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Erection and ejaculation in man. Assessment of the electromyographic activity of the bulbocavernosus and ischiocavernosus muscles.

Electromyographic (EMG) recordings were obtained by concentric needle electrodes from the bulbocavernosus (BC) and ischiocavernosus (IC) muscles in 7 human volunteers during excitement to erection and subsequent ejaculation. Simultaneous registration of the time course and volume of each expressed spurt of semen was obtained using an aluminium pan suspended in front of the subject's penis on a force transducer the output of which was charted with the EMG activity. The BC and IC muscles showed no EMG activity during erection and detumescence cycles induced by visual sex stimulation. In 5 of 7 subjects, the first EMG burst of the BC in ejaculations induced by masturbation was not correlated with an expelled spurt of semen as were subsequent bursts. However, only 26 to 60% of the total number of EMG bursts were accompanied by expulsion of a spurt of semen. There thus appears to be a large safety factor in the striated muscle expulsive mechanism. Oral phenoxybenzamine treatment in 2 subjects did not significantly affect either the number of EMG bursts of the BC or the subjective pleasure of the orgasm but did significantly reduce the volume of semen expelled. Semen volume does not appear to be a unique determinant of the pleasure felt or the trigger for ejaculation.

Adult↗

Fractures of the penis: therapeutic approach and long-term results.

Injury to the external male genitalia is considered, with attention focused on accidental fracture of the corpora cavernosa (by coitus or masturbation). Such injuries are often complicated by urethral lesions. We present 13 patients with either simple or complicated fracture of the penis, all of whom were operated on between 2 h and 8 days following injury, with excellent functional results. The need for immediate surgery is emphasised, in order to avoid erectile failure and curvature, which are typical complications of conservative treatment. Surgery consists of complete evacuation of haematoma, curettage and repair of the albuginea. If the fracture is associated with urethral disruption, the latter is also repaired.

Adult↗

Male and female sexual function and activity following ileal conduit urinary diversion.

A group of 66 patients (40 males, 26 females) underwent an ileal conduit urinary diversion because of bladder cancer (44 patients) or incontinence/bladder dysfunction (22). They were questioned about pre- and post-operative sexual function and activity and it was found that 90% of the males (26/29) who were sexually active before surgery lost the ability to achieve erection following radical cystectomy. Although they were unable to achieve penile erection, 41% were able to experience orgasm by means of masturbation. Five of the 29 males received penile implants. Five of the 6 females treated by cystectomy, who were sexually active before the operation, reported either a decrease or cessation of sexual activity (i.e. coitus) post-operatively. The main problems were a decrease in sexual desire, dyspareunia and vaginal dryness. One women reported the inability to experience orgasm after surgery. Compared with women with bladder cancer, those with incontinence/bladder dysfunction were more likely to have an active sexual life after urostomy surgery. Seven females in this group, of whom 4 were sexually inactive before surgery, increased their sexual activity after the operation. For these women the conduit operation removed the need to use incontinence pads or indwelling catheters.

Adult↗

Primary headaches associated with sexual activity--some observations in Indian patients.

Primary headache associated with sexual activity appears to be relatively uncommon in a clinic-based study in Indian patients. Only 24 patients (M:F 18:6) were encountered over a 20-year period (1985-2004). Of the 18 male patients, 14 (age 33-42 years) had preorgasmic headache of tension-headache type for 2-8 months, one patient (age 58 years) had orgasmic headache of vascular type for 1 month and three subjects (age 19-23 years) had masturbatory headache also simulating tension-type headache for 3-7 weeks. These observations are at variance with those generally reported from western countries. Of the six female patients, four (age 26-32 years) had typical orgasmic headache of the vascular type (for a few months to a few years), only one of whom had been a migraine sufferer. One patient (age 35 years) presented with a single episode of thunderclap headache where angiography had been negative. Another female subject (age 30 years) experienced typical orgasmic headache only during masturbation but not during actual sexual intercourse. Occurrence of sexual headaches in both male and female subjects had been unpredictable. Few had associated migraine and none ever experienced exertional headache.

