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Pelvic Floor Sexology, Behaviour, Psychology (part III)

Sexuality in older adults: behaviours and preferences.
Ginsberg TB, Pomerantz SC, Kramer-Feeley V
Age Ageing. 2005 Sep;34(5):475-80. Epub 2005 Jul 25.
BACKGROUND: while much has been written about adult sexuality, relatively little is available about the sexuality of older people. Available literature often does not discuss specific sexual behaviours and includes predominantly married, better-educated, mostly young old. OBJECTIVE: the purpose of this study was to assess a sample of lower-income older adults, about whom there is limited information, to describe a full range of sexual behaviours and to identify the degree to which they are satisfied with their sexual activities. METHODS: subjects were 179 people (60 and older) who were residents of subsidised independent-living facilities, recruited during a lecture or in public areas in the building. Thirteen of 179 were excluded due to age. Most were white (82%), living alone (83%) and female (63%). RESULTS: overall, the majority reported to have had physical and sexual experiences in the past year such as touching/holding hands (60.5%), embracing/hugging (61.7%) and kissing (57%) daily to at least once a month; mutual stroking, masturbation and intercourse were experienced 'not at all' by 82% or more. For all activities except masturbation, participants wanted to participate in sexual activities more often than they did. The most important barrier to sexual activity was lack of a partner. Self-reported health was related to sexual activities wanted, with age also related to some preferences. CONCLUSIONS: most of the elderly surveyed want to maintain a sexual relationship which includes touching and kissing, and they would like to have more sexual experiences than they have accessible. Further studies are needed.

Erectile Dysfunction and Premature Ejaculation are the Most Frequently Self-Reported Sexual Concerns: Profiles of 9,536 Men Calling A Helpline.
Papaharitou S, Athanasiadis L, Nakopoulou E, Kirana P, Portseli A, Iraklidou M, Hatzimouratidis K, Hatzichristou D
Eur Urol. