Estrogen Mediates Metabolic Syndrome‐Induced Erectile Dysfunction: A Study in the Rabbit

IntroductionEstrogen receptor (ER) α is critical in mediating the harmful effects of hyperestrogenism in fetal or neonatal life on the developing penis. In contrast, little is known on the impact of an excess of estrogens on penile function in adulthood.AimTo investigate the effect of estrogens on metabolic syndrome (MetS)‐associated erectile dysfunction (ED).MethodsWe employed a recently established animal model of high fat diet (HFD)‐induced MetS. Subgroups of MetS rabbits were dosed with either testosterone (T) or tamoxifen. We evaluated penile responsiveness to acetylcholine (Ach) as well as the expression of genes related to penile smooth muscle relaxation and contractility.Main Outcome MeasureAssociations between MetS‐induced penile alterations and sex steroids were investigated in an animal model of HFD‐induced MetS. To understand the role of either androgen deficiency or estrogen excess on ED, we treated subgroups of MetS rabbits with either T or tamoxifen, a classical ER antagonist.ResultsFeeding an HFD‐induced MetS was associated to elevated estradiol (E2) and low T levels. E2, but not T, was independently and negatively associated with genes able to affect penile erection. Smooth muscle‐related markers decreased as a function of E2 and were positively associated with all the variables investigated. Increasing concentrations of circulating E2 were negatively associated with Ach‐induced relaxation. In HFD rabbits, in vivo T dosing significantly improved MetS and completely normalized circulating E2. Conversely, in vivo tamoxifen dosing reduced visceral adiposity and partially restored T level. Ach‐induced relaxation was severely impaired by HFD and significantly restored, up to the control level, by both tamoxifen and T dosing. In rabbit smooth muscle cells cultures 17β‐E2 (1 nM) significantly reduced the expression of α‐smooth muscle actin, transgelin, and phosphodiesterase type 5. The effects of 17β‐E2 were completely reverted by tamoxifen (100 nM).ConclusionsThis study demonstrates, for the first time, that HFD‐induced ED is more associated with a high E2, rather than to a low T, milieu. HFD‐induced ED is partially restored by in vivo treatment not only with T but also with the nonsteroidal ER antagonist, tamoxifen. Vignozzi L, Filippi S, Comeglio P, Cellai I, Morelli A, Marchetta M, and Maggi M. Estrogen mediates metabolic syndrome‐induced erectile dysfunction: A study in the rabbit. J Sex Med 2014;11:2890–2902.     

Testosterone and Metabolic Syndrome: A Meta‐Analysis Study

IntroductionMetabolic syndrome (MetS) is often associated with male hypogonadism. Despite the well‐known link, the role of testosterone replacement therapy (TRT) in MetS has not been completely clarified.AimTo systematically analyse the relationship between androgen levels and MetS we performed a review and meta‐analyses of available prospective and cross‐sectional studies. In addition, a specific meta‐analysis on the metabolic effects of TRT in available randomized clinical trials (RCTs) was also performed.MethodsAn extensive Medline search was performed including the following words “testosterone,” “metabolic syndrome,” and “males”.Main Outcome MeasuresOut of 323 retrieved articles, 302 articles were excluded for different reasons. Among the 20 published studies included, 13, 3, and 4 were cross‐sectional, longitudinal, and RCTs, respectively. Another unpublished RCT was retrieved on http://www.clinicaltrials.gov.ResultsMetS patients showed significantly lower T plasma levels, as compared with healthy individuals. Similar results were obtained when MetS subjects with and without erectile dysfunction were analyzed separately or when NCEP‐ATPIII MetS criteria were compared with other definitions. Meta‐regression analysis demonstrated that type 2 diabetes (T2DM) increased the MetS‐associated T fall. In a multiple regression model, after adjusting for age and BMI, both T2DM and MetS independently predicted low testosterone (adj. r = ?0.752; P < 0.001 and ?0.271; P < 0.05, respectively). Analysis of longitudinal studies demonstrated that baseline testosterone was significantly lower among patients with incident MetS in comparison with controls (2.17 [?2.41;?1.94] nmol/L; P < 0.0001). Combining the results of RCTs, TRT was associated with a significant reduction of fasting plasma glucose, homeostatic model assessment index, triglycerides, and waist circumference. In addition, an increase of high‐density lipoprotein cholesterol was also observed.ConclusionsThe meta‐analysis of the available cross‐sectional data suggests that MetS can be considered an independent association of male hypogonadism. Although only few RCTs have been reported, TRT seems to improve metabolic control, as well as central obesity. Corona G, Monami M, Rastrelli G, Aversa A, Tishova Y, Saad F, Lenzi A, Forti G, Mannucci E, and Maggi M. Testosterone and metabolic syndrome: A meta‐analysis study. J Sex Med 2011;8:272–283.     

