Endocrine Disruptors and Male Sexual Dysfunction
Rajesh K. Naz in Endocrine Disruptors, 2004
Testosterone is the main sex hormone in men. Low testosterone levels have a strong correlation with decreased libido, which suggests a major role for androgens in sexual function. With advancing age, bioavailable testosterone shows a typical pattern (Figure 11.1). Testosterone levels have been shown to correlate significantly with nocturnal penile tumescence [20]. Studies have demonstrated a significant decline in penile NO synthase activity in castrated animals that can be reversed by androgen supplementation, especially with dihydrotestosterone (DHT). Increases in NOS mRNA have been demonstrated with androgen supplementation [21]. These studies suggest active biochemical pathways for the influence of androgens on erectile function and dysfunction. However, the clinical use of androgens for the treatment of erectile response not resulting from hypogonadism is controversial.
Diagnosis of Chronic Fatigue Syndrome
Jay A. Goldstein in 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.
Sexual Dysfunction in Men with Narcolepsy
Meeta Goswami, Charles P. Pollak, Felissa L. Cohen, Michael J. Thorpy, Neil B. Kavey, Austin H. Kutscher, Jill C. Crabtree in Psychosocial Aspects of Narcolepsy, 2015
Mr. W., a 32-year-old, married man, had a history of excessive daytime sleepiness for the past 10 years. He also reported sudden weakness in certain muscle groups when he became extremely excited. Two years after the onset of his complaints, he was diagnosed as having narcolepsy and dextroamphetamine was prescribed. This medication provided relief, initially. However, it became ineffective after several months. His complaints were severe enough to require hospitalization and gradual withdrawal from dextroamphetamine. While hospitalized, a regimen of methylphenidate and imipramine was established. Subsequently, he began to experience problems obtaining erection and a decrease in his sexual desire. The patient related the onset of his sexual problems to the medications he was taking. We evaluated the patient polysomnographically, both while he was taking the medications and six days after he discontinued them. Recordings indicated improved nocturnal penile tumescence after cessation of drug therapy. We advised alternation between medication use and scheduled naps and modification of lifestyle to accommodate more daytime naps.
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].
Related Knowledge Centers
- Locus Coeruleus
- Rapid Eye Movement Sleep
- Sleep
- Spinal Nerve
- Testosterone
- Norepinephrine
- Erectile Dysfunction
- Erection
- Penis
- Nocturnal Clitoral Tumescence