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The Journal of Emergency Medicine Dec 2023
Topics: Male; Humans; Sildenafil Citrate; Penile Erection; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Piperazines; Drug Interactions; Erectile Dysfunction
PubMed: 37827862
DOI: 10.1016/j.jemermed.2023.06.021 -
International Journal of Impotence... Dec 2022Erectile Dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient for sexual intercourse. Available treatments for ED provide only... (Review)
Review
Erectile Dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient for sexual intercourse. Available treatments for ED provide only symptomatic relief, which is for the most part temporary. Regenerative therapies such as Low Intensity Shockwave, Platelet-Rich Plasma, and Stem Cell therapy can potentially provide a "cure" for ED by reversing the underlying pathology of ED rather than just treating the symptoms. Low Intensity Shockwave therapy is the most evidence based at this point and is thought to act by improving penile blood flow, repairing previous nerve damage, and activating stem cells. Stem Cell therapy takes advantage of the self-replicative potential of stem cells to create new corporal tissue, but also to recruit host cells and angiogenic factors to stimulate endogenous repair. Platelet-Rich Plasma therapy uses concentrated growth factors that already exist within the bloodstream to repair damaged nerves and increase penile blood flow. The use of combination restorative therapy may provide an additive or synergistic benefit greater than any one therapy alone because of its overlapping mechanisms of action on the penis but is a topic that remains to be studied.
Topics: Male; Humans; Erectile Dysfunction; Penile Erection; Penis; Stem Cell Transplantation
PubMed: 34253869
DOI: 10.1038/s41443-021-00456-1 -
Actas Urologicas Espanolas Nov 2021Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000... (Review)
Review
INTRODUCTION
Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined.
PATIENTS AND METHODS
Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020.
RESULTS
A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms.
CONCLUSIONS
High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.
Topics: Angiography; Child; Humans; Male; Penile Erection; Penis; Priapism; Retrospective Studies
PubMed: 34688599
DOI: 10.1016/j.acuroe.2021.05.001 -
Nature Jun 2024Krause corpuscles, which were discovered in the 1850s, are specialized sensory structures found within the genitalia and other mucocutaneous tissues. The physiological...
Krause corpuscles, which were discovered in the 1850s, are specialized sensory structures found within the genitalia and other mucocutaneous tissues. The physiological properties and functions of Krause corpuscles have remained unclear since their discovery. Here we report the anatomical and physiological properties of Krause corpuscles of the mouse clitoris and penis and their roles in sexual behaviour. We observed a high density of Krause corpuscles in the clitoris compared with the penis. Using mouse genetic tools, we identified two distinct somatosensory neuron subtypes that innervate Krause corpuscles of both the clitoris and penis and project to a unique sensory terminal region of the spinal cord. In vivo electrophysiology and calcium imaging experiments showed that both Krause corpuscle afferent types are A-fibre rapid-adapting low-threshold mechanoreceptors, optimally tuned to dynamic, light-touch and mechanical vibrations (40-80 Hz) applied to the clitoris or penis. Functionally, selective optogenetic activation of Krause corpuscle afferent terminals evoked penile erection in male mice and vaginal contraction in female mice, while genetic ablation of Krause corpuscles impaired intromission and ejaculation of males and reduced sexual receptivity of females. Thus, Krause corpuscles of the clitoris and penis are highly sensitive mechanical vibration detectors that mediate sexually dimorphic mating behaviours.
Topics: Animals; Female; Male; Mice; Clitoris; Ejaculation; Mechanoreceptors; Optogenetics; Penile Erection; Penis; Sexual Behavior, Animal; Spinal Cord; Touch; Vagina; Vibration; Neurons
PubMed: 38898273
DOI: 10.1038/s41586-024-07528-4 -
Asian Journal of Andrology 2022There is no well-established procedure for the management of small penis syndrome (SPS), especially when psychological interventions fail. This study aimed at...
There is no well-established procedure for the management of small penis syndrome (SPS), especially when psychological interventions fail. This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation (PA) using injectable hyaluronic acid (HA) gel. Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year. Penile size, erectile function, and psychological burden measured by the Index of Male Genital Image (IMGI), Index of International Erectile Function (IIEF), and Beliefs about Penis Size (BPAS), respectively, were assessed at the beginning and at 1, 3, 6, and 12 months postinjection. The volume of HA gel injected was 21.5 ± 3.7 ml. Compared to baseline data, flaccid penile girth and length significantly increased by 3.41 ± 0.95 cm (P < 0.01) and 2.55 ± 0.55 cm (P < 0.01) at the 1 month postinjection, respectively. At the endpoint, despite attenuations, statistically significant improvements in flaccid penis size were still obtained, namely 2.44 ± 1.14 cm in girth (P < 0.01) and 1.65 ± 0.59 cm in length (P < 0.01). Similarly, erectile penile girth statistically increased by 1.32 ± 1.02 cm (P < 0.01) at the 1 month but were only 0.80 ± 0.54 cm bigger than baseline (P < 0.01) at the endpoint. At the 1 month, the average score of IMGI and the mean score of IIEF statistically increased by 46.2 ± 10.5 (P < 0.01) and 7.6 ± 6.2 (P < 0.01), respectively; the score of BAPS significantly decreased by 18.3 ± 4.5 (P < 0.01). These alterations remained steady during follow-up. Considering the significant penile size improvement, lasting psychological benefit, and low complication rate, PA with HA might serve as an appropriate alternative for patients with SPS.
