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Medicine Jun 2023Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or...
An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report.
RATIONALE
Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED.
PATIENT CONCERNS
The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges.
DIAGNOSES
Atypical ED, psychogenic ED not excluded; infertility.
INTERVENTIONS
Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife.
OUTCOMES
The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization.
CONCLUSIONS
The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.
Topics: Aged; Middle Aged; Pregnancy; Female; Male; Humans; Adult; Erectile Dysfunction; Penile Implantation; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Semen; Infertility
PubMed: 37352063
DOI: 10.1097/MD.0000000000034023 -
Archives of Sexual Behavior Oct 2023The notions that manhood is hard to attain, easy to lose, and needs to be proven via public action constitute precarious manhood beliefs (PMB). PMB is a new concept and...
The notions that manhood is hard to attain, easy to lose, and needs to be proven via public action constitute precarious manhood beliefs (PMB). PMB is a new concept and it remains unclear whether and how PMB relate to erectile dysfunction (ED) in cisgender men. The ability to achieve an erection remains considered as a cornerstone of masculinity and sexual performance can be conceived as a proof of one's masculinity. In this context, ED can be received as sexual failure and a threat to a man's masculinity and sense of adequacy. For these reasons, the hypothesis that PMB are associated with ED warranted empirical testing. In an anonymous online survey focusing on men's mental health conducted in German-speaking countries of Europe, 507 cisgender men (M = 44.2, SD = 15.2) completed measures on PMB, sexual function, self-stigma, social desirability, and conformity to traditional masculinity ideology (TMI). Multilinear regression analysis with stepwise introduction of relevant covariates evaluated potential associations between PMB and ED. Of a 507 cisgendered male sample, 63.1% reported an increased risk for ED based on previously established cutoff points. Elevated levels of PMB endorsement among the men predicted reduced sexual and erectile function in all models, even when accounting for relevant control variables such as age, education, self-stigma, social desirability, or conformity to TMI. Group comparisons revealed that the men suffering from ED showed higher levels of PMB endorsement but not self-stigma nor TMI relative to men without ED. PMB are significantly associated with ED. While determining causality will require further study, our results may support the hypothesis that higher levels of PMB endorsement may lead to increased tension to perform sexually, resulting in increased psychological pressure and a higher risk to develop ED.
Topics: Male; Humans; Adult; Adolescent; Erectile Dysfunction; Masculinity; Sexual Behavior; Men's Health; Penile Erection
PubMed: 37351710
DOI: 10.1007/s10508-023-02640-4 -
Sexual Medicine Jun 2023The relationship between galanin and erectile function under low androgen levels is still unclear.
BACKGROUND
The relationship between galanin and erectile function under low androgen levels is still unclear.
AIM
To explore whether a low testosterone level damages the erection of a rat by regulating the expression of galanin and GalR in penile cavernous tissue.
METHODS
Thirty-six male Sprague-Dawley rats, 8 weeks of age, were randomly grouped as follows (n = 6): control, castration, castration + testosterone replacement, control + transfection, castration + transfection, and castration + empty transfection. At 4 weeks after castration, rats in the transfection group were injected with lentivirus carrying the targeting galanin gene (2 × 10 TU/mL, 10 μL) in the corpus cavernosum. After 1 week of injection, the intracavernosal pressure (ICP), mean arterial blood pressure (MAP), nitric oxide (NO), serum testosterone concentration, galanin, GalR1-3, ROCK1, ROCK2, and p-eNOS/eNOS in the rat penile tissues were evaluated.
OUTCOMES
ICPmax/MAP and the expression of galanin in the corpus cavernosum in castrated rats were obviously decreased as compared with those in the control rats.
RESULTS
The castrated rats showed remarkably lower ICPmax/MAP, galanin, GalR1-3, p-eNOS/eNOS, and NO content and markedly higher ROCK1 and ROCK2 in penile tissues than the control group ( < .05). The transfected rats administrated with LV Gal had obviously higher ICPmax/MAP, p-eNOS/eNOS, and NO content and less ROCK1 and ROCK2 protein expression in the corpus cavernosum when compared with the castration group ( < .05).
