In Men with Erectile Dysfunction,Satisfaction with Quality of Erections Correlates with Erection Hardness,Treatment Satisfaction,and Emotional Well-Being

IntroductionThe validated Quality of Erection Questionnaire (QEQ) evaluates satisfaction with erection quality.AimTo collate QEQ data, including correlations between QEQ outcomes and outcomes assessing emotional well-being, treatment satisfaction, and erection hardness after sildenafil citrate treatment.MethodsIn four trials, men older than 18 years and with erectile dysfunction, a stable sexual partner, and no recent phosphodiesterase type 5 inhibitor use were randomized to double-blind flexible-dose sildenafil or placebo (1:1 ratio) for 6 or 10 weeks (two trials), fixed-dose 50 mg, 100 mg, and placebo (1:1:1 ratio) for 8 weeks (one trial), and 50 mg and 100 mg (1:1 ratio) for 4 weeks after 4 weeks of single-blind sildenafil 50 mg. Exclusion criteria included recent significant cardiovascular disease, use of nitrates, nitric oxide donors, cytochrome P450 3A4 inhibitors, or other erectile dysfunction treatment, and sildenafil hypersensitivity or previous severe or serious treatment-related adverse event.Main Outcomes MeasuresScores on the QEQ, QEQ Question 5 (satisfaction with erection hardness), the Self-Esteem and Relationship Questionnaire, and the Erectile Dysfunction Inventory of Treatment Satisfaction; the percentage of occasions with Erection Hardness Score 3 (EHS 3, hard enough for penetration but not completely hard) and/or EHS 4 (completely hard and fully rigid); and Pearson correlation coefficients.Results1,296 men (18–80 years) were randomized. Except for the percentage of occasions with EHS 3, all outcomes improved in men treated with sildenafil and correlated positively with the change in QEQ scores in all trials.ConclusionsSatisfaction with the quality of erections, which is easily monitored with the QEQ, correlated positively with measures of emotional well-being and treatment satisfaction and with the change in percentage of erections that were completely hard and fully rigid, but not with the change in percentage of erections that were hard enough for penetration but not completely hard. Kaminetsky JC, Depko AJ, Ströberg P, Buvat J, Tseng L-J, and Stecher VJ. In men with erectile dysfunction, satisfaction with quality of erections correlates with erection hardness, treatment satisfaction, and emotional well-being. J Sex Med 2009;6:800–808.     

Association of asthma diagnosis, severity, symptoms, and treatment with risk of preeclampsia

OBJECTIVE: Existing studies relating asthma and preeclampsia provide conflicting results, perhaps due to differences in study populations, varying definitions of asthma, and inadequate control for confounding, particularly asthma medication use. This prospective study examines associations between aspects of asthma (diagnosis, severity, symptoms, and medication use) and risk of preeclampsia. METHODS: A total of 1,708 pregnant women, of whom 656 had asthma diagnosis and 1,052 had no asthma diagnosis, were included in this analysis. Asthma symptoms, treatment, and severity were classified according to Global Initiative for Asthma guidelines. Hospital records were abstracted, and strict criteria were applied to classify women as preeclamptic based on National Heart, Lung, and Blood Institute guidelines. RESULTS: There were 568 of 656 women with diagnosed asthma and 353 of 1,052 women without asthma diagnosis who had symptoms or took asthma medication during pregnancy. Separate adjusted logistic regression models were run for different measures of asthma status: 1) asthma diagnosis; 2) overall Global Initiative for Asthma severity; 3) Global Initiative for Asthma symptom and treatment steps; and 4) Global Initiative for Asthma symptom step and medication type. Women at increased risk of preeclampsia were those classified as Global Initiative for Asthma symptom step 3/4 compared with no symptoms (odds ratio 3.36, 95% confidence interval 1.24-9.14) and theophylline users (odds ratio 1.16 for every dose/month increase in use, 95% confidence interval 1.02-1.33). In contrast, neither a history of physician-diagnosed asthma nor Global Initiative for Asthma treatment step was associated with preeclampsia status. CONCLUSION: Our findings suggest that women with moderate to severe asthma symptoms, regardless of asthma diagnosis or treatment, are at increased risk of preeclampsia compared with women with no symptoms.     

