Sexualstörungen des alternden Mannes

Sexual dysfunction in the aging male has only recently found widespread attention. As apposed to enduring conceptions of "asexual" elderly, recent representative surveys show that the majority of men maintain sexual wishes and fantasies into old age. Sexual activity primarily depends on the availability of a partner and on maintaining intimacy and sexuality in the face of changes in the sexual response cycle and increasing morbidity. Sexual dysfunctions in aging result from physical, psychological, partner-related changes and lifestyles. These should be considered in the diagnosis and treatment of sexual dysfunctions in the aging male.     

Prostate and sexuality: An overview

OBJECTIVE: Diseases of the prostate, prostatitis, prostatodynia, benign prostatic hyperplasia (BPH), and carcinoma of the prostate interfere with sexual function. Since the American Urological Association have issued their position statement in 1990 that male sexual dysfunction is a recognized disease entity, studies examined the interrelation between sexuality and the prostate. These studies were identified in our review. METHOD: A computer- and hand-based search of the literature was conducted with the key words health-related quality of life, sexual function and the various disease states of the prostate, the drawback being that validated quality-of-life instruments have just recently and mostly nationally been validated. RESULTS: Sexual function is a dimension of quality-of-life questionnaires with 1 up to 11 questions addressing sexuality. The effect of aging on male sexuality as determined in Sweden serves as an important background information. Whereas prostadynia and sexual dysfunction aggravate each other, BPH and its treatment influence only certain sexual functions. Carcinoma of the prostate, untreated or under observation, has the greatest impact on sexuality which is tolerated differently from country to country and depends upon the expectation of survival. CONCLUSION: The impact of treatment of prostatic diseases on sexuality can now be studied easier in utilizing validated questionnaires. This update may serve as a base for these upcoming studies.     

M?nnliche Sexualit?t im Alter

Male sexuality in the elderly is an important issue with a growing relevance. In contrast to the assumption of an asexual state when becoming older, recent representative surveys show that the majority of men maintain sexual desires and fantasies into old age. Sexual activity primarily depends on the availability of a partner and on maintaining intimacy and sexuality in the face of changes in the sexual response cycle and increasing comorbidity. This review aims to clarify the normal aging process, the sexual behavior of aging males and the prevalence of sexual dysfunction.     

中老年人椎体骨密度定量CT测定研究

目的探讨定量CT（quantitative CT,QCT）椎体骨密度（bone mineral density,BMD）测定在诊断骨质疏松症中的临床价值,分析骨质疏松发生率与年龄、性别的关系。方法对597例中老年无症状体检者进行BMD测定,其中男性356例,女性241例,年龄30～89岁,按年龄、性别分组,每10岁为一年龄段。将QCT扫描线分别定位于L1～4椎体中间层面,与椎体上下缘平行扫描。结果中老年人BMD随年龄增高而下降,本组骨质疏松症发生率,女性：50～59岁为54.05%,60～69岁为81.81%,70～79岁为94.74%,80～89岁为100%;男性：50～59岁为25%,60～69岁为50%,70～79岁为64.52%,80～89岁为90.91%。结论 QCT诊断骨质疏松症敏感、准确、重复性强,易于推广应用。骨质疏松症发生率与年龄增加有关,年龄越大,骨质疏松症发生率越高,女性显著高于男性。     

Correlations between hormones, physical, and affective parameters in aging urologic outpatients

OBJECTIVE: To determine the relationship between sex hormones, physical complaints, depression, sexuality, and life satisfaction in aging men. METHODS: 263 outpatients aged 40 years and above (M=56.2; 40-84 years) were recruited from 6 andrological outpatient departments in Germany to evaluate "aging male" symptoms. Subjects were assessed by standardised self-report questionnaires, physical, and endocrinological examination. RESULTS: Total and free testosterone as well as DHEA-S (dehydroepiandrosterone-sulfate) levels decreased significantly with age. SHBG (sex hormone binding globulin) and LH (luteinizing hormone) increased; estradiol remained unchanged. Inactivity, lower urinary tract symptoms, erectile and orgasmic dysfunction also increased significantly with age. A low testosterone level was significantly associated with a reduced motivation and a lack of sexual desire. In addition to reduced testosterone levels, a reduced motivation was also predicted by depression and an impaired physical self-concept. Reduced activity, erectile dysfunction, and low testosterone levels contributed significantly to the lack of sexual desire. CONCLUSIONS: Aging men are frequently afflicted with a wide range of physical complaints (e.g. fatigue, prostate symptoms), erectile and orgasmic dysfunction, reflected in a reduced physical self-concept. Assessment and treatment of age-related physical and affective alterations must consider their close interplay with hormonal and lifestyle variables.     