CLINICAL TRANSLATION
Upregulating the expression of galanin in the penile corpus cavernosum might be a novel method of treating erectile dysfunction caused by a low androgen level.
STRENGTHS AND LIMITATIONS
The conclusions obtained in the animal experiments need to be confirmed in human data.
CONCLUSION
The erectile function of hypoandrogen rats might be inhibited by downregulating the level of galanin and GalR1-3, upregulating ROCK1 and ROCK2 levels, and inhibiting the eNOS/NO signaling pathway in penile corpus cavernosum.
PubMed: 37351545
DOI: 10.1093/sexmed/qfad029 -
Redox Report : Communications in Free... Dec 2023The present study evaluated the effect of lead exposure with and without zinc therapy on male sexual and erectile function.
AIM
The present study evaluated the effect of lead exposure with and without zinc therapy on male sexual and erectile function.
METHODS
Twenty male Wistar rats were randomly assigned into four groups; the control, zinc-treated, lead-exposed, lead + zinc-treated groups. Administrations were per os daily for 28 days.
RESULTS
Zinc co-administration significantly improved absolute and relative penile weights and the latencies and frequencies of mount, intromission, and ejaculation in lead-exposed rats. Also, zinc ameliorated lead-induced reductions in motivation to mate and penile reflex/erection. These findings were accompanied by attenuation of lead-induced suppression of circulating nitric oxide (NO), penile cyclic guanosine monophosphate (cGMP), dopamine, serum luteinizing hormone, follicle-stimulating hormone, and testosterone. In addition, zinc alleviated lead-induced upregulation of penile activities of acetylcholinesterase and xanthine oxidase (XO), and uric acid (UA) and malondialdehyde (MDA) levels. Furthermore, zinc ameliorated the lead-induced decline in penile nuclear factor erythroid 2-related factor 2 (Nrf2) and reduced glutathione (GSH) levels, and catalase, superoxide dismutase (SOD), glutathione peroxidase (GPx), and glutathione-S-transferase (GST) activities.
CONCLUSION
This study revealed that co-administration of zinc improves lead-induced sexual and erectile dysfunction by suppressing XO/UA-driven oxidative stress and upregulating testosterone via Nrf2-mediated signaling.
Topics: Male; Rats; Animals; Humans; Testosterone; Zinc; Erectile Dysfunction; Acetylcholinesterase; NF-E2-Related Factor 2; Rats, Wistar; Uric Acid
PubMed: 37345699
DOI: 10.1080/13510002.2023.2225675 -
Translational Andrology and Urology May 2023It has been speculated for decades whether there is a significance of the adrenal corticosteroid cortisol in the process of male sexual function, including the control...
BACKGROUND
It has been speculated for decades whether there is a significance of the adrenal corticosteroid cortisol in the process of male sexual function, including the control of sexual arousal and penile erection. In order to investigate further the role of the adrenocorticotropic axis in the physiological process of penile erection, we aimed to determine the course of cortisol in the cavernous and systemic blood through different stages of sexual arousal in patients suffering from erectile dysfunction (ED) in comparison to a cohort of healthy males.
METHODS
Fifty-four healthy adult males and 45 patients with ED were presented sexually explicit visual material in order to elicit tumescence and (in the healthy males) rigid erection. Blood was collected from the cavernous space (corpus cavernosum penis, CC) and a cubital vein (CV) at different stages of the sexual arousal cycle as indicated by the penile stages flaccidity, tumescence, rigidity (attained only by the healthy males) and detumescence. Cortisol (µg/dL serum) was measured using a radioimmunometric assay (RIA).
RESULTS
In healthy males, cortisol decreased in both the cavernous and systemic blood with the beginning of sexual stimulation (CV: 15 to 13, CC: 16 to 13). At detumescence, in the systemic circulation, no alterations in cortisol levels were registered, whereas it decreased further in the CC (to 12). In the ED patients, no significant changes in cortisol were noticed in the systemic and cavernous blood.
