A Multicenter, Randomized, Open-Labeled, Parallel Group Trial of Sildenafil in Alcohol-Associated Erectile Dysfunction: The Impact on Psychosocial Outcomes

To examine the effect of sildenafil on erectile dysfunction (ED) and psychosocial outcomes in alcohol-dependent (AD) men, 108 men with these diagnoses were randomly assigned to either take sildenafil (50 mg) as add-on to standard treatment for AD, or the same treatment without sildenafil, for 12 weeks. Only 50 patients in sildenafil group and 51 in control group twice completed the International Index of Erectile Function (IIEF) and a battery of self-report questionnaires. IIEF scores and psychosocial functioning, self-esteem and support from friends improved only for sildenafil-treated patients (P < 0.001). The high effect sizes suggest that the observed benefits are unlikely to be a placebo effect, although their unspecific nature could not be ruled out. In men with ED associated with AD, sildenafil improves both ED and psychosocial outcomes. Further placebo-controlled clinical trial is warranted

Relationship between hyperuricemia with deposition and sexual dysfunction in males and females

Purpose The association between gout, the most common crystal arthropathy, and sexual dysfunctions has often been investigated by studies in the last decades. Despite the presence of shared risk factors and comorbidities and the possible effects on sexual health of long-term gout complications, awareness of this association is severely lacking and the pathogenetic mechanisms have only partially been identified. In the present review, we aimed to investigate the current evidence regarding the potential mechanisms linking sexual dysfunctions and gout. Methods A comprehensive literature search within PubMed was performed to provide a summary of currently available evidence regarding the association between gout and sexual dysfunctions. Results Gout and sexual dysfunctions share several risk factors, including diabesity, chronic kidney disease, hypertension, metabolic syndrome, and peripheral vascular disease. Gout flares triggered by intense inflammatory responses feature severe pain and disability, resulting in worse sexual function, and some, but not all, treatments can also impair sexual health. Long-term gout complications can result in persistent pain and disability due to joint deformity, fractures, or nerve compression, with negative bearing on sexual function. The presence of low-grade inflammation impairs both sex steroids synthesis and endothelial function, further advancing sexual dysfunctions. The psychological burden of gout is another issue negatively affecting sexual health. Conclusions According to currently available evidence, several biological and psychological mechanisms link sexual dysfunctions and gout. Addressing risk factors and providing adequate treatment could potentially have beneficial effects on both conditions. Appropriate clinical evaluation and multidisciplinary approach are recommended to improve patient care

Autonomic dysregulation in multiple sclerosis

Multiple sclerosis (MS) is a chronic, progressive central neurological disease characterized by inflammation and demyelination. In patients with MS, dysregulation of the autonomic nervous system may present with various clinical symptoms including sweating abnormalities, urinary dysfunction, orthostatic dysregulation, gastrointestinal symptoms, and sexual dysfunction. These autonomic disturbances reduce the quality of life of affected patients and constitute a clinical challenge to the physician due to variability of clinical presentation and inconsistent data on diagnosis and treatment. Early diagnosis and initiation of individualized interdisciplinary and multimodal strategies is beneficial in the management of autonomic dysfunction in MS. This review summarizes the current literatureon the most prevalent aspects of autonomic dysfunction in MS and provides reference to underlying pathophysiological mechanisms as well as means of diagnosis and treatment. © 2015 by the authors; licensee MDPI, Basel, Switzerland

Erectile Dysfunction

Erectile dysfunction is a widespread problem, affecting many men across all age groups and it is more than a serious quality of life problem for sexually active men. This book contains chapters written by widely acknowledged experts, each of which provides a unique synthesis of information on emergent aspects of ED. All chapters take into account not only the new perspectives on ED but also recent extensions of basic knowledge that presage directions for further research. The approach in this book has been to not only describe recent popular aspects of ED, such as basic mechanism updates, etiologic factors and pharmacotherapy, but also disease-associated ED and some future perspectives in this field

An exploratory study of the impact of scarring on sexuality and body image of females who have sustained a burn injury

This study explores how burn injuries impact sexuality, body image and interpersonal relationships in females. A sequential, mixed methods research design was used to identify potential correlations between the incidence of poor sexual esteem, sexual avoidance and satisfaction with life and increased body image dissatisfaction in female burn survivors. Female burn survivors are at risk of sexuality and body image dissatisfaction post injury, which is long standing and independent of improvement in physical function