The Metabolic Syndrome and Sexual Function in Climacteric Women: A Cross‐Sectional Study

IntroductionStudies have associated the metabolic syndrome with poor sexual function; the results, however, are controversial.AimsTo evaluate the relationship between the metabolic syndrome and sexual function and to identify the factors associated with poor sexual function.MethodsA secondary analysis of a cross‐sectional cohort study including 256 women of 40–60 years of age receiving care at the outpatient department of a university teaching hospital.Main Outcome MeasuresA specific questionnaire was applied to collect sociodemographic and behavioral data, and the Short Personal Experience Questionnaire was used to evaluate sexual function, with a score ≤7 being indicative of poor sexual function. Anthropometric measurements, blood pressure, fasting glucose, high‐density lipoprotein, total cholesterol, triglycerides, follicle‐stimulating hormone and thyroid stimulating hormone levels were determined.ResultsThe prevalence of the metabolic syndrome, as defined by the International Diabetes Federation, was 62.1%, and the prevalence of poor sexual function was 31.4%. The only factor related to female sexual function that was associated with the metabolic syndrome was sexual dysfunction in the woman‘s partner. The factors associated with poor sexual function in the bivariate analysis were age >50 years (P = 0.003), not having a partner (P < 0.001), being postmenopausal (P = 0.046), the presence of hot flashes (P = 0.02), poor self‐perception of health (P = 0.04), partner's age ≥50 years, and time with partner ≥21 years. Reported active (P = 0.02) and passive (P = 0.01) oral sex was associated with an absence of sexual dysfunction. In the multiple regression analysis, the only factor associated with poor sexual function was being 50 years of age or more.ConclusionsThe prevalence of the metabolic syndrome was high and was not associated with poor sexual function in this sample of menopausal women. The only factor associated with poor sexual function was being over 50 years of age. Politano CA, Valadares ALR, Pinto‐Neto A, and Costa‐Paiva L. The metabolic syndrome and sexual function in climacteric women: A cross‐sectional study. J Sex Med 2015;12:455–462.     

Alterations in microRNA Expression in a Murine Model of Diet‐Induced Vasculogenic Erectile Dysfunction

IntroductionMicroRNAs (miRs) are noncoding, endogenous RNA molecules that regulate gene expression and play roles in response to vascular injury.AimThe aim of this study was to identify miRs expressed in corporal tissue (CT) and to determine whether miRs demonstrate differential expression in a mouse model of diet‐induced erectile dysfunction (ED).MethodsRNA was isolated from the CT from control mice and mice with diet‐induced ED. A quantifiable miR profiling technique (NanoString) was used to determine the expression of over 600 miRs.Main Outcome MeasuresDifferential expression analysis was performed using a negative binomial regression model for count‐based data. Mean expression levels, fold change, and false discovery‐corrected P values were determined. Candidate miRs were validated via quantitative polymerase chain reaction (Q‐PCR).ResultsIn control mice, NanoString analysis revealed that 181 miRs were expressed above background levels and 5 miRs were expressed at high levels. Diet‐induced ED resulted in the up‐regulation of 6 miRs and the down‐regulation of 65 miRs in the CT compared with mice on control diet. Focusing on the upregulated miRs, we chose five for Q‐PCR validation. Of these five, two (miR‐151‐5p and miR‐1937c) demonstrated significance via Q‐PCR, whereas the other three (miR‐720, miR‐1937a, miR‐205) trended in the correct direction.ConclusionsMiRs may play a significant role in mRNA regulation in CT and specific miRs may be involved in diet‐induced vasculogenic ED. Future studies are aimed at determining the mRNA targets of these miRs. Barbery CE, Celigoj FA, Turner SD, Smith RP, Kavoussi PK, Annex BH, and Lysiak JJ. Alterations in microRNA expression in a murine model of diet‐induced vasculogenic erectile dysfunction. J Sex Med 2015;12:621–630.     

