Effect of increased prolactin and psychosocial stress on erectile function

Sexual dysfunctions in men are complex disorders that consist of organic and psychogenic components. The most common sexual dysfunction is erectile dysfunction. It is the inability to achieve or maintain an erection for satisfactory sexual performance. This disorder can be caused by high blood pressure, heart disease, vascular problems, psychological and hormonal factors such as problems with testosterone and prolactin levels. In this study, we tested the relationship between erectile dysfunction, hyperprolactinemia and psychosocial stress. Clinical examinations of 60 patients with erectile dysfunction, which also included psychosocial stress, focussed on patient history, comprehensive sexological examination, biochemical analyses of serum prolactin, total testosterone and thyroid-stimulating hormone with psychometric evaluation of erectile function and a checklist of trauma symptoms (TSC-40). The results show significant Spearman correlations of psychometric evaluation of erectile function with prolactin (R = .50) and results of the trauma checklist score (R = .55) and significant Spearman correlations between TSC-40 and prolactin (R = .52). This result indicates a significant relationship between erectile dysfunction, hyperprolactinemia and stress symptoms in men.     

Psychogenic erectile dysfunction. Classification and management

Psychogenic factors are involved alone or in combination with organic causes in a substantial number of cases of erectile dysfunction. Epidemiologic studies have implicated the role of depressed mood, loss of self-esteem, and other psychosocial stresses in the cause of erectile dysfunction. A new definition and classification of psychogenic erectile dysfunction has been proposed based on recent clinical and research findings. According to this new classification, psychogenic erectile dysfunction is categorized as generalized or situational type, with subcategories of each type proposed. Traditional treatment approaches for psychogenic erectile dysfunction have included anxiety reduction and desensitization procedures, cognitive-behavioral interventions, guided sexual stimulation techniques, and couples' or relationship counseling. Recently, these approaches increasingly have been combined with pharmacologic therapy such as sildenafil. Special situations have been identified in which combining psychosocial interventions with medical therapy is recommended. These situations include problems of sexual initiation, low sexual desire, other sexual dysfunctions, and significant couples' or relationship problems. More research is needed on the role of psychosocial interventions in the treatment of erectile dysfunction.     

Specific aspects of erectile dysfunction in psychiatry

The participation of the psychiatrist in the management of erectile dysfunction (ED) is focused on three types of patients based on the origin of the dysfunction: (1) patients with functional or psychogenic ED, (2) patients with mixed, organic psychogenic ED, and (3) patients with ED and active psychopathology. The second group is influenced by three psychological factors: perpetuating factors, aggravating factors, and accompanying factors. The main psychopathological disorders that interfere directly with the erectile mechanism are depressive disorders (18-35%), anxiety disorders (37%), obsessive-compulsive disorder, psychotic disorders (46-47%), and the antipsychotic medications used to treat these disorders. The diagnostic proposal includes psychological and sexologic evaluation and differential diagnosis. The therapeutic proposal includes the basic principles of sex therapy in the model of behavioral-cognitive therapy (eg, prohibition of intercourse, sensate focus, voluntary loss of erections, no expectations about response), pharmacological therapy (eg, sildenafil, intracavernous injection of vasoactive drugs), and a combination of both therapies.     

心因性勃起障碍影响因素的对照研究

应用对照研究方法研究了心因性勃起障碍（ｐｓｙｃｈｏｇｅｎｉｃ ｅｒｅｃｔｉｌｅ ｄｙｓｆｕｎｃｔｉｏｎ, ＥＤ）的主要影响因素。我们采用自己编制的勃起障碍评定量表（ｅｒｅｃｔｉｌｅ ｄｙｓｆｕｎｃｔｉｏｎ ｒａｔｉｎｇ ｓｃａｌｅ, ＥＤＲＳ）、Ｂｅｍ 性别角色调查表、状态－特质焦虑问卷和自己编制的影响心因性ＥＤ 的性心理问卷对ＥＤ 患者和正常受试者进行测评。所有研究工作均在计算机上进行,测试结果直接由测试软件转移到统计软件后作统计分析。结果表明,性操作焦虑、性别角色认同不当和交流差是心因性ＥＤ的主要影响因素     