Understanding and treating ejaculatory dysfunction in men with Diabetes mellitus

INTRODUCTION: Diabetes mellitus (DM) is a rapidly rising metabolic disorder with important systemic complications. Global figures have demonstrated the prevalence of DM has almost quadrupled from 108 million in 1980 to 422 million in 2014, with a current prevalence of over 525 million. Of the male sexual dysfunction resulting from DM, significant focus is afforded to erectile dysfunction (ED). Nevertheless, ejaculatory dysfunction (EjD) constitutes important sexual sequelae in diabetic men, with up to 35-50% of men with DM suffering from EjD. Despite this, aspects of its pathophysiology and treatment are less well understood than ED. The main disorders of ejaculation include premature ejaculation (PE), delayed ejaculation (DE), anejaculation (AE) and retrograde ejaculation (RE). BACKGROUND: Although EjD in DM can have complex multifactorial aetiology, understanding the pathophysiological mechanisms caused by DM has facilitated the development of therapies in the management of EjD. Most of our understanding of its pathophysiology is derived from diabetic animal models, however observational studies in humans have also provided useful information in elucidating important associative factors potentially contributing to EjD in diabetic men. These have provided the potential for more tailored treatment regimens in patients depending on the ejaculatory disorder, other co-existing sequelae of DM, specific metabolic factors as well as the need for fertility treatment. However, the evidence for treatment of EjD, especially DE and RE, is based on low-level evidence comprising small sample-size series and retrospective or cross-sectional studies. Whilst promising findings from large randomised controlled trials (RCTs) have provided strong evidence for the licensed treatment of PE, similar robust studies are needed to accurately elucidate factors predicting EjD in DM, as well as for the development of pharmacotherapies for DE and RE. Similarly, more contemporary robust data is required for fertility outcomes in these patients, including methods of sperm retrieval and assisted reproductive techniques (ART) in RE. This article is protected by copyright. All rights reserved

Managing voiding dysfunction in young men

AbstractVoiding dysfunction is an uncommon condition in young men. With increased understanding of the etiology of chronic lower urinary tract dysfunction, there has been significant improvement in the management of the condition. We have reviewed the current literature and make suggestions about diagnosis, treatment, and further research on this topic. We searched the PubMed database for the management of voiding dysfunction in young men using the following terms: voiding dysfunction, lower urinary tract symptoms, young men, risk factor, urodynamics study, uroflowmetry, magnetic resonance imaging, primary bladder neck obstruction/bladder neck dysfunction, dysfunctional voiding/pseudodyssynergia, impaired detrusor contractility/detrusor underactivity, adrenergic antagonist, transurethral incision, urotherapy, baclofen, and botulinum toxin. Uroflowmetry is an important noninvasive examination for screening young men for possible voiding dysfunction. A videourodynamic study is recommended for patients with low urine flow. Primary bladder neck obstruction and dysfunctional voiding are the two most common diagnoses. α-Adrenergic antagonists and urotherapy are widely used for treating bladder neck obstruction and dysfunctional voiding, respectively. Botulinum toxin A may become a potential therapeutic option in the future. Although the published reports usually included a small number of patients and lacked randomization and a placebo-controlled group, these clinical studies still provide great advances in managing voiding dysfunction in young men. Further well-designed studies are warranted to support optimal management of these conditions

Psychological Sexual Health of People with Paraplegia

People with paraplegia have to fight their own and societal attitudes and stereotypes that reduce sexuality to the physiological functions of genitalia. These psychological and social limitations arise from cultural and disability models that focus sexual pleasure on phallocentric primacy, and sexual attractiveness of perfect bodies. In this chapter, we evaluate the impacts of a psychoeducational intervention in a personal growth group on the sexual life of two groups of people with spinal cord injury (SCI) and their partners, throughout their sexual interest and satisfaction, depression, and anxiety. In the first study, nonparametric statistical tests were used to compare pre- and post-outcome measures for all participants. In the second study, the grounded theory was used to explore dialogs and activities that were audiotaped during the group meetings. The participants in both groups were patients and their partners. The psychoeducational intervention was clearly effective in increasing sexual interest and satisfaction as well as the motivation and ability to enjoy sexuality. Anxiety was minimized for all participants, although it may not have been associated with the psychoeducational intervention. In addition, the intervention significantly improved the partner and patient group’s opportunity and ability to enjoy sexuality

Practical Clinical Andrology

This open access book offers a valuable resource for understanding the correct pathways in the context of sexual disorders, couple reproduction, gender identity dysphoria, conditions for which patients commonly ask for consultation and treatment. Based on clinical evidence, international guidelines and experts experience, practical clinical management strategies are presented for each condition. Each clinical care pathway is based on updated algorithm, level of evidence, photos and video-clips that describes the clinical presentations and the best practice management through diagnostic tools and medical or surgical treatment. Leading experts from the most important center of excellence in the field of sexual medicine joined to cover the field of andrology in its entirety, each of them dealing with a single topic from the top of their recognized experience and providing a complete and update textbook that will help urologists and other physicians in their daily clinical practice. This book is thought to be a practical and valuable reference for urologists, gynecologists, endocrinologists, psychiatrics and psychologists, and residents who are not specialty trained in andrology. It is designed for both young fellows training in different specialties and coming into contact with andrological issues for the first time and also more experienced clinicians and surgeons requiring updated guidelines and clear advice on the most controversial issues. This book will represent an invaluable quick consulting tool, updated in its scientific contents and rich in tables, images and video-clips