Health‐Related Quality of Life in Patients with Polycystic Ovary Syndrome (PCOS): A Model‐Based Study of Predictive Factors

IntroductionUnderstanding the factors that contribute to health‐related quality of life (HRQOL) is critical for developing the most appropriate interventions for improving or maintaining the HRQOL in polycystic ovary syndrome (PCOS) patients.AimThis study sought to determine the most significant predictors of the HRQOL in patients with PCOS.MethodsThis was a cross‐sectional study of 300 women with PCOS that was carried out in Kashan, Iran. A sample of women with PCOS was entered into the study and completed the following questionnaires: the Hospital Anxiety and Depression Scale, the Body Image Concern Inventory (BICI), the Rosenberg's Self‐Esteem Scale score, the modified polycystic ovary syndrome health‐related quality of life questionnaire, the Female Sexual Function Index.Main Outcome MeasureBoth direct and indirect relationships among clinical severity, psychological status, self‐esteem, body image, and sexual function as independent predictors of HRQOL were examined using structural equation modeling (SEM) analysis. By using the SEM, we simultaneously test a number of possible hypotheses concerning the interrelations among the predictors of HRQOL in PCOS patients.ResultsIn relation with severity of PCOS, reproductive history and menstrual status explained a high proportion of the variance of clinical variables (factor loading 0.37 and 0.34, respectively). The highest effect on HRQL was exerted by indirect effect of clinical factor (β = 0.90), self‐esteem (β = 1.12), body image (β = 1.06), and sexual function (β = 0.26) that influenced negatively HRQOL. The infertility and menstrual domains were the most affected areas of HRQOL. In relation with sexual dysfunction, the most affected domains were desire and arousal.ConclusionThe highest effect of PCOS symptoms on HRQOL impairment among patients was exerted by self‐esteem, body image, and sexual dysfunction. With regard to HRQOL in clinical routine, we conclude these mediating factors should be taken into consideration and adequately treated if present. Bazarganipour F, Ziaei S, Montazeri A, Foroozanfard F, Kazemnejad A, and Faghihzadeh S. Health related quality of life in patients with polycystic ovary syndrome (PCOS): A model‐based study of predictive factors. J Sex Med 2014;11:1023–1032.     

Effects of 12‐Month Tadalafil Therapy for Erectile Dysfunction on Couple Relationships: Results from the DETECT Study

IntroductionErectile dysfunction (ED) is distressing and can affect a couple's relationship.AimTo investigate partner awareness of ED, relationship problems, and the effects of tadalafil treatment over 12 months.MethodsThe Determinants of Continued Use of Tadalafil study is a prospective 12‐month European observational study in patients with ED initiating or changing treatment to on‐demand tadalafil. A total of 1,900 patients were enrolled in eight countries. Assessments were made on predefined treatment outcomes in a routine clinical setting.Main Outcome MeasuresAt baseline, 1, 6, and 12 months, patients were asked about relationship problems (unspecified), partner awareness and support of consultation, and partner sexual problems. Data were analyzed for patients continuing tadalafil at 12 months.ResultsAt baseline, 96% of patients had a partner, 80% of partners supported an ED consult, and 73% were aware of the consultation. Relationship problems were reported by 17% of patients at baseline. At 12 months, 84% of patients were still taking tadalafil. Of these, 19% reported relationship problems at baseline. After 12 months of treatment with tadalafil, 4% of patients still reported perceived problems. Factors associated with no relationship problems at 12 months were: at baseline, no previous ED treatment, partner in poor health; and at 12 months a lower ED severity. If the partner was felt to have a sexual problem at 12 months, relationship improvement was less likely. Further, 3% of patients developed relationship problems during treatment. Factors associated with developing a relationship problem were: a history of pelvic surgery at baseline, a different partner at 12 months than at baseline, and a partner with a sexual problem at 12 months.ConclusionsImprovement of ED with tadalafil was associated with reduced relationship problems, suggesting that problems were associated with ED and resolved with treatment. Verheyden B, Roumeguère T, Bitton A, Belger M, and Schmitt H. Effects of 12‐month tadalafil therapy for erectile dysfunction on couple relationships: Results from the DETECT study. J Sex Med 2009;6:3458–3468.     

Is Metabolic Syndrome a Useless Category in Subjects with High Cardiovascular Risk? Results from a Cohort Study in Men with Erectile Dysfunction