CONCLUSIONS
The findings indicate that cortisol might act as an antagonist of the normal sexual response cycle of the adult male. A dysregulation of the secretion and/or degradation of the hormone might well play a role in the manifestation of ED.
PubMed: 37305638
DOI: 10.21037/tau-22-566 -
Translational Andrology and Urology May 2023We investigated the relationship between the size of the penis and that of the nose.
BACKGROUND
We investigated the relationship between the size of the penis and that of the nose.
METHODS
We retrospectively analyzed 1,160 patients whose nose and penis sizes were measured. These participants were selected from a subset of 1,531 patients who visited the Dr. JOMULJU Urology Clinic between March and October 2022. Patients aged <20 years and those who underwent surgery for the nose and penis were excluded. Nose size was determined by measuring the length, width, and height of the nose, which were used to calculate the volume of the triangular pyramid. Stretched penile length (SPL) and penile circumference before erection were measured. The participants' height, weight, foot size, and serum testosterone levels were measured. Testicular size was measured using ultrasonography. Predictors of penile length and circumference were assessed using linear regression analysis.
RESULTS
The participants' average age was 35.5 years, mean SPL was 11.2 cm, and mean penile circumference was 6.8 cm. Univariate analysis revealed that body weight, body mass index (BMI), the serum testosterone level, and nose size were associated with SPL. Multivariable analysis revealed that BMI (P=0.001) and nose size (P=0.023) were significant predictors of SPL. Univariate analysis revealed that penile circumference was related to an individual's height, weight, BMI, nose size, and foot size. Multivariable analysis revealed that body weight (P=0.008) and testicular size (P=0.002) were significant predictors of penile circumference.
CONCLUSIONS
Nose size was a significant predictor of penile size. The sizes of the penis and nose increased with a decrease in BMI. This interesting study confirms the truth of an erstwhile myth about penis size.
PubMed: 37305632
DOI: 10.21037/tau-22-869 -
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 -
Brain Sciences May 2023Erectile dysfunction (ED) is the inability to get and maintain an adequate penile erection for satisfactory sexual intercourse. Due to its negative impacts on men's life... (Review)
Review
Erectile dysfunction (ED) is the inability to get and maintain an adequate penile erection for satisfactory sexual intercourse. Due to its negative impacts on men's life quality and increase during aging (40% of men between 40 and 70 years), ED has always attracted researchers of different disciplines, from urology, andrology and neuropharmacology to regenerative medicine, and vascular and prosthesis implant surgery. Locally and/or centrally acting drugs are used to treat ED, e.g., phosphodiesterase 5 inhibitors (first in the list) given orally, and phentolamine, prostaglandin E1 and papaverine injected intracavernously. Preclinical data also show that dopamine D receptor agonists, oxytocin and α-MSH analogues may have a role in ED treatment. However, since pro-erectile drugs are given on demand and are not always efficacious, new strategies are being tested for long lasting cures of ED. These include regenerative therapies, e.g., stem cells, plasma-enriched platelets and extracorporeal shock wave treatments to cure damaged erectile tissues. Although fascinating, these therapies are laborious, expensive and not easily reproducible. This leaves old vacuum erection devices and penile prostheses as the only way to get an artificial erection and sexual intercourse with intractable ED, with penile prosthesis used only by accurately selected patients.
PubMed: 37239274
DOI: 10.3390/brainsci13050802 -
Urology Case Reports May 2023Self-insertion of foreign body into male urethra represents heterogeneous group of cases in terms of causes, symptoms and management. We reported a case of 60-year old...
Self-insertion of foreign body into male urethra represents heterogeneous group of cases in terms of causes, symptoms and management. We reported a case of 60-year old male patient filled his urethra with silicone-jell. Patient had severe penile pain and difficult urination. Physical examination revealed palpable hard mass starting from distal part of prostatic urethra to midpenile urethra. Rigid cystoscopy showed complete occlusion of urethra. Laser fragmentation and mechanic extraction failed. Open surgery was decided. Midline incision was performed at the distal end of foreign body in the penile urethra. The foreign material was extracted successfully.
PubMed: 37215059
DOI: 10.1016/j.eucr.2023.102407