Penile venous surgery – prognostic factors and long-term results

Summary Poor longterm success has been reported for penile vein ligation the last few years. Therefore, we decided to re-investigate our group of 147 patients who were operated on between 1987 and 1996. All patients showed a negative response to intracavernous injection therapy at the time of diagnosis and revealed a maintenance flow > 15 ml/min, as well as a pathological venous flow with pharmacocavernosometry or pharmacocavernosography. These patients underwent ligation of all superficial dorsal veins and resection of the deep dorsal vein of the penis. An up-to-date record of the success of the operation was kept either by a renewed clinical visit or by a standardized telephone interview or questionnaire. A total of 126 patients were available here for long-term follow-up. We divided the findings into three groups: complete spontaneous erection, postoperative response to cavernous auto-injection therapy and no changes in erectile competency postoperatively. The short-term success rate for these groups after 1–3 months was an outcome of 31 (24.6 %), 25 (19.8 %) and 70 (55.6 %) patients; 86 % of the cases whose results deteriorated after the initial operation success rate had this happen within the first postoperative year (p K 0.001). Favorable prognostic factors were preoperative erectile dysfunction of K 7 years, a normal CC-EMG and a maintenance flow of K 45 ml/min. If all three parameters were present, the long-term success rate (spontaneous erection plus response to intracavernous injection) of 30 % of all patients was found to rise to 67 % in this selected group of patients (p K 0.001). This study reveals that long-term success for unselected patients undergoing penile venous surgery is disappointing; however, careful selection of patients by certain prognostic factors can improve long-term results.      

Sexual response in men with inhibited or retarded ejaculation

Inhibited ejaculation (IE) is a poorly understood male sexual dysfunction having both somatic and psychological etiologies. This study investigated sexual response in 25 IE men with no probable somatic cause. Using a standard psychophysiological assessment procedure, these men were compared with sexually functional and other dysfunctional groups on two measures of sexual response: erectile response and self-reported sexual arousal. Within the sample of IE men, sexual response was investigated as a function of both diagnostic classification and relationship factors. Differences occurred between IE men and the other groups on erectile response and self-reported sexual arousal during psychosexual stimulation in the lab, with IE men reporting lowest levels of sexual arousal. Within the IE group, diagnostic classifications and relationship variables were also related to self-reported sexual arousal. These findings suggest that inhibited arousal may be fairly common among IE men having no apparent somatic etiology, and further that several specific relationship factors may provide potential strategies for enhancing arousal in these men.     

Pharmacotherapy of erectile dysfunction

Summary Pharmacotherapy of erectile dysfunction comprises oral and local application of drugs. Today, Yohimbin is the only drug listed for this indication. Yohimbin acts via central alpha-receptor blockade and showed a significant effect in a recent double blind study compared to placebo. The centrally acting substances Apomorphin and Trazodone were also tested for their potential use with Apomorphin showing promising results. The orally active phosphodiesterase-V inhibitor Sildenafil acts predominantly on the peripheral side; broad clinical studies demonstrated a significant effect of the drugs compared to placebo. For local use, intraurethral (MUSE) and intracavernous applications are available with PGE1 being the drug the most widely used for the moment. Since many different drugs with various modes of action and different modes of application are being developped at the moment, future pharmacological treatments will allow a more refined approach towards an individually adapted regimen.      

Interdisciplinary assessment and follow-up of patients with erectile dysfunction--psychiatric aspects.

