INFLUENCE OF RADIOACTIVE BACKGROUND ON SEXUAL FUNCTION IN MEN FROM DIFFERENT REGIONS OF UKRAINE

OBJECTIVE

The article attempts to analyze the nature of sexual dysfunctions in patients living in areas exposed toionizing radiation as a result of the Chornobyl accident.

MATERIALS AND METHODS

A study of sexual function was carried out in 186 people (group I) living in the territoriesof Kyiv (Polisske, Chornobyl, Ivankiv, Borodianka, Vyshhorod, Makariv districts) and Zhytomyr (Malyn and Korostendistricts) regions. The control group consisted of persons who were born and lived on the territory of Ivano-Frankivsk and Chernivtsi regions (group II, n = 123). Diagnostics was carried out on an outpatient basis in accor-dance with the standards of the WHO and the Ministry of Health of Ukraine.

RESULTS

Analyzing the obtained research results, a significantly larger number of patients with sexual dysfunctionwas identified in group I (82.3 %) than in group II (44.7 %) (р < 0.01). Psychopathological disorders disturbed,respectively, 60.2 % and 41.4 % (p < 0.01). Complaints of decreased libido were presented by 25.8 % of the surveyedmen exposed to ionizing radiation, and 6.5 % of them were concerned about a sharp depression of libido. In groupII patients, this indicator was 14.6 % and 3.3 %, respectively. The integral index of «libido» of the ICEF question-naire revealed a statistically significant difference between the groups (9.23 ± 0.89 and 12.22 ± 1.26, respectively;р < 0.05). In patients exposed to ionizing radiation as a result of the Chornobyl accident, the concentration oftestosterone decreases, and the content of FSH, LH, as well as globulin, which makes sex hormones, increases.Erectile dysfunction in patients of group I was detected in 58.1 % of men, and in patients of group II - 35.0 % (р < 0.01).The difference in the integral indicators of the ICEF questionnaire between the groups was 1.3 times behind the«libido» domain. For other domains - by 1.5-1.6 times. In men living in the territories of Kyiv and Zhytomyr regions,erectile dysfunction occurs earlier and is characterized by a more severe course than in people born and lived in theterritory of Ivano-Frankivsk and Chernivtsi regions. Both in terms of low rates of normal erection (in patients ofgroups I and II, respectively 3.8 % and 13.3 %), and for high percentages of existing moderate/severe ED (respec-tively 71.0 % and 45.5 %), persons from group I are characterized by significantly worse data than persons fromgroup II (р < 0.01). Orgasm pathology was found in 40.3 % of patients in group I and in 25.2 % of patients in groupII (р < 0.01). The quality of life index according to the QoL index in the context of existing sexual disorders in groupI of patients was 4.7 ± 0.4, in patients of group II - 3.9 ± 0.2 (р < 0.05).

CONCLUSIONS

The data obtained indicate a tendency for a more significant violation of sexual functions in men whowere born and lived in territories exposed to radioactive contamination as a result of the Chornobyl accident.

Effect of psychosocial trauma and stress on sexual dysfunction in women with endometriosis

BACKGROUND

Endometrial tissue plays an important role in the regulation of female fertility and there is evidence that endometrial pathology (including endometriosis) is closely related to endocrine disorders. On the other hand, various neuroendocrine changes can be significantly affected by psychosocial stress. In connection with these findings, we tested the relationship between neuroendocrine changes, sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms in women with endometriosis.

METHODS

A total of 65 patients with endometriosis were included in the study. Clinical examinations were focused on the biochemical analysis of neuroendocrine markers of endometriosis (cancer antigen 125 [CA 125] and cancer antigen 19-9 [CA 19-9]), estradiol, psychometric evaluation of sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms.

RESULTS

The results showed significant Spearman correlations between the values of the revised range of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale), psychosocial/traumatic stress (Trauma Symptoms Checklist) (R = 0.31), and dissociative symptoms (Somatoform Dissociation Questionnaire) (R = 0.33). Positive correlations were also found between CA 125 and CA 19-9 (R = 0.63), and between CA 125 and the results of the values of the revised scale of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale) (R = 0.29). Also psychosocial/traumatic stress (Trauma Symptoms Checklist) significantly correlated with CA 125 (R = 0.38) and with CA 19-9 (R = 0.33).

CONCLUSION

These results represent the first findings regarding the relationship of the neuroendocrine markers CA 125 and CA 19-9 and sexual dysfunction with trauma/stress-related symptoms and dissociative symptoms in women with endometriosis.

SHBG as a Marker of NAFLD and Metabolic Impairments in Women Referred for Oligomenorrhea and/or Hirsutism and in Women With Sexual Dysfunction

PCOS is one of the most common endocrine disorders and NAFLD is one of its most dangerous metabolic consequences. The diagnosis of NAFLD is not a practical task and the condition is at risk of being overlooked. The use of simpler but still reliable surrogate markers is necessary to identify women with a high likelihood of NAFLD. The aim of this study was to evaluate the clinical correlates of NAFLD Liver Fat Score (NAFLD-LFS) in women with oligomenorrhea and/or hirsutism. Furthermore, the study aimed to evaluate whether, among the hormonal parameters evaluated in such women, possible hallmarks of NAFLD may be identified. To this purpose, 66 women who attended our Outpatient Clinic for oligomenorrhea and/or hyperandrogenism were included in the study. In order to validate the results obtained in the first cohort, a second independent sample of 233 women evaluated for female sexual dysfunction (FSD) was analyzed. In cohort 1, NAFLD-LFS positively correlated with metabolic and inflammatory parameters. Among the hormone parameters, NAFLD-LFS showed no significant relationships with androgens but a significant negative correlation with SHBG (p<0.0001) that therefore appeared as a candidate hallmark for pathologic NAFLD-LFS. The ROC analysis showed a significant accuracy (81.1%, C.I.69.1-93.0, p <0.0001) for SHBG in identifying women with a pathological NAFLD-LFS. In particular, a SHBG 33.4 nmol/l was recognized as the best threshold, with a sensitivity of 73.3% and a specificity of 70.7%. In order to validate this SHBG as a marker of metabolic impairment possible related with the presence of NAFLD, we tested this threshold in cohort 2. FSD women with SHBG <33.4 nmol/l had worse metabolic parameters than women with SHBG ≥33.4 nmol/l and a significantly higher NAFLD-LFS even after adjusting for confounders (B=4.18 [2.05; 6.31], p=0.001). In conclusion, this study provides a new evidence in the diagnostic process of NAFLD, showing that the measurement of SHBG, which is routinely assessed in the workup of women referred for possible PCOS, could identify women at higher metabolic risk, thus detecting those who may deserve further targeted diagnostic assessment.

Associations between androgens and sexual function in premenopausal women: a cross-sectional study

BACKGROUND

Although clinicians often measure the serum concentration of androgens in premenopausal women presenting with sexual dysfunction, with some women given testosterone or dehydroepiandrosterone as treatment if their concentrations are low, whether androgens are determinants of sexual function in women of reproductive age is uncertain. We aimed to clarify the associations between androgens and sexual function in a community-based sample of non-health-care-seeking women.

METHODS

This is a substudy of the Grollo-Ruzzene cross-sectional study, which recruited women aged 18-39 years from eastern states in Australia (QLD, NSW, VIC). After providing consent, women completed an online survey that included the Profile of Female Secual Function (PFSF) questionnaire, and those who were who were not pregnant, breastfeeding, or using systemic steroids were asked to provide a blood sample. At sampling, women were asked the dates of their last menstrual bleed. Serum androgens was measured by liquid chromatography and tandem mass spectrometry and sex hormone binding globulin (SHBG) by immunoassay. Associations between androgens and domains of sexual function, assessed by the PFSF, were examined in participants with regular menstrual cycles. After univariable linear regression (model 1), age, BMI, stage of menstrual cycle, and smoking status were added to the model (model 2), and then parity, partner status, and psychotropic medication use (model 3).

FINDINGS

Of 6986 women who completed the online survey (surveys completed between Nov 11, 2016, and July 21, 2017), 3698 were eligible and 761 (20·6%) provided blood samples by Sept 30, 2017. Of those who provided a blood sample, 588 (77·3%) had regular menstrual cycles and were included in the analysis. Adjusting for age, BMI, cycle stage, smoking, parity, partner status, and psychoactive medication, sexual desire was positively associated with serum dehydroepiandrosterone (β-coefficient 3·39, 95% CI 0·65 to 6·03) and androstenedione (4·81, 0·16 to 9·12), and negatively with SHBG (-5.74, -9.54 to -1·90), each model explaining less than 4% of the variation in desire. Testosterone (6·00, 1·29 to 10·94) and androstenedione (6·05, 0·70 to 11·51) were significantly associated with orgasm, with the final models explaining less than 1% of the variation in orgasm. Significant associations were found between androstenedione (7·32, 0·93 to 13·08) and dehydroepiandrosterone (4·44, 0·86 to 7·95) and pleasure, and between testosterone and sexual self-image 5·87 (1·27 to 10·61), with inclusion of parity, partners status, and psychotropic drug use increasing the proportion of variation explained by each model to approximately 10%. There were no statistically significant associations between 11-oxygenated steroids and any PFSF domain, or between arousal or responsiveness and any hormone. No associations were seen between 11-oxygenated steroids and any sexual domain, or between arousal or responsiveness and any hormone.