IntroductionAlthough several studies have demonstrated that MetS is associated with a two‐fold increase in the risk of cardiovascular (CV) diseases, this risk does not appear to be greater than the sum of risks associated with each of its individual components.AimTo determine the association of men with ED and individual components of MetS and their subsequent relationship to CV risk, and, more specifically whether the sum of the MetS components is greater than the individual components in predicting CV risk.MethodsWe longitudinally studied a consecutive series of 1,687 (mean age 52.9 ± 12.8; range 17–88 years) patients attending our clinic for ED and evaluated different clinical and biochemical parameters.Main Outcome MeasuresInformation on major adverse CV event (MACE) was obtained through the City of Florence Registry Office.ResultsOne hundred thirty‐nine MACE, 15 of which were fatal, occurred during a mean follow‐up of 4.3 ± 2.6 years. Subjects with MetS at baseline showed a higher incidence of MACE (hazard ratio [HR] = 1.77), after adjusting for age, however, the association disappeared in an alternative Cox model, adjusting both for age and for individual MetS components (HR = 1,525 [0,564–4,123]; P = 0.408). The two most predictive MetS components of CV risk were low high‐density lipoprotein (HDL) cholesterol and high triglycerides. Exploring possible interactions between individual components of MetS and their effect on CV risk using two alternative approaches indicates that the effect of MetS components on CV risk is additive, but not synergistic. Among subjects with hypertension, after adjusting for age, elevated glycemia, and low HDL cholesterol confer relevant additional risk, while in subjects with high triglycerides, hyperglycemia increased the risk of incident MACE.ConclusionsWith regards to CV risk, the MetS construct seems to add little or nothing to the careful assessment of its components. Thus, there is no reason to recommend the use of MetS as a diagnostic category in patients with ED. Corona G, Monami M, Rastrelli G, Melani C, Balzi D, Sforza A, Forti G, Mannucci E, and Maggi M. Is metabolic syndrome a useless category in subjects with high cardiovascular risk? Results from a cohort study in men with erectile dysfunction. J Sex Med 2011;8:504–511.     

Effect of Drug Use and Influence of Abstinence on Sexual Functioning in a Spanish Male Drug‐Dependent Sample: A Multisite Study

IntroductionTo date, it has been difficult to address the issue of sexual functioning and drug use, and many approaches to it have basic problems and methodological errors.AimThe present cross‐sectional study compared the sexual functioning scores of a group of drug users with those of a group of nondrug users. It explored the relationship between drug abstinence and sexual functioning.Main Outcome MeasuresA sample of 905 males participated in this study (549 met the substance dependence criteria and 356 were controls). All of them were assessed with the Changes in Sexual Functioning Questionnaire‐Drugs version.MethodThe assessment was conducted from September 2009 to January 2011. The clinical sample was evaluated in nine different substance abuse treatment facilities.ResultsResults show that, overall, all dimensions (pleasure, desire, arousal, and orgasm) were moderately impaired. Yet, differences regarding preferred substance were observed. Pleasure and orgasm were the two areas most significantly impaired. In these areas, all drugs seemed to negatively affect sexual functioning. However, desire and arousal were not affected by all the substances. In addition, at least after 2 weeks of drug abstinence, no relationship was found between drug abstinence and improvement in sexual functioning. The sample studied had an average of 1 year of drug abstinence and was found to have poorer sexual functioning than the control group.ConclusionsTherefore, these results seem to contradict those that argue that drug use only impairs sexual functioning temporarily. Moreover, they suggest that sexual functioning does not improve just by stopping drug use. Vallejo‐Medina P and Sierra JC. Effect of drug use and influence of abstinence on sexual functioning in a Spanish male drug‐dependent sample: A multisite study. J Sex Med **;**:**–**.     

The Neuroprotective Effect of Platelet‐rich Plasma on Erectile Function in Bilateral Cavernous Nerve Injury Rat Model

IntroductionNeurogenic erectile dysfunction resulting from cavernous nerve (CN) injury is a major complication caused by radical prostatectomy. The use of platelet‐rich plasma (PRP) on the nerve‐injured site has shown promising results for the nerve regeneration. However, the effects of PRP injection in corpus cavernosum after bilateral CN injury have never been investigated.AimTo assess the neuroprotective effect of PRP injection in corpus cavernosum after bilateral CN injury.MethodsMale Sprague‐Dawley rats were randomly divided into three groups: Group I underwent sham operation, while the remaining two groups underwent bilateral CN crush. Crush injury groups were treated at the time of injury with an application of PRP or normal saline only injection in the corpus cavernosum, respectively. Four weeks later, erectile function (EF) was assessed by CN electrosimulation, and CNs as well as penile tissue were collected for histology.Main Outcome MeasuresIntracavernous pressure (ICP) monitored during electrical stimulation of CNs; myelinated axons number of CNs and dorsal penile nerve; collagen type change, number of apoptotic cells, and mRNA expression of caspase‐3 and transforming growth factor‐β1 (TGF‐β1) in the corpus cavernosum.ResultsFour weeks after surgery, in the vehicle‐only group, the functional evaluation showed a lower mean maximal ICP than that in the sham group (P < 0.05). PRP treatments resulted in significant recovery of EF, as compared with the vehicle‐only group (P < 0.05). Histologically, the PRP‐treated group had a significant preservation of myelinated axons of CNs compared with the vehicle‐only group (P < 0.05) and reduced the apoptotic index. The mRNA expression of TGF‐β1 in the corpus cavernosum tissue was significantly decreased in the PRP group compared with the vehicle‐only group (P < 0.05).ConclusionsPRP injection in the corpus cavernosum increased the number of myelinated axons and facilitated recovery of EF in the bilateral CN injury rat model. Wu C‐C, Wu Y‐N, Ho H‐O, Chen K‐C, Sheu M‐T, and Chiang H‐S. The neuroprotective effect of platelet‐rich plasma on erectile function in bilateral cavernous nerve injury rat model. J Sex Med 2012;9:2838–2848.     

