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.     

男性心因性性功能障碍的认知行为治疗(附个案报告)

目的探讨男性性功能失调的认知行为治疗。方法本文通过对1例男性性功能失调个案发生前后的心理社会环境包括认知因素、父母教养方式、个人成长中的不良经历、防御方式等与疾病过程的相互作用的分析,并结合个案,从学习理论、认知理论探讨了男性性功能障碍的病理心理机制,给予该患者的认知一行为综合疗法。结果患者精神心理症状缓解,勃起功能恢复止常。结论认知行为治疗在心因性性功能勃起功能障碍患者中的治疗作用应该引起重视。     

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     

Sildenafil citrate (Viagra) treatment for erectile dysfunction: An updated profile of response and effectiveness

In the 7 years since sildenafil citrate (VIAGRA) was introduced as the first oral phosphodiesterase type 5 inhibitor therapy for erectile dysfunction, it has been used to treat nearly 27 million men with erectile dysfunction worldwide. Patient populations with erectile dysfunction of varying etiologies and with diverse comorbidities have benefited from sildenafil treatment. This update focuses on relatively recent research that further defines the response and effectiveness profiles of sildenafil and provides additional insight into optimizing treatment. In addition to providing recent data on sildenafil efficacy and safety/tolerability, the update provides data on assessments of erection hardness, measures of psychosocial outcomes (e.g., emotional well-being and treatment satisfaction), and treatment approaches to maximize response and effectiveness (e.g., by titrating to the maximum tolerated dose). Increased understanding of the sildenafil response and effectiveness profiles and optimal sildenafil treatment are central to the appropriate management of erectile dysfunction using sildenafil.     

The false organic-psychogenic distinction and related problems in the classification of erectile dysfunction

The traditional distinction between organic and psychogenic erectile dysfunction (ED) was maintained in the recent report of the Nomenclature Committee of the International Society for Sexual and Impotence Research. Among the major problems with this distinction are that it is based on an obsolete view of mind-body distinctions, does not take into account knowledge of the neurobiology of 'psychological' disorders, disregards the fundamental meaning of 'psychosomatic,' is too often diagnosed by exclusion, and may imply to the patient that his ED is 'all in the mind.' As a result, the distinction has become counterproductive in the diagnosis, classification, and treatment of ED, and in research into the causes of ED. An alternative taxonomy, based on that proposed by the Nomenclature Committee, reclassifies as organic several of the causes of ED now considered to be psychogenic, and considers others as situational ED, a class reserved for episodic occurrences of ED clearly due to particular attributes of sexual encounters.     

The utility of sildenafil citrate for infertile men with sexual dysfunction: a pilot study

OBJECTIVE: To investigate the use the sildenafil citrate, recognized as a first-line therapy for men with erectile dysfunction (ED), and which is safe and effective in men with various causes and severity of ED, including psychogenic ED, in a population of infertile men with sexual dysfunction. PATIENTS AND METHODS: Infertility is a major source of life stress and might be associated with sexual dysfunction through the erosion of self-esteem and self-confidence, and in stimulating discord in a relationship. Men presenting for evaluation of fertility who on questioning by the physician reported the recent onset of sexual dysfunction, had a history taken, a physical examination, hormonal profile, and completed the International Index of Erectile Function (IIEF), a validated inventory for assessing sexual dysfunction. Thirty men with a score of <26 on the erectile function domain of the IIEF, or who complained of new onset rapid or delayed ejaculation, were treated with sildenafil with no randomization or placebo control. The evaluation was repeated and the IIEF completed again > or =3 months after starting treatment. RESULTS: For men complaining of ED, subjective erectile rigidity, duration of erection, and the percentage of successful penetration attempts significantly improved with sildenafil. The mean (sd) IIEF domain scores for erection and satisfaction, at 18 (4) vs 27 (3), and 12 (2) vs 16 (3) (both P = 0.01), and orgasm, at 4 (1) vs 6 (3) (P = 0.001), respectively, significantly improved after treatment. In patients with ejaculatory dysfunction, the function improved in 64% after sildenafil therapy. CONCLUSIONS: We identified the nature of sexual dysfunction associated with male-factor infertility, and showed the efficacy of sildenafil therapy in men with this condition.     