INTERPRETATION

Associations between androgens and sexual function in premenopausal women are small, and their measurement offers no diagnostic use in this context. Further research to determine whether 11-ketoandrostenedione or 11-ketotestosterone are of clinical significance is warranted.

FUNDING

The Grollo-Ruzzene Foundation.

Prevalence and reproductive manifestations of macroprolactinemia

PURPOSE

Macroprolactinemia is characterized by predominance of macroprolactin molecules in circulation and generally has extra-pituitary origin. Macroprolactin is viewed as biologically inactive, therefore asymptomatic, and thus may not require any treatment or prolonged follow-up. In addition, data on prevalence of macroprolactinemia and its clinical manifestation are also rare. Therefore, the present study was aimed to find out prevalence of macroprolactinemia and its association, if any, with reproductive manifestations.

MATERIAL AND METHODS

Macroprolactin was measured in 102 hyperprolactinemia cases (>100 ng/ml prolactin level), 135 physiological hyperprolactinemia cases (50 pregnant and 85 lactating females; >100 ng/ml prolactin level) and 24 controls. Poly ethylene glycol (PEG) precipitation method was carried out to screen macroprolactin. Prolactin recovery of <25% was considered overt macroprolactinemia. Detailed clinical data was recorded which included complete medical history, physical examination and hormone measurements besides CT/MRI for pituitary abnormalities.

RESULTS

Prevalence of macroprolactinemia was 21.57% (22/102) in hyperprolactinemia (prolactin >100 ng/ml). There was no case of macroprolactinemia in physiological hyperprolactinemia, or healthy control females. Reproductive manifestations were present in 72.73% (16/22) macroprolactinemia cases, out of which macroprolactinemia was the sole cause of associated reproductive manifestations in 68.7% (11/16) cases. Reversal of reproductive dysfunction/s was observed in five cases with appropriate treatment for high macroprolactin.

CONCLUSION

Macroprolactinemia prevalence was found to be 21.5%, out of which 72.73% cases had associated reproductive dysfunctions.

Secondary adrenal insufficiency and pituitary dysfunction in oral/transdermal opioid users with non-cancer pain

Objective To evaluate pituitary function, sexual function and quality of life (QoL) in patients on oral or transdermal opioids. Design and methods Cross-sectional study comparing pituitary function, QoL and sexual function in people on long-term opioid therapy (n = 40) vs an age- and sex-matched control group (n = 25). Baseline pituitary function was assessed on blood samples collected prior to 0900 h. Further testing with corticotropin (250 µg IV) and metyrapone (30 mg/kg) stimulation tests was undertaken on participants with serum cortisol <250 nmol/L. Validated questionnaires completed to assess QoL, fatigue and sexual function. Results Secondary adrenal insufficiency (SAI) was identified on the basis of a failed stimulation test in 22.5% of opioid users vs no controls (P = 0.01). Opioid users with SAI had a higher median morphine-equivalent daily dose (MEDD), P = 0.037 - 50% with MEDD >200 mg and 0% with MEDD <60 mg had SAI. Among male participants, testosterone was inversely associated with BMI (P = 0.001) but not opioid use. A non-significant trend to low testosterone <8 nmol/L in male opioid users (11/24 opioid users vs 2/14 control, P = 0.08) suggests a small subgroup with opioid-induced androgen deficiency. Opioid users had greater fatigue, reduced quality of life in all subsections of the SF-36 and impaired sexual function in both males and females (all scores P < 0.001 compared to controls). Conclusion Long-term opioid therapy was associated with dose-related SAI in over 20% of chronic pain patients and is associated with poor quality of life, fatigue and sexual dysfunction. Obesity confounds the interpretation of opioid-induced male androgen deficiency.

Quality of Life in Long-Term Testicular Cancer Survivors With Compensated Leydig Cell Dysfunction

BACKGROUND

Compensated Leydig cell (LC) dysfunction, defined by elevated serum levels of luteinizing hormone (LH) in combination with normal total testosterone levels, is common in testicular cancer (TC) survivors. The association between this condition and quality of life is unknown. We aimed to clarify if TC survivors with compensated LC dysfunction have impaired quality of life.

PATIENTS AND METHODS

In total, 147 long-term TC survivors were included. On the basis of a single measurement of testosterone and LH, compensated LC dysfunction was defined by age-adjusted levels of LH above normal range combined with testosterone levels within the normal range. Quality-of-life outcomes including sexual function, anxiety and depression, fatigue, and overall self-evaluated quality of life were compared between patients with and without compensated LC dysfunction with adjustment for age.

RESULTS

In total, 60 TC survivors had compensated LC dysfunction and 87 TC survivors had normal LC function. TC survivors with compensated LC dysfunction had lower serum levels of total testosterone (11 vs. 13 nmol/L, P = .016). There were no significant differences in the investigated quality-of-life outcomes (anxiety, depression, sexual function, fatigue) between the 2 groups.

CONCLUSION

Compensated LC dysfunction in TC survivors was not associated with symptoms of depression, anxiety, sexual dysfunction, fatigue, or impaired overall self-evaluated quality of life. Limitations include the few cases of symptoms of depression (n = 7). Our findings do not suggest that testosterone substitution is indicated in TC survivors with compensated LC dysfunction.

Sexual function and sex hormones in breast cancer patients

PURPOSE

Breast cancer patients (BCP) are at risk of female sexual dysfunction (FSD). Our aim was to clarify the effects of treatment strategies, and steroid hormones levels on FSD.

METHODS

We enrolled 136 BCP (46.9 ± 0.8 years), and 122 completed questionnaires. BCP were divided into four groups: 22 women with advanced breast cancer on neoadjuvant therapy (NAT), 48 on adjuvant therapy (AT), 30 taking hormonal therapy (HT) and 22 with metastatic cancer on first line chemotherapy (FLT). Fifty-eight healthy women (43 ± 2.8 years) were enrolled as controls. FSD was evaluated by FSFI, and sexual distress was assessed with FSDS-R. We have collected demographic data, laboratory values, and LH, FSH, total testosterone (T), and estradiol (E2) levels.

RESULTS

BCP showed a prevalence of FSD of 69%, total FSFI score was 17. FSDS-R was 8.3. FSD had a prevalence of 72 % in NAT, 65% in AT, 77% in metastatic BCP under FLT, 67% in HT, compared with a prevalence of 20% in controls. BCP showed lower E2 than normal values, as well as T. LH and FSH were significantly elevated than normal values. Total FSFI score was positively correlated with T in 122 BCP, no significant correlation was found between E2 and FSFI. Significant differences were found between NAT and HT in lubrication, pain domains and total FSDS-R score, AT and HT in pain domain, AT and NAT in lubrication domain.

CONCLUSIONS

BCP are at high risk of developing FSD both for treatment choice and hormonal status, but they have not sexually related personal distress.

Oxytocin plasma levels in orgasmic and anorgasmic women

The study aimed to evaluate oxytocin (Oxt) serum levels before and after sexual intercourse in women affected by anorgasmia. The sample was constituted of 15 anorgasmic women and 16 orgasmic women. The Female Sexual Function Index (FSFI, cutoff ≤26.55) and the Female Sexual Distress Scale (FSDS, cutoff ≥15) questionnaires were used to assess sexual function and sexual distress, respectively. Serum Oxt levels were measured before sexual intercourse (T0) and 5 min after coital sexual activity (T1). Anorgasmic women had an unpleasant sexual experience (FSFI total score, 20.1 ± 1.2;) and were stressed (FSDS score, 19.4 ± 1.3), whereas orgasmic women were fully satisfied with their sexual activity (FSFI total score 28.7 ± 1.3; FSDS score 11.5 ± 1.8). At T0, anorgasmic women had lower levels of Oxt than orgasmic women, 1.8 ± 0.2 pg/mL versus 2.1 ± 0.5 pg/mL, respectively, [95% CI: (-0.58, -0.01); p < .04]. At T1, Oxt levels did not change in anorgasmic women (1.8 ± 0.2 pg/mL versus 2 ± 0.4 pg/mL, p = .09). Finally, orgasmic women had higher levels of Oxt than anorgasmic women, 4.6 ± 0.7 pg/mL versus 2 ± 0.4 pg/mL, respectively [95% CI: (-3.02, -2.17); p < .001]. The repetitive processes to experience the sexual body sensations could represent a survival behavior of species by attachment to a partner.