A Tri‐Service Perspective on the Implementation of a Centering Pregnancy Model in the Military

With the rising cost of health care, group prenatal care has come into the forefront as a viable, evidence‐based option for care delivery. In this article, the authors from three different branches of service (Army, Navy, Air Force) review the strategies and challenges of implementing a centering pregnancy model at military treatment facilities.     

Therapeutic Effect of Adipose‐Derived Stem Cells and BDNF‐immobilized PLGA Membrane in a Rat Model of Cavernous Nerve Injury

IntroductionCavernous nerve injury is the main reason for post‐prostatectomy erectile dysfunction (ED). Stem cell and neuroprotection therapy are promising therapeutic strategy for ED.AimTo evaluate the therapeutic efficacy of adipose‐derived stem cells (ADSCs) and brain‐derived neurotrophic factor (BDNF) immobilized Poly‐Lactic‐Co‐Glycolic (PLGA) membrane on the cavernous nerve in a rat model of post‐prostatectomy ED.MethodsRats were randomly divided into five groups: normal group, bilateral cavernous nerve crush injury (BCNI) group, ADSC (BCNI group with ADSCs on cavernous nerve) group, BDNF‐membrane (BCNI group with BDNF/PLGA membrane on cavernous nerve) group, and ADSC/BDNF‐membrane (BCNI group with ADSCs covered with BDNF/PLGA membrane on cavernous nerve) group. BDNF was controlled‐released for a period of 4 weeks in a BDNF/PLGA porous membrane system.Main Outcome MeasuresFour weeks after the operation, erectile function was assessed by detecting the ratio of intra‐cavernous pressure (ICP)/mean arterial pressure (MAP). Smooth muscle and collagen content were determined by Masson's trichrome staining. Neuronal nitric oxide synthase (nNOS) expression in the dorsal penile nerve was detected by immunostaining. Phospho‐endothelial nitric oxide synthase (eNOS) protein expression and cyclic guanosine monophosphate (cGMP) level of the corpus cavernosum were quantified by Western blotting and cGMP assay, respectively.ResultsIn the ADSC/BDNF‐membrane group, erectile function was significantly elevated, compared with the BCNI and other treated groups. ADSC/BDNF‐membrane treatment significantly increased smooth muscle/collagen ratio, nNOS content, phospho‐eNOS protein expression, and cGMP level, compared with the BCNI and other treated groups.ConclusionsADSCs with BDNF‐membrane on the cavernous nerve can improve erectile function in a rat model of post‐prostatectomy ED, which may be used as a novel therapy for post‐prostatectomy ED. Piao S, Kim IG, Lee JY, Hong SH, Kim SW, Hwang T‐K., Heang S, Lee JH, Ra JC, and Lee JY. Therapeutic effect of adipose‐derived stem cells and BDNF‐immobilized PLGA membrane in a rat model of cavernous nerve injury. J Sex Med 2012;9:1968–1979.     

One‐Year Efficacy and Safety Study of a 1.62% Testosterone Gel in Hypogonadal Men: Results of a 182‐Day Open‐Label Extension of a 6‐Month Double‐Blind Study

IntroductionA new formulation of testosterone gel (1.62% testosterone gel) with increased viscosity and reduced volume of application has been shown to be safe and efficacious after 182 days of use in a phase 3, double‐blind study in adult hypogonadal males.AimThe objective of this study was to evaluate the efficacy and safety of the 1.62% testosterone gel after daily application to the skin in a 182‐day (6‐month) open‐label extension of the initial 182‐day double‐blind study.MethodsOne hundred and sixty‐three subjects, aged 26 to 77 years, continued on active (Continuing Active subjects) 1.62% testosterone gel for the remainder of the study (364 days total). In 28 subjects who had previously received placebo (Formerly Placebo subjects), the dose was titrated to normal levels of serum total testosterone (300–1,000 ng/dL). Dose adjustments for both groups were allowed at specific visits to maintain serum testosterone within a normal range.Main Outcome MeasureThe main outcome measure was the percentage of subjects with serum total testosterone average concentrations (C_av) within the normal range at day 364.ResultsOn day 364, 77.9% (95% confidence interval: 70.0, 84.6) of the Continuing Active subjects and 87.0% (66.4, 97.2) of the Formerly Placebo subjects had C_av values within the eugonadal range. The 1.62% testosterone gel was safe and well tolerated in this study.ConclusionTreatment with 1.62% testosterone gel for up to 1 year (182 days for the Formerly Placebo subjects, 364 days for the Continuing Active subjects) was safe and efficacious, resulting in >77% of treated subjects achieving normal serum testosterone levels at final visit. Kaufman JM, Miller MG, Fitzpatrick S, McWhirter C, and Brennan JJ. One‐year efficacy and safety study of a 1.62% testosterone gel in hypogonadal men: Results of a 182‐day open‐label extension of a 6‐month double‐blind study. J Sex Med 12;9:1149–1161.     