Adolescent↗

An unusual case of retrograde ejaculation.

Despite normal seminal analyses obtained for assay by masturbation, persistent negative postcoital tests led to the testing of postejaculatory urine following normal intercourse. This disclosed an unusual problem of retrograde ejaculation occurring only during intercourse. The mechanism for this selective form of retrograde ejaculation is unknown.

Ejaculation↗

Treatment of vasculogenic sexual dysfunction with pentoxifylline.

OBJECTIVE: To evaluate the use of pentoxifylline to treat impotence in men with mild to moderate penile vascular insufficiency. DESIGN: Double-blind randomized clinical trial. SETTING: Sexual Dysfunction Clinic at VA Medical Center, Sepulveda, CA. PARTICIPANTS: Convenience sample of couples. INTERVENTION: Twelve weeks of treatment with placebo or 400 mg tid of pentoxifylline. MEASUREMENTS: (1) Report of patient verified by partner as to number of coital episodes per month; (2) penile-brachial pressure index determinations. RESULTS: Pentoxifylline therapy regularly increased the PBPI in impotent men in comparison with the placebo, frequently into the normal range. Pentoxifylline therapy was particularly useful in restoring the PBPI in men with the pelvic steal syndrome; six of seven such subjects improved into the normal range. During the pentoxifylline treatment period, in contrast with the control period, nine men were able to reestablish coital function and three had no improvement. Six couples did not attempt intercourse despite a professed interest in sexual activity; however five out of the six men experienced erections during episodes of fantasy or attempts at masturbation during treatment. There were no complications of therapy. CONCLUSIONS: These promising preliminary results suggest a well tolerated alternative therapy for erectile dysfunction in patients with mild to moderate penile vascular disease.

Aged↗

Detection of monocyte chemotactic and activating factor (MCAF) and interleukin (IL)-6 in human seminal plasma and effect of leukospermia on these cytokine levels.

PROBLEM: To demonstrate whether monocyte chemotactic and activating factor (MCAF) and interleukin-6 (IL-6) are present in the seminal plasma, and whether these presence is modulated by leukospermia. METHODS: Semen samples from 53 men were obtained by masturbation and examined for the presence of MCAF and IL-6 by enzyme immunoassay (EIA). Semen samples were obtained from 28 infertile men without leukospermia, 16 infertile men with leukospermia, and nine proven-fertile men. The correlation between the amount of MCAF in the seminal plasma with some spermiogram parameters and other cytokines such as IL-6 and IL-8 was statistically evaluated. RESULTS: Immunoreactive MCAF was detected in the seminal plasmas of all 53 subjects. The MCAF titer in the seminal plasma of patients with leukospermia (11.19 +/- 2.75 micrograms/l) was significantly higher than that in the seminal plasma of the patients without leukospermia (3.24 +/- 0.53 micrograms/l) and the fertile men (2.78 +/- 0.35 micrograms/l) (P < 0.001). The IL-6 titer in the seminal plasma of the patients with leukospermia (21.05 +/- 4.49 ng/l) was also significantly higher than that in the seminal plasma of the patients without leukospermia (8.77 +/- 1.92 ng/l) and the fertile men (6.94 +/- 1.27 ng/l) (P < 0.01). There was a high degree of correlation among the levels of MCAF, IL-6 and IL-8 in the seminal plasma. CONCLUSIONS: These findings demonstrated the presence of MCAF and IL-6 in the seminal plasma, and that the levels of these cytokines were elevated in the seminal plasma of the infertile patients with leukospermia.

Chemokine CCL2↗

Increased IL-18 levels in seminal plasma of infertile men with genital tract infections.