Protective effects of Lycium barbarum polysaccharide on male sexual dysfunction and fertility impairments by activating hypothalamic pituitary gonadal axis in streptozotocin-induced type-1 diabetic male mice

Diabetes-associated male sexual dysfunction and fertility impairments are both common clinical complications with limited therapeutic options; hence it seriously affects the quality of life of the patients, in particular, the patients of reproductive age. Lycium barbarum polysaccharide (LBP) has long being believed to maintain and to promote reproductive functions in the traditional medical practice in China. The current study was to investigate if LBP may contribute to recovery of male sexual dysfunction and fertility impairments in diabetic individuals. The effects of LBP on sexual behaviors and histological changes of testis were studied in the type-1 diabetes male mice induced by intra-peritoneal (i.p.) injection of streptozotocin (STZ). After oral administration of LBP (10, 20 or 40 mg/kg), sildenafil citrate (SC, 5 mg/kg) or saline for 62 consecutive days, the typical abnormal changes in the sperm parameters, in relative weight of reproductive organs and in morphology of testis were observed in diabetic mice. LBP treatment of the diabetic mice considerably reversed those changes and Johnsen's testicular score, serum testosterone (T), follicular stimulating hormone (FSH) and luteinizing hormone (LH) level were also increased to different degrees. Moreover, our data have also shown that a marked improvement in sexual behavior and fertility level after administration of LBP (40 mg/kg) compared to the diabetic group. These results suggested that LBP can exert functional recovery of male sexual dysfunction and fertility damages induced by diabetes in male mice, which is likely to be mediated through regulating the hypothalamus- pituitary-gonadal axis endocrine activity.

[Aripiprazole for drug-induced sexual dysfunction in schizophrenic males]

OBJECTIVE

To investigate the clinical effects of aripiprazole on sexual dysfunction induced by amisulpride or risperidone in male patients with schizophrenia.

METHODS

This study included 75 male patients with drug-induced secondary sexual dysfunction after treated with amisulpride or risperidone for first-episode schizophrenia between October 2014 and October 2016. We substituted aripiprazole for amisulpride or risperidone, gradually increased the dose from 10 to 30 mg/d within 2 weeks, and maintained 30 mg/d from the 3rd week. At 4 and 8 weeks after medication, we evaluated the sexual function of the patients, measured the levels of serum prolactin (PRL) and testosterone (T), obtained the scores of the Positive and Negative Symptoms Scale (PANSS), recorded adverse reactions, and compared the parameters with those before aripiprazole administration.

RESULTS

Compared with pre-aripiprazole administration, the patients showed significant increases after 4 weeks of medication in the sexual function score (24.3 ± 2.1 vs 32.6 ± 3.6, P <0.05) and T level (［13.3 ± 2.7］ vs ［17.4±3.0］ mmol/L, P <0.05) but a decreased level of PRL (［38.5 ± 10.5］ vs ［27.9 ± 8.2］ ng/ml, P <0.05). At 8 weeks, the sexual function score and serum PRL were both restored to the baseline levels at admission, and the erectile function score, ejaculation score, total score, and serum T level even exceeded the baseline, though with no statistically significant differences (P >0.05). In comparison with pre-aripiprazole administration, the PANSS score was significantly decreased at 4 weeks after medication (62.1 ± 4.9 vs 57.2 ± 5.5, P <0.05) and even lower at 8 weeks (51.2 ± 5.2) (P <0.05). The incidence rates of medication-related excitation, dizziness, insomnia, and loss of appetite were 6.7%, 5.3%, 4.0% and 1.3% respectively, and no other serious adverse reactions were observed.

CONCLUSIONS

Aripiprazole is effective for the treatment of drug-induced sexual dysfunction in schizophrenic men by continuously alleviating their positive and negative symptoms and meanwhile improving their sexual function and restoring their sexual hormone levels.

Sexual dysfunction in premenopausal women could be related to hormonal profile

Female sexual dysfunction (FSD) is a public health problem that affects women's quality of life. Although the relationship between some hormones and the FSD has been described, it is not well established for all hormones. Therefore, the aim of our study was to evaluate the association between hormonal dysfunction and sexual dysfunction in premenopausal women. We performed a cross-sectional study with 60 patients with regular menstrual cycles, with age ranging from 18 to 44 years, with previous diagnosis of FSD. All patients were evaluated using the female sexual function index (FSFI) questionnaire and had the levels of total testosterone, prolactin (PRL), thyroid-releasing hormone and free testosterone index measured. Among the 60 patients, 43 (71.7%) were diagnosed with hypoactive sexual desire disorder (HSDD), 9 (15%) had anorgasmy and 8 (3.3%) had sexual pain dysfunction. Hormonal evaluation, demonstrated that 79.1% of patients with HSDD, 78.4% of patients with anorgasmy and 50% of patients with sexual pain dysfunction had female androgen insensitivity. We can conclude that there is an important association between low levels of total and free testosterone and FSD. This finding offers a new alternative for diagnosis and treatment of HSDD. Moreover, given the potential role of androgens in sexual function, randomized controlled trials with adequate long-term follow-up are essential to confirm its possible effect.

Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women∗: ∗2016 ISSM Female Sexual Dysfunction Prize

INTRODUCTION

The female sexual response is complex and influenced by several biological, psychological, and social factors. Testosterone is believed to modulate a woman's sexual response and desire, because low levels are considered a risk factor for impaired sexual function, but previous studies have been inconclusive.

AIM

To investigate how androgen levels and psychosocial factors are associated with female sexual dysfunction (FSD), including hypoactive sexual desire disorder (HSDD).

METHODS

The cross-sectional study included 428 premenopausal women 19 to 58 years old who completed a questionnaire on psychosocial factors and had blood sampled at days 6 to 10 in their menstrual cycle. Logistic regression models were built to test the association among hormone levels, psychosocial factors, and sexual end points.

MAIN OUTCOME MEASURES

Five different sexual end points were measured using the Female Sexual Function Index and the Female Sexual Distress Scale: impaired sexual function, sexual distress, FSD, low sexual desire, and HSDD. Serum levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate, and androsterone glucuronide were analyzed using mass spectrometry.

RESULTS

After adjusting for psychosocial factors, women with low sexual desire had significantly lower mean levels of free testosterone and androstenedione compared with women without low sexual desire. None of the androgens were associated with FSD in general or with HSDD in particular. Relationship duration longer than 2 years and mild depressive symptoms increased the risk of having all the sexual end points, including FSD in general and HSDD in particular in multivariate analyses.

CONCLUSION

In this large cross-sectional study, low sexual desire was significantly associated with levels of free testosterone and androstenedione, but FSD in general and HSDD in particular were not associated with androgen levels. Length of relationship and depression were associated with FSD including HSDD. Wåhlin-Jacobsen S, Kristensen E, Tønnes Pedersen A, et al. Androgens and Psychosocial Factors Related to Sexual Dysfunctions in Premenopausal Women. J Sex Med 2017;14:366-379.

Characteristics of Men Who Report Persistent Sexual Symptoms After Finasteride Use for Hair Loss

CONTEXT

Some men who use finasteride for hair loss report persistent sexual and other symptoms after discontinuing finasteride therapy.

OBJECTIVE

To determine whether these persistent symptoms after discontinuation of finasteride use are due to androgen deficiency, decreased peripheral androgen action, or persistent inhibition of steroid 5α-reductase (SRD5A) enzymes.

PARTICIPANTS

Finasteride users, who reported persistent sexual symptoms after discontinuing finasteride (group 1); age-matched finasteride users who did not report sexual symptoms (group 2); and healthy men who had never used finasteride (group 3).

OUTCOMES

Sexual function, mood, affect, cognition, hormone levels, body composition, functional magnetic resonance imaging (fMRI) response to sexually and affectively valenced stimuli, nucleotide sequences of androgen receptor (AR), SRD5A1, and SRD5A2; expression levels of androgen-dependent genes in skin.

SETTING

Academic medical center.

RESULTS

Symptomatic finasteride users were similar in body composition, strength, and nucleotide sequences of AR, SRD5A1, and SRD5A2 genes to asymptomatic finasteride users and nonusers. Symptomatic finasteride users had impaired sexual function, higher depression scores, a more negative affectivity balance, and more cognitive complaints than men in groups 2 and 3 but had normal objectively assessed cognitive function. Testosterone, dihydrotestosterone, 5α-androstane-3α,17β-diol-glucuronide, testosterone to dihydrotestosterone and androsterone glucuronide to etiocholanolone glucuronide ratios, and markers of peripheral androgen action and expression levels of AR-dependent genes in skin did not differ among groups. fMRI blood oxygen level-dependent responses to erotic and nonerotic stimuli revealed abnormal function in brain circuitry linked to sexual arousal and major depression.

CONCLUSIONS

We found no evidence of androgen deficiency, decreased peripheral androgen action, or persistent peripheral inhibition of SRD5A in men with persistent sexual symptoms after finasteride use. Symptomatic finasteride users revealed depressed mood and fMRI findings consistent with those observed in depression.

Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels

CONTEXT

The Testosterone Trials are a coordinated set of seven trials to determine the efficacy of T in symptomatic men ≥65 years old with unequivocally low T levels. Initial results of the Sexual Function Trial showed that T improved sexual activity, sexual desire, and erectile function.

