS

A consecutive series of 2,303 heterosexual male patients (mean age 58.1 ± 10.5) was studied.

MAIN OUTCOME MEASURES

Patients were interviewed with the Structured Interview on Erectile Dysfunction (SIEDY) structured interview. They also completed the Middlesex Hospital Questionnaire, a brief questionnaire for the screening of the symptoms of mental disorders.

RESULTS

Among the patients studied, 458 (19.9%) reported a mild loss of their partner's desire, 302 (13.1%) a moderate reduction of libido, while 118 (5.1%) complained of a complete absence of sexual interest on the part of their partner. After adjustment for confounding factors, the perceived women's HSD was associated with different sexual, lifestyle, and relational factors. In particular, more extra-marital affairs, a longer and more hostile couple relationship, as well as a stressful job and both alcohol and smoking abuse were all significantly associated with perceived women's HSD. In addition, the perceived women's moderate to severe HSD was significantly associated with severe ED and less frequent sexual intercourse. Finally, partner HSD was significantly associated with a stepwise increase of free-floating anxiety and depressive symptoms (adj. r = 0.081, P < 0.05 and 0.158, P < 0.0001, respectively).

CONCLUSIONS

Perceived sexual interest (éros) on the part of the woman can be seen for men not only as a fun and enjoyable behavior, but also a safe strategy for improving a man's overall health and life expectancy.