INTRODUCTION:

We describe the characteristics of Peyronie's disease (PD) and its associated psychosocial implications in men who have sex with men (MSM).

AIM:

The aims of this article are to identify presenting characteristics and treatment for MSM with PD, compare these findings to non-MSM PD patients, and determine the psychosocial impact of PD among MSM.

MAIN OUTCOME MEASURES:

Subjective and objective presenting characteristics, MSM psychosocial factors.

METHODS:

We identified 27 MSM with PD presenting from 2000 to 2012 through a retrospective chart review. A random selection of 200 non-MSM PD patients was identified, who presented during the same time period. A prospective nonvalidated questionnaire was given to MSM PD patients for evaluation of psychosocial constructs.

RESULTS:

A traumatic event leading to activation of PD was identified equally among MSM and non-MSM (P = 0.815). Most common recognized activators of PD among MSM were: penetrative sexual intercourse (22.2%), self-stimulation (11.1%). More MSM presented with the primary complaint of penile deformity, including narrowing, indentation, hourglass, and hinge (11.1% MSM vs. 1.0% non-MSM, P = 0.01). No differences in total curvature, erection grade were found (P > 0.05). PD had a negative effect on emotional status (89.0% MSM, 80.5% non-MSM, P > 0.05) and intimate relationships (45.0% MSM, 64.0% non-MSM, P > 0.05). Nonsurgical treatment was given to 88.9% MSM and 76.5% non-MSM (P > 0.05), and corrective surgery in 29.6% MSM and 25.0% non-MSM (P > 0.05). Of the 75.0% of MSM engaging in anal sex, 41.7% reported penetrative anal intercourse as the activator of PD. Among MSM, 31.3% experienced decreased libido, 50.0% decreased frequency of sexual activity, 92.9% were self-conscious about the appearance of their penis, and 92.9% were dissatisfied with the size of their penis.

CONCLUSIONS:

Few differences exist in the clinical presentation and treatments used between MSM and non-MSM PD patients. There was evidence of emotional distress in both groups. As a result, psychosexual assessment and treatment, when indicated, should be considered essential to the patient presenting with PD. Farrell MR, Corder CJ, and Levine LA. Peyronie's disease among men who have sex with men: Characteristics, treatment, and psychosocial factors. J Sex Med **;**:**-**.

OBJECTIVE:

To determine the coital frequency among infertile couples and which factors are associated with less frequent coitus.

DESIGN:

Cross-sectional study.

SETTING:

Tertiary-level male infertility clinic.

PATIENT(S):

A total of 1,298 infertile men.

INTERVENTION(S):

Administration of computer-based survey, semen analysis, and serum hormone evaluation.

MAIN OUTCOME MEASURE(S):

Monthly coital frequency.

RESULT(S):

A total of 1,298 patients presented to clinic for infertility consultation and completed the computer-based survey. The median male age was 35 years (interquartile range [IQR] 32-39 years) and the median duration of infertility was 2 years (IQR 1-4 years) before consultation. Median monthly coital frequency was seven (IQR 5-10; range 0-40); 24% of couples were having intercourse ≤4 times per month. Overall, 0.6%, 2.7%, 4.8%, 5.8%, and 10.8% of the men reported having intercourse 0, 1, 2, 3, and 4 times per month, respectively. When simultaneously taking into account the influence of age, libido, erectile function, and semen volume on coital frequency, older patients had 1.05 times higher odds (per year of age) of less frequent coitus (odds ratio 1.05, 95% confidence interval 1.03-1.08). In addition, patients with better erectile function had 1.12 times higher odds (per point on Sexual Health Inventory for Men scale) of more frequent coitus (odds ratio 1.12, 95% confidence interval 1.09-1.18).

CONCLUSION(S):

Similar to the general population, most infertile couples report having coitus more than four times per month. Older male age and erectile dysfunction are independent risk factors for less frequent coitus among infertile men, which could have an impact on fertility. Coital frequency should be considered in infertility assessments.

ABSTRACT

Objective The aim of this review was to summarize the literature regarding the potential role of testosterone therapy for women. Methods The author conducted a search of the literature using Medline (Ovid, 1946-present) and PubMed (1966-2013) for English-language studies that included the following search terms: 'testosterone' or 'androgen' combined with 'women', 'therapy' or 'treatment'. Results Randomized, placebo-controlled trials have consistently shown that transdermal testosterone therapy improves sexual desire, arousal, orgasm frequency and satisfaction in premenopausal and postmenopausal women presenting with sexual desire/arousal problems. No adverse metabolic effects have been observed in these studies. In postmenopausal women, testosterone therapy has also been associated with favorable effects on body composition, bone, cardiovascular function and cognitive performance. Conclusions Although androgens have many varied roles, the focus of testosterone therapy for women has been on improving sexual desire. Not only do testosterone effects on sexuality extend beyond libido, but testosterone has other key physiological actions. Issues that urgently need to be addressed include approval of a testosterone formulation that delivers a female dose such that physicians refrain from prescribing compounded testosterone or modifying doses of testosterone formulated for men and regulation of prescription of compounded androgens for women.