OBJECTIVE

To assess the responsiveness of specific sexual activities to T treatment; to relate hormone changes to changes in sexual function; and to determine predictive baseline characteristics and T threshold for sexual outcomes.

DESIGN

A placebo-controlled trial.

SETTING

Twelve academic medical centers in the United States.

PARTICIPANTS

A total of 470 men ≥65 years of age with low libido, average T <275 ng/dL, and a partner willing to have sexual intercourse at least twice a month.

METHODS

Men were assigned to take T gel or placebo for 1 year. Sexual function was assessed by three questionnaires every 3 months: the Psychosexual Daily Questionnaire, the Derogatis Interview for Sexual Function, and the International Index of Erectile Function.

RESULTS

Compared with placebo, T administration significantly improved 10 of 12 measures of sexual activity. Incremental increases in total and free T and estradiol levels were associated with improvements in sexual activity and desire, but not erectile function. No threshold T level was observed for any outcome, and none of the 27 baseline characteristics predicted responsiveness to T.

CONCLUSIONS

In older men with low libido and low T levels, improvements in sexual desire and activity in response to T treatment were related to the magnitude of increases in T and estradiol levels, but there was no clear evidence of a threshold effect.

Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review

AIMS

Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective.

METHODS

A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis.

RESULTS

Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction.

CONCLUSIONS

The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

Diabetes Mellitus-Associated Functional Hypercortisolism Impairs Sexual Function in Male Late-Onset Hypogonadism

Functional hypercortisolism is generated by conditions able to chronically activate hypothalamic-pituitary-adrenal axis and has been proven to have a negative role in several complications. However, no study has evaluated the possible influence of diabetes mellitus-associated functional hypercortisolism on male hypogonadism and sexual function. We aimed to identify any association of hypothalamic-pituitary-adrenal axis dysregulation measures with testosterone and sexual function in men simultaneously affected by diabetes mellitus and late-onset hypogonadism. Fifteen diabetes mellitus and late-onset hypogonadism subjects suffering from functional hypercortisolism and fifteen diabetes mellitus and late-onset hypogonadism subjects who were free of functional hypercortisolism were retrospectively reviewed. Clinical, hormonal, and sexual parameters were considered. Hypercortisolemic subjects showed higher values of body mass index, waist, and glycated hemoglobin and lower ones of testosterone compared to normocortisolemic ones. All sexual parameters, except for orgasmic function, were significantly worse in hypercortisolemic than in normocortisolemic subjects. Hypercortisolemic patients showed higher values of cortisol after dexamethasone and urinary free cortisol as well as a lesser ACTH response after corticotropin releasing hormone test (ACTH area under curve) compared to normocortisolemic ones. No significant association was found at Poisson regression analysis between hormonal and sexual variables in normocortisolemic patients. In hypercortisolemic subjects, negative and significant associations of cortisol response after corticotropin releasing hormone (cortisol area under curve) with erectile function (β: -0.0008; p: 0.015) and total international index of erectile function score (β: -0.0006; p: 0.001) were evident. This study suggests for the first time the impairing influence of the dysregulated hypothalamic-pituitary-adrenal axis on sexual function in diabetes mellitus-associated late-onset hypogonadism.

Aqueous root extract of Lecaniodiscus cupanioides restores nitric oxide/cyclic guanosine monophosphate pathway in sexually impaired male rats

ETHNOPHARMACOLOGICAL RELEVANCE

Aqueous root extract of Lecaniodiscus cupanioides is widely used in the management of sexual dysfunction in Nigeria. The effect of aqueous root extract of L. cupanioides root on the concentrations of penile cyclic Guanosine Monophosphate (cGMP) and plasma nitric oxide in paroxetine-induced sexually impaired male rats was evaluated.

METHODS

Thirty (30) albino rats were assigned into six groups (A, B, C, D, E and F) of five rats each such that animals in Group A (control) received distilled water while those in Groups B, C, D, E and F which were induced into sexual dysfunction (p.o 10mg/kg of paroxetine hydrochloride suspension in Tween-80) and in addition received distilled water, 7.14 mg/kg body weight of a reference herbal drug (PowmaxM), 25, 50 and 100mg/kg body weight of the extract respectively, orally, once daily for five days.

RESULTS

Administration of paroxetine significantly reduced the levels of penile cyclic Guanosine Monophosphate (cGMP) and plasma nitric oxide. These decreases were dose dependently reversed by the aqueous extract of L. cupanioides root. The reversal by the 25 and 50mg/kg body weight of the extract compared favorably with the PowmaxM, whereas the 100mg/kg body weight of the extract compared favorably with the non-sexually impaired distilled water treated control animals.

CONCLUSION

The results of this study show that aqueous extract of L. cupanioides root restored the levels of cGMP and nitric oxide in sexually impaired rats. This study further lends credence to the use of aqueous root extract of L. cupanioides in the management of sexual dysfunction in Nigeria.

Sexual Response in Women with Type 1 Diabetes Mellitus: A Controlled Laboratory Study Measuring Vaginal Blood Flow and Subjective Sexual Arousal

Previous studies have indicated that women with diabetes mellitus are at higher risk to develop sexual dysfunctions. In the current study, we hypothesized that lower genital arousal response-as a consequence of diabetes-related damage to nerves and blood vessels-might play a part in these higher prevalence rates. Vaginal blood flow, subjective sexual response, and clitoral sensitivity were compared between women with diabetes and healthy controls, and associations with diabetes complications were investigated. In pre- and postmenopausal women with type 1 diabetes (n = 42) and healthy controls (n = 46), vaginal blood flow was measured as vaginal pulse amplitude (VPA). VPA was assessed at rest, during erotic film viewing, and during vibrotactile clitoral stimulation. Subjective sexual arousal was measured using a questionnaire. Clitoral sensitivity was assessed by a vibration perception test. Data on diabetes complications were obtained from medical records, and neuropathy was assessed by quantitative sensory testing. VPA, subjective sexual arousal, and clitoral sensitivity were not significantly different between women with diabetes and controls. Nevertheless, women with diabetes who had retinopathy showed significantly lower VPA than women without retinopathy, and women with diabetes who had neuropathy showed significantly higher sensation thresholds for vibrotactile clitoral stimulation. The results do not support the hypothesis of a disrupted genital arousal response in women with diabetes. However, the observed associations between retinopathy and vaginal blood flow, and between neuropathy and clitoral sensitivity, suggest that diabetes-related complications might adversely affect the physiological basis of female sexual response.

Testosterone Replacement in Androgen-Deficient Men With Ejaculatory Dysfunction: A Randomized Controlled Trial

CONTEXT

Low T levels have been associated with ejaculatory dysfunction (EjD) in cross-sectional studies; however, the efficacy of T replacement in improving EjD has not been studied in a randomized controlled trial.

OBJECTIVE

To evaluate the efficacy of T replacement in androgen-deficient men with EjD.

DESIGN

A multicenter, double-blind, randomized, placebo-controlled, 16-week trial with T solution 2% versus placebo.

SETTING

Medical centers in the United States, Canada, and Mexico.

PATIENTS OR OTHER PARTICIPANTS

Seventy-six men with one or more EjD symptoms, including delayed ejaculation, anejaculation, reduced ejaculate volume, and/or reduced force of ejaculation, and two total T levels <300 ng/dL (<10.41 nmol/L) measured with liquid chromatography tandem mass spectrometry.

INTERVENTIONS

Sixty milligrams of T solution 2% or placebo applied to the axillae for 16 weeks.

MAIN OUTCOME MEASURES

The primary outcome was a change in the score of the three-item Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form (MSHQ-EjD-SF); secondary outcomes included measured ejaculate volume, scores of the bother/satisfaction item of the MSHQ-EjD-SF, the orgasmic function domain of the International Index of Erectile Function Questionnaire, and the sexual activity log.

RESULTS

Seventy-six participants were randomized; 66 completed the study. Baseline demographic and clinical characteristics were comparable between the treatment arms. T replacement improved the MSHQ-EjD-SF score (mean score change, +3.1); however, this effect was not statistically different from placebo (mean score change, +2.5; P = .596). No differences were seen in any of the secondary outcomes or frequency of adverse events.

CONCLUSION

T replacement was not associated with significant improvement in EjD in androgen-deficient men.

The longitudinal relationship of sexual function and androgen status in older men: the Concord Health and Ageing in Men Project

CONTEXT

It is unclear whether declining sexual function in older men is a cause or consequence of reduced androgen status.

OBJECTIVE

Longitudinal associations were examined between reproductive hormones and sexual function in older men.

DESIGN, SETTING, AND PARTICIPANTS

Men aged 70 years and older from the Concord Health and Ageing in Men Project study were assessed at baseline (n = 1705) and 2-year follow-up (n = 1367), with a total of 1226 men included in the final analyses.

MAIN OUTCOMES AND MEASURES

At both visits, serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry, and SHBG, LH, and FSH were measured by immunoassay. Sexual functions (erectile function, sexual activity, and sexual desire) were self-reported via standardized questions.