Interactions of Sexual Activity,Gender, and Depression with Immunity

IntroductionDepression can suppress immune function, leading to lower resistance against infection and longer healing times in depressed individuals. Sexuality may also influence immune function, with evidence that sexual activity is associated with lowered immune function in women and mixed results in men. Immune mediators like immunoglobulin A (IgA) are immediately relevant to sexual health, since they are the first line of defense against pathogens at mucous membranes like the vagina.AimThis study aims to determine if and how depression, sexual activity, and their interaction impact salivary IgA (SIgA) in men and women.MethodsIn Study 1, a community‐based sample of 84 women and 88 men provided saliva samples and completed questionnaires on their demographic background, level of depression, and frequency of partnered and solitary sexual activity. Study 2, conducted separately in an undergraduate student sample of 54 women and 52 men, had similar methods.Main Outcome MeasuresThe main outcome measures were scores on the General Well‐Being Schedule depression subscale, reported frequency of sexual activity, and SIgA levels as measured by enzyme immunoassay.ResultsAcross studies, higher levels of partnered sexual activity were associated with lower SIgA for women with high depression scores, but not for women with low depression scores. In contrast, higher levels of partnered sexual activity were associated with higher SIgA for men with high depression scores, but not for men with low depression scores.ConclusionOur results show that partnered sexual activity is a risk factor for lowered immunity in women with depressive symptoms but a possible resilience factor for men with depressive symptoms. This suggests a role for sexual activity in determining the impact of depression on physical health parameters. Lorenz T and van Anders S. Interactions of sexual activity, gender, and depression with immunity. J Sex Med 2014;11:966–979.     

Treatment of vaginal candidiasis with ketoconazole, a new, orally active, antimycotic.

The efficacy of a new, orally active antimycotic, ketoconazole, in the treatment of vaginal candidiasis was studied at different doses involving 63 patients. All patients had subjective complaints and were mycologically positive. There was no significant difference in the cure rates of the different doses. The oral treatment was successful in 55 out of 63 patients (87.3%). No correlation was found between the relapse rate of vaginal candidiasis and the dose regimen. There were no serious side-effects, and no significant changes were reported in hematological and biochemical parameters.     

A conversation with Dr Anne McLaren,DBE, DPhil,FRS, FRCOG

Anne McLaren is one of the world's foremost developmental biologists; a leader in elucidating the principles of early mammalian development whose research has underpinned advances in reproductive medicine and the treatment of infertility. After undergraduate and postgraduate studies at Oxford University and postdoctoral work in London, she was for 15 years at the Institute of Animal Genetics in Edinburgh followed by 18 years as Director of the MRC Mammalian Development Unit in London. She is currently a Group Leader at the Wellcome Trust/Cancer Research UK Gurdon Institute in Cambridge. She was elected a Fellow of the Royal Society in 1975 and became the first woman to hold office in that Society – as Foreign Secretary, from 1991–1996. Dr McLaren played a pivotal role in the creation of the UK Human Fertilisation and Embryology Authority. She was a member of the Warnock Committee, served on the Voluntary (later Interim) Licensing Authority and was a key member of the HFEA from its establishment until the end of 2001. She chaired the Scientific and Technical Advisory Group of WHO's Human Reproduction Programme and is President of the Association of Women in Science and Engineering. She is a member of the European Group on Ethics that advises the European Commission on social and ethical implications of new technologies. In 2002, she was awarded (jointly with A. K. Tarkowski) the Japan Prize for Developmental Biology. She continues to have one of the sharpest minds in the business; for her, science has been not only a joy but an intellectual adventure of the highest order. She is interviewed here by Editorial Board Member Jane Denton.     

Treatment with paclitaxel plus carboplatin, alone or with irradiation, of advanced or recurrent endometrial carcinoma

OBJECTIVES: The goal of this study was to evaluate the efficacy and toxicity of paclitaxel plus carboplatin in the treatment of primarily advanced or recurrent endometrial carcinoma. METHODS: Thirty-seven consecutive patients with advanced or recurrent endometrial carcinoma were enrolled in this study. Paclitaxel at a dose of 175 mg/m(2) was administered intravenously over 3 h followed by carboplatin with area under the curve of 5 to 6 over 1 h at 4-week intervals. Five patients were received 50 Gy pelvic irradiation, and 7 were received 50 Gy pelvic and 50 Gy paraaortic irradiation, after adjuvant chemotherapy with paclitaxel plus carboplatin. Eighteen patients had evaluable lesions. Responses were assessed before the use of any irradiation. RESULTS: Eleven patients (61%) achieved an objective response, including one complete response (5.6%) and 10 partial responses (56%). The most common toxicity was hematologic: grade 3 or 4 leukopenia and neutropenia occurred in 59% and 86% of patients, respectively. Three patients (8%) required granulocyte colony-stimulating factor support. One patient required a platelet transfusion, and four required blood transfusions. There was a single adverse event of anaphylaxis. CONCLUSION: The combination of paclitaxel and carboplatin appears to be an effective regimen for the treatment of patients with advanced or recurrent endometrial carcinoma with tolerable toxicity.     

