Androgens are generally believed to be necessary for normal sexual responsiveness in the human male and female. The evidence for this is limited and sometimes conflicting. This paper considers evidence from experiments in which exogenous androgens are given to people with impaired sexual response. Results from a study in which testosterone was given to unresponsive women are reported, together with the preliminary results of giving androstenedione to sexually unresponsive women taking oral contraceptives and giving testosterone undecanoate to hypogonadal males. In the first study, when testosterone was combined with counselling, significant effects were produced by the addition of testosterone. In the androstenedione study, where no counselling was given, beneficial effects of the androgen have been unusual. Examples of the evaluation of androgen replacement in hypogonodal males are also presented. Finally, some methodological problems of evaluating the effects of exogenous hormone in human sexual behaviour are briefly discussed.

Adult↗

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Imaging of plantaris muscle rupture.

Rupture of plantaris muscle is demonstrated in two patients, one with magnetic resonance imaging (MRI) and one with ultrasound. This entity, thought to be clinically common, has never before been demonstrated at surgery or with imaging. Anatomic and physiologic aspects of the diagnosis that enable radiologists to make the diagnosis, once familiar with the entity, are discussed.

Adult↗

PubMedDate not supplied

Conceptualizing women's sexual problems.

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Female↗

PubMedDate not supplied

Irreducible posterior dislocation of the shoulder: MR and CT findings.

Failure to reduce an acute posterior dislocation of the shoulder is rare and is usually due to the interposition of a structure into the joint. In this paper we report the MR and CT findings of a failed reduction due to interposition of a dislocated biceps tendon between the humeral head and anterior glenoid fossa. This was associated with an avulsed subscapularis tendon with its attachment to the lesser tuberosity and a nondisplaced fracture of the humeral neck, findings which were only evident on MR.

Adult↗

PubMedDate not supplied

Relationship between premenstrual symptoms and oral contraceptive use: a controlled study.

Patterns of menstrual cycle-related change were compared in three groups of women differing in their use of oral contraceptives and being matched for age, occupation, and parity. These groups were: a "monophasic group" (n = 35) established on low dose "combined" pills with stable levels of estrogen and progestagen. a "triphasic group" (n = 30) on low dose pills with escalating progestagen dosage, and a "non-pill control group" (n = 57) using nonsteroidal contraceptives. Each woman kept visual analogue ratings of mood, irritability, energy, tension, breast tenderness, bloating, and sexual interest for two or three cycles. Cyclicity was evident in all variables assessed, but the only variable to show a clear difference between groups was breast tenderness; the "monophasic group" showed less premenstrual breast tenderness than the other two groups. The monophasic group also showed a tendency to menstrual rather than premenstrual symptoms. In view of the similarity of timing of most cyclical symptoms in the three groups, it is difficult to attribute such cyclical phenomena to the effects of either ovulation or variation in corpus luteum function. For most subjects, the cyclical changes were relatively mild, and these findings need to be replicated in women suffering from severe premenstrual syndrome. However, alternative explanations need to account for changes in women both taking and not taking oral contraceptives.

Adolescent↗

PubMedDate not supplied

Perimenstrual complaints in women complaining of PMS, menorrhagia, and dysmenorrhea: toward a dismantling of the premenstrual syndrome.

Four groups of women were compared in terms of their perimenstrual symptoms, reported menstrual blood loss and period pain, and neuroticism scores: three patient groups were referred to a Gynaecology Outpatient Clinic because of menorrhagia (N = 101), PMS (N = 104), dysmenorrhea (N = 56), and a control group (N = 105). The three patient groups showed considerable overlap in a number of symptoms. This has led us to postulate three factors contributing to perimenstrual complaints: a) a 'timing factor' linked to the ovarian cycle; b) a 'menstruation factor,' associated with the buildup of the endometrium and its shedding; and c) a 'vulnerability factor,' one aspect of which, 'neuroticism,' was measured in this study. Depressive symptoms, which were the most important in leading women to seek help for their PMS, were related to all three factors. Depressive mood changes seemed to be linked to the 'timing factor' but were noticeably worse and more prolonged in women with high neuroticism, heavy bleeding, or severe pain. One premenstrual symptom, food craving, was of considerable interest. This was weakly related to neuroticism, not apparently affected by the 'menstruation factor' and differed in severity between those in the PMS group and the other three groups. It is potentially relevant that both carbohydrate craving and depression are linked to serotonergic changes in the brain, which may prove to be particularly marked in the late luteal phase.

Adolescent↗

PubMedDate not supplied

Vulnerability to perimenstrual mood change: the relevance of a past history of depressive disorder.

