Ejaculatory incompetence: a theoretical formulation and case illustration

Three theoretical formulations of ejaculatory incompetence have been proposed in the literature. They include: (1) aversive conditioned inhibition of the ejaculatory reflex, (2) an "autosexual" orientation associated with discrepant levels in the cognitive and physiological dimensions of sexual arousal, and (3) a discriminative learning model. These three models are discussed in relation to their theoretical and therapeutic implications. Clinical data supporting the discriminative view is presented.     

British Association of Urological Surgeons (BAUS) consensus document: management of bladder and ureteric injury

Injuries to the bladder and ureter are uncommon but usually require prompt urological management. Due to their infrequent nature, Urologists maybe unfamiliar with managing these acute problems and may not work in specialist centres with readily available expertise in open and abdominal surgery. We aim to provide advice in the form of a consensus statement led by the Female, Neurological and Urodynamic Urology (FNUU) Section of the British Association of Urological Surgeons (BAUS), in consultation with BAUS members and consultants working in units throughout the UK, to create a comprehensive management pathway and a series of statements to aid clinicians.     

An immunohistochemical study of androgen, oestrogen and progesterone receptors in the vulva and vagina

Objective Tomap potential sites of sex steroid action in the human vulva.
Methods Monoclonal antibodies to androgen, oestrogen and progesterone receptors were used to stainfrozen sections of vulval skin, vagina and suprapubic skin. A scoring system was devised to comparereceptor distribution in the epidermis and dermis of skin with vaginal epithelium and stroma.
Results Androgen receptors were seen in epidermal keratinocytes, sebaceous glands, sweat glands, hairfollicles and dermal fibroblasts of skin, and epithelial cells and stromal fibroblasts of the vagina. Androgen receptor scores were significantly higher in the epidermis of labia majora and minora thanin vaginal epithelium. Oestrogen receptors were seen in basal and suprabasal cells of vaginalepithelium and epidermis of labia minora but were restricted to basal keratinocytes in true skin.They were seen in stromal fibroblasts and vaginal smooth muscle, and dermal fibroblasts of theskin. Oestrogen receptors were highest in vaginal epithelium and stroma, and lowest insuprapubic skin. Progesterone receptors were seen in vaginal epithelium, fibroblasts and smoothmuscle but not in the vulva. There was no evidence of significant differences in androgen oroestrogen receptor staining in the vulva of pre- or postmenopausal women.
Conclusion The transition from vagina to vulva is marked by an increase in androgen and a decrease inoestrogen and progesterone receptors. This distribution of receptors would indicate a limited role foroestrogen creams on the vulva.     

Multifocal infantile hemangiomas associated with concomitant giant hepatic rapidly involuting congenital hemangioma

We present a 9-day-old girl with multifocal cutaneous and hepatic infantile hemangiomas as well as a hepatic rapidly involuting congenital hemangioma. These two distinct vascular tumors have rarely been reported to co-occur. We additionally review the sonographic features that distinguish a hepatic congenital hemangioma from the hepatic infantile hemangioma.     

Gambling and Problem Gambling in Canada in 2018: Prevalence and Changes Since 2002

Objective:The purpose of this study was to provide an updated profile of gambling and problem gambling in Canada and to examine how the rates and pattern of participation compare to 2002.Method:An assessment of gambling and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 24,982 individuals aged 15 and older. The present analyses selected for adults (18+).Results:A total of 66.2% of people reported engaging in some type of gambling in 2018, primarily lottery and/or raffle tickets, the only type in which the majority of Canadians participate. There are some significant interprovincial differences, with perhaps the most important one being the higher rate of electronic gambling machine (EGM) participation in Manitoba and Saskatchewan. The overall pattern of gambling in 2018 is very similar to 2002, although participation is generally much lower in 2018, particularly for EGMs and bingo. Only 0.6% of the population were identified as problem gamblers in 2018, with an additional 2.7% being at-risk gamblers. There is no significant interprovincial variation in problem gambling rates. The interprovincial pattern of problem gambling in 2018 is also very similar to what was found in 2002 with the main difference being a 45% decrease in the overall prevalence of problem gambling.Conclusions:Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods. Several mechanisms have likely collectively contributed to these declines. Decreases have also been reported in several other Western countries in recent years and have occurred despite the expansion of legal gambling opportunities, suggesting a degree of inoculation or adaptation in large parts of the population.     

An unusual pattern of testosterone metabolism in tissue associated with a keratin-filled cutaneous cyst.

Testosterone metabolism was studied in tissues associated with a keratin-filled cutaneous cyst. Instead of the 5alpha-reduced metabolites usually associated with skin steroid metabolism, considerable amounts of 5beta-reduced steroids were found. These included 5beta-androstane-3,17-dione, 17beta-hydroxy-5beta-androstan-3-one, and 5beta-androstane-3beta,17beta-diol. This change in metabolic pattern is discussed.     

Androgen metabolism in skin and skeletal muscle of the rainbow trout (Salmo gairdnerii) and in accessory sexual organs of the spur dogfish (Squalus acanthias).

The in vitro metabolism of testosterone, 4-androstene-3,17-dione (androstenedione) and dehydroepiandrosterone by skin and muscle from the rainbow trout (Salmo gairdnerii), and by skin and accessory sexual tissues from the spur dogfish (Squalus acanthias) was studied. In trout skin, testosterone was transformed mainly into 5α-dihydrotestosterone together with smaller amounts of 5α-androstane-3α, 17β-diol, androstenedione, 5α-androstane-3,17-dione and androsterone. Androstenedione was transformed mainly into 5α-androstane-3,17-dione with smaller amounts of testosterone, 5α-dihydrotestosterone, androsterone and 5α-androstane-3α,17β-diol. Dehydroepiandrosterone was transformed to 5-androstene-3β,17β-diol with trace quantities of androstenedione and 5α-androstane-3,17-dione. Unidentified polar nonconjugated metabolites and traces of steroid glucuronides were formed from the three substrates. The patterns of steroid metabolism were similar in dorsal and ventral skin, and in dorsal skin from male and female, adult and immature fish. Most of the 5α-reductase activity in the skin was in the dermis, only a small fraction of the total activity being in the epidermis. The trout muscle converted testosterone into 5α-dihydrotestosterone but in much lower yields than did skin.The skin, clasper, sperm sac and vas deferens of an adult male spur dogfish converted testosterone to 5α-dihydrotestosterone and androstenedione, though in much lower yields than did trout skin. Androstenedione was converted into testosterone, 5α-androstane-3, 17-dione and androsterone, while dehydroepiandrosterone was converted into 5-androstene-3β,17β-diol. No metabolism of testosterone was detected in the skeletal muscle of the dogfish.