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PubMed2006

[The male genital in legal medicine].

Pathomorphological findings for the male genital are an exception among forensic cases. In earlier publications they were usually published as individual cases. A significant percentage are the so-called fertility- and potency medical certificates, which are usually commissioned for doubtful paternity cases. Old forensic writings about genital injuries distinguish--apart from the necessity of a complete dissection--between "deadly as such" and "accidentally deadly" injuries. Another group consists of reports about self-inflicted genital mutilation, e.g. among prison inmates or soldiers of the last world wars to become an invalid. When it was necessary to identify a corpse, e.g. in cases of progressive decomposition, Merkel recommended in 1945 the representation of the so-called "Schnepfenkopf" (snipe head; colliculus seminalis) in the lesser pelvis. In this article a medical and forensic review of forensically relevant findings of the male genital is presented and illustrated with historical cases.

Forensic Medicine↗
PubMed2006

Genital sympathetic skin responses in fibromyalgia syndrome.

The study was designed to investigate the autonomic dysfunction in fibromyalgia syndrome (FMS) by recording sympathetic skin response (SSR) from palmar, plantar and genital regions. The second aim was to evaluate the relation between sexual problems and autonomic dysfunction in FMS. SSR potential was recorded from palmar, plantar and genital regions in 28 married, female FMS patients and 18 married, healthy females. Fibromyalgia Impact Questionnaire (FIQ) was used to show the clinical severity and functional disability in FMS patients. Glombok Rust Inventory of Sexual Satisfaction (GRISS), a 28-item questionnaire, was used to assess the existence and severity of sexual problems. Beck test was used to evaluate anxiety and depression. The amplitude of SSR recorded from palmar, plantar and genital regions was lower than in the control subjects (P < 0.05). GRISS (total and subscale), Beck test and FIQ scores of FMS patients were higher than in the control subjects (P < 0.05). No correlation was found between the SSR potential and GRISS scores. The results of our study reveal that abnormality in SSR recorded from palmar, plantar and genital regions reflects the abnormality in the autonomic nervous system (ANS) of FMS patients. These patients have more sexual problems than healthy subjects, and we think this finding is related to increased anxiety and depression in these patients.

Adult↗
PubMed1998

Organising activities of engrailed, hedgehog, wingless and decapentaplegic in the genital discs of Drosophila melanogaster.

The genes engrailed (en), hedgehog (hh), wingless (wg) and decapentaplegic (dpp) have been shown to play vital organising roles in the development and differentiation of thoracic imaginal discs. We have analysed the roles of these genes in organising the development and differentiation of the genital discs, which are bilaterally symmetrical and possess different primordia, namely, the male and female genital primordia and an anal primordium. Our results suggest that the organising activity of en in genital discs programs the normal development and differentiation of the genital disc by regulating the expression of hh. Hh in turn induces wg and dpp, the genes whose products act as secondary signalling molecules. Moreover, the complementary patterns of wg and dpp expression are essential for the bilateral symmetry and are maintained by mutual repression.

Animals↗
PubMedDate not supplied

Oral famciclovir for the suppression of recurrent genital herpes: the combined data from two randomized controlled trials.