Topics: Humans; Male; Hyaluronic Acid; Erectile Dysfunction; Patient Satisfaction; Penis; Penile Erection
PubMed: 35417989
DOI: 10.4103/aja20223 -
International Journal of Impotence... Sep 2022Men with Stuttering Priapism (SP) and sleep-related painful erections (SRPE) experience bothersome nocturnal painful erections resulting in poor sleep. The aim of this...
Men with Stuttering Priapism (SP) and sleep-related painful erections (SRPE) experience bothersome nocturnal painful erections resulting in poor sleep. The aim of this study is to observe common features and differences between men with SP and SRPE based on polysomnography, nocturnal penile tumescence (NPT), and penile doppler ultrasound (PDU). This is a prospective cohort study of 20 participants divided into two groups (Group 1 = SP [n = 12]; Group 2 = SRPE [n = 8]) with bothersome painful nocturnal erections. All participants were referred to the sleep disorder clinic to be assessed and consented for overnight polysomnography with simultaneous NPT recording and to complete validated sleep, sexual dysfunction and health-related quality of life questionnaires. Unstimulated PDU was also performed. Abnormal Polysomnographic findings (reduced sleep efficiency, total sleep time, and awake after sleep onset) were identified in both groups suggesting poor sleep. Men with SP had significantly longer erections (60.0 vs 18.5; p = 0.002) and took longer to detumesce once awake (25.7 vs 5.4 min; p = 0.001) than men with SRPE. They also had significantly higher peak systolic and end diastolic velocities on unstimulated PDU with an abnormal low resistance waveform identified. No sleep pathology was identified in men with SP. This implies a local (penile) etiology in men with SP. Men with SRPE had a normal resting PDU and abnormal sleep architecture with REM awakenings and significantly more Periodic limb movements (p = 0.04) than men with SP suggesting a central (sleep-related) cause in men with SRPE. Sexual dysfunction and poor HR-QoL was identified on validated questionnaires in both groups. SP and SRPE are rare entities that share similar symptoms (painful nocturnal erections and poor sleep) but dissimilar features of nocturnal erection onset, duration and resolution with different polysomnographic features which may allude to a different pathophysiology.
Topics: Humans; Male; Pain; Penile Erection; Priapism; Prospective Studies; Quality of Life; REM Sleep Parasomnias; Stuttering; Ultrasonography, Doppler
PubMed: 34389802
DOI: 10.1038/s41443-021-00462-3 -
Sexual Medicine Reviews Jul 2021The process of ejaculation has important meanings not only for its association with orgasm but also for the timing to ejaculate in the context of sexual activity.... (Review)
Review
INTRODUCTION
The process of ejaculation has important meanings not only for its association with orgasm but also for the timing to ejaculate in the context of sexual activity. Spontaneous (involuntary) ejaculation (SE) without any sexual stimulation is a distressing symptom. Our understanding of SE is limited. Unfortunately, many physicians are not aware of these cases.
OBJECTIVES
The objective of this study is to describe the etiopathogenesis, clinical features, diagnosis, and treatment options for SE.
METHODS
We searched the literature for publications on "SE," "spontaneous emission" or "involuntary ejaculation," and factors influencing SE in the PUBMED/MEDLINE, Scopus, Cochrane Library, EMBASE, PsycINFO, ProQuest, Academic Search Complete database, Google Scholar, and CINAHL databases from inception to August 2020.
RESULTS
The literature search yielded 36 relevant publications reporting on 43 patients with SE. Attempts to explain the cause of pathologic SE have included 4 etiological groups (spinal cord lesions, psychological causes, rabies, and drug-induced). The underlying mechanisms responsible for induction of SE may include increased adrenergic activity, overactivity in dopaminergic system, decreased serotonergic activity, damage of descending inhibitory pathway, or penile hyperexcitability. SE may occur in the absence of an identifiable trigger or may be triggered by non-sexual circumstances (micturition, defecation, glans touch, anxiety, panic attack, or school examinations). Treatment options include psychoanalytic treatment, paroxetine, citalopram, sertraline, silodosin, and anxiolytics. In drug-induced SE, dose reduction and drug withdrawal with or without switching to another drug may relief SE.
