[Application of MRI in the studies of female sexual dysfunction]

Female sexual dysfunction (FSD) is a disease associated with various factors such as psychological conditions, age, physical illness, and drugs. Magnetic resonance imaging (MRI) has the advantages for the studies FSD due to its non-invasiveness and high soft-tissue contrast. Brain MRI revealed significant differences in brain function activation sites and signaling between women with FSD and those with normal sexual function. Pelvic MRI found a close relation of the location and size of the clitoris with the sexual function of women, which may help to determine the lesion area of the FSD patient. A comparative analysis of the central nervous system and peripheral reproductive organs in women with normal sexual function and FSD patients by MRI is of great value for exploring the etiology of FSD and its treatment options.

Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use

Pornography consumption is highly prevalent, particularly among young adult males. For some individuals, problematic pornography use (PPU) is a reason for seeking treatment. Despite the pervasiveness of pornography, PPU appears under-investigated, including with respect to the underlying neural mechanisms. Using functional magnetic resonance imaging (fMRI), we examined ventral striatal responses to erotic and monetary stimuli, disentangling cue-related 'wanting' from reward-related 'liking' among 28 heterosexual males seeking treatment for PPU and 24 heterosexual males without PPU. Subjects engaged in an incentive delay task in the scanner, in which they received erotic or monetary rewards preceded by predictive cues. Blood-oxygen-level-dependent responses to erotic and monetary cues were analyzed and examined with respect to self-reported data on sexual activity collected over the 2 preceding months. Men with and without PPU differed in their striatal responses to cues predicting erotic pictures but not in their responses to erotic pictures. PPU subjects when compared with control subjects showed increased activation of ventral striatum specifically for cues predicting erotic pictures but not for cues predicting monetary gains. Relative sensitivity to cues predicting erotic pictures vs monetary gains was significantly related to the increased behavioral motivation to view erotic images (suggestive of higher 'wanting'), severity of PPU, amount of pornography use per week, and number of weekly masturbations. Our findings suggest that, similar to what is observed in substance and gambling addictions, the neural and behavioral mechanisms associated with the anticipatory processing of cues specifically predicting erotic rewards relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.

Quetiapine effective in treatment of inappropriate sexual behavior of lewy body disease with predominant frontal lobe signs

Dementia of Lewy body disease is the second most common degenerative cause of dementia after Alzheimer's disease, among all the dementias. The core features are a progressive dementia, fluctuations in cognitive functions, visual hallucinations, and spontaneous parkinsonism. Rapid eye movement sleep behavior disorder, severe neuroleptic sensitivity, and low dopamine transporter uptake in basal ganglia are other suggestive features. Behavioral abnormalities are commonly present in the form of aggressive behavior, irritability, and uninhibited behaviors. These are mostly seen in the advanced stages of dementia. However, inappropriate sexual behavior is uncommonly seen in such cases. Three types of inappropriate sexual behaviors commonly found in cases of dementia are sex talks, sexual acts, and implied sexual acts. Such inappropriate sexual behaviors have not been described adequately in dementia of Lewy body disease. We report inappropriate sexual behaviors in a case of dementia of Lewy body disease, which improved rapidly after treatment with quetiapine.

[Hypothalamus may be involved in psychogenic erectile dysfunction]

OBJECTIVE

To study the changes of hypothalamus metabolism in patients with psychogenic erectile dysfunction (ED) so as to get some clues to the possible pathogenic factors and pathophysiological mechanism of the problem.

METHODS

Six cases of psychogenic ED and 4 normal volunteers were studied by positron emission tomography (PET) for the characteristics of hypothalamus glucose metabolism. Following audiovisual sexual stimulation, the concentration of fluorine-18-fluorodeoxyglucose (18 F-FDG) was determined and the ratio of the left (right) hypothalamus count to the cerebrum count was calculated.

RESULTS

Audiovisual sexual stimulation significantly increased 18F-FDG in the volunteers (left: 1.026 +/- 0.115 vs 2.400 +/- 0.210; right: 1.003 +/- 0.187 vs 2.389 +0.196, P < 0.05) as compared with the psychogenic ED patients (left: 2.781 +/- 0.156 vs 2.769 +/- 0.223; right: 2.809 +/- 0.129 vs 2.793 +/- 0.217, P > 0.05).

CONCLUSION

Psychogenic ED may not be simply a functional disease; the hypothalamus may be involved in the pathophysiology of the problem.