Reliability,feasibility, and safety of minihysteroscopy with a vaginoscopic approach: experience with 6,000 cases

OBJECTIVE: To assess the reliability, feasibility, and safety of lens-based minihysteroscopy. DESIGN: Retrospective comparative study. SETTING: Academic research environment. PATIENT(S): Women with different indications for hysteroscopy. INTERVENTION(S): Six thousand seventeen outpatient diagnostic hysteroscopies with a minihysteroscope (2.7-mm outer diameter [OD] telescope with 3.5-mm OD single-flow diagnostic sheath) and 4,204 with traditional hysteroscope (4-mm OD telescope with 5-mm OD single-flow diagnostic sheath). All hysteroscopies were performed using a vaginoscopic approach and saline to distend the uterus. MAIN OUTCOME MEASURE(S): Rate of successful introduction of the hysteroscope, rate of satisfactory examinations, pain intensity experienced using an arbitrary pain scale (0 = no pain; 1 = low pain; 2 = moderate pain; 3 = severe pain), and number of side effects and complications. RESULT(S): In the minihysteroscopy, group rates of successful introduction and satisfactory examinations were significantly higher than in the traditional hysteroscope group (99.52% vs.72.53% and 98.53% vs. 92.33%, respectively), while pain and vagal reactions were significantly lower (0.10 +/- 0.34 vs.1.09 +/- 0.53 and 2.25% vs.17.12%, respectively). CONCLUSION(S): Hysteroscopy with lens-based minihysteroscopes was easier, less painful, more reliable, and safer than with 5-mm hysteroscopes. Minihysteroscopy with a vaginoscopic approach is a very well tolerated, effective, and safe outpatient procedure.     

A conversation with Dr Anne McLaren, DBE, DPhil, FRS, FRCOG

Anne McLaren is one of the world's foremost developmental biologists; a leader in elucidating the principles of early mammalian development whose research has underpinned advances in reproductive medicine and the treatment of infertility. After undergraduate and postgraduate studies at Oxford University and postdoctoral work in London, she was for 15 years at the Institute of Animal Genetics in Edinburgh followed by 18 years as Director of the MRC Mammalian Development Unit in London. She is currently a Group Leader at the Wellcome Trust/Cancer Research UK Gurdon Institute in Cambridge. She was elected a Fellow of the Royal Society in 1975 and became the first woman to hold office in that Society - as Foreign Secretary, from 1991-1996. Dr McLaren played a pivotal role in the creation of the UK Human Fertilisation and Embryology Authority. She was a member of the Warnock Committee, served on the Voluntary (later Interim) Licensing Authority and was a key member of the HFEA from its establishment until the end of 2001. She chaired the Scientific and Technical Advisory Group of WHO's Human Reproduction Programme and is President of the Association of Women in Science and Engineering. She is a member of the European Group on Ethics that advises the European Commission on social and ethical implications of new technologies. In 2002, she was awarded (jointly with A. K. Tarkowski) the Japan Prize for Developmental Biology. She continues to have one of the sharpest minds in the business; for her, science has been not only a joy but an intellectual adventure of the highest order. She is interviewed here by Editorial Board Member Jane Denton.     

Maternal myo-inositol, glucose, and zinc status is associated with the risk of offspring with spina bifida

Objective

The purpose of this study was to investigate the maternal and children's myo-inositol, glucose, and zinc status in association with spina bifida risk.

Study design

Sixty-three mothers and 70 children with spina bifida and 102 control mothers and 85 control children were investigated. The maternal and child serum myo-inositol, serum glucose, and red blood cell zinc concentrations were measured when the child was between 1 and 3 years old. These data were compared between cases and control subjects. The association with spina bifida was expressed by the ratio of geometric means and by odds ratios and 95% CI for a cutoff value at the extreme 10th percentile of the control group.

Results

The geometric mean of the maternal myo-inositol concentration tended to be 5% (95% CI, −1% to 11%) lower in cases. Interestingly, the odds ratio for the extreme low maternal myo-inositol concentration was 2.6 (95% CI, 1.1-6.0). The glucose and zinc concentrations were significantly higher at 7% (95% CI, 4%-10%) and significantly lower at 5% (95% CI, 0%-9%), in case mothers compared with control mothers. The odds ratios (95% CI) for maternal high glucose and low zinc concentrations were 4.6 (2.0-10.5) and 2.9 (1.2-7.0), respectively. The geometric mean of the myo-inositol concentration tended to be 7% (95% CI, 0%-14%) lower in children with spina bifida; the glucose and zinc concentrations were comparable.

Conclusion

Maternal myo-inositol, glucose, and zinc status are associated with the risk of spina bifida in offspring. Furthermore, the myo-inositol status of the child seems to contribute to this risk as well.     