青年男子心因性勃起功能障碍治疗初探

目的：探讨青年男子心因性勃起功能障碍的有效治疗方法。方法：1996年2月～1997年6月，对36例心因性勃起功能障碍（ED）的未婚成年男子采用心理咨询、性知识讲解和性咨询，配合阴茎海绵体局部注射小剂量血管活性药物（盐酸罂粟碱3～6mg十前列腺素E_15～10μg混合液）及真空负压吸引装置（VCD）对其进行治疗。结果：22．2％（8／36）在治疗至第2周时，已能正常完成性生活，55．6％（20／36）于第一疗程结束时可以正常完成性生活，17例已经生育。88．9％（32／36）对这种联合治疗方式表示满意。结论：对于青年男子心因性ED应尽早并尽可能给予治疗；在性知识教育、性心理疏导的基础上，配合进行小剂量血管活性药物阴茎海绵体注射及阴茎真空负压吸引治疗，是一种较为有效、无创及经济的治疗方法。     

Erectile dysfunction in the 21st century: whom we can treat, whom we cannot treat and patient education

Erectile dysfunction affects 31-52% of American men. Although considerable advances have been made in the diagnosis and treatment of erectile dysfunction in the past decade, more than 80% of men with erectile dysfunction are not treated because they do not seek medical attention or their physicians do not initiate a dialogue about sexual problems during their visits. This despite patients' desires to confront sexual problems and receive treatment. Most subgroups of men can now be effectively treated for sexual dysfunction. Although men with severe cardiac disease may require stabilization of their cardiac condition before treatment, most can successfully return to an active sex life. Some men, however, do not respond to the use of oral agents. These men can be treated with second- and third-line treatment modalities or with the newer concept of combined-modality treatment. Despite excellent treatment alternatives, many men have low libido or hypoactive sexual desire disorder. In the ultimate resolution of a patient's sexual dysfunction, physicians must open a free and sympathetic dialogue and offer a full spectrum of treatment modalities tailored to the individual patient and partner. If initial treatment modalities fail, more invasive alternatives or combination therapy should be offered to cure the patient's erectile dysfunction.     

Spontaneous erections in a patient with erectile dysfunction after palliative chemotherapy for non-small cell lung cancer

Erectile dysfunction is a common problem, especially among older men. It is often caused by psychological problems, and is also the reason for pronounced impairment of psychosocial well-being. Many systemic diseases, genitourinary surgery, drugs, particularly antihypertensive and psychotropic drugs, and also chemotherapeutic agents and dexamethasone are attributed as being causes of erectile dysfunction. In our case, severe erectile dysfunction was present for 8 months before non-small cell lung cancer was diagnosed. Normal sexual function, observed for a short period immediately following chemotherapy, is a highly unusual finding and has not been published before. Chemotherapeutic agents have repeatedly been shown to result in cessation of sexual function including erection. While we cannot offer a definite explanation for our findings, undefined paraneoplastic processes leading to erectile dysfunction amenable to successful cytotoxic intervention could be a possible explanation for our observation.     

Hypogonadism and erectile dysfunction: the role for testosterone therapy

The role of low testosterone levels in erectile dysfunction (ED) remains unclear. Both organic and psychogenic factors contribute to ED, with vasculogenic causes being the most common etiology. Approximately 10-20% of patients with ED are diagnosed with hormonal abnormalities. At the physiologic level, two second messenger systems are involved in mediating erections, one involving cyclic adenosine monophosphate (cAMP) and the other involving cyclic guanosine monophosphate (cGMP). PDE5 inhibitors such as sildenafil promote the cGMP pathway, while alprostadil affects the cAMP pathway. Evidence is strong that, in animal systems, testosterone has direct effects on erectile tissue. However, although testosterone clearly has an impact on libido in humans, its effect on penile function is less clear. Evaluation of ED includes medical, sexual, and psychosocial history assessments, as well as laboratory tests to check for diabetes and hormonal abnormalities. Initial interventions should involve correction of potentially reversible causes of ED, such as hypogonadism. First-line therapy for other patients is typically oral PDE5 inhibitors, such as sildenafil, tadalafil, or vardenafil. For patients who fail treatment with PDE5 inhibitors, local therapies such as intracavernous alprostadil are highly successful. Recent data also support the success of combination therapy with sildenafil and testosterone. This opens the possibility of other combinations of testosterone and other treatments of ED. The ability to exploit multiple pathways in the physiologic processes leading to erection may help improve therapy for ED.     

Couples-based interventions following prostate cancer treatment: a narrative review

Background

Sexual dysfunction following prostate cancer (PC) treatment often results in sexual avoidance and a loss of sexual intimacy, which can lead to relationship distress. This review aims to evaluate six studies intended to address relational and sexual intimacy following PC treatment and discuss methodological concerns which may help produce more effective interventions.

Methods

Electronic databases used to conduct literature searches included Medline, PsychINFO, and Web of Science. Studies were included if they were: randomized controlled trials (RCTs) using samples of men diagnosed with PC of any stage, had a psychosocial intervention, and addressed at least one sexual and relational outcome.

