SEXUAL IMPOTENCE AND THE LIMBIC SYSTEM

Neuroelectric Correlates of Human Sexuality: A Review and Meta-Analysis

Many reviews on sexual arousal in humans focus on different brain imaging methods and behavioral observations. Although neurotransmission in the brain is mainly performed through electrochemical signals, there are no systematic reviews of the electrophysiological correlates of sexual arousal. We performed a systematic search on this subject and reviewed 255 studies including various electrophysiological methods. Our results show how neuroelectric signals have been used to investigate genital somatotopy as well as basic genital physiology during sexual arousal and how cortical electric signals have been recorded during orgasm. Moreover, experiments on the interactions of cognition and sexual arousal in healthy subjects and in individuals with abnormal sexual preferences were analyzed as well as case studies on sexual disturbances associated with diseases of the nervous system. In addition, 25 studies focusing on brain potentials during the interaction of cognition and sexual arousal were eligible for meta-analysis. The results showed significant effect sizes for specific brain potentials during sexual stimulation (P3: Cohen's d = 1.82, N = 300, LPP: Cohen's d = 2.30, N = 510) with high heterogeneity between the combined studies. Taken together, our review shows how neuroelectric methods can consistently differentiate sexual arousal from other emotional states.

Sexual Dysfunction of Patients with Diffuse Low-Grade Glioma: A Qualitative Review of a Neglected Concern

Simple Summary

Patients suffering from diffuse Low-Grade Glioma (LGG) are usually young adults and present long life expectancy thanks to multimodal therapeutic management. In this context, the preservation of quality of life (QoL) is essential, and sexual health is part of it. We reviewed here the current knowledge about sexual dysfunction in LGG patients. We highlighted how this issue has been largely neglected, despite an incidence from 44 to 62% in the rare series of the literature. Thus, there is a need to assess more systematically the occurrence of SD in clinical routine in order to adapt cancer treatments accordingly, to manage actively these troubles, and finally to improve patients’ QoL in the long run.

Abstract

Diffuse low-grade gliomas (LGG) commonly affect young adults and display a slow evolution, with a life expectancy that can surpass 15 years, thanks to multimodal therapeutic management. Therefore, preservation of quality of life (QoL), including sexual health, is mandatory. We systematically searched available medical databases of Pubmed, Cochrane, and Scopus for studies that reported data on sexual activity or dysfunction (SD) in LGG patients. We analyzed results to determine incidence of SD and its association with QoL in this population. Three studies focused on SD incidence in patients presenting specifically LGG, or brain tumors including LGG. They comprised 124 brain tumor patients, including 62 LGG, with SD incidence ranging from 44 to 63%. SD was reported by more than 50% of interrogated women in the three studies. Regarding QoL, two out of the three studies found significant associations between SD and alterations of QoL parameters, particularly in the field of social and functional wellbeing. Finally, we discussed those results regarding methods of evaluation, inherent biases, and therapeutic implications regarding antiseizure medications and also planning of surgery, chemo-, and radiotherapy. Our review showed that SD is highly prevalent but still poorly studied in LGG patients. As those patients are usually young and enjoy an active life, there is a need to assess more systematically the occurrence of SD in clinical routine, in order to adapt cancer treatments accordingly, to manage actively these troubles, and finally to improve patients’ QoL in the long run.

Sexual outcome after epilepsy surgery

The aim of this study was to provide a description of patient-perceived sexual change after temporal lobe resection (TLR) and extratemporal resection (ETR). Fifty-eight TLR and sixteen ETR patients completed a semistructured interview and questionnaire assessing sexual change after epilepsy surgery. Five areas of sexual functioning were addressed: sexual drive, thoughts/fantasies, interest, masturbation, and activity. Each patient's perception of sexual changes relative to perceived levels of normal functioning was assessed. Characteristically, the onset of sexual change occurred in the first three postoperative months and persisted to the time of interview. A postoperative sexual change was significantly more likely to be reported by patients who had undergone TLR (64%) than ETR (25%). In the TLR group, sexual change was significantly more frequent following right-sided resections. Marked sexual change occurred more frequently in females than males. Postoperative sexual change is an important outcome feature after epilepsy surgery. The predisposition of TLR patients to postoperative change provides further evidence for a temporal lobe contribution to sexual function.

The amygdala and sexual drive: Insights from temporal lobe epilepsy surgery

The aim of this study was to explore the relationship between the amygdala and human sex drive. We compared amygdalar volume in groups of patients with or without sexual changes after temporal lobe resection and in age-matched neurologically normal subjects. Forty-five patients with intractable temporal lobe epilepsy who underwent surgical resection in the Comprehensive Epilepsy Program at the Austin and Repatriation Medical Centre completed a semistructured interview and questionnaire relating to sexual outcome after surgery. Volumetric analyses of both amygdalae were conducted on the patients' preoperative T(1)-weighted magnetic resonance imaging scans and those of 46 neurologically normal controls. Patients who reported a postoperative sexual increase had a significantly larger amygdalar volume contralateral to the site of their resective surgery than patients with a sexual decrease or no change than control subjects. There was a significant positive relationship between contralateral amygdalar volume and the maximum degree of sexual change. We have demonstrated a relationship between contralateral amygdalar volume and sexual outcome in patients undergoing temporal lobe resection. This finding provides evidence for an important role of the amygdala in regulating human sexual behavior. A larger contralateral amygdala may contribute to the expression of increased or improved sexuality after temporal lobe resection.