Andropause is a syndrome that usually occurs during men's midlife. It is associated with clinical short-term and long-term effects, as well as some physiological and psychological symptoms due to subnormal levels of testosterone serum. The objective of this study was to identify the factors that significantly contribute to the prevalence of symptoms that may be related to androgen deficiency. The study used a cross-sectional structured questionnaire and a sample of 214 Kuwaiti men aged 40 years and older. The questionnaire consisted of the sociodemographic characteristics of the participants and the Androgen Deficiency of the Aging Male Scale of Andropausal Symptoms. The results of the study indicate that Kuwaiti men who were 40 to 49 years old reported fewer symptoms than did Kuwaiti men aged 50 years and older, including deterioration in their ability to play sports, easily falling asleep after dinner, anger, and hot flushes (p < .05); and Kuwaiti men aged 50 years and older reported experiencing decrease in muscle strength, decrease in sport performance, sweating, loss of height, decreased libido, as well as falling asleep after dinner. For those aged 40 to 49 years, lower education levels, marital status, and employment status were significantly associated with the men's symptoms (p < .05). On the other hand, in the case of respondents aged 50 years and older, only education level was significantly associated with their symptoms (p < .05). This is a preliminary study that reports the prevalence of aging male symptoms among Kuwaiti men. The findings will offer insight into the necessary health care provisions to educate, treat, and provide information related to andropause for the general public.

Sexual dysfunction is common among women with schizophrenia treated with antipsychotic medication. Multiple factors influence sexual function and reproductive health in this patient population, including the effects of medications on prolactin secretion and the complexities of making contraceptive decisions in the context of a serious mental illness. The author explores the causes and management of loss of libido as illustrated by a case vignette and describes the course and outcome of a clinical intervention that was implemented to alleviate the sexual dysfunction. Possible approaches and potential pitfalls of the intervention are described. Clinicians must be open to discussions regarding sexual concerns, relationships with sexual partners, and reproductive issues with women suffering from schizophrenia. Both patients and clinicians need to be aware of unintended effects of intervention. Opportunities exist for improved education among clinicians to achieve a more proactive approach to sexual health in women receiving antipsychotic medication.

Apoplexy of the pituitary gland is a rare complication of pituitary adenomas, involving hemorrhage with or without necrosis within the tumor. This condition may be either asymptomatic or may present with severe headache, visual impairment, ophthalmoplegia, and pituitary failure. Transsphenoidal surgery is the treatment of choice, and early intervention is usually required to ensure reversal of visual impairment. Reports of pituitary apoplectic lesions exceeding 60.0mm in diameter are very rare. A 39-year-old man with long-standing history of nasal congestion, decreased libido and infertility presented with a sudden onset of severe headache and diplopia. MRI of the head demonstrated a massive skull base lesion of 70.0×60.0×25.0mm, compatible with a giant pituitary macroadenoma. The lesion failed to enhance after administration of a contrast agent, suggesting complete necrotic apoplexy. Urgent surgical decompression was performed, and the lesion was resected via a transnasal transsphenoidal approach. Pathological analysis revealed evidence of necrotic pituitary apoplexy. At the 2 month follow-up, the patient had near-complete to complete resolution of his visual impairment. To the authors' knowledge, this report is unique as the patient demonstrated complete necrotic apoplexy and it underlines the diagnostic dilemma in such a case.

Contradictory arguments regarding the benefits and harm of insecticides, especially DDT, have caused concerns in different societal circles, threatening to undermine the achievements of the indoor residual spraying (IRS) programme in South Africa. These concerns were exacerbated by the screening of a documentary on South African Broadcasting Corporation (SABC) Television with anti-DDT sentiments. Consequently, Limpopo Malaria Control Programme (LMCP) Management advocated for an investigation to determine the potential effect of such campaigns on vector-control personnel's knowledge and perceived effects of insecticides on human health, with a view to improving the educational materials designed for use in training vector-control personnel.The study was a cross-sectional descriptive survey using a structured field-piloted questionnaire, administered to 233 randomly selected vector-control personnel. Ethical clearance was granted by the University of KwaZulu-Natal. Approval for the study was granted by the Department of Health, Limpopo. Participation in the study was voluntary and all respondents signed informed consent. Descriptive statistics were used to analyse the collected data.Most respondents (96.6%) had a positive perception of IRS as a method to control malaria. Despite their positive perception, 93.6% viewed IRS insecticides to be potentially harmful to the users. DDT was perceived to cause long-term reproductive and respiratory effects, whereas alpha-cypermethrin and deltamethrin were largely associated with skin irritation/itchiness and skin burn. Study participants were more worried about DDT's potential effects on their reproductive system, including poor sexual performance, decline in libido, miscarriage and bearing children with genetic defects. However, none reported personal experience of bearing a child with genetic defects or miscarriage.Most anti-insecticide messages, especially relating to DDT, emanated from sources external to the LMCP, mainly through radio (62%) and television (33.9%) and about 70% believed such messages. While most respondents preferred to work with a moderately itchy deltamethrin, DDT was admittedly the most effective insecticide.Vector-control personnel faced health and ethical dilemmas, in that, while they perceived insecticides used for IRS in Limpopo to be potentially harmful to the health of users, as purported through media, they also viewed IRS using insecticides to be effective in controlling malaria.