A past history of depressive illness, defined in terms of treatment by antidepressants, was found to be more common in women seeking help for premenstrual syndrome (PMS) (31.3%; N = 83) than in women complaining of menorrhagia (8.9%; N = 90) or controls (5.8%; N = 104) with dysmenorrhea sufferers (22%; N = '50) reporting intermediate rates. Such a history in the clinical groups was associated with a tendency for premenstrual depression to be relatively prolonged (i.e., persisting through the menstrual phase and sometimes into the postmenstrual week) and with more severe depressive symptoms during the premenstrual, menstrual, and to a lesser extent, postmenstrual phases of the cycle. This, association was not evident for reported heaviness of menstrual bleeding and only weakly evident for severity of pain during the menstrual phase. Women with a depressive history gave higher neuroticism scores. A history of depression, as defined, seems to increase the vulnerability of women to depressive perimenstrual mood change in terms of both duration and severity. This effect on duration may hitherto have served to obscure the relationship between history of depression and premenstrual syndrome.

Adult↗

PubMedDate not supplied

Stress and the erectile response to intracavernosal prostaglandin E1 in men with erectile dysfunction.

The erectile response to intracavernosal injection (ICI) of smooth muscle relaxants is often impaired in men with presumed psychogenic erectile dysfunction. This study tests the hypothesis that such impairment results from stress-related increase in circulating norepinephrine (NE). Fifty-nine men with erectile dysfunction had their nocturnal penile tumescence (NPT) monitored over 2 nights, and ICI of 10 micrograms prostaglandin E1 was given on the second morning. Psychometric and neuroendocrine measures of stress, including plasma and urinary catecholamines, were taken on both mornings. Inhibition of the ICI response was determined by the difference between NPT and ICI responses, and two groups of "high inhibition" and "low inhibition" men were compared. The high inhibition group showed higher "Trait" and "State" anxiety and a neuroendocrine profile of higher initial cortisol and lower plasma catecholamine levels than the low inhibition group. These differences were evident on both mornings and hence were not specifically related to the ICI. There was no support for the hypothesis that inhibition of response to ICI results from increased circulating NE, though the possibility that increased NE release occurred specifically in the erectile tissues could not be excluded.

Adult↗

PubMedDate not supplied

The effects of a new alpha-2 adrenoceptor antagonist on sleep and nocturnal penile tumescence in normal male volunteers and men with erectile dysfunction.

The effects of a new alpha-2 adrenoceptor antagonist, RS 15385, on sleep and nocturnal penile tumescence (NPT) was assessed by intravenous infusion of the drug, in two doses (high and low), and of placebo through the night in 12 young normal volunteers and 24 men with erectile dysfunction. The drug reduced total sleep time in the younger normal volunteers only with the high dose and in the dysfunctional men with both doses. There was no selective effect on different sleep stages in the normal volunteers, except for an increase in the per cent of total sleep time in Stage 1 with the high dose. The dysfunctional men were divided into two age groups (< 47 years and > 47 years). There was an age-related increase in the proportion of total sleep in rapid eye movement (REM), which was only apparent in the older age group. In the volunteers, there was a curvilinear dose-response effect on NPT. The lower dose modestly increased erectile response, particularly during non-REM sleep, whereas the higher dose reduced erectile response, most noticeably during REM. The only positive effect of the higher dose was an increase in spontaneous erections after lights out before sleep onset. The older dysfunctional group showed no drug effects on NPT. The younger dysfunctional men showed increased erectile response during non-REM with the higher dose, an effect that was also significant in the interval between sleep onset (Stage 2) and first REM.

Adolescent↗

PubMedDate not supplied

Perimenstrual depression: its relationship to pain, bleeding, and previous history of depression.

Daily ratings of depression, pain, and menstrual blood loss, as well as past history of treated depression, were analyzed in 210 women attending a Premenstrual Syndrome Clinic. Severity and duration of perimenstrual depression was strongly associated with the severity of premenstrual and menstrual pain, raising the possibility of a causal relationship. It is not yet clear whether the occurrence of depression alters a woman's perception of pain, pain aggravates a tendency to perimenstrual depression, or some common factor aggravates both. A relationship between depression and subjective ratings of blood loss was also observed but was less marked than the relationship with pain. Both relationships had been reported in an earlier study using retrospective ratings. A relationship between past history of treated depression and severity and timing of current perimenstrual depression, observed previously, was not found in this study. This discrepancy was not due to differences between retrospective and prospective methods of assessment, but may have partly resulted from differences in the reporting of premenstrual pain in the two studies. Further studies of this association should control for the confounding effect of pain.

Adult↗

PubMedDate not supplied

Cardiovascular and endocrine changes during sexual arousal and orgasm.

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Arousal↗