Gustave Flaubert's illness: a case report in evidence against the erroneous notion of psychogenic epilepsy

The concept of psychogenic epilepsy was recently revived by Sartre (L'Idiot de la Famille, 1971-2) in relation to Gustave Flaubert's epilepsy, which he believed was secondary to hysterical neurosis and not due to a cerebral lesion. A detailed clinical description of Gustave Flaubert's personal and medical history from birth to death is provided. The relationships between his epileptic seizures and both his personal life and the response of others to the attacks are discussed, as is the interaction between seizure occurrence and his literary work and productivity. The various diagnoses made by medical and nonmedical persons during and after Flaubert's lifetime are then reviewed. Particular emphasis is given to Sartre's purely psychogenic interpretation of the seizures, to his total disinterest in their medical aspects, and to the fact that he did not obtain any medical opinions. It is shown that a definitive diagnosis can be made for Flaubert's illness--that of epilepsy associated with a quite normal psychosocial response by current standards. Moreover, the clinical nature of the seizures and other clinical details permit the more specific diagnosis of "complex partial epilepsy of occipital-temporal origin, secondary to lesion of the left posterior hemisphere with occasional secondary generalization of seizures." The concept of the existence of "psychogenic epilepsy" is reaffirmed as erroneous, despite the occasional precipitation of seizures in some individuals by psychological factors. Finally, Gustave Flaubert's case, like Dostoevski's, points to the possible coexistence of a serious and poorly controlled form of epilepsy with true literary genius without the latter being dependent in any way on the former.

Hypogonadism, hyperprolactinaemia, and temporal lobe epilepsy in hyposexual men

Previously unrecognised temporal lobe epilepsy (TLE) was diagnosed in 11 of 16 hyposexual men. 6 had neuroendocrine abnormalities (hypogonadism in 4 and hyperprolactinaemia in 2). 4 men with hypogonadism and TLE had persistently subnormal serum testosterone, with a blunted luteinising hormone (LH) response to luteinising hormone releasing hormone (LHRH) in 2 and, in these men, unlike those with isolated hypogonadism, there was no improvement in libido or potency when parenteral testosterone was given. Men with TLE and hyperprolactinaemia had normal serum testosterone and an enhanced serum LH response after LHRH, but effective doses of the dopaminergic agonists, bromocriptine or pergolide, did not produce sustained normoprolactinaemia. In the men with neuroendocrine dysfunction and TLE the most effective therapeutic sequence was first to treat the epilepsy with anticonvulsants and then to add appropriate neuroendocrine therapy. In 2 men hormone levels became normal and sexual function was restored on anticonvulsant therapy alone.

Sexual and hypothalamic dysfunction in the postconcussional syndrome

Nineteen males with a well-developed postconcussional syndrome were studied by CT-scan, by psychometric testing and by endocrinological evaluation including a variety of laboratory tests and an assessment of sexual function, 68% had cerebral atrophy on CT-scan and 79% were intellectually impaired, 37% to a severe degree. Sexual dysfunction (reduced libido and/or erective dysfunction) related to the head injury occurred in 58%, and severe intellectual impairment was significantly more frequent in this group. Increased plasma concentration of follicle stimulating hormone was observed in 37%, suggesting a reduced spermiogenesis. The possibility of a primary hypothalamic disorder causing reduced spermiogenesis is raised. Otherwise no radiological or laboratory evidence of major hypothalamic-pituitary dysfunction was demonstrated. The high frequency of cerebral atrophy and intellectual deterioration in postconcussional syndrome suggests organic brain dysfunction, but not causal relationship was established.

Sexual and pituitary-testicular function in torture victims

Seventeen men who previously had been subjected to torture were studied. Sexual dysfunction (reduced libido and erectile dysfunction) occurred in 29%. There was no relationship between presence of sexual disturbances and previous cranial and/or genital traumas, severity of torture, or length of imprisonment. Plasma concentrations of pituitary gonadotrophins, prolactin, and testosterone were normal in all subjects studied. The cause of sexual dysfunction in torture victims remains to be established.

Sexual disturbances in temporal lobe epilepsy:a controlled study

Seventy cases each of temporal lobe epilepsy and grand mal epilepsy were studied for their sexual functioning. The two groups were similar as regards age, sex, duration of illness, frequency of seizures and menstrual and marital history. A significantly greater number of temporal lobe epileptics were found to be hyposexual. They had a global loss of performance and interest in the sexual sphere and showed no concern over it. One case in the group of temporal lobe eiplepsy, as against none in the other group, was hypersexual. There were no cases of sexual deviations in either of the groups. The findings of the study are discussed in the light of the relevant literature.

Organic psychosyndromes due to boxing

The “punch-drunk” syndrome of boxers was recognized by lay people many years before it received attention from the medical profession. The syndrome included slurred speech, ataxic gait and impaired mental function and so simulated alcoholic intoxication. Martland (1928) gave the first clinical description of its neurological and psychiatric features. These consisted of cerebellar, striatal and pyramidal signs in varying combination together with dementia and sometimes episodic psychotic behaviour. Martland stressed the psychiatric features of the syndrome, and noted that of 23 punch drunk boxers known to him, four were permanently in mental hospitals.