BACKGROUND: Genital herpes is a very common sexually transmitted disease. Safe and effective therapies are needed for patients with frequent recurrences. OBJECTIVE: The aim of our study was to determine the efficacy and safety of famciclovir for suppression of herpes simplex virus (HSV) infection in patients with history of clinically diagnosed recurrent genital HSV infection. METHOD: An analysis was conducted of the combined data from two randomized, double-blind, placebo-controlled studies of 52 weeks' duration involving a total of 469 patients (201 men, 268 women) from 47 university, hospital, or private referral centers in Europe and North America. The patients were 18 years or older with a history of six or more episodes of genital herpes during 12 of the 14-months prior to study entry and were not receiving suppressive therapy. They were randomized to receive oral famciclovir 250 mg twice daily or placebo for 52 weeks. The primary outcome measures were (1) the proportion of patients who remained free from clinical HSV recurrences, confirmed by viral culture, for at least 6 months after the start of study medication; (2) the time to first clinically confirmed lesional episode; and (3) the frequency of adverse events. RESULTS: A significantly greater proportion of famciclovir-treated patients (151/191, 79%) were free from HSV recurrences at 6 months compared with placebo recipients (48/184, 26%) (p<0.001); efficacy was maintained at 12 months. The median time for the first clinically confirmed lesional episode was significantly prolonged for famciclovir recipients (more than one year) compared with placebo recipients (59 days; p<0.0001). Famciclovir was well tolerated, with an adverse-experience profile comparable with placebo. CONCLUSIONS: Oral famciclovir 250 mg twice daily is an effective, well-tolerated treatment for the suppression of genital HSV infection in patients with frequent recurrences.

2-Aminopurine↗
PubMed2005

Understanding genital-shrinking epidemics in West Africa: koro, juju, or mass psychogenic illness?

A small-scale epidemic of genital shrinking occurred in six West African nations between January 1997 and October 2003. This article presents a summary and analysis of 56 media reports of these cases. A clinical formulation of these cases considers a variety of explanations from theory and research in social and cultural psychology, psychopathology, and anthropology. Of particular interest is a comparison of genital-shrinking distress in West African settings with koro, a culture-bound syndrome involving fears of genital retraction that is prominent in Southeast Asian settings. The paper concludes with a brief discussion of the role of culture in both the experience of genital-shrinking distress and conceptions of psychopathology.

Africa, Western↗
PubMed1981

Management of genital herpes simplex virus infection occurring during pregnancy.

Genital herpes simplex virus (HSV) infection during pregnancy has caused considerable concern among lay and professional personnel in the past 10 years. Knowledge concerning the potential hazards of HSV to the newborn infant has increased the use of cesarean section for women who have or are suspected of having genital HSV infection near or at the time of labor. Because of this, a 57-month prospective study was begun at Vanderbilt University Hospital and its affiliate, Nashville General Hospital, January 1, 1976, and involved HSV culturing of all suspected genital herpes lesions during pregnancy. Those patients with positive HSV cultures prior to labor and without a subsequent negative culture underwent cesarean section. Those patients whose cultures reverted to negative were considered candidates for vaginal delivery. During the study period, there were 16,381 deliveries at the two institutions. One hundred twenty pregnant women were cultured, with 80 being HSV culture negative and 40 culture positive. The outcome of these pregnancies as well as a review of the experience with neonatal HSV infection in Middle Tennessee is presented. It is concluded that by utilizing HSV cultures of genital lesions as a guide to determining the route of delivery, the incidence of cesarean sections and neonatal HSV infection can be kept to a minimum.

Cesarean Section↗
PubMed1987

Microbiology of the female genital tract.

Patients who contract genital tract infections are predominantly young, are otherwise healthy, and generally respond well to treatment for bacterial infections. These infections are most commonly polymicrobial in etiology, with several noteworthy exceptions. Often there is an inciting event such as childbirth, surgical intervention, pregnancy termination or intrauterine contraceptive device insertion. With treatment, prognosis for cure is excellent; however, sequelae such as recurrent infections, infertility, or ectopic pregnancy can be serious. Bacteria encountered in the female genital tract can be divided into aerobic and anaerobic organisms. Among the aerobic gram-positive organisms, several varieties of streptococci such as Group B streptococci and enterococci occur frequently. Staphylococcus aureus is an infrequent but important pathogen. Among the aerobic gram-negative organisms, the most common is Escherichia coli. Klebsiella sp. and Proteus sp. occur in about 5% of genital tract infections. Species that are more resistant to antibiotics, such as Pseudomonas aeruginosa and Enterobacter sp., occur in approximately 1% or 2% of these cases and are more likely to appear in patients who have previously received antibiotic therapy or who have been hospitalized for some time. Among the anaerobic organisms, the most common gram-positive isolates are Peptostreptococci and Peptococci. Clostridia sp. occurs less frequently. Among the anaerobic gram-negative organisms, the Bacteroides sp. most frequently encountered are Bacteroides bivius and Bacteroides disiens. Bacteroides fragilis is still a common problem but appears to be less predominant. Other organisms encountered are Chlamydia trachomatis, the genital mycoplasmas, yeasts, protozoa, and viruses.