PROBLEM: Interleukin (IL)-18 is a novel cytokine, previously known as interferon (IFN)-gamma inducing factor. We evaluated the levels of IL-18 and IFN-gamma in seminal plasma (SP) of fertile and infertile men. METHOD OF STUDY: Semen samples were obtained by masturbation from 80 men, and were examined for the levels of IL-18 and IFN-gamma by enzyme-linked immunosorbent assay. Seven groups were included: (i) fertile men (n = 18), (i) infertile men with genital tract infections (n = 17), (iii) with varicocele (n = 15), (iv) with Klinefelter syndrome (n = 6), (v) with cryptorchidism (n = 7), (vi) with mumps orchitis (n = 7), and (vii) with idiopathic testicular lesions (n = 10). RESULTS: Mean levels of IL-18 were higher in SP from infertile men with genital tract infections compared with SP from other groups except Klinefelter syndrome (P < 0.05). However, no significant differences could be detected for IFN-gamma. A significant positive correlations was found between IL-18 and IFN-gamma in total patient population (P < 0.001). Moreover, a negative correlation was observed between IL-18 and sperm concentrations, and motility (P < 0.01 and < 0.03, respectively). Furthermore, there was a positive and statistically significant association between IL-18 and IFN-gamma levels in SP of infertile men with genital tract infections (P < 0.0001). However, there was no relationship between IL-18 and IFN-gamma, and semen parameters in the same group. CONCLUSION: SP IL-18 levels were increased in men with urogenital infections. Thus, the elevated expression of IL-18 in SP may be used as a diagnostic marker in the male genital tract infections.

Adolescent↗

A history of sexual medicine in the United kingdom.

The history of sexual medicine in the United Kingdom since the 19th century is reviewed, with particular reference to masturbation, homosexuality, contraception, and in the past four decades, the treatment of sexual dysfunction. The medical profession's tendency to deal with sexual issues according to the sociopolitical and moral issues of the time is emphasized, and whereas "sex negativism" has prevailed within the medical profession for most of this historical period, there has been a succession of individuals within the profession who have presented a more positive approach to defining and promoting sexual health. Four tracks within sexual medicine over the past 30 years are described: the psychoanalytic approach of the Institute of Psychosexual Medicine, modern "sex therapy," psychophysiological sex research, and the involvement of andrology in the assessment and treatment of erectile dysfunction. The impact of Viagra is seen as the most recent chapter in this history.

History, 19th Century↗

Persistent sexual arousal syndrome: a descriptive study.

INTRODUCTION: Persistent sexual arousal disorder (PSAS) is a poorly documented condition characterized by persistent genital arousal in the absence of conscious feelings of sexual desire. AIM: To determine whether there are replicable features associated with PSAS, to describe salient characteristics of women reporting this condition, and to determine predictors of distress. METHODS: A 46-item Internet survey containing demographic information, symptom description, triggers, exacerbation and relief measures, distress ratings, and life and sexual satisfaction was placed on a secure server. MAIN OUTCOME MEASURES: Frequency analyses of descriptive data, and stepwise multiple regression analysis to identify independent predictors of level of distress. RESULTS: Of the 103 respondents, most were in good health, well educated, and in long-term relationships. Ninety-eight percent of respondents met at least one criterion for PSAS and 53% met all five criteria. Involuntary genital and clitoral arousal persisting for extended time periods, genital arousal unrelated to subjective feelings of sexual desire, and genital arousal not relieved with orgasms were the most frequently endorsed features associated with this syndrome. Symptom triggers included sexual stimulation, masturbation, stress, and anxiety. Distress about the condition was low in 25%, moderate in 35%, and high in 40% of respondents. The strongest predictors of distress were intrusive and unwanted feelings of genital arousal (P < 0.0001), continuous symptoms (P < 0. 001), feelings of unhappiness (P < 0.03), shame (P = 0.0001) and worry (P = 0.01), reduced sexual satisfaction (P < 0.004), enjoyment of symptoms some of the time (P = 0.01), and relationship status (P < 0.004). CONCLUSIONS: The results of this research support the description of a condition (persistent sexual arousal) involving involuntary genital and clitoral arousal unrelated to subjective feelings of sexual desire which persists despite one or more orgasms and which usually feels intrusive and unwanted. Varying levels of distress were identified with this condition as well as a variety of primarily negative emotional reactions.

Adolescent↗

Does exposure to computers affect the routine parameters of semen quality?