Sexual Function in Men with Lower Urinary Tract Symptoms and Prostatic Enlargement Secondary to Benign Prostatic Hyperplasia: Results of a 6‐Month,Randomized, Double‐Blind,Placebo‐Controlled Study of Tadalafil Coadministered with Finasteride

IntroductionTadalafil (TAD) 5 mg coadministered with finasteride (FIN) 5 mg significantly improves lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) and prostatic enlargement. However, its effects on erectile/sexual function have yet to be fully described.AimAssess the effects of TAD/FIN coadministration (compared with placebo [PBO]/FIN) on erectile and sexual function in sexually active men with LUTS and prostatic enlargement secondary to BPH with or without baseline comorbid erectile dysfunction (ED).MethodsA randomized, double‐blind, PBO‐controlled study of 695 men (610 sexually active; 450 with baseline ED; 404 sexually active with baseline ED) conducted at 70 sites in 13 countries. TAD 5 mg or PBO once daily coadministered with FIN 5 mg once daily for 26 weeks.Main Outcome MeasuresInternational Index of Erectile Function (IIEF) domain and single‐item scores; proportions of patients who demonstrated minimal clinically important differences (MCIDs) in IIEF‐Erectile Function domain scores (IIEF‐EF; MCID defined as ≥4‐point improvement); and sexual dysfunction adverse events (AEs).ResultsCompared with PBO/FIN, TAD/FIN resulted in improvements for all IIEF domain and single‐item scores assessed among patients with baseline ED (P ≤ 0.002 for all measures) and among patients without baseline ED (P ≤ 0.041 for all measures). Compared with PBO/FIN, significantly larger percentages of sexually active men with baseline ED treated with TAD/FIN achieved an IIEF‐EF MCID after 4, 12, and 26 weeks of therapy (P < 0.001 for odds ratio comparisons between TAD/FIN and PBO/FIN at all 3three postbaseline timepoints). The incidence of sexual AEs was low: five TAD/FIN patients and seven PBO/FIN patients reported sexual AEs, including ED, decreased/lost libido, and ejaculation disorders.ConclusionsTAD/FIN coadministration for the treatment of men with LUTS and prostatic enlargement secondary to BPH concurrently leads to statistically significant improvements in erectile/sexual function and is well‐tolerated, regardless of the presence/absence of ED at treatment initiation. Glina S, Roehrborn CG, Esen A, Plekhanov A, Sorsaburu S, Henneges C, Büttner H, and Viktrup L. Sexual function in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia: Results of a 6‐month, randomized, double‐blind, placebo‐controlled study of tadalafil coadministered with finasteride. J Sex Med 2015;12:129–138.     

The Quality of Sexual Experience in Women Correlates with Post‐Orgasmic Prolactin Surges: Results from an Experimental Prototype Study

IntroductionSexual intercourse, orgasm, and sexual satisfaction are associated with well‐being and improved quality of life. The pituitary hormone prolactin (PRL) may have an important role in regulating (and thus indexing) sexual satiety and satisfaction.AimPhysiological indices to quantify the quality and resulting satisfaction from female orgasm would be valuable. Therefore we aim to validate associations of orgasm‐induced PRL surges with women's orgasm quality and subsequent sexual satisfaction.MethodsIn a prospective study, with a pre‐post, single‐blinded, cross‐over design in a naturalistic field setting, we analyzed the correlation of women's post‐orgasmic serum PRL surges following sexual intercourse with women's perceived quality of orgasm and resulting sexual satisfaction, as measured by a questionnaire.Main Outcome MeasuresPRL levels prior to and following penile‐vaginal intercourse with and without orgasm, and scores from the Acute Sexual Experience Scale (ASES) on quality of orgasm and sexual satisfaction.ResultsAn analysis of variance of the blood samples in nine women indicated large magnitude, significant effects of intercourse orgasm on PRL levels (P = 0.004, eta squared = 0.78), as well as an interaction with the effect of multiple orgasms (P = 0.008, eta squared = 0.80). PRL post/pre ratios and arithmetic difference correlated strongly with orgasm quality (r = 0.85, P = 0.016, and r = 0.69, P = 0.08) and sexual satisfaction (r = 0.75, P = 0.05 and r = 0.77, P = 0.045).ConclusionWomen's intercourse orgasm induced PRL surges are strongly related to the quality of orgasm and subsequent sexual satisfaction. This implies that post‐orgasmic PRL surges are an objective index of orgasm and orgasm quality. PRL might be used in future studies on basic research as well as a treatment target in sexual disorders in women.     