Bacteria↗
PubMed1995

Vasoactive intestinal polypeptide and other preprovasoactive intestinal polypeptide-derived peptides in the female and male genital tract: localization, biosynthesis, and functional and clinical significance.

Vasoactive intestinal polypeptide, a neuropeptide with wide distribution in the central and peripheral nervous system, has a broad spectrum of biologic actions. The demonstration of vasoactive intestinal polypeptide containing nerve fibers within the female and male genital tract 17 years ago indicated a putative role for this peptide in the local nervous control of reproductive functions. The genes encoding the preprovasoactive intestinal polypeptide precursor molecule and the vasoactive intestinal polypeptide receptor have been identified. The gene expression has been studied by the use of specific antibodies against the functional domains of the vasoactive intestinal polypeptide precursor and the biologic action elucidated by both in vivo and in vitro methods. Evidence has been provided to support vasoactive intestinal polypeptide as a neurotransmitter in several physiologic events in the genital tracts (i.e., blood flow and nonvascular smooth muscle relaxation). In the ovary vasoactive intestinal polypeptide seems to play an important role as regulator and/or modulator of folliculogenesis and steroidogenesis. In the male genital tract vasoactive intestinal polypeptide seems to participate in the control of erection. Vasoactive intestinal polypeptide has been suggested as a causative factor in some diseases of the genital organs (e.g., it may play a pathophysiologic role in male impotence and the peptide is currently used in the treatment of this condition). Vasoactive intestinal polypeptide may be important for control of the low resistance in the fetomaternal vascular bed and is therefore a putative factor involved in the development of preeclampsia. The therapeutic potential of vasoactive intestinal polypeptide and future agonists and antagonists will be revealed by ongoing and forthcoming studies.

Amino Acid Sequence↗
PubMed1986

Epithelial and mesenchymal cell differentiation in the fetal rat genital ducts: changes in the expression of cytokeratin and vimentin type of intermediate filaments and desmosomal plaque proteins.

Mesonephric and paramesonephric ducts develop in different ways in male and female fetuses. We have analyzed the changes in the expression of cytokeratin and vimentin type of intermediate filaments and desmosomal plaque proteins in progressing and regressing genital ducts of rat fetuses. The concomitant changes in the basement membranes were detected by laminin antibody. Epithelial cells of the indifferent (Day 15) male and female mesonephric and paramesonephric ducts contained faint vimentin positivity which, however, later disappeared. Indifferent mesonephric duct epithelium stained strongly for cytokeratin, whereas in the corresponding paramesonephric duct only a weak and spotty positivity was seen. Immunocytochemical localization of cytokeratin filaments and desmosomal plaque proteins correlated with the ultrastructural differences in the apical junctional complexes of the mesonephric and paramesonephric ducts. Regardless of the ongoing regression of the male paramesonephric duct, cytokeratin positivity increased in the disorganizing epithelium; the most weak and a granular immunoreaction was seen in the cells found in the intensively vimentin-positive periductal mesenchyme. In the regressing female mesonephric duct cytokeratin positivity was lost before the final dissolution of the basement membrane. Immunoblotting analysis of cytokeratin and vimentin polypeptides of the individual genital ducts were in agreement with the immunocytochemical results obtained in 15- and 16-day-old fetuses. The results suggest that the expression of vimentin type intermediate filaments is an indication of the mesothelial origin of the genital ducts. The increase in cytokeratin positivity of the regressing paramesonephric duct epithelium suggests that the degenerative changes are initiated by the mesenchyme. Cytokeratin-positive cells found in the periductal mesenchyme of the male paramesonephric duct may be epithelial cells transforming into mesenchyme. The results emphasize a close relationship between the changes of the intermediate filament system and extracellular matrix upon differentiation of the fetal genital ducts.