勃起神经保留性膀胱全切Roux-y乙状结肠新膀胱的临床结果

目的:观察勃起神经保留性膀胱全切和Roux-y乙状结肠新膀胱术后患者阴茎勃起功能、尿控、排尿和肿瘤复发情况。方法:共有18例患者进行了勃起神经保留性膀胱全切和Roux-y乙状结肠新膀胱术,评价肿瘤复发情况和功能性结果(尿控、排尿、勃起功能)。结果:平均随访41个月,2例分别于术后10个月和15个月死于癌症广泛性转移,这2例均为盆腔淋巴结阳性的患者。白天和夜间尿控率均为100%,11例患者有阴茎勃起功能,勃起率达61.1%,2例患者勃起功能受损,5例无勃起功能,手术前后ⅡEF-5评分为(13.72±6.39)、(10.83±8.25)分,差异有显著性(P<0.05)。结论:勃起神经保留性膀胱全切和Roux-y乙状结肠新膀胱术后患者阴茎勃起功能和尿控情况良好,肿瘤复发情况尚可接受,但仍需要长时间随访和大样本患者证实。     

Hormonal replacement therapy and aging： Asian practical recommendations on testosterone supplementation

Profound and diffuse alterations in the production of gonadal and adrenal androgens as well as growth hormone are associated with aging. To convey this concept more appropriately, partial endocrine deficiency in the aging male (PEDAM) was introduced as a term for the phenomenon of hormonal alterations in the aging male.Hormones responsible for some of the manifestations associated with male aging are testosterone, growth hormone,dehydroepiansdrosterone (DHEA), melatonin, thyroid hormones and leptin. Of these, testosterone has been widely investigated and its beneficial and adverse effects on male bodily systems are relatively well established. However, a serious body of confusion and misunderstandings surrounding the diagnosis, treatment and monitoring of men suspected of having androgen deficiency has been raised. Therefore, it is timely to provide practical criteria for diagnosis and treatment to avoid misconception about the use of testosterone in the aging male. To provide an understanding and information of the issues, the following headings are summarized: (1) Important clinical consideration on testosterone supplementation in the aging male; (2) Asian practical recommendations on testosterone supplementation in the aging male.     

男性性心理

人类的性具有生物性与社会性两重属性。其生物学意义上的性秘密已近似全部揭开 ,但有关性心理及社会层面的性问题并未解决 ,且人类的性活动受心理、社会因素的影响远大于生物因素的控制。本文概括介绍构成男性性心理的诸因素以及手淫与常见心理障碍的内容。     

Androgen therapy in hypogonadotrophic hypogonadism: time course of erotosexual functions

This study was designed to assess the duration of androgen's effects on male sexuality to recommend an optimal therapeutic regime. Nine young men with hypogonadotrophic hypogonadism were repeatedly tested for 9 weeks after an i.m. dose of a Depo-testosterone preparation. Testing included self-rating of sexuality and recording of penile tumescence during sleep and during pornographic film, slides, and self-induced fantasy. Although serum testosterone decreased to subnormal levels by the fourth week, erectile strength, according to self-report, became subnormal by the eighth week, whereas other reported parameters remained unchanged. Erectile response to erotic stimulations remained unchanged for the entire 9 weeks. Nocturnal erections were supranormal for the first 2-4 weeks and normalized thereafter. Testosterone's effect on male sexuality seems to persist beyond the period of normal serum testosterone. Treatment can, therefore, be given bimonthly.     

Aging changes in the male face

Discrete anatomic differences exist between the male and female face that are relevant in surgical planning. Although the aging process of male and female faces share many common features, attention to the particular differences in the aging man is warranted. Gender differences in the male face include the presence of facial hair, increased facial vascularity, increased thickness, increased sebaceous content, hormonal influences, and potentially differing rates of fat and bone absorption during the life cycle. This article describes the anatomic characteristics of the male face that require attention as the facial plastic surgeon constructs a treatment plan for the aging face Further investigation is required to describe in more detail the anatomic and biologic differences in male and female facial aging.     