Effects of Tadalafil on Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia and on Erectile Dysfunction in Sexually Active Men with Both Conditions: Analyses of Pooled Data from Four Randomized,Placebo‐Controlled Tadalafil Clinical Studies

IntroductionErectile dysfunction (ED) and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) are common in aging males and frequently occur together. Tadalafil has demonstrated efficacy in treating both conditions.AimThe study aims to evaluate the efficacy and safety of tadalafil 5 mg once daily vs. placebo over 12 weeks in treating both LUTS/BPH and ED in sexually active men. We also assessed relationships of baseline disease severity and prostate specific antigen (PSA) to outcomes.MethodsData were pooled from four multinational, randomized studies of men ≥45 years with LUTS/BPH, with analyses restricted to sexually active men with ED. Randomization (baseline) followed a 4‐week placebo run‐in; changes from baseline were assessed vs. placebo using analysis of covariance.Main Outcome MeasuresInternational Prostate Symptom Score (IPSS), IPSS subscores, Quality‐of‐Life Index (IPSS‐QoL), BPH Impact Index (BII), and International Index of Erectile Function‐Erectile Function (IIEF‐EF) Domain score were used in this study.ResultsTadalafil (N = 505) significantly improved total IPSS vs. placebo (N = 521); mean changes from baseline were ?6.0 and ?3.6, respectively (P < 0.001). Improvements in IIEF‐EF Domain score (tadalafil, 6.4; placebo, 1.4) were also significant vs. placebo, as were the IPSS storage and voiding subscores, IPSS‐QoL, and BII (all P < 0.001).No significant impact of baseline ED severity or PSA category on IPSS response was observed (interaction P values, 0.463 and 0.149, respectively). Similarly, improvement in IIEF‐EF Domain score was not significantly impacted by baseline LUTS/BPH severity or PSA category (interaction P values, 0.926 and 0.230, respectively). Improvements in IPSS and IIEF‐EF Domain score during treatment were weakly correlated (r = ?0.229). Treatment‐emergent adverse events were consistent with previous reports.ConclusionsTadalafil was efficacious and well tolerated in treating ED and LUTS/BPH in sexually active men with both conditions. Improvements in both conditions were significant regardless of baseline severity. Improvements in the total IPSS and the IIEF‐EF Domain score were weakly correlated. Porst H, Roehrborn CG, Secrest RJ, Esler A, and Viktrup L. Effects of tadalafil on lower urinary tract symptoms secondary to benign prostatic hyperplasia and on erectile dysfunction in sexually active men with both conditions: Analyses of pooled data from four randomized, placebo‐controlled tadalafil clinical studies. J Sex Med 2013;10:2044–2052.     

Postorgasmic Illness Syndrome (POIS) in a Chinese Man: No Proof for IgE‐Mediated Allergy to Semen

IntroductionPostorgasmic illness syndrome (POIS) is a rarely described syndrome characterized by transient flu‐like symptoms and cognition disorders. Recent studies suggest that immunogenic reactivity to autologous semen is the underlying mechanism in POIS. However, there are no data published on immunoglobulin E (IgE)‐mediated allergy to autologous semen in men without POIS.AimThe purpose of the current work was to characterize the first diagnosed POIS patient in China and to study the allergic response of autologous semen in the affected patient and in three healthy males.MethodsSpecific IgE was tested with seminal fluid and common perennial aeroallergens in vitro. Skin prick tests and intracutaneous tests with autologous diluted semen were performed in the patient and three healthy donors. The pattern of IgE reactivity to patient's semen was identified using immunoblotting and ELISA.Main Outcome MeasureClinical features of POIS, skin reactions with autologous diluted seminal fluid, and the IgE reactivity patterns of immunoblotting and ELISA in vitro.ResultsA patient was diagnosed with POIS. The patient complained of lifelong premature ejaculation symptoms and allergic rhinitis. Routine laboratory and hormonal assessments were generally within normal range. The patient had a positive skin test with his own semen. Three healthy donors also showed positive skin tests. No semen‐specific IgE to autologous semen was detected in the serum of the affected patient or healthy males.ConclusionsThis is the first report of a man with POIS in China. He had positive skin reactions after injection of autologous seminal fluid but no detectable serum concentrations of specific IgE antibodies. IgE‐mediated semen allergy in men may not be the potential mechanism of POIS. Jiang N, Xi G, Li H, and Yin J. Postorgasmic illness syndrome (POIS) in a Chinese man: No proof for IgE‐mediated allergy to semen. J Sex Med 2015;12:840–845.     