AIM: To assess whether exposure to computers harms the semen quality of healthy young men. METHODS: A total of 178 subjects were recruited from two maternity and children healthcare centers in Shanghai, 91 with a history of exposure to computers (i.e., exposure for 20 h or more per week in the last 2 years) and 87 persons to act as control (no or little exposure to computers). Data on the history of exposure to computers and other characteristics were obtained by means of a structured questionnaire interview. Semen samples were collected by masturbation in the place where the semen samples were analyzed. RESULTS: No differences in the distribution of the semen parameters (semen volume, sperm density, percentage of progressive sperm, sperm viability and percentage of normal form sperm) were found between the exposed group and the control group. Exposure to computers was not found to be a risk factor for inferior semen quality after adjusting for potential confounders, including abstinence days, testicle size, occupation, history of exposure to toxic substances. CONCLUSION: The present study did not find that healthy men exposed to computers had inferior semen quality.

Adult↗

The effects of a teacher training program in family life and human sexuality on the knowledge and attitudes of public school teachers.

This study evaluated the effects of a teacher training program in family life and human sexuality. An attempt was made to determine the extent to which age, sex, race, marital status and years of teaching experience can be used to predict sex-related attitudes of teachers. Teachers who volunteered for a Title IV-C Teacher Training Program in Family Living and Human Sexuality were tested before and after the training program using a knowledge test and an attitude inventory. The pretest and posttest scores of the experimental teachers were compared with a control group to assess the degree of change. Results indicated the teachers who participated in the teacher training program made significant gains in sex-related knowledge. While no changes were evident in overall attitudes, the experimental teachers became more accepting of the practice of masturbation. A major finding in the study was the relationship between age and permissiveness of attitudes toward controversial issues.

Adult↗

The relationship between the sexual attitudes of parents and their college daughters' or sons' sexual attitudes and sexual behavior.

This study determined if three selected sexual attitudes of parents were related to similar sexual attitudes of their college daughters or sons and to five sexual behaviors. Only never married, college freshmen (N = 83) with both parents participating were utilized. A self-report questionnaire was administered to students at a large midwestern university and distributed to and returned from parents by mail. The Pearson product-moment correlation and the stepwise and multiple regressions were used to test four hypotheses. Mothers' sexual attitudes had a stronger relationship than fathers' attitudes with offspring sexual attitudes and behaviors, particularly for daughters. Generally, mothers with the most positive attitudes toward sexual-self had daughters who were more responsive relative to personal sexual expression (masturbation frequency and orgasmic experience), but who were not any more involved heterosexually (frequency of coitus and number of coital partners). Fathers' sexual attitudes had little relationship to offspring sexual attitudes and behavior. None of the male students' sexual behaviors were related strongly to parent sexual attitudes. Implications for school and parent sexuality education programs are briefly discussed.

Adolescent↗

Elementary school teachers' techniques of responding to student questions regarding sexuality issues.

Fifth- and sixth-grade elementary school teachers' (n = 277) techniques of responding to students' human sexuality-related questions were assessed. Few teachers (34%) reported receiving formal training in sexuality education. The most commonly asked student questions dealt with STDs, puberty, homosexuality, pregnancy, and abortion. Teachers' willingness to answer sexually-related questions in front of the class varied (73% to 14%) by content of the question. There were no questions on the questionnaire in which more than one in five teachers would choose not to answer. The most common questions the teachers identified they would not respond to dealt with topics such as abortion, masturbation, homosexuality, and issues about the male genitals. Finally, none of the questions was perceived by more than one in eight of the teachers as questions they would not be allowed to answer.

Analysis of Variance↗

Problems of differentiation between epilepsy and non-epileptic paroxysmal events in the first year of life.