RESULTS

In longitudinal analyses, although baseline hormones (T, DHT, E2, and E1) did not predict decline in sexual function, the decline in serum T (but not DHT, E2, or E1) over 2 years was strongly related to the change in sexual activity and desire (but not erectile function). For each 1-SD decrease in T from baseline to 2-year follow-up, there was a multivariate-adjusted odds ratio of 1.23 (95% confidence interval, 1.12-1.36) for an additional risk of further decline in sexual activity. However, the magnitude of the decrease in serum T was strikingly small (<10%). Similar associations were found for changes over 2 years in serum T and decline in sexual desire, but not for erectile function.

CONCLUSIONS

We found a consistent association among older men followed over 2 years between the decline in sexual activity and desire, but not in erectile function, with a decrease in serum T. Although these observational findings cannot determine causality, the small magnitude of the decrease in serum T raises the hypothesis that reduced sexual function may reduce serum T rather than the reverse.

Gynecomastia in subjects with sexual dysfunction

PURPOSE

To analyze possible relationships between gynecomastia and clinical and biochemical parameters in a large cohort of subjects with sexual dysfunction (SD).

METHODS

A consecutive series of 4,023 men attending our Outpatient Clinic for SD was retrospectively studied.

RESULTS

After excluding Klinefelter's syndrome patients, the prevalence of gynecomastia was 3.1 %. Subjects with gynecomastia had significantly lower testosterone (T) levels; the association retained statistical significance after adjusting for age and life-style. However, only 33.3 % of subjects with gynecomastia were hypogonadal. Gynecomastia was associated with delayed puberty, history of testicular or hepatic diseases, as well as cannabis abuse. Patients with gynecomastia more frequently reported sexual complaints, such as severe erectile dysfunction [odds ratio (OR) = 2.19 (1.26-3.86), p = 0.006], lower sexual desire and intercourse frequency [OR = 1.23 (1.06-1.58) and OR = 1.84 (1.22-2.78), respectively; both p < 0.05], orgasm difficulties [OR = 0.49 (0.28-0.83), p = 0.008], delayed ejaculation and lower ejaculate volume [OR = 1.89 (1.10-3.26) and OR = 1.51 (1.23-1.86), respectively; both p < 0.05]. Gynecomastia was also positively associated with severe obesity, lower testis volume and LH, and negatively with prostate-specific antigen levels. The further adjustment for T did not affect these results, except for obesity. After introducing body mass index as a further covariate, all the associations retained statistical significance, except for delayed ejaculation and ANDROTEST score. When considering gynecomastia severity, we found a step-wise, T-independent, decrease and increase of testis volume and LH, respectively. Gynecomastia was also associated with the use of several drugs in almost 40 % of our patients.

CONCLUSION

Gynecomastia is a rare condition in subjects with SD, and could indicate a testosterone deficiency that deserves further investigation.

Aphrodisiac effect of aqueous root extract of Lecaniodiscus cupanioides in sexually impaired rats

BACKGROUND

The phytochemical constituents of the aqueous root extract of Lecaniodiscus cupanioides Planch. Ex Bth. and its aphrodisiac activity on male rat sexual behavior and reproductive hormones in paroxetine-induced sexual dysfunction were evaluated.

METHODS

The extract was screened for the presence of phytochemicals. The extract (25, 50, and 100 mg/kg body weight) and the reference herbal drug PowmaxM (7.14 mg/kg body weight) were administered orally to paroxetine-induced sexually impaired male rats, once daily for 5 days, and their sexual behavior parameters were monitored and computed. The serum hormones (testosterone, follicle-stimulating hormone, and luteinizing hormone) were determined at the end of treatment period.

RESULTS

Phytochemical screening revealed the presence of alkaloids, anthraquinones, phenolics, saponins, and tannins. Mount frequency (MF), intromission frequency (IF), ejaculatory frequency (EF), and testosterone, follicle-stimulating hormone, and luteinizing hormone concentrations were reduced significantly (p<0.05) in paroxetine-treated rats. Administration of 25, 50, and 100 mg/kg body weight of the aqueous root extract of L. cupanioides significantly (p<0.05) reversed the paroxetine-mediated alterations in MF, IF, EF, mount latency (ML), intromission latency (IL), ejaculatory latency (EL), postejaculatory interval (PEI), and testosterone, follicle-stimulating hormone, and luteinizing hormone concentrations dose-dependently. The reversal of the male sexual behavior parameters by the extract compared well (p<0.05) with the PowmaxM-treated animals.

CONCLUSIONS

Data obtained from this study revealed that the aqueous root extract of L. cupanioides restored sexual competence in sexually impaired rats possibly by increasing sexual drive through enhanced reproductive hormones concentration, particularly testosterone, thus supporting the folkloric claim of the plant for the management of sexual disorder in males.

Relationship between sexual function and prostate-specific antigen bounce after iodine-125 permanent implant brachytherapy for localized prostate cancer

OBJECTIVE

To analyze clinical and dosimetric factors involved in prostate-specific antigen bounce in patients who underwent permanent implant brachytherapy for localized prostate cancer, and to study the relationships among prostate-specific antigen bounce, age and sexual function.

METHODS

Between March 2007 and April 2012, 116 patients with localized prostate cancer underwent permanent implant, iodine-125 brachytherapy. Patients receiving external-beam radiotherapy or who used phosphodiesterase-5 inhibitor pre- or post-treatment were excluded. Prostate-specific antigen bounce was defined as an increase of ≥0.2 ng/mL and ≥0.4 ng/mL above an initial prostate-specific antigen nadir followed by a subsequent decline to or below the initial nadir without treatment. Clinical and dosimetric factors involved in prostate-specific antigen bounce were analyzed using multivariate logistic regression analysis with the forced entry method.

RESULTS

The median age was 66 years (range 51-80 years), and prostate-specific antigen bounce on a prostate-specific antigen rise of ≥0.2 ng/mL occurred in 47 of the 116 participants (40.5%). The median period before the prostate-specific antigen bounce was 17.5 months (range 8-36 months). Patients with prostate-specific antigen bounce were younger and had higher sexual function before treatment (P = 0.003) than those who not show prostate-specific antigen bounce. Regression analysis results showed that young age and a high level of pretreatment sexual function were significant predictive factors for prostate-specific antigen bounce (P = 0.028 and P = 0.048).

CONCLUSION

Sexual function seems to be associated with a prostate-specific antigen bounce in patients undergoing permanent implant brachytherapy for localized prostate cancer, and it can be preserved after treatment if it is well present before treatment. Highly maintained sexual function after treatment might influence prostate-specific antigen bounce.

Sexual asthenia: Tradamixina versus Tadalafil 5 mg daily

BACKGROUND

Reduced libido is widely considered the most prominent symptomatic reflection of low testosterone (T) levels in men. Testosterone deficiency (TD) afflicts approximately 30% of men aged 40-79 years. This study seeks to evaluate the effect of a new natural compound "tradamixina "in order to improve male sexual function in elderly men, particularly libido and possible erectile dysfunction, versus administration of tadalafil 5 mg daily.

METHODS

Seventy patients (67.3 ± 3.7 years) with stable marital relations and affected by reduced libido, with or without erectile dysfunction were recruited. They were randomly separated in 2 groups A-B of 35. Group A was administered twice a day a new compound "Tradamixina" (150 mg of Alga Ecklonia Bicyclis, 396 mg of Tribulus Terrestris and 144 mg of D-Glucosamine and N-Acetyl-D-Glucosamine) for two months, while Group B was administered tadalafil 5 mg daily, for two months. At visit and after 60 days of treatment patients were evaluated by means of detailed medical and sexual history, clinical examination, laboratory investigations (Total and Free T), instrumental examination (NPTR- nocturnal penile tumescence and rigidity test- with Rigiscan). Patients completed a self-administered IIEF questionnaire (The international index of erectile function) and SQoLM questionnaire (Sexual quality of life Questionnarie-Male). The results pre and post treatment were compared by Student t test (p<0.005).

RESULTS

After 2 months of treatment in group A serum TT levels (230 ± 18 ng/dl vs 671 ± 14 ng/dl ) and FT levels(56 ± 2.4 pg/ml vs 120 ± 3.9 pg/ml) increased, while in group B serum TT levels (245 ± 12 ng/dl vs 247 ± 15 ng/dl ) and FT levels(53 ± 0.3 pg/ml vs 55 ± 0.5 pg/ml) increased not statistically significant. The patient's numbers with negative NPTR improved after treatment in group A and B (15 vs 18 and 13 vs 25 respectively). The IIEF total score in group A increased after treatment with tradamixina (15 ± 1.5 vs 29.77 ± 1.2); the IIEF total score in group B increased slightly (12 ± 1.3 vs 23.40 ± 1.2). The SQoLM total score improved in both groups (A:16 ± 2,3 vs 33 ± 4,1 and B: 16 ± 3,4 vs 31 ± 2,1).