CONCLUSIONS
SE is one of the least reported ejaculatory dysfunction. The key feature shared in common by these men is SE without any sexual thoughts or fantasies, may be triggered by non-sexual contexts, rarely associated with orgasm or erection. Treatment by psychoanalytic treatment and pharmacotherapy may be helpful. Further research might explore the definite underlying mechanisms. Abdel-Hamid IA, Ali OI. Spontaneous Ejaculation: A Focused Review for the Clinicians. Sex Med Rev 2021;9:406-422.
Topics: Ejaculation; Humans; Male; Orgasm; Penile Erection; Penis; Premature Ejaculation
PubMed: 33262094
DOI: 10.1016/j.sxmr.2020.11.001 -
Journal of Clinical Anesthesia Nov 2019
Topics: Adrenergic alpha-Agonists; Analgesics, Opioid; Autonomic Nervous System; Humans; Infusions, Intravenous; Injections; Intraoperative Period; Male; Pain, Postoperative; Penile Erection; Penis; Remifentanil; Urologic Surgical Procedures, Male; Young Adult
PubMed: 30978642
DOI: 10.1016/j.jclinane.2019.04.011 -
Andrologia Dec 2022This study aimed to assess the relationship between 25(OH) levels and erectile dysfunction (ED), particularly arteriogenic ED (A-ED). From September 2020 to January...
This study aimed to assess the relationship between 25(OH) levels and erectile dysfunction (ED), particularly arteriogenic ED (A-ED). From September 2020 to January 2022, 150 patients diagnosed with ED by the International Index of Erectile Function-5 (IIEF-5) questionnaire were included. All patients were classified as organic ED and psychological ED by nocturnal penile tumescence and rigidity (NPTR) examination. Organic ED patients were divided into A-ED and NA-ED by penile doppler ultrasound (PDU) examination. Finally, 150 patients complaining of ED were enrolled in our study. 25(OH)D levels were significantly lower in patients with organic ED (18.24 ± 6.04 ng/ml) than in patients with psychogenic ED (20.90 ± 8.79 ng/ml) (p = 0.032). In A-ED and NA-ED, the mean of peak systolic flow velocity (PSV) values was 18.94 ± 5.28 cm/s and 51.57 ± 15.42 cm/s (p < 0.001), and the mean of 25(OH)D was 15.66 ± 5.86 ng/ml and 20.48 ± 5.90 ng/ml, respectively (p < 0.001). The results showed that 25(OH)D levels were positively correlated with IIEF-5 scores and the PSV values in A-ED patients. The 25(OH)D cut-off value differentiating between A-ED and NA-ED was 15.05 ng/ml. Low 25(OH)D levels may be an independent risk factor for ED, especially A-ED. ED patients should routinely undergo serum 25(OH)D level measurement, and 25(OH)D replacement therapy is necessary for patients with low vitamin D levels.
Topics: Male; Humans; Erectile Dysfunction; Penis; Penile Erection; Impotence, Vasculogenic; Vitamin D; Calcifediol
PubMed: 36054412
DOI: 10.1111/and.14568 -
Scientific Reports May 2023The human penis transmits behaviorally important sensory information via the dorsal penile nerve, which is required for initiation and maintenance of erection. The human...
The human penis transmits behaviorally important sensory information via the dorsal penile nerve, which is required for initiation and maintenance of erection. The human penis differs from the penes of other hominids. The lack of a baculum makes the human penis dependent on erectile tissue, which is under control of neural signals activated by tactile stimulation. Accordingly, the penile sensory innervation is crucial for human sexual behavior. To clarify penile innervation, we analyzed the architecture of the dorsal penile nerve of five male subjects who donated their body. We stained the sensory fibers in the penile dorsal nerve with anti-neurofilament H antibody, and identified myelinated axons with Luxol fast blue staining. Furthermore, we visualized nerve bundles as they travel along the shaft of the penis by performing microfocus computed tomography scans after counterstaining penes with iodine. Our results show that the dorsal penile nerve is organized in 25-45 loosely packed nerve bundles, running mediodorsally in the shaft of the penis. This organization corresponds to that in penes of other mammalian species, but differs from the organization of the other peripheral sensory nerves. Around half of the dorsal penile nerve fibers were myelinated and a human hemipenis contained a total of 8290 ± 2553 (mean ± SD) axons. Thus, the number of sensory axons in the human dorsal penile nerve is higher than in other species described so far. The large fraction of unmyelinated nerve fibers suggests that the conduction speed is not a crucial aspect of penile sensory transmission.
Topics: Animals; Humans; Male; Pudendal Nerve; Penis; Penile Erection; Axons; Peripheral Nerves; Mammals
PubMed: 37258532
DOI: 10.1038/s41598-023-35030-w