Animals↗
PubMed1995

Genital bleeding in premenarcheal children.

OBJECTIVE: The earlier occurrence of secondary sexual development and the advance in diagnostic techniques prompted us to review our recent experience with genital bleeding in childhood. METHOD: We analyzed data for all patients aged less than 10 years who were referred to Gifu University School of Medicine-affiliated hospitals from 1984 through 1993. RESULTS: From a total of 330 girls, 62 (approximately 20%) complained of genital bleeding. The patients were distributed equally between 0 and 10 years of age. In 46 of 62 patients (74%), bleeding resulted from a local lesion of the vagina: 28 due to vulvovaginitis, six to urethral prolapse, six to trauma, three to foreign bodies and three to vaginal tumors. Malignant vaginal tumors were seen in two patients: sarcoma botryoides and endodermal sinus tumor. Both were diagnosed by histopathological examination of an exophytic vaginal tumor, with several weeks' interval from the initial episode of bleeding to diagnosis. The remaining 16 patients (26%), with no demonstrable local lesions, bled as a result of some form of precocious puberty. In six patients, precocious puberty was secondary to a hormonally active ovarian tumor, five of these patients also experiencing advanced breast development. Routine ultrasound and hormonal evaluations promptly detected the presence of tumor. None of three patients with idiopathic precocious puberty presented with secondary sexual development. No specific etiology was established in seven patients. CONCLUSION: Genital bleeding alerts us to the possibility, though rare, of a genital tract tumor. Prompt and precise detection may lead to cure and preservation of future fertility.

Age Distribution↗
PubMed1985

The effect of spironolactone on genital skin 5 alpha-reductase activity.

The effect of spironolactone (S) on genital skin 5 alpha-reductase activity (5 alpha-RA) of hirsute women (HW) in vivo as well as in normal genital skin in vitro was evaluated. Thirteen HW (Ferriman-Gallwey score of 23.3 +/- 2.8) received S 100 mg twice a day for a month. Twenty-three non-hirsute women were selected as controls for the assessment of genital skin 5 alpha-RA. S was added to incubations of genital skin from 9 additional controls in vitro in concentrations from 1.2 X 10(-8) to 10(-5) M. HW had significantly higher conversion ratios (CR) of T to DHT compared to controls (P less than 0.05). Post treatment values for the CR T to DHT were significantly lower than prior to S (17.5 +/- 1.7 and 8.05 +/- 1.2%, P less than 0.05) and the mass of DHT produced also decreased by 37 +/- 9% (P less than 0.05). The CR T to 3 alpha-diol decreased by 30 +/- 9% (P less than 0.05). In 11 of 13 women, a significant reduction of 5 alpha-RA was demonstrated while in 2 patients the activity remained unchanged. The maximum in vitro inhibitory effect of S on the CR T to DHT occurred with a concentration of 1.2 X 10(-5) M (P less than 0.01). In conclusion, S has a direct inhibitory effect on 5 alpha-RA. The beneficial effect of S treatment in HW may be related, in part, to this inhibition of 5 alpha-RA.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1989

The 56 kDa protein of human genital skin fibroblasts is identical to that radiolabelled by [3H]dihydrotestosterone 17 beta-bromoacetate.