Ovarian cancer, diagnosed with PET, with bilateral inguinal lymphadenopathy as primary presenting sign

BACKGROUND: Ovarian cancer groin lymph nodes metastases are rare. Only one case of disease spread isolated to the groins has been reported in the English literature. We report the case of a patient with bilateral inguinal lymphadenopathy due to tumor metastases and in which tumor origin was diagnosed using [(18)F]fluorodeoxyglucose positron emission tomography (PET). CASE REPORT: This is the first case of bilateral groin lymph nodes as sole site of metastases from ovarian cancer. Primary origin was identified using PET. CONCLUSIONS: In rare cases, the ovaries can directly metastasis to the groin even in a relatively initial tumor growth phase. PET may play a role in the diagnosis of occult ovarian tumors.     

Brachycephalosyndactyly with ptosis, cataract, colobomas, and linear areas of skin depigmentation.

A male patient with brachycephalosyndactyly syndrome associated with ocular and skin anomalies is reported and it is suggested that this patient has a previously undescribed disorder.     

Two patients with varying combinations of sternal cleft, haemangiomas, midline abdominal raphe, coarctation of the aorta with a right aortic arch

We report two patients, one with sternal cleft, haemangiomas, supraumbilical midline raphe and the other with a sternal cleft, haemangiomas, coarctation of the aorta with a right aortic arch.     

Women with Deep Infiltrating Endometriosis: Sexual Satisfaction,Desire, Orgasm,and Pelvic Problem Interference with Sex

IntroductionEndometriosis is a chronic and progressive condition of women of reproductive age. It is strongly associated with a significant reduction of quality of life (QOL) and sexual function.AimsThis study aims to objectively evaluate sexual function in women with deep infiltrating endometriosis (DIE) and to study the impact of endometriosis symptoms and type of lesion on patient's sexual function.MethodsThis is a cross‐sectional study in a tertiary care university hospital. It included 182 patients with preoperative clinical and ultrasound diagnosis of DIE who were referred to our center from 2008 to 2011.Main Outcome MeasuresA sexual activity questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW‐Q) was used to collect data pertaining to satisfaction, orgasm, desire, and pelvic problem interference with sex. Short Form 36 (SF‐36) was used to evaluate QOL. Demographic and clinical characteristics were assessed: age, body mass index, parity, ethnicity, postsecondary education, employment, smoking, history of surgical treatment, and hormonal contraception. Patients were asked about pain symptoms (dysmenorrhea, dyspareunia, dyschezia, chronic pelvic pain, and dysuria) using a visual analog scale.ResultsThe mean values obtained on the different scales of the SHOW‐Q showed poor sexual function (mean SHOW‐Q total score 56.38 ± 22.74). Satisfaction was the dimension most affected (mean satisfaction score 55.66 ± 34.55), followed by orgasm (mean orgasm score 56.90 ± 33.77). We found a significant correlation between the SF‐36 scores and the SHOW‐Q scores (P < 0.0001). Sexual dysfunction and deterioration of QOL seem to be correlated. Analyzing the impact of symptoms and lesions on sexual function, we found that dyspareunia and vaginal DIE nodules significantly affect sexual activity (P < 0.05).ConclusionThe results of this study demonstrated that women with DIE have a sexual function impairment, correlated with the overall well‐being decrease. Moreover, the presence of dyspareunia and vaginal endometriotic lesions seems to be involved in sexual dysfunction.     

Trend associations of smoking with maternal, fetal, and neonatal morbidity

Smoking habits, prenatal health, and pregnancy outcome were surveyed among 1700 nulliparous women. During pregnancy, increases in levels of hemoglobin and hematocrit and the frequency of women reporting bleeding and decreases in diastolic pressure and frequency of toxemia were observed with increased maternal smoking. A higher frequency of fetal bradycardia was detected among women smoking greater than or equal to one-half pack per day. With increased smoking there was an increased frequency of abnormal placentas. Mean birth weight and crown-heel length decreased with increased smoking, and neonates born to women smoking greater than or equal to one-half pack per day had a higher frequency of jaundice. The association between smoking and reduced birth weight and crown-heel length persisted after controlling for gestational age, maternal weight gain, prenatal visits, and other confounding variables.     

Association of homocysteine, asymmetric dimethylarginine, and nitric oxide with preeclampsia

Purpose  

Endothelial dysfunction underlies the pathogenesis of preeclampsia, but its mechanism has not yet been completely understood. In this study we have aimed to measure homocysteine (Hcy), asymmetric dimethylarginine (ADMA), and nitric oxide (NO) levels as endothelial dysfunction markers in preeclamptic women.