Severity of Virilization Is Associated with Cosmetic Appearance and Sexual Function in Women with Congenital Adrenal Hyperplasia: A Cross‐Sectional Study

IntroductionWomen with the classical form of congenital adrenal hyperplasia (CAH) are born with different degrees of virilization of the external genitalia. Feminizing surgery is often performed in childhood to change the appearance of the genitalia and to enable penile–vaginal intercourse later in life. There are suggestions that this affects sexual functioning.AimsThe aim is to study the anatomical, surgical, cosmetic, and psychosexual outcomes in women with CAH.MethodsForty women with CAH, aged over 15 years, from two referral centers for management of Disorders of Sex Development in the Netherlands were included. Physical and functional status were assessed by a gynecological interview and examination. Sexual functioning was assessed with the Female Sexual Function Index and Female Sexual Distress Scale—Revised scales and compared with a reference group.Mean Outcome MeasuresSurgery performed, anatomy, cosmetic score, sexual function and distress.ResultsThirty‐six of the 40 women had undergone feminizing surgery; 25 women (69%) underwent more than one operation. Resurgery was performed in seven of the 13 (54%) women who had had a single‐stage procedure. Anatomical assessment showed reasonable outcomes. Multiple linear regression showed that only level of confluence had a significant effect on cosmetic outcome, the impact depending on the number of surgeries performed. Cosmetic evaluations did not differ between the women and the gynecologists. Only 20 women had experience of intercourse. Eight women reported dyspareunia; seven women reported urinary incontinence. The women's perceived sexual functioning was less satisfactory than in the reference group, and they reported more sexual distress.ConclusionThe level of confluence was the major determinant for cosmetic outcome; the impact depended on the number of surgeries performed. Fifty‐four percent of the women required resurgery after a single‐stage procedure in childhood. Anatomical assessment showed reasonable outcomes. The women evaluated their sexual functioning and functional outcome less favorable than the reference group, and they experienced less often sexual intercourse. van der Zwan YG, Janssen EHCC, Callens N, Wolffenbuttel KP, Cohen‐Kettenis PT, van den Berg M, Drop SLS, Dessens AB, Beerendonk C. Severity of virilization is associated with cosmetic appearance and sexual function in women with congenital adrenal hyperplasia: A cross‐sectional study. J Sex Med 2013;10:866–875.     

Implicit Measurements of Sexual Preference in Self‐Declared Heterosexual Men: A Pilot Study on the Rate of Androphilia in Italy

IntroductionAn unambiguous measurement of the rate of nonheterosexuality in the male population (male bisexuality and homosexuality) is essential to estimate the health risks associated with same‐sex sexual behavior and to scale social and health programs for these citizens. However, self‐reported questionnaires on explicit measures of sexual orientation yield significant underestimations of nonheterosexuality. A necessary prerequisite for nonheterosexual preference is androphilia (sexual–erotic attraction to males), which can be explored through psychological tests.AimsThis study, using a pilot sample, investigates the possibility to inventory the frequency of male androphilia in the general population through a sexual preference implicit association test (sp‐IAT). This test is a classical IAT that is based on an association of pictures and words and is easily portable.MethodsFirst we conducted a preliminary validation of the specific IAT protocol on 24 control subjects; then, we examined a sample of 150 adult males in Italy as a pilot study. The subjects responded to the sp‐IAT and completed the explicit Kinsey scale questionnaire.Main Outcome MeasuresKinsey scale scores and D value of sp‐IAT for both preliminary and pilot sample.ResultsOn the explicit Kinsey scale, 2.7% of the sample declared themselves to be sexually attracted to men, corresponding to previous explicit samplings of the Italian homosexual male population. However, the sp‐IAT identified that 11.3% of self‐declared gynephilic heterosexuals showed a moderate to strong androphilia with a significant effect size (D) always below −0.2, and another 5.6% of the heterosexual sample showed no preference for females (D between −0.2 and 0).ConclusionThe Kinsey questionnaire strongly dichotomized the responses as either attracted to females or attracted to men, whereas the sp‐IAT showed a wider distribution of responses from gynephilia to androphilia. In conclusion, the sp‐IAT could be a novel and unambiguous instrument useful to ascertain androphilia population prevalence as a proxy for possible male nonheterosexuality. Camperio Ciani A and Battaglia U. Implicit measurements of sexual preference in self‐declared heterosexual men: A pilot study on the rate of androphilia in Italy. J Sex Med 2014;11:2207‐2217.