The objectives of this investigation were to assess the psychiatric comorbidity and patients' satisfaction with treatment in a sample of 73 men with erectile dysfunction (ED) who were consecutively admitted to an andrologic outpatient centre. After comprehensive interdisciplinary assessment, 49% of these patients were assigned an organic etiology, 33% had psychogenic impotence, and in 18% somatic and psychogenic factors seemed to be relevant. 63% of all patients received a psychiatric diagnosis (according to ICD-9). Depressive disorders were found in 25%. Organic psychosyndromes (nonpsychotic) were prominent in the somatic group. In a follow-up after 29.4 +/- 5.0 months, 41 out of 73 patients could be reevaluated, of which 85% of organic patients had received some kind of therapy, but 65% were not satisfied with the chosen treatment. These results underline the importance of close interdisciplinary co-operation in the assessment and therapy of patients with erectile importance. Potential reasons for drop-out and limited acceptance of the offered treatments are discussed.     

Creative-dynamic image synthesis: a useful addition to the treatment options for impotence

In contrast to the impressive advances made in somatic research on erectile dysfunction, psychogenic erectile dysfunction is usually treated as a monolithic block. In this study, we evaluated the erectogenic power of creative-dynamic image synthesis in men with psychogenic erectile dysfunction. Sixty-nine men with a mean age of 46 y, suffering from erectile dysfunction of no known organic cause, were entered in a placebo-controlled study in which the erectogenic power of imagination, yohimbine and a placebo were compared. There was a significant difference between the subjective results of creative-dynamic image synthesis (75% increase of potency) and those achieved through treatment with the drug yohimbine (55% increase in potency) and with a placebo (30% increase in potency). Creative-dynamic image synthesis is a potent initiator of erections in men with psychogenic erectile dysfunction, has no known side effects and is very cost-effective.     

Psychological features and Doppler-Duplex in erectile disfunction

ObjectivesTo establish a relationship between Doppler-Duplex colour ultrasound after prostaglandin intracorporeal injection and psychological features in patients suffering from erectile dysfunction.MethodsForty two patients with erectile dysfunction were prospectively evaluated with Doppler-Duplex colour ultrasonography after intracavernosal injection of 20 micrograms of E1 prostaglandin. Dynamic vascular pattern were analyzed and penile tumescence were graded in poor, moderate or good (I, II, III). All of them completed the International Index of Erectile Dysfunction, International Exam of Personality Traits (IPDE) and the Symptom Checklist (SCL-90).Results29 patients (69.05%) showed a normal ultrasonography response (Peak Systolic Velocity >30 cm/s; Telediastolic velocity negative or less than 5cm/s and penile tumescence grade III) and were classified as good responders with probably psychogenic erectile dysfunction. Patients who did not show these values were classified in the group of erectile dysfunction of vascular origin. We found significative differences between the two groups in sex desire, tumescence and paranoid personality. The more frequent personality features were paranoid and squizoid (excentric) and ananchastic and anxious (fearful ones). Somatization and obsessive-compulsive symptoms have been outlined over the rest. We have found that paranoid personality is sixteen times more frequent in patients with normal ultrasonography.ConclusionsPsychological features and dysfunctional personality traits accompany psychogenic and organic erectile dysfunction, thus it is thought that mixed aetiology coexist in this patients. Doppler-Dupplex Colour ultrasound is an useful method to exclude organic vascular factors. On de basis of our article, is more common to find psychological discomfort and dysfunctional personality traits in patients with normal ultrasound, which may help in their diagnosis and treatment.     

Vascular surgery, implantation surgery, and vacuum erection aids. Review-overview-aspects of three therapy options in erectile dysfunction