Analysis of soluble proteins from human genital skin fibroblasts by two-dimensional polyacrylamide gel electrophoresis reveals an abundant protein doublet of mol. wt 56,000 with isoelectric points (pI) of 6.7 and 6.5. This protein is absent in non-genital skin fibroblasts as well as in genital skin fibroblasts of most patients with complete forms of androgen insensitivity. The protein specifically binds androgen. A protein of similar estimated molecular weight (58,000) from human genital skin fibroblasts has recently been found to be covalently radiolabelled by the affinity ligand dihydrotestosterone 17 beta-bromoacetate (DHT-BA). In the present study these proteins have been found to be indistinguishable on one- and two-dimensional gel electrophoresis. Antibodies raised against the 56 kDa pI 6.7/6.5 protein also recognized the protein covalently radiolabelled by DHT-BA. A third protein of estimated mol. wt 59,000 has been found to be associated with several steroid hormone receptor complexes but has no known ligand binding activity. This protein was found to be clearly separable from the 56/58 kDa protein on two-dimensional gel electrophoresis as it has a more acidic pI of approximately 5.4. Furthermore, antibodies against the 59 kDa protein do not recognize the 56 kDa species, and vice versa.

Affinity Labels↗
PubMed1985

Evidence for cell-replacement repair of X-ray-induced teratogenic damage in male genital imaginal discs of Drosophila melanogaster.

Male genital imaginal discs from old (late-third-instar) larvae of Drosophila that had been X-irradiated with appropriate doses developed into severely damaged adult genitalia when implanted into old larvae, but they developed into completely normal adult genitalia when transplanted into 2-day-younger larvae. The major cause of X-ray-initiated teratogenesis in the genital disc was DNA damage because development of the genital discs of strain mei-9a with defective DNA repair was twice as sensitive as that of the wild-type strain to impairment by X-irradiation, just as larvae of this strain were twice as sensitive to killing by X-irradiation as those of the wild-type strain. Complete repair of X-ray-induced teratogenic damage in the genital discs on transplantation into young host larvae was similar in the wild-type and mei-9a strains. These results are discussed in relation to the hypothesis that repair of X-ray-induced teratogenic damage depends not on DNA repair but on replacement of damage-bearing primordial cells by healthy ones after suicidal elimination of the former.

Animals↗
PubMed1995

Fetal genital effects of first-trimester sex hormone exposure: a meta-analysis.

OBJECTIVE: To determine if first-trimester exposure to sex hormones, and oral contraceptives (OCs) specifically, is associated with an increased risk of external fetal genital malformations. DATA SOURCES: MEDLINE and Science Citation Index data bases were searched for the years 1966-1992 for relevant English-language articles on first-trimester sex-hormone exposure and fetal genital changes. METHODS OF STUDY SELECTION: One hundred eighty-six articles were identified initially. Inclusion criteria were cohort or case-control studies, first-trimester sex-hormone exposure, and live infants or full-term stillborn infants with external genital malformations. Exclusion criteria were diethylstilbestrol exposure, spontaneous abortions, and teratogen exposure. DATA EXTRACTION AND SYNTHESIS: The Methods section of each study was reviewed independently by two authors and two outside reviewers, using the above criteria. Fourteen studies, seven cohort and seven case-control, involving 65,567 women, met the criteria for meta-analysis. Extracted data were entered into 2 x 2 tables. The overall summary odds ratio (OR) was 1.09 (95% confidence interval [CI] 0.90-1.32); subanalysis of OC exposure identified an OR of 0.98 (95% CI 0.24-3.94). CONCLUSION: There was no association between first-trimester exposure to sex hormones generally (or to OCs specifically) and external genital malformations. Thus, women exposed to sex hormones after conception may be assured there is no increased risk of fetal sexual malformation.

Case-Control Studies↗
PubMed1995

Genital herpes during pregnancy: no lesions, no cesarean.