Twenty two babies under 1 year old were referred for evaluation of suspected epileptic seizures. Nine were found to have epilepsy. In the other 13--all developing normally, aged up to 10 months--the spells were non-epileptic paroxysmal events (NEPE). They consisted of five patterns of movement: (1) eye blinking; (2) 'no' movements; (3) body posturing with head and arm jerks; (4) masturbation-like movements; and (5) myoclonic head flexion. The NEPE were present for a period of two weeks to seven months. Although some NEPE cannot be clinically differentiated from true epilepsy, in these infants at least four interictal EEGs were normal, the spells completely resolved after a relatively short period without antiepileptic treatment, and the infants continued to develop normally with no evidence of epilepsy during a follow up period of 28 to 38 months. This sample indicates that the frequency of NEPE in the first year of life may be high. Cautious clinical consideration, repeat EEGs and, when appropriate, a few weeks' observation are recommended. Awareness of these benign behavioural spells in this young age group is important, and parents can be reassured. Nevertheless, the spells may illustrate a 'foggy frontier' between NEPE and epilepsy. The lack of evidence for any other disease process in affected infants, as well as the disappearance of the NEPE without any intervention, indicates that a maturational process may be involved.

Diagnosis, Differential↗

Child sex rings.

Details of 11 child sex rings identified in one working class community were obtained by interviewing investigating police officers and examining health and social services records. The rings contained 14 adult male perpetrators and 175 children aged 6-15 years. Most perpetrators used child ringleaders to recruit victims; others became a "family friend" or obtained a position of authority over children. Secrecy was encouraged and bribery, threats, and peer pressure used to induce participation in sexual activities. Offences reported included fondling, masturbation, pornography, and oral, vaginal, and anal intercourse. Eleven perpetrators were successfully prosecuted; all but one received a sentence of three years or less. Behavioural problems were common among those children who had participated for a long time. Child sex rings are difficult to detect and may be common. Many children are seriously abused as a consequence of them.

Adolescent↗

Who reports sexual function problems? Empirical evidence from Britain's 2000 National Survey of Sexual Attitudes and Lifestyles.

OBJECTIVE: To identify sociodemographic, sexual, and health behavioural and attitudinal factors associated with reporting sexual function problems. METHODS: A probability sample survey of 11 161 men and women aged 16-44 years resident in Britain in 2000. Data collected by a combination of computer assisted face to face and self interviewing. Outcomes were self report of a range of sexual function problems, considered as "any problems" (1+ lasting 1+ months in the past year) and "persistent problems" (1+ lasting 6+ months in the past year), and associations with sociodemographic, behavioural, and attitudinal variables. RESULTS: Both "any" and "persistent" sexual function problems were more commonly reported by women than men. A variety of sociodemographic factors were associated with both measures but differed by gender. For example, the adjusted odds ratio (AOR) for reporting any problems for married v single respondents was 0.70 (95% confidence interval (CI) 0.57 to 0.87) v 1.31 (95% CI 1.10 to 1.56) for men and women, respectively. Sexual behaviours significantly associated with reporting sexual function problems included competence at first sex, paying for sex in the past 5 years, number of occasions of sex and masturbation, both in the past 4 weeks. For men (only), reporting STI diagnosis(es) was significantly associated with reporting "any" problems (AOR 2.1, 95% CI 1.4 to 3.2) and "persistent" problems (AOR 2.1, 95% CI 1.1 to 3.9). Both measures were significantly more likely among men and women who reported communication difficulties with their partners, with AORs in excess of 1.9. CONCLUSIONS: Sexual fulfilment is an important part of sexual health. Understanding factors associated with reporting sexual problems, and recognising that such factors maybe partnership specific, is an important step towards improving our understanding of sexual function and thus improving the provision of care and support available.

Adolescent↗

Sexually acquired metronidazole-resistant trichomoniasis in a lesbian couple.

A lesbian couple in a monogamous relationship each presented with vaginal discharge demonstrable on culture to contain Trichomonas vaginalis. Their symptoms had failed to respond to standard regimens of metronidazole, and subsequent microbiological sensitivities confirmed resistance of the trichomonads to metronidazole (minimum inhibitory concentrations in aerobic conditions > 8 mcg/ml). In addition, the couple denied use of penetrative sex toys or recent male partners, supporting the concept of transmission through mutual masturbation.

Adult↗