Summary Vascular surgery or penile prosthesis implantation are the main surgical options for erectile dysfunction. In this category, penile revascularization is the only causal therapy for selected patients: males younger than 50 years of age at time of surgery, maximum of two risk factors, exclusion of diabetes mellitus. Long-term success decreased to 53 % to 55 % in comparison to first encouraging reports of 80 % success. Venous surgery resulted in an even more distinct decline of success the longer the elapse of time after surgery. Long-term success dropped under 40 %, leaving only a few indications for penile venous ligation. In contrast, penile prosthesis implantation results in high satisfaction rates. Despite this, it is not generally recommended as first choice surgical management as it is linked to irreversible damage of the cavernosal bodies. Among numerous types of penile implants, preference is nowadays mostly given to the three-piece hydraulic models. However, such complications as defective or perforated cylinders in up to 35 % after 5 years have arisen, depending on the type of implant. In a selected patient group, vacuum constriction devices with a mean patient acceptance of 75 % (50 % to 90 %) seldom result in complications and are thus considered to be a well-established therapeutical option.      

Sexual function with localized prostate cancer: active surveillance vs radical therapy

Study Type – Outcomes (cohort sample) Level of Evidence 2b What's known on the subject? and What does the study add? The study compares the sexual function of men with low‐risk prostate cancer who chose active surveillance (expectant management) with similar men who received radiation therapy or radical prostatectomy. The first group appeared to be sexually active more frequently and had less erectile dysfunction. The study was non‐randomized. No other studies exist on the effect of active surveillance on sexual function vs other treatment methods.

OBJECTIVE

• ? To compare sexual function of men with localized prostate cancer (PCa) on active surveillance (AS) with similar patients who received radical therapy.

PATIENTS AND METHODS

• ? Two groups of men with screening‐detected localized PCa were compared. The first were men on AS within the prospective protocol‐based Prostate Cancer Research International: Active Surveillance study. The second were men participating in the European Randomized Study of Screening for Prostate Cancer study who had received radical prostatectomy (RP) or radiation therapy (RT).
• ? Questionnaires were completed at two different timepoints after diagnosis or treatment (6 and 12–18 months). These contained 10 items on sexual function, the mental and physical component summary from the Short‐Form 12‐item health survey, the Center for Epidemiologic Studies Depression scale depression measure and the State Trait Anxiety Inventory general anxiety measure.
• ? Sexual function was compared between groups, and determinants were analysed in multivariable analysis, adjusting for baseline differences.

RESULTS

• ? A total of 65–68% of men on AS, 35–36% of those who underwent RP, 36–37% of those who underwent RT and 36% of men in the RP and RT groups combined (combined Tx) were sexually active.
• ? A total of 20–30% of men in the AS group, 86–91% of men in the RP group, 56–60% of men in the RT group and 71–76% of men in the combined Tx group were sexually inactive as a result of erectile dysfunction.
• ? A total of 44–51% of men in the AS group, 96% of men in the RP group, 73–76% of men in the RT group and 84–85% of men in the combined Tx group who were sexually active had problems getting or keeping an erection.
• ? In multivariable analysis these differences were significant, except for AS vs RT.

CONCLUSIONS

• ? Men with localized PCa on AS were more often sexually active than similar men who received radical therapy, especially RP. If not sexually active, this was less often attributable to erectile dysfunction for those on AS. If sexually active, this was less often associated with problems getting or keeping an erection for those on AS.
• ? The study was non‐randomized; the latest advances in RP and RT might impact results.

     

Posttraumatic stress disorder after motor vehicle accidents

Summary Posttraumatic stress disorder (PTSD) can occur after motor vehicle accidents (MVAs). It is an anxiety disorder characterized by intrusive reliving of the accident, avoidance of reminders of the trauma and increased arousal. Diagnostic criteria as specified in DSM-IV and in ICD-10 are discussed. A case example illustrates the features of PTSD incurred by MVA. An overview concerning the history of empirical studies on the consequences of MVAs is given. PTSD is one of the more common psychiatric disorders, with prevalence rates after MVAs ranging from 1 % to nearly 9 %. Other psychiatric and comorbid disorders that can occur as a consequence of MVAs are described. The present paper reviews the most influential etiological theories for PTSD. It describes and discusses current knowledge on risk factors for the development of PTSD after surviving an MVA. In the treatment of PTSD cognitive-behavioural approaches have proven to be the most effective interventions.      