46, XX male sex reversal syndrome: a case report and review of the genetic basis

Sex reversal syndrome is a kind of human genetic disease about gender dysplasia, which is characterised by inconsistency between gonadal sexuality and chromosome sexuality; the incidence rate was about 1 : 20 000–100 000. The clinical manifestations, hormonal levels and cytogenetic findings in a patient of 46, XX male sex reversal syndrome retrospectively were analysed and related published reports were reviewed. The DNA fragments of sex-determining region Y (SRY) gene from the patient was found by polymerase chain reaction, but the fluorescent in situ hybridisation analysis revealed that the SRY translocated from Y to X chromosome. We concluded that the Y chromosomal SRY gene is required for the regulation of male sex determination. The detection of SRY is important for the clinical diagnosis of sex reversal syndrome. Translocation of SRY to X chromosome or other autosomes would be one of the key factors that induced XX male SRS.     

Occupational Influences on Male Fertility and Sexuality

The authors present herewith a survey of occupational influences on male fertility and sexuality. From literature data of the last 15 years, the potential risks of physical factors (traumatisms, temperature, radiation, micro-waves), of chemical factors (metals, mineral oils, hormones, pesticides and herbicides, neurotoxins, vinylchloride and analogs, carbondisulfide), of physio(patho)logical factors (infectious diseases occupationally acquired, low back syndrome) and of psychological factors (stress, alcoholism) are discussed. The authors also discuss the methodological aspects in monitoring the fertility and sexuality of male workers. As conclusion, they warn physicians, practising occupational medicine, to be aware of these potential risks regarding gonadal function and to neglect no longer the reproductive and sexual functions of the male. In the future, these problems will be faced more than at present, because of the increasing production of very active and toxic substances. Occupational hygienic measures are the first step in preventing environmental pollution hazards.     

自我不和谐男同性恋诱发因素探讨

根据临床性咨询总结了１４８名自我不和谐男同性恋的临床特点，并分析了其诊断标准、诱发因素、预后或可纠正性，希望为今后性教育的实施及更好地做到早期预防、早期纠正这类自青春期起出现的性取向障碍提供一些经验和依据。     

Symptomatik oder Befindlichkeitsstörungen des alternden Mannes—Welche Fragebögen stehen zur Verfügung?

Age associated hypoandrogenism and related changes in sexual function, as well as multiple physical complaints, and affective and cognitive changes have all been described in the aging male. In addition to decreased testosterone levels, clinical symptoms are required in order to perform substitution therapy. The assessment of symptoms and complaints in the aging male is discussed based on scientific test criteria. Commonly used questionnaires have the advantages of economy and independence from the investigator. In order to cover the broad range of age associated changes, numerous standardized and reliable procedures are available. However, these have usually not been developed specifically in order to assess androgen dependent changes. Preliminary, specific "aging male" questionnaires do not correlate reliably with the levels of testosterone. Thus there is a need for research and development in order to identify and assess androgen dependent complaints.     

Extraordinarily high rates of male circumcision in South Korea: history and underlying causes