Brain processing of visual sexual stimuli in men with hypoactive sexual desire disorder

Although hypoactive sexual desire disorder (HSDD) is a common condition and has long been hypothesized to result from malfunctions of the cerebral control mechanisms that adjust the level of sexual motivation, very little is known about the pathophysiology of this disorder. The primary objective was to identify in patients with HSDD brain regions where functional perturbations disrupt the regulation of sexual motivation. We used positron emission tomography to compare seven male patients with HSDD with eight healthy men on their regional cerebral blood flow responses to visual sexual stimuli (VSS) of graded intensity. Statistical Parametric Mapping was used to locate brain regions that demonstrated a differential activation (or deactivation) across the groups. Whereas in control subjects the medial orbitofrontal cortex showed a deactivation in response to VSS, in HSDD patients there was an abnormally maintained activity of this region, which has been implicated in the inhibitory control of motivated behavior. By contrast, the reverse pattern-activation in control subjects, deactivation or unchanged activity in patients-was found in the secondary somatosensory cortex and inferior parietal lobules, regions mediating emotional and motor imagery processes, as well as in those areas of the anterior cingulate gyrus and of the frontal lobes that are involved in premotor processes.

A prospective duplex Doppler ultrasonographic study in women with sexual arousal disorder to objectively assess genital engorgement induced by EROS therapy

The EROS therapy device is FDA-approved for the treatment of women with sexual dysfunction and has been shown to improve sexual function and satisfaction. The aim of this study was to obtain objective information regarding the ability of the EROS Therapy device to induce clitoral and corpus spongiosum volumetric and hemodynamic changes following therapeutic use in women with sexual arousal disorder. Seven patients with sexual arousal disorder formed the study population. All seven subjects met inclusion and exclusion criteria, including having normal hormonal values at the time of the study. All seven subjects were able to comfortably operate the device. All seven reported either slight-to-moderate pleasure or orgasm at home with the device. We observed no adverse events. This study shows that EROS therapy is associated with significant increases in clitoral and corpus spongiosum diameter as well as with clitoral and corpus spongiosum peak systolic and end-diastolic velocity values.

Duplex Doppler ultrasound assessment of clitoral hemodynamics after topical administration of alprostadil in women with arousal and orgasmic disorders

There are limited hemodynamic data in women with arousal or orgasmic disorders and even fewer normative control hemodynamic data in women without sexual dysfunction. In addition, there is limited experience with topical vasoactive agents (used to maximize genital smooth muscle relaxation) applied to the external genitalia during hemodynamic evaluations. The aim of this study was to report duplex Doppler ultrasound clitoral cavernosal arterial changes before and after topical PGE-1 (Alprostadil) administration in control women and in patients with arousal and orgasmic sexual disorders. We found that women with sexual arousal and orgasmic disorders had significantly (p < 0.05) diminished clitoral peak systolic and end diastolic velocity responses compared to controls. Further research is needed to establish the diagnostic role of topical vasoactive agents in the hemodynamic evaluation of women with sexual dysfunction.

Third degree obstetric tears; outcome after primary repair

BACKGROUND

Disruption of the anal sphincter occurs in 0.5 to 2.5% of women during delivery. Defects of the sphincter are major causes of fecal incontinence. More than 30% of women who suffer from third degree perineal tears develop incontinence. We sought to determine the incidence of symptoms and injury to the anal sphincter among women who gave birth during a 5 year period. We also investigated the sensitivity of manometry and endosonography as well as the correlation of these two diagnostic modalities.

METHODS

Thirty-eight women were examined one to five years after delivery. We used a questionnaire to assess symptoms of anal incontinence. Anal manometry and endosonography were performed.

RESULTS

Twenty (57%) women had symptoms; most of them (34%) in the form of flatulence incontinence. The rest were incontinent of either liquid or solid stools. Four of these women were re-operated. Seventeen percent of the women suffered from anal incontinence during sexual intercourse. Only seven women had been in contact with a doctor regarding these problems.

CONCLUSION

The fact that 57% of the women that took part in this study reported complications, leads us to the conclusion that the primary repair of third degree anal sphincter tears is unsatisfactory. It is important to decide whether any changes in primary repair may improve results in the future. Sexual dysfunction is also a complication of third degree obstetric tear with primary repair. It is important that the women who suffer from anal sphincter tear, as well as doctors, are given information about possible symptoms and the treatment available.