CONCLUSION

The treatment twice a day with "Tradamixina" for 2 months improved libido in elderly men without side effects of Tadalafil.

A comparative study of ethanolic extracts of Pedalium murex Linn. fruits and sildenafil citrate on sexual behaviors and serum testosterone level in male rats during and after treatment

ETHNOPHARMACOLOGICAL RELEVANCE

Pedalium murex Linn. has been used as Vajikaran Rasayana (aphrodisiac) in traditional Indian medicine to treat male sexual dysfunction and impotency.

AIM OF THE STUDY

The aim of this study was to investigate effects of P. murex fruits extract on sexual behaviors and testosterone level of male rats during and past withdrawal of treatment.

MATERIALS AND METHODS

The extract (50, 100,150mg/kg body weight/day) and sildenafil citrate (5mg/kg body weight/day) were administered orally by gavages for 28 days to male Wistar albino rats. Penile erection index (PEI), mount latency (ML), intromission latency (IL), ejaculation latency (EL), mounting frequency (MF), intromission frequency (IF), post ejaculatory interval (PEjI) and serum testosterone levels were studied at day 0, 15, 28 during treatment. They were further evaluated after day 7 and 15 past discontinuation of the treatment. In-vitro nitric oxide release activity was also investigated in human corpus cavernosal cell line.

RESULTS

The ethanolic extract significantly reduced the ML, IL, EL and PEjI (p<0.05). There was a significant increase in the PEI, MF and IF and serum testosterone level (p<0.05) throughout the period of study. Ethanolic extract produced a significant effect on sexual behavior and serum testosterone level past withdrawal of the treatment. In-vitro nitric oxide release was significantly higher in extract and sildenafil citrate compared to the control group.

CONCLUSIONS

Present findings provide experimental in-vivo and in-vitro evidence that the ethanolic extract of P. murex fruits possesses aphrodisiac property. Study lends growing support for the traditional use of P. murex as a sexual stimulating agent and offers a significant potential for studying the effect on male sexual response and its dysfunctions. The findings justify the concept of Rasayana as rejuvenative tonics and support their role in prevention or delay of the aging process.

Low testosterone levels and increased inflammatory markers in patients with cancer and relationship with cachexia

CONTEXT

Male cancer patients suffer from fatigue, sexual dysfunction, and decreased functional performance and muscle mass. These symptoms are seen in men with hypogonadism and/or inflammatory conditions. However, the relative contribution of testosterone and inflammation to symptom burden in cancer has not been well-established.

OBJECTIVE

The aim of this study was to measure testosterone levels in male cancer patients and determine the relationship between testosterone, inflammation, and symptom burden.

DESIGN/SETTING

This cross-sectional study enrolled patients from a tertiary-care center. SUBJECTS/OUTCOME MEASURES: Subjects included males with cancer-cachexia (CC; n = 45) and cancer without cachexia (CNC; n = 50), as well as noncancer controls (CO; n = 45). Total testosterone (TT), bioavailable testosterone, C-reactive protein (CRP), and IL-6 were measured in plasma. Functional performance was assessed by the ECOG (Eastern Cooperative Oncology Group) and KPS (Karnofsky Performance Scales), and sexual function was assessed by the IIEF (International Index of Erectile Function).

RESULTS

Low testosterone levels were seen in more than 70% of CC cases. TT was lower in CC compared to CNC (P < 0.05). Also, CC had lower bioavailable testosterone, grip strength, IIEF scores, appendicular lean body mass, and fat mass and higher IL-6 and CRP compared to controls (P ≤ 0.05). ECOG and KPS were lower in CC and CNC compared to controls (P ≤ 0.05). On multiple regression analysis, TT, albumin, and CRP predicted symptoms differentially in cancer patients.

CONCLUSIONS

CC patients have higher inflammation and lower testosterone, grip strength, functional status, erectile function, fat mass, and appendicular lean body mass. Inflammation, TT, and albumin are associated with heavier symptom burden in this population. Interventional trials are needed to determine whether testosterone replacement and/or antiinflammatory agents benefit cancer patients.

Characteristics of androgen deficiency in late-onset hypogonadism: results from the European Male Aging Study (EMAS)

CONTEXT

Late-onset hypogonadism (LOH) has been defined as a syndrome in middle-aged and elderly men reporting symptoms in the presence of low testosterone (T).

OBJECTIVE

The objective of the study was to seek objective biochemical and end-organ evidence of androgen deficiency in men classified as having LOH according to our previously published criteria.

DESIGN, SETTING, AND PARTICIPANTS

The design of the study included cross-sectional data from the European Male Aging Study on 2966 community-dwelling men aged 40-79 years in eight European countries.

MAIN OUTCOME MEASURE(S)

Waist circumference, body mass index, muscle mass, estimated heel bone mineral density (eBMD), hemoglobin, insulin sensitivity, physical activity, metabolic syndrome, insulin resistance index, and cardiovascular disease were measured.

RESULTS

Sixty-three men (2.1%) were classified as having LOH: 36 moderate and 27 severe. They were older and more obese than eugonadal men and had, in proportion to the graded T deficiency, lower muscle mass, eBMD, and hemoglobin, with poorer general health. Both moderate and severe LOH was associated with lower hemoglobin, mid-upper arm circumference, eBMD, physical function (measured by the Short Form-36 questionnaire), slower gait speed and poorer general health. Only men with severe LOH showed significant associations with larger waist circumference (β=1.93 cm; 0.04-3.81), insulin resistance (β=2.81; 1.39-4.23), and the metabolic syndrome (odds ratio 9.94; 2.73-36.22) after adjustments for confounders. Men with low testosterone only (irrespective of symptoms) showed lesser magnitudes of association with the same end points.

CONCLUSIONS

LOH is associated with multiple end-organ deficits compatible with androgen deficiency. These data support the existence of a syndrome of LOH in only a minority of aging men, especially those with T below 8 nmol/liter.

Evaluation of the relationship between endogenous gonadotropins and female sexual function and psychological status in predialysis and hemodialysis patients

OBJECTIVES

To evaluate sexual function and psychological state and the factors affecting female sexual dysfunction in predialysis and hemodialysis patients.

DESIGN AND METHODS

Forty-seven women with chronic renal failure including 22 predialysis patients, 25 hemodialysis patients, and 30 healthy controls were included in this study. Demographic and clinical variables of the patients were recorded. The sexual functions and psychological states of the patients, assessed by the Arizona Sexual Experiences Scale (ASEX) and Beck Depression Inventory (BDI), respectively, were compared between the groups.

RESULTS

Total ASEX scores, ability to reach orgasm, and BDI scores were significantly higher in predialysis and hemodialysis patients than controls, reflecting sexual dysfunction. The patients in the predialysis group were 6 and 3.8 times more likely to develop depressive symptoms compared to the controls and hemodialysis patients, respectively. The predialysis patients who showed depressive symptoms were 24 times more likely to develop sexual dysfunction compared to those without depression. Serum FSH and LH levels were also positively correlated with arousal and erection/lubrication scores in the predialysis patients with depressive symptoms.

CONCLUSION

Female predialysis rather than dialysis patients might be more likely to develop depression. Those patients with depressive symptoms may also be at greater risk of developing sexual dysfunction in which increased gonadotropin levels and age may also be contributing factors. Therefore, psychiatric and gynecologic consultations may be beneficial.

How to recognize late-onset hypogonadism in men with sexual dysfunction

Late-onset hypogonadism (LOH) has been considered the most common form of male hypogonadism with a prevalence of approximately 1 in 100 men. Diagnosis of LOH should be made in symptomatic men with unequivocally low serum testosterone (T) levels. However, its clinical presentation is often insidious and difficult to recognize because it is characterized by nonspecific symptoms that make differential diagnosis with physiological ageing problematic. Sexual dysfunction is the most important determinant for medical consultation and the most specific symptom associated with low T. We therefore analysed a consecutive series of 1734 subjects who attended our unit for sexual dysfunction to investigate the associations between low T (different thresholds), sexual parameters, medical history data (delayed puberty, pituitary disease or cryptorchidism) and their physical exam results. Metabolic parameters, in particular waist circumference, display the greatest accuracy in detecting low T. We found that only the association of several symptoms and signs could significantly raise the clinical suspicion of low T. Structured inventories, which cluster together symptoms and signs of hypogonadism, can help clinicians suspect androgen deficiency. In particular, structured interviews, such as ANDROTEST, have been demonstrated to have a greater accuracy when compared to self reported questionnaires in detecting low T levels.