OBJECTIVE: To investigate the high circumcision rate in South Korea and its rapid increase in the short period since its introduction. SUBJECTS AND METHODS: From January to December 2000, 5434 South Korean males (or their parents) aged 0-92 years were interviewed in detail about their circumcision status, their age at circumcision, and the possible effect of circumcision on their sexuality. In addition, 267 practising medical doctors were surveyed about their basic understanding of circumcision and phimosis. RESULTS: Currently the circumcision rate for high-school boys is > 90% and for those > 70 years old is < 10%. The circumcision rate in 1945 was < 0.1%. When averaged over the whole population, the present South Korean circumcision rate is approximately 60%; the rate has increased dramatically with time and particularly in the past 20 years, when the estimated number of male circumcisions has exceeded the number of male births. Although circumcision in South Korea has been strongly influenced by American culture, it has never been predominantly neonatal. The age at circumcision has continued to decrease and boys are now circumcised at approximately 12 years old. Of those who were circumcised long after they had been sexually active, > 80% reported no noticeable difference in sexuality, but a man was twice as likely to have experienced diminished sexuality than improved sexuality. Of the doctors who were surveyed, 41% carried out circumcision but, unlike in America, gynaecologists and paediatricians rarely did so. Among the doctors, basic knowledge on circumcision and phimosis was generally lacking, regardless of whether they practised circumcision or not. Amongst the factors contributing to the high circumcision rate was the mistaken notion held by both doctors and the general public that circumcision is directly correlated with industrialization and general progress of living standards. Many doctors believe the out-dated and sometimes controversial benefits of circumcision, i.e. prevention of cervical cancer and sexually transmitted diseases, and improved sexuality. Thus the vast majority of doctors recommend circumcision regardless of the patient's age. Peer pressure was also an important contributing factor. CONCLUSION: South Korea has an unusual history of circumcision. The mistaken and out-dated notions about circumcision and lack of knowledge of phimosis by physicians seem to be a leading contributory factor to the extraordinarily high circumcision rate.     

Sexual potency: a pioneer's thirty-five-year overview

Thirty-five years of interest in human sexual potency are summarized, citing my clinical research and periodic publications during those decades. Emergence of scientific study of human sexuality has been rapid in recent years, leading to improved diagnostic and therapeutic techniques to benefit the impotent male. Although my approach pertained primarily to psychogenic etiology, the interdigitation of emotional and organic factors is emphasized. Currently utilized surgical and pharmacodynamic treatments are noted, as are probable future methodologies.     

Late-onset hypogonadism: the Asian experience

The majority of the world's population resides in Asia, where the elderly segment will comprise more than one third of its people in the next 50 years. The health and well-being of the aging male in Asia is receiving more attention as health care systems develop and mature. The concept of hormone therapy in association with virility and vitality has been rooted in Asian cultures for thousands of years. As with the rest of the world, interest in diagnosing and treating late-onset hypogonadism (LOH) is gaining enthusiasm with better scientific understanding of the effects of testosterone deficiency in the aging male. Asian researchers have been making progress, with more studies set to mature over the next few years, and they are keen to discover the variations in the Asian aging male. In this review, we present the current experience and guidelines from Asia in the field of LOH.     

Influence of male sexual rest and oocyte aging on parthenogenesis frequency in mice: cytogenetic analysis after in vitro fertilization.

This study was conducted to evaluate the influence of male sexual rest and oocyte aging on fertilization rate and parthenogenesis frequency after in vitro fertilization of mouse oocytes. We used a comparison between cleavage rates and fertilization rates according to chromosomal analysis of oocytes to estimate the parthenogenesis frequency. Fertilization rate was not impaired by male sexual rest. Parthenogenesis frequency was increased by male sexual rest. This effect was enhanced by a concomitant moderate oocyte aging. It is concluded that cleavage rate could not be considered as a reliable test of fertilization after attempted in vitro fertilization in such conditions.     

Fertility and sexual life of men after their forties and in older age

Owing to the demographic development, the aging male will require more consideration in future. In contrast to a rapid decline of estradiol during menopause in women, the process of aging in the male is retarded and subject to high individual variations. Impairment of spermatogenesis is observed as a continuous process occurring over decades. However, only about 50% of men in their eighties show complete loss of fertility. In principle, spermatogenesis may be retained well into senescence. Of importance for the individual health condition is the fact that the number of Leydig cells declines with advancing age. Thus, altered sex hormone concentrations in aging men result from both functional disturbances and a gradual reduction in Leydig cells. Furthermore, an impaired feed-back mechanism of the pituitary-gonadal axis occurs, with disappearance of the circadian testosterone (T) rhythm. LH and FSH levels are increased, and a reduced bioavailability of sex hormones is observed. Lower total testosterone concentrations in men over 60 years are accompanied by clinical signs of reduced virility, such as decreased muscle mass and strength as well as reduced sexual hair growth and libido. An age-related decline in androgen secretion and plasma testosterone levels therefore suggests the use of androgen supplementation. However, there is a lack of risk-benefit long-term studies. Increased research in the male is mandatory to meet the requirements of the aging population. This should include the availability of precise epidemiological data about the frequency of partial androgen deficiency in aging males (PADAM).