Erectile dysfunction. Is an oral medication during the diagnostic pathway indicated?

For patients with erectile dysfunction oral medication seems to be the most comfortable form of application. This can also be seen in the expectations looking forward to Sildenafil and other drugs in development. We present a prospective examination with the oral medication of 100 mg acecarbamol, 30 mg extract of cortex quebracho and 33 mg tocopherol acetate (Afrodor) in 100 patients complaining secondary erectile dysfunction. The patients were treated unselected with 3 x 1 tablet/day during the diagnostic schedule. 14% of the patients were able to perform satisfying sexual intercourse after 4 weeks of medication and another 15% showed an increased libido. Therefore we suggest, that the application of an oral medication, might be useful, especially during the time of diagnostics. Especially for those patients who gain without invasive diagnostic tools as intracavernous injection.     

Multicentral clinical evaluation of the aetiology of erectile dysfunction: A survey report

Patients with erectile dysfunction, who admitted to 4 different urological centres in Turkey were evaluated in terms of aetiological factors to establish the aetiology of erectile dysfunction in our population and compare it with the data derived from Western communities. After the history, physical examination, psychological evaluation and laboratory testing, a clinical diagnosis was established as primarily psychogenic, organic, or mixed aetiology. Mean patient age was 43.5 years (range 17 to 69), and 9 of the patients were unmarried. Of the patients 53 had vascular risk factors, and 10 reported a history of alcohol abuse. Eleven patients were using drugs that might interfere with the disorder. In this multicentral study of 115 impotent men, an organic cause was found in 43%, psychogenic in 47%, and mixed in 19%. Mean age of the overall patients was 43.48. When the ages of the patients with organic erectile dysfunction and those with psychogenic erectile dysfunction were compared, it was clearly seen that those with organic erectile dysfunction were much older (52.73 versus 33.02). This revised version was published online in June 2006 with corrections to the Cover Date.     

Prevalence of premature ejaculation in Turkish men with chronic pelvic pain syndrome

Chronic pelvic pain syndrome is a common and serious health problem affecting the quality of life in men. Limited studies exist on the relation of this condition to premature ejaculation. We evaluated prevalence rates of premature ejaculation in Turkish male patients with chronic pelvic pain syndrome and compared them with healthy control subjects. Sixty-six men with chronic pelvic pain syndrome were included in the study (group 1). A questionnaire consisting of 2 parts--demographic data and a Turkish version of the National Institutes of Health Chronic Prostatitis Symptom index--was administered to all patients. Premature ejaculation was defined as intravaginal ejaculation latency of less than 2 minutes with the same partner for at least 6 months. All patients were evaluated with physical examinations and routine laboratory tests. If erectile dysfunction was noted from the medical history, penile Doppler ultrasonography also was performed. The results were compared with the results of 30 healthy men without urinary symptoms (group 2). The chi2 test was used for statistical analyses. Of 66 patients with chronic pelvic pain syndrome, 51 had premature ejaculation (77.3%), and in 10 (15.2%) patients, premature ejaculation and erectile dysfunction were found together. Penile Doppler ultrasonography showed no vascular pathology in patients with erectile dysfunction. The rate of premature ejaculation was higher in patients in the study group than it was in patients in the control group, and this difference was statistically significant (P < .05). Both chronic pelvic pain syndrome and premature ejaculation are common disorders, but their ethiopathogeneses are not well understood. In Turkish men with chronic pelvic pain syndrome, the incidence of psychogenic sexual problems was higher than in the normal population.     

