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Diagnosis of Chronic Fatigue Syndrome
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
The primary genitourinary complaint in the male patient with CFS involves prostatic discomfort, frequency, and nocturia. Al-though many of these men are treated for prostatitis, very few of them have had a culture-proven infection, either of the urine or of prostatic fluid. Many have not had a three-glass test. My impression is that prostatitis, either chronic bacterial or abacterial, is considerably less common than prostatodynia. Acute bacterial prostatitis is seen no more frequently than in the general population. Prostatic tenderness is often detected in CFS patients, but induration or nodules with or without fever are not common. Alpha-blocking drugs such as prazosin (Minipress) or terazosin (Hytrin) are effective in diagnosis and treatment. Testalgia occurs infrequently, but is not accompanied by structural changes. This pain may be neuropathic. Intense scrotal and testicular pain was reported in a 9-year-old boy with a right parietal lobe seizure focus.9 Lack of libido and erectile dysfunction are common complaints as well. When we have done nocturnal penile tumescence evaluation with Rigiscans, they have been abnormal.
Infertility Diagnosis and Treatment
Published in Sujoy K. Guba, Bioengineering in Reproductive Medicine, 2020
Using the devices described above, nocturnal penile tumescence (NPT) has been studied and its relation to sleep cycles investigated. Results from such investigations help in differentiating the factors leading to impotence in individual patients. Normal NPT in a person unable to achieve erection for intercourse is suggestive of neurogenic origin of the impotence.
Erectile Dysfunction
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Mark Johnson, Marco Falcone, Tarek M. A. Aly, Amr Abdel Raheem
In most cases, the diagnosis of ED is clinical; however, some patients may need additional diagnostic evaluation. Nocturnal penile tumescence and rigidity test (NPT): The NPT assesses the presence of any penile tumescence and erection during night. It may facilitate differentiating between an organic or a psychogenic ED [31].Dynamic duplex ultrasound of the penis (Figure 12.2): Penile duplex (after the endocavernous injection of a full-dose of alprostadil) allows the verification of the vascular status of the penis. It aids in determining whether ED is due to vascular (arterial or venous due to corporal occlusive mechanism alteration) or psychogenic causes [32,33].Arteriography: A selective internal pudendal arteriography is recommended in patients with a de novo diagnosis of arterial ED following a pelvic or perineal trauma; it may identify a posttraumatic internal pudendal artery occlusion. If this is the case, a penile revascularization (arterial bypass) is indicated [34].
The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders
Published in The World Journal of Biological Psychiatry, 2020
Florence Thibaut, Paul Cosyns, John Paul Fedoroff, Peer Briken, Kris Goethals, John M. W. Bradford
The primary androgen produced by the testes, plays a significant role, not only in the development and maintenance of the male sexual characteristics, but also in the regulation of sexuality, aggression, cognition, emotion and personality (Rubinow and Schmidt 1996). In particular, it is a significant determinant of sexual desire, fantasies, and behaviour and basically, it controls the frequency, duration, and magnitude of spontaneous erections (Carani et al. 1992). The effects of testosterone (and of its metabolite 5α-dihydrotestosterone (DHT)) are mediated through their actions on the intracellular androgen receptor. Testosterone secretion is regulated by a feedback mechanism in the hypothalamic-pituitary gonadal axis. The hypothalamus produces the gonadotrophin hormone-releasing hormone (GnRH), which is released in a pulsatile manner and stimulates the anterior pituitary gland to produce the luteinising hormone (LH). LH stimulates the release of testosterone from the testes, which in turn inhibits the hypothalamus and the pituitary. Testosterone has been shown to restore nocturnal penile tumescence responses in a hypogonadal adult man with impaired nocturnal penile tumescence. A minimal level of testosterone is necessary for the sexual drive in males. However, the threshold remains questionable. Testosterone levels do not correlate with the intensity of sexual drive. The relationships between testosterone and aggressive behaviour are also complex (Batrinos 2012).
Pharmaceutical management of sexual dysfunction in men on antidepressant therapy
Published in Expert Opinion on Pharmacotherapy, 2022
Ahmed M. Bakr, Amro A. El-Sakka, Ahmed I. El-Sakka
Depression and ED not only share many risk factors [4], depression on its own could have a direct effect on erectile function (EF). Studies reported a significant reduction in nocturnal penile tumescence in depressed patients [35]. Depression is also associated with decreased self-esteem, loss of confidence, and preemptive sense of failure of male role [36]. Beside these psychological effects, many explanations proposed biologic mechanisms in the pathogenesis of ED [37]; e.g. a vascular dysfunction that affect both brain and cavernous systems [38], and autonomic overactivity [39]. In addition, with increasing severity of depression there is increased prevalence of ED [33].
The erectile dysfunction as a marker of cardiovascular disease: a review
Published in Acta Cardiologica, 2020
Camelia Cristina Diaconu, Maria Manea, Dragos Radu Marcu, Bogdan Socea, Arsenie Dan Spinu, Ovidiu Gabriel Bratu
The evaluation may also include specific diagnostic tests, such as: nocturnal penile tumescence and rigidity test (electronic device placed on the penis over the night, which monitors the number of erections, their duration and the penile rigidity during the erections), intracavernous injection test (injection of different types of vasodilators agents into the base of the penis, that usually lead to penile tumescence within 10–15 minutes), penile duplex ultrasound, arteriography, dynamic infusion cavernosometry, cavernosography (in patients who suffer from vascular pathology associated with ED), psychological and psychiatric evaluation [2].