The Relationship between female sexual arousal and response bias in women with and without provoked vestibulodynia

Smaller correlations have typically been found between genital and subjective sexual arousal in female versus male samples. This study evaluated the association between response bias and the relationship between genital and subjective arousal (i.e., concordance) in women with (n = 20) and without (n = 21) provoked vestibulodynia. Participants (M = 21.27 years, SD = 2.27) underwent blood flow imaging via a laser Doppler imager to assess genital responsiveness to a visual erotic stimulus; subjective arousal was assessed during and following the film. The relationships between three types of subjective arousal ratings (perceived sexual arousal, perceived genital responsiveness, and reported desire to engage in sexual activity) and two forms of socially desirable responding (impression management and self-deceptive enhancement) were examined. Concordance estimates were statistically non-significant in both groups, with the exception of the desire to engage in sexual activity, which was moderately correlated with genital arousal in the control group. Impression management was not a statistically significant moderator of the relationship between genital and subjective arousal, but was moderately negatively related to the three forms of subjective arousal ratings in the provoked vestibulodynia group. The results highlight the importance of assessing response bias in laboratory studies comparing women with and without sexual dysfunction.

Determinants of sexual dysfunction among clinically diagnosed diabetic patients

BACKGROUND

Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD) if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana.

METHOD

Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years) visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS) and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study.

RESULTS

Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%), non-sensuality (74.5%), dissatisfaction with sexual acts (71.9%), non-communication (70.8%) and impotence (67.9%). Other areas of sexual function, including premature ejaculation (56.6%) and avoidance (42.7%) were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT) are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c), FBS, perceived desirable, too short IELT, and weight as well as waist circumference.

CONCLUSION

SD rate from this study is high but similar to that reported among self-reported diabetic patients in Kumasi, Ghana and vary according to the condition and age. The determinants of SD from this study are income level, exercise, obesity, higher perception of "desirable" and "too short" IELT.

Experimental study on Satureja montana as a treatment for premature ejaculation

AIM OF THE STUDY

Satureja montana (winter savory) is a medicinal plant traditionally used to treat different disorders including male sexual dysfunction. In this study we evaluated the effect of Satureja montana hydroalcoholic extract on copulatory behavior of sexually potent male rats.

MATERIALS AND METHODS

The extract was orally administered acutely or repetitively for 8 consecutive days at the doses of 25 and 50 mg/kg. The main parameters of sexual behavior, mount (ML), intromission (IL), ejaculation (EL) latencies and post-ejaculatory interval (PEI), were evaluated in animals submitted to mating test and multiple ejaculations test. Testosterone serum levels were measured in rats acutely treated with Satureja montana extract dosed at 50 mg/kg. In addition the open field test was conducted to evaluate the locomotor behavior.

RESULTS

When acutely administered at both dosages, the extract was able to significantly increase EL and decrease intromission frequency (IF) in comparison with controls. The significant increase in EL was found also when the extract was subacutely administered, daily for 8 consecutive days, at the dose of 25 mg/kg. In the multiple ejaculations test, EL values of treated rats were significantly increased during the 1st and 2nd sequence in comparison with controls; in addition only rats treated with the extract were able to reach the 4th ejaculation within 30 min. Testosterone serum level measured in rats acutely treated with Satureja montana at the dose of 50 mg/kg was significantly increased in rats in comparison with controls. Finally, the locomotor activity recorded in the open field test was not affected by the acute administration of the plant extract.

CONCLUSIONS

These data suggest that Satureja montana could be considered as a natural remedy for the treatment of premature ejaculation delaying ejaculation latency without exerting any negative effect on the other parameters of sexual behavior and without exerting a sedative effect. In addition the increased serum level of testosterone confirms the positive influence of Satureja montana on male sexual function.

Retrograde ejaculation and abnormal hormonal profile in a subject under treatment with valproate and phenytoin

Anti-epileptic drugs may have negative effects on sexual function and hormonal profile. The exact mechanisms involved, however, have yet to be completely understood. We report a case of ejaculation failure and abnormal hormonal profile in a patient affected by epilepsy. A 59-year-old man, under treatment with valproate and phenytoin for 15 years, complained of orgasmic an ejaculation over the previous 6 months. He was not affected by other relevant pathologies and he had not undergone pelvic surgery. We found spermatozoa in post-orgasmic urine, which confirmed our suspicion of retrograde ejaculation. The hormonal profile showed high levels of FSH, LH and, surprisingly, increased levels of total testosterone and SHBG. We hypothesized bladder sphincter inhibition and receptor alterations due to the anti-epileptic drugs.

Sexuality and fertility in women with Addison's disease

CONTEXT

Females with primary adrenal insufficiency (Addison's disease) have reduced levels of circulating androgens, which are allegedly important for sexual functioning.

OBJECTIVE

The aim was to determine peripheral androgen status, sexual functioning, and birth rates in Addison's disease females.

DESIGN

In a postal survey, all 269 females in the Norwegian Addison's registry were invited to complete the Sexual Activity Questionnaire (SAQ) and registration of childbirths. Blood samples were analyzed for 5alpha-androstane-3alpha,17beta-diol-3-glucuronide (3alpha-Diol-G) and compared with blood donor levels. The SAQ scores were compared with 740 age-matched controls from the general population and 234 women subjected to risk-reducing salpingo-oophorectomy. Fertility was estimated as standardized incidence ratio for birth; the expected number of births was estimated from population statistics.

RESULTS

The SAQ was completed by 174 (65%) of the Addison's patients. Those not taking DHEA had significantly lower 3alpha-Diol-G levels than blood donors (mean, 0.53 vs. 2.2 ng/ml; P < 0.0001), whereas those on DHEA treatment had elevated levels (mean, 5.8 vs. 2.2 ng/ml; P = 0.002). The Addison's disease females were equally sexually active as the controls, but they reported significantly higher pleasure and less discomfort. They reported lower pleasure but less discomfort than the risk-reducing salpingo-oophorectomy women. The fertility was significantly reduced in females with Addison's disease; 54 children were born to mothers with established diagnosis (87.5 expected), yielding a standardized incidence ratio for birth of 0.69 (confidence interval, 0.52-0.86).

CONCLUSION

Despite androgen depletion, females with Addison's disease do not report impaired sexuality. The fertility is reduced after the diagnosis is made; the reasons for this remain unknown.

[Ejaculatory disorders in some regions of the Russian Federation]

Ejaculatory disorders are one of the most frequent sexual dysfunction. To study this problem in different climatic regions, we made a population-based trial with participation of 543 Russian men (149 from the south of Russia, 394 from Siberia). Correlation of ejaculatory disorders with IELT duration, a testosterone level, comorbid chronic prostatitis was estimated. We found that 59.2% of young men had normal ejaculation but only 20% of men over 50 years of age. In the latter group of patients delayed ejaculation predominated. 43.6% of the southerners and 33.5% of the Siberians had premature ejaculation, and 6.1 and 16.9%--delayed ejaculation, respectively; 26.7 and 31.2% were hypogonadal, respectively. Ejaculation was normal in 74.6% men with a normal testosterone level. Hypogonadal patients had premature ejaculation in 48.2% cases, delayed ejaculation in 28.3%. Of the total 543 men, 67.2% had chronic prostatitis. Only 46% of patients with chronic prostatitis had normal ejaculation, 43.3% had premature ejaculation and 10.7% had delayed ejaculation. Thus, in cold climate delayed ejaculation occurs more often, in the South premature ejaculation predominates. A low testosterone level as well as chronic prostatitis resulted in ejaculatory disorders. There are significant differences in ejaculation between young and old men, whose living in the South and Siberia, eugonadal and hypogonadal. Therefore, when characterizing a copulative act as "normal" it is necessary to take into account age, comorbidity, region of living and other factors.

Aging males' symptoms in relation to the genetically determined androgen receptor CAG polymorphism, sex hormone levels and sample membership

Late-onset hypogonadism describes the co-occurrence of a range of physical, psychological and sexual symptoms in aging men, with the implication that these symptoms are caused by androgen deficiency. Previous investigations examined mostly population samples and did not take into account the testosterone modulating effects of the genetically determined CAG repeat polymorphism (CAGn) of the androgen receptor (AR) gene. This is the first study which investigates aging male symptoms (AMS) in relation to the genetically determined androgen receptor CAG polymorphism, estradiol and testosterone levels in men > or =50 years of age in a healthy population sample (n=100), outpatients of an andrological department (n=76) who presented with sexual and "aging male" symptoms and a psychosomatic/psychiatric sample (n=120) who presented with various psychological and medically unexplained somatic complaints. Although the population sample was significantly older than the two patient groups, they reported significantly fewer AMS and had higher testosterone levels and shorter CAG repeats of the AR. Regression analysis revealed influences of CAGn on the AMS global score and the psychological and somatic subscale only in the two patient samples, while testosterone had some impact on the sexual subscale. Our results suggest that the so-called aging male symptoms show a certain association to androgenicity, but that they are rather unspecific and of multifactorial origin. Other factors contributing to AMS need further clarification.

[Sexual and reproductive function in males with somatotropinoma]

The examination of 72 males with somatotropinoma has found that 65% of such patients have hypogonadism which is essential in pathogenesis of sexual dysfunction and spermatogenetic disorders. However, hypogonadism in males with somatotropinoma does not provoke sexual dysfunction in most the cases. High production of somatotropic hormone and insulin-like growth factor 1 in somatotropinoma leads to prostatic hyperplasia which is not accompanied with a rise of a PSA level and symptoms of infravesical obstruction.