糖尿病性勃起功能障碍的血管因素

糖尿病性勃起功能障碍(DED)是一种由多因素引起的综合病症,其中血管内皮系统的损害起着重要作用。在糖尿病发展过程中,一些血管舒缩因子和生长因子有着显著的改变。这些改变与DED的发生存在明显的相关性。     

Depression and sexual dysfunction

For sexual medicine the relationship between depression and sexual functioning is of major importance since both affective and sexual disorders are highly prevalent, are thought to exhibit a marked co-morbidity and might even share a common etiology. A high percentage of men and women suffering from mild, moderate, or severe forms of depression experiences sexual dysfunction. However, the relationship between depressive mood and sexual dysfunction is bidirectional and further complicated by the sexual side effects of antidepressant treatment, thus constituting a complex network of factors. In women, sexual desire was found to be the sexual sphere predominantly affected by depressive illness, while in male patients both sexual desire and erectile function tend to be impaired. As a consequence, sexually dysfunctional patients should be routinely screened for symptoms of depression. Since improvements in sexual functioning consistently belong to the most significant predictors of depression remission, adequate treatment of sexual functioning should be an integral component of therapy for all depressed men and women – irrespective of the causal relationship between both conditions.     

Do endocrines play an etiological role in diabetic and nondiabetic sexual dysfunctions?

Sexually dysfunctional diabetic and nondiabetic males were compared with a group of normal controls using different endocrinological, psychophysiological, and psychological parameters. One hundred male subjects participated in this study: 47 diabetics with sexual dysfunction (DD), 31 nondiabetics with sexual dysfunction (NDD), and 22 normal controls (C). They were evaluated by an internist (physical examination and medical history), a psychologist (psychological and sexual functioning tests), a psychiatrist (psychiatric history and mental status examination), a urologist (genitourinary physical examination), and an endocrine biochemist (evaluation of endocrine factors). Additionally, subjects were evaluated for nocturnal penile tumescence (NPT) during three nights in the sleep laboratory to obtain a differential diagnosis of impotence, that is, psychogenic vs. organic. Both sexually dysfunctional groups showed significant differences on several measures in the psychological and psychophysiological evaluations. There were also significant differences between these two groups and the control group. Plasma levels of total testosterone and serum levels of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) showed no significant differences among the three groups, but there were some significant correlations between the endocrine and psychological measures. No significant correlations were found between the endocrine and psychophysiological measures.     

Combined Sabal and Urtica extract vs finasteride in BPH (Alken stage I–II)

Summary Therapeutic equivalence should be demonstrated in a randomised, reference-controlled multicentric double blind clinical trial with PRO 160/120, a combination of Sabal- and Urtica-Extract, and Finasteride, respectively, in patients suffering from benign prostatic hyperplasia (BPH, Stage I to II according to Alken). The study involved 543 patients, who were treated for 48 weeks with two capsules of PRO 160/120 or one capsule of Finasteride per day, in a double dummy design. Primary variable was the change of the maximum urinary flow after 24 weeks of therapy in comparison to therapy start. As secondary variables urodynamic parameters such as average urinary flow, miction volume and miction time were monitored. Urinary symptoms were recorded by the International-Prostate-Symptom-Score (I-PSS, Paris 1993). Additionally, the impacts of the symptoms on quality of life had been assessed by a quality of life questionnaire according to The American Urological Association Measurement Committee (1991) [9]. An increase of the urinary flow rate could be observed in both treatment groups (1,9 ml/s with PRO 160/120; 2,4 ml/s with Finasteride). During the trial, the average urinary flow increased, whereas the miction time decreased in both groups in a similar extent. The miction volume did not show any relevant differences after treatment with either PRO 160/120 or Finasteride. The I-PSS decreased from 11.3 at the therapy start to 8.2 after 24 weeks and 6.5 (week 48) under PRO 160/120 and from 11.8 to 8.0 and 6.2, under Finasteride, respectively. Accordingly, life quality improved between therapy start and therapy end from 7.5 to 4.3 with PRO 160/120 and from 7.7 to 4.1 with Finasteride. In terms of safety aspects less adverse events occured with the Sabal/Urtica-Extract as with Finasteride. Especially less cases of diminished ejaculation volume, erectile dysfunction and headache have been reported.