The present study aimed to investigate the effect of ethyl acetate fraction of A. cepa bulb on mating behavior in paroxetine-induced sexually dysfunction male rats. Sexual dysfunctions such as decreased libido, delayed orgasm, difficulties in maintaining an erection, and inhibition of ejaculation are common side effects of paroxetine. A. cepa bulb ethyl acetate fraction (200 mg/kg) was administered orally in paroxetine-induced sexually impaired male rats for 7 days. At the end of 7th day, mount frequency (MF), intromission frequency (IF), ejaculatory frequency (EF), mount latency (ML), intromission latency (IL), ejaculatory latency (EL) and post-ejaculatory interval (PEI) were the parameters observed. Results showed that in relation to the paroxetine treated group, ethyl acetate fraction, significantly restored the normal sexual behavior as evident from increased MF, IF, EF and reduced ML, IL, EL and PEI.

ETHNOPHARMACOLOGICAL RELEVANCE: Corchorus depressus Linn. has been used as an aphrodisiac in traditional Indian medicine to treat male sexual dysfunction and impotency. AIM OF THE STUDY: The petroleum ether, chloroform, ethyl acetate, n-butanol and aqueous fractions of 95% methanol extract of Corchorus depressus were screened initially for their in vitro aphrodisiac activity on rabbit corpus cavernosum smooth muscle. The chloroform fraction (CDC) was found to be the most active and therefore investigated further on general mating behavior, libido and potency of normal male Wistar albino rats in comparison with the standard drug, Sildenafil citrate.

MATERIALS AND METHODS:

Animals were divided into the following groups: Control, SC CDC 100, CDC 200, and CDC 400, who received saline, Sildenafil citrate or the chloroform fraction of Corchorus depressus at doses of 100, 200 or 400mg/kg b.wt., respectively. The route of administration for all the groups was oral dosing, which was once in a day for 45 days. To analyze the mating behavior, female rats with estrus phase were used.

RESULTS:

The chloroform fraction of methanolic extract of Corchorus depressus significantly reduced ML, IL, PEI and III. There was a significant increase in the MF, IF and EL and serum testosterone levels throughout the study period. The potency test significantly increased erections, quick flips, long flips and total reflex. In vitro aphrodisiac activity was significantly higher in chloroform fraction at a concentration of 25.0mg/ml, which induced 71.4% relaxation. The combined results of the above mentioned models indicate that the chloroform fraction of Corchorus depressus produces a significant increase in sexual activity as exhibited by 25mg/ml in vitro and 400mg/kg in vivo. In comparison with the control, all the drug-treated groups have shown drug-induced effects for a few parameters.

CONCLUSIONS:

In vitro and in vivo studies provide valuable experimental evidence that the chloroform fraction of methanolic extract of Corchorus depressus possesses aphrodisiac property. This study further substantiates the ethnopharmacological claims of Corchorus depressus as a sexual stimulating agent and offers a significant potential for studying the effect on male sexual response and its dysfunctions.

Retinopathy, neuropathy, and nephropathy are well-known complications of diabetes; they are often expected to occur and, therefore, are usually tested for. However, urogenital complications, such as sexual and voiding dysfunctions, are less well known, and consequently, many patients are not treated appropriately despite their symptoms. Thus, we surveyed diabetic patients with regard to their perception of urogenital complications.We designed a survey for patients in our hospital who were being treated for diabetes mellitus (DM). The questionnaire included items on age, sex, treatment duration, treatment options for and the level of perception of urogenital symptoms, the presence of urogenital symptoms, and whether treatment was intended or had been initiated.In total, 275 patients participated in the survey. The perception questions on DM-associated urogenital complications showed that 89 patients (32.4%) had no knowledge, 84 patients (30.5%) had some knowledge, and 102 patients (37.1%) had detailed knowledge about these complications. A total of 124 patients (45.1%) reported urogenital symptoms: 93 patients (75.0%) reported voiding dysfunction and 61 patients (49.2%) reported sexual dysfunction. Common symptoms of voiding dysfunction were urinary frequency, nocturia, sense of residual urine, weak stream, and urinary incontinence. Common symptoms of sexual dysfunction were reduced libido, and erectile and ejaculatory dysfunction.The survey showed that the subjective prevalence rate of urogenital symptoms in diabetic patients was 45.1%. However, only a small percentage (37.1%) of the patients cognized that these symptoms were associated with DM. Therefore, it is necessary to properly inform and educate diabetic patients on possible urogenital complications that may occur.