OBJECTIVE: To determine the effects at our hospital of adoption of the 1988 guidelines recommended by ACOG for management of genital herpes infections during pregnancy. METHODS: Between 1984-1986, 96 pregnancies complicated by active genital herpes were delivered at Parkland Hospital. The outcome of these pregnancies were compared with 217 similar pregnancies managed after implementation of the 1988 ACOG herpes guidelines. RESULTS: Adoption of the 1988 ACOG herpes guidelines resulted in a 37% decrease in the use of cesarean delivery for women with genital herpes infections at our hospital. Most of this decrease was because the new guidelines eliminated the need for a confirmatory negative herpes culture before permitting vaginal delivery. No neonatal herpes infections occurred as a result of implementing the ACOG recommendations. CONCLUSION: The rate of cesarean delivery for women with genital herpes infections during pregnancy declined significantly at our hospital as a result of the adoption of ACOG herpes guidelines, and there were no neonatal consequences, such as increased incidence of neonatal herpes simplex virus infection.

Cesarean Section↗
PubMed1989

Penile desensitization does not affect postcopulatory genital autogrooming in rats: evidence for central motor patterning.

Postcopulatory genital autogrooming was studied in rats following desensitization of the glans penis due to topical application of an anesthetic ointment or to surgical transection of the dorsal penile nerve. These treatments sharply reduced the number of mounts resulting in intromission, but genital autogrooming was largely unaffected. The probability and duration of genital grooming were sensitive to the mount bout status of the copulatory event. The probability of autogrooming was higher, and the duration longer, after mounts that ended mount bouts and after intromissions, than after mounts that were incorporated within a mount bout. These findings suggest that the apparently compulsive genital autogrooming within a copulatory context is not regulated by afferent impulses from the penis, but may largely reflect central motor programing.

4-Aminobenzoic Acid↗
PubMed1991

Genital-type human papillomavirus infection is not associated with surface epithelial ovarian carcinoma.

Tumor tissues from 29 women with borderline or malignant epithelial ovarian tumors were examined for the presence of human papillomavirus (HPV) DNA by the polymerase chain reaction (PCR). The PCR analysis used a set of consensus primers that are complementary to highly conserved sequences in the genital HPVs (M. M. Manos, Y. Ting, D. K. Wright, A. J. Lewis, T. R. Broker, and S. M. Wolinsky, Cancer Cells 7, 209-214, 1989). Amplification products were detected by Southern hybridization with consensus oligonucleotide probes. A total of 70 paraffin-embedded tissue sections from ovarian carcinomas were tested and we did not detect genital-type HPV DNA sequences in any of these specimens. However, all of the tissue specimens were considered adequate for PCR analysis because a human cellular gene (beta-globin) was successfully amplified in each tissue specimen. In addition, HPV 16 DNA was found in a concurrent invasive squamous-cell carcinoma of the cervix from one ovarian cancer patient, indicating that the PCR was able to detect HPV in the lower genital tract of this individual. We conclude that there is no association between infection with the most common genital HPVs and borderline and malignant epithelial ovarian tumors.

Adult↗
PubMed1990

A study of three blood culture media for isolating genital mycoplasmas from obstetrical and gynaecological patients.

Mycoplasma species are often found colonising the female genital tract. Their ability to become invasive and pathogenic, however, is often ignored, since attempts may not be made to culture these organisms from the bloodstream. We have investigated the ability of three types of blood culture media to support the growth of genital mycoplasmas. The media studied included brain-heart infusion broth, brain-heart infusion broth supplemented with 30% V/V sucrose and fastidious anaerobe broth. Genital mycoplasmas were cultured from the latter medium only. Since this was the sole medium which was liquoid-free, the inhibitory effects of liquoid on Mycoplasma spp. is discussed. This study comprised an investigation of 75 patients in obstetric and gynaecological wards with postpartum or post-operative fever. Genital mycoplasmas were isolated from five (6.7%) patients, four with Ureaplasma urealyticum and one with M. hominis. The value of considering these organisms in the differential diagnosis of fever in 'at risk' patients and of including appropriate media for their isolation is emphasised.

Adult↗