Hyperglycemia in postmenopausal women screened for the metabolic syndrome is associated to increased sexual complaints

BACKGROUND

Postmenopausal metabolic changes increase cardiovascular risk and impair quality of life (QoL). Despite this, few reports have addressed the association of these changes with female sexuality.

OBJECTIVE

To determine the association between the metabolic syndrome (METS), and its components, and female sexuality.

METHODS

Data of sexually active postmenopausal women who participated in a METS screening program who filled out the menopause-specific quality of life questionnaire (MENQOL) were assessed. Specifically the sexual domain of the MENQOL was analyzed in regard to mean total and item scores (decreased libido, vaginal dryness, and sexual avoidance). Criteria of the Third Adult Treatment Panel (ATP III) were used to identify women with the METS.

RESULTS

Two hundred six women fulfilled inclusion criteria. Mean age of participants was 54 ± 6.9 years (median: 54 years). Prevalence of the METS in this sexually active postmenopausal series was 39.8%. About 52.9% of them presented abdominal obesity, 35.4% hypertension, 55.8% high triglycerides, 17.5% hyperglycemia, and 59.7% decreased high density lipoprotein cholesterol (HDL-C). Women with the METS as compared with those without the syndrome displayed no significant differences in MENQOL sexual scorings (total or of its composing items). Equally there were also no score differences among those presenting any of the five components of the METS, except women with hyperglycemia who significantly displayed a higher total sexual domain score (5.6 ± 2.1 vs. 4.8 ± 2.3, p < 0.05) in association to a higher mean score in the decreased libido item (6.0 ± 2.3 vs. 4.8 ± 2.6, p < 0.01). After controlling for several confounding factors, logistic regression confirmed that women with hyperglycemia were significantly at higher risk for presenting decreased libido (higher item score, OR 2.4, CI 95%: 1.0-5.7, p < 0.05) and more impaired sexuality (higher total MENQOL sexual domain score: OR, 2.5, CI 95%: 1.1-5.4, p < 0.05).

CONCLUSION

Despite the limitations of this study, as assessed with the MENQOL, hyperglycemia in postmenopausal women screened for the METS was associated to a negative impact in sexuality. More research is warranted in this regard.

Sexual dysfunction in patients with hypothalamo-pituitary disorders

Four different studies of sexual problems and sexual dysfunction in patients with hypothalamo-pituitary disorders have been undertaken and data about the sex life of the patients have been correlated with diagnosis, tumour extension and pathology, endocrine insufficiency and pituitary hormone hypersecretion. In the first study 48 out of 53 (76.2%) adult males with pituitary tumours reported decreased or absent sexual desire. The corresponding figure in the second study was 29 out of 37 (78.4%) among adult males with pituitary tumours and hyperprolactinaemia. Twenty (31.7%) and 18 (48.6%) patients, respectively, reported decreased sexual desire as the first symptom of their tumour. A highly significant correlation between a decrease in serum testosterone and a decrease in sexual desire was found. Some males with normal serum testosterone but hyperprolactinaemia also reported decreased sexual desire. In the third study, 109 females (aged 20-60) with morphologically verified hypothalamo-pituitary disorders, 68 (62.4%) had noticed a decrease in sexual desire. This problem was registered for 53 (84.1%) out of the 63 women in this group who had hyperprolactinaemia but only in 15 (32.6%) out of the 46 women with normal serum prolactin (p less than 0.001). In the last study 48 women with well-defined hypothalamo-pituitary disorders underwent a comprehensive interview about sexual function and sexual appreciation. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasms were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Preservation of normal menstrual pattern, age, and intrasellar tumour growth was correlated to normal sexual desire and function.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of trivalent antimony on the rat hormonal status under experimental conditions]

The paper gives the data of experimental studies of oral trivalent antimony used at 1 and 20 maximum permissible concentrations (MPC) on the rat hormonal status. The findings are indicative of the specific features of changes in the hormonal status of experimental animals depending on the dose of trivalent antimony. The concentration of trivalent antimony at the level of 20 MPC is shown to act as a role of a reprotoxic agent that causes a change in the serum content of hormones, such as follicle-stimulating and luteinizing ones.

Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels

OBJECTIVE

An unknown proportion of transsexual women (defined as post-operative male-to-female transsexuals on oestrogen replacement) experience hypoactive sexual desire disorder (HSDD). It has been suggested that the absence of ovarian androgen production together with oestrogen treatment-related increase in sex hormone-binding globulin (SHBG) levels could be leading to HSDD, due to low levels of biologically available testosterone. This study wishes to document the HSDD prevalence among transsexual women and the possible association to androgen levels.

DESIGN

Cross-sectional study.

METHODS

Transsexual women (n=62) and a control group of ovulating women (n=30) participated in this study. Questionnaires measuring sexual desire (sexual desire inventory) and relationship and sexual satisfaction (Maudsley Marital Questionnaire) were completed. Serum levels of total testosterone, LH and SHBG were measured in blood samples obtained at random in transsexual women and in the early follicular phase in ovulating women.

RESULTS

The transsexual group had lower levels of total and calculated free testosterone (both P<0.001) than the ovulating women. HSDD was reported in 34% of the transsexual and 23% of the ovulating women (P=0.30). Both groups reported similar levels of sexual desire (P=0.97). For transsexual women, no significant correlation was found between sexual desire and total (P=0.64) or free testosterone (P=0.82). In ovulating women, these correlations were significant (P=0.006, resp. P=0.003).

CONCLUSIONS

HSDD is reported in one-third of transsexual women. This prevalence is not substantially different from controls, despite markedly lower (free) testosterone levels, which argues against a major role of testosterone in this specific group.

Female Sexual Dysfunction and Hormonal Status in Spinal Cord Injured (SCI) Patients

To investigate a possible correlation between sexual hormonal status and the presence of female sexual dysfunction (FSD) using the Female Sexual Function Index (FSFI) in females with spinal cord injuries (SCI), we selected 39 SCI fertile-aged women. At visit 1, we assessed the presence of FSD using the FSFI, and all individuals were submitted to a blood hormone evaluation on the third day of their menstrual cycle. The levels of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyroid-stimulating hormone (TSH), cortisol, dehydroepiandrosterone sulphate (DHEA-S), androstenedione, 17[alpha]-hydroxyprogesterone; total and free testosterone, 17beta-estradiol, inhibin, sex hormone-binding globulin (SHBG), and thyroid hormones (fT3 and fT4) were checked. Progesterone was measured on the 20th to 21st day after the menstrual cycle. In patients with amenorrhea, we tested all the hormones using 1 random blood test. After a 3-month period, the tests were repeated. Overall, 23/39 (58.9%) patients continued to manifest at least one sexual dysfunction. These patients reached a median score of 19.52. All but 6 patients (15.3%) consistently showed hormonal values within the normal range. Of the 6 patients with abnormal hormonal alterations, 5 showed at least one sexual dysfunction, 2 had low levels of total testosterone, 1 had a low level of free testosterone, 1 suffered from hypothyroidism, 1 presented with low levels of cortisol, and 1 showed hypoprogesterone. There was no significant correlation between abnormal hormonal status and the presence of a specific sexual dysfunction, as assessed with the FSFI.

Hormones and sexuality during transition to menopause

OBJECTIVE

To examine the relationship between reproductive hormonal dynamics and sexual dysfunction assessed in a cohort of women approaching menopause.

METHODS

Women in the Penn Ovarian Aging Study were assessed at yearly intervals for 3 years with early follicular hormone measurements (estradiol, follicle-stimulating hormone, luteinizing hormone [LH], sex hormone binding globulin, dehyroepiandrosterone sulfate [DHEAS], total testosterone), anthropometric measures, and extensive questionnaires including the Female Sexual Function Index. Univariable analyses were performed to determine the association between hormones, menopausal status, and sexual dysfunction. Multivariable linear and logistic regression models were created to examine the influence of hormones on sexual function adjusting for the effect of potential confounders.

RESULTS

The final multivariable model indicated that sexual dysfunction increased with advanced menopausal status, with postmenopausal women being 2.3 times as likely to experience sexual dysfunction compared with premenopausal women (odds ratio 2.3, 95% confidence interval [CI] 1.3-4.1). Low DHEAS serum concentrations were associated with decreased sexual function (odds ratio 1.59, 95% CI 1.19-2.14). Additional risk factors associated with sexual dysfunction included absence of a sexual partner (11.2, 95% CI 6.9-18.1), high anxiety (3.8, 95% CI 1.6-9.2), and children under the age of 18 living at home (1.6, 95% CI 1.1-5.5). Lubrication, orgasm, and pain were specific aspects of sexuality negatively affected by menopause.

CONCLUSION

This study confirms the observation that sexual dysfunction increases over the menopausal transition. Several factors associated with sexual dysfunction include low DHEAS, absence of a sexual partner, anxiety, and children under the age of 18 living at home.

LEVEL OF EVIDENCE

II.