Results

As a whole, the literature has produced mixed results. While significant findings were reported, many of the primary hypotheses were not achieved. The six studies show that men with PC may benefit from education and support related to treatment options for erectile dysfunction (ED), whereas their partners may benefit more from interventions focused on relational issues. Important methodological limitations included: selection of general outcome measures as opposed to measures specific to sexuality or intimacy outcomes, lack of assessing distress or bother of the patient/couples as study entry criteria, heterogeneity of study populations, and lack of innovative intervention content as the current studies tested standard educational interventions, sex therapies techniques, and couples therapy strategies with only marginal success.

Conclusions

Interventions based on innovative theoretical approaches as well as study designs that address the outlined methodological limitations are needed in this area.     

Update on the relationship between sexual dysfunction and lower urinary tract symptoms/benign prostatic hyperplasia

PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is a condition that commonly affects older men and is often associated with sexual dysfunction. Recent evidence of an association between LUTS/BPH and sexual dysfunction will be reviewed, as well as the effects of pharmacological treatment options for symptomatic LUTS/BPH on sexual function. RECENT FINDINGS: Large-scale epidemiological studies conducted worldwide have provided strong evidence for an association between LUTS, erectile dysfunction and ejaculatory dysfunction. In multivariate analyses controlling for age, comorbidities, and lifestyle factors, LUTS have been clearly demonstrated to be an independent risk factor for erectile and ejaculatory dysfunction. Various pathophysiological mechanisms have been proposed for the association between LUTS and male sexual dysfunction. These include autonomic hyperactivity, alterations in Rho/Rho kinase pathway, endothelial (nitric oxide synthase/nitric oxide) dysfunction, pelvic ischemia, and age-related hormone imbalances. Owing to the link between LUTS/BPH and male sexual dysfunction, patients presenting with one of these conditions should be routinely screened for the other condition. In addition, because medical and surgical treatments for LUTS/BPH are commonly associated with sexual side effects, patients with LUTS/BPH should be monitored for treatment-related sexual outcomes. SUMMARY: LUTS/BPH is an independent risk factor for sexual dysfunction in aging men. Further studies are needed to define the mechanism(s) underlying the link between LUTS/BPH and male sexual dysfunction. Additional studies of combination therapy for LUTS/BPH, sexual dysfunction, and other age-associated comorbidities are needed to establish new approaches to the optimal management of these conditions in aging men.     

Neurogenic etiology in patients with erectile dysfunction

OBJECTIVES: Erectile dysfunction (ED) is a disorder with a high prevalence that increases with age. It is estimated that 18.9% of men's between 25 and 70 years suffer it in Spain. Most cases have a multifactorial origin and it is admitted the influence on its pathogenesis of systemic diseases, different kind of drugs, psychogenic factors, cardiovascular, endocrinological and neurological diseases. Neurologic cause erectile dysfunction may have its origin in the central or peripheral nervous system. Among possible process of neurogenic erectile dysfunction of central origin would be tumors, cerebral vascular accidents, encephalitis, Parkinson disease, multiple sclerosis and other demyelinization diseases, dementias, olivopontocerebellar degeneration and epilepsy. Myelopathies of any etiology may be, depending on their localization and extension, cause of erectile dysfunction. At the peripheral level, disorders of the sensitive tracts constituting the afferent limb of the erection spinal reflex, and the efferent vegetative or somatic tracts mediating arterial vasodilatation, cavernous smooth muscle relaxation or pelvic floor striated muscle contraction. The aim of this work is to review in detail the most relevant causes of neurogenic erectile dysfunction, their etiopathogenic mechanisms and therapeutic approaches currently considered more adequate for each particular case. CONCLUSIONS: The correct diagnostic approach to patients with erectile dysfunction passes through identification, if possible, of the etiopathogenic factors implied. Regarding this, detection and identification of a possible neurogenic risk factor will contribute to a better understanding of the physiopathologic mechanisms, and more adequate diagnostic, prognostic and therapeutic approaches, mainly in those patients refractory to first line therapy.     

Diagnostic evaluation of erectile dysfunction in the era of oral therapy

Therapy for erectile dysfunction (ED) may be specific to the cause of ED or it may be nonspecific. There are only three causes of ED which have specific therapy: psychogenic, endocrine and certain types of reversible vasculogenic ED. In the era of oral therapy for ED, treatment is not cause-specific in the great majority of patients. For this great majority, only the basic evaluation of ED is needed. Only when there is a strong suspicion that the cause of a patient's ED is endocrine, psychogenic or reversible vascular disease are additional diagnostic tests indicated. In these three categories of patients, specific treatment of the cause of ED can produce a permanent and dramatic improvement in sexual function and satisfaction. International Journal of Impotence Research (2000) 12, Suppl 4, S12-S14.     

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.     

Impact of erectile dysfunction on confidence, self-esteem and relationship satisfaction after 9 months of sildenafil citrate treatment

PURPOSE: The first double-blind, placebo controlled trial in the United States of the Self-Esteem And Relationship questionnaire revealed that treatment with sildenafil citrate improves erectile function and measures of quality of life in men with erectile dysfunction. We investigated long-term improvement, and correlations between improved erectile function and confidence, self-esteem and sexual relationship satisfaction in men with erectile dysfunction. MATERIALS AND METHODS: This was a 36-week open label extension of the double-blind, placebo controlled trial. The blind was not broken. Patients were 18 years or older with clinically diagnosed erectile dysfunction. Erectile function was assessed using the International Index of Erectile Function. Self-esteem, confidence and relationship satisfaction were assessed using the Self-Esteem And Relationship questionnaire. Correlations were determined using Pearson's product moment coefficients. RESULTS: A total of 204 participants were enrolled in the open label extension, including 108 on placebo and 96 on sildenafil. In men who received placebo in the double-blind, placebo controlled phase mean erectile function scores and self-esteem, confidence and relationship satisfaction scores were increased significantly at week 36 of the open label extension (p < 0.0001). Men who received sildenafil in the double-blind, placebo controlled phase maintained high scores in the open label extension. Correlations between improved erectile function, and self-esteem, confidence and relationship satisfaction were strong and positive (p < 0.0001). CONCLUSIONS: Open label extension sildenafil after double-blind, placebo controlled placebo significantly improved erectile function, self-esteem, confidence and relationship satisfaction. Following an initial 12 weeks of double-blind, placebo controlled sildenafil therapy for erectile dysfunction improvements were sustained an additional 9 months. Positive correlations between erectile function, and self-esteem, confidence and relationship satisfaction suggest that improved erectile quality can improve long-term psychosocial quality of life.     

Primary erectile dysfunction

We evaluated 67 patients 18 to 60 years old (mean age 28.5 years) with primary erectile dysfunction (absence of full sustained erections since early childhood or puberty) using a multidisciplinary approach. Organic causes of the erectile dysfunction were found in 57 of the 67 patients (85 per cent): 12 (18 per cent) had neurological, 35 (52 per cent) arteriogenic and 35 (52 per cent) venogenic abnormalities. Psychogenic factors were diagnosed in 11 patients (16 per cent), while in 4 (6 per cent) a classification was not possible. Concomitant psychogenic abnormalities were found in 39 of the 57 patients (68 per cent) with organic primary erectile dysfunction. Our results suggest that primary erectile dysfunction is caused mainly by organic factors. However, for successful therapy the frequent secondary psychogenic abnormalities must be considered.     

Sexual dysfunction in partners of men with premature ejaculation

Research in partners of men with erectile dysfunction suggests that a woman's sexual difficulties can be contingent on her partner's sexual dysfunction. However, little research has been conducted in partners of men with other sexual dysfunctions, such as premature ejaculation (PE). We evaluated 139 partners of men diagnosed with having PE and 89 age-matched women whose partners did not have any sexual dysfunction. Results showed that 77.7% of PE partners had at least one sexual dysfunction, compared to 42.7% of the control group. Further research needs to be undertaken to investigate the temporal relationship between sexual dysfunctions in both partners.     

Psychological subtypes of erectile dysfunction: results of statistical analyses and clinical practice

Summary In contrast to the impressive advances made in somatic research of erectile dysfunction (ED), psychogenic ED is mostly treated as a monolithic block or is merely defined by exclusion of organic factors. This paper proceeds from the assumption that a classification of psychological subtypes of ED is urgently needed and has to include a categorization of different pathogenetic mechanisms as well as a classification of interaction patterns with somatic risk factors. After a brief review of current approaches, psychological subtypes of ED are examined along two different lines of evidence. First, 236 consecutive patients from an ED outpatient unit were included in a cluster analysis to identify homogeneous subgroups of cases. Three clusters emerged, whose main characteristics as well as most important discriminating variables were further explored by various statistical procedures. Second, on the basis of clinical experience a four-level model of psychogenic ED is proposed that consists of dispositional, etiologic, pathogenetic, and maintaining factors. In addition, four different pathogenetic modes of psychogenic ED are differentiated, which have been labeledactual-neurotic, psychoneurotic, psychosomatic, andfunctional. Conclusions concentrate on these modes as well as on the empirical subtypes and their implications for clinical practice and future research. Our results indicate that we are just beginning to understand the complex pathogenetic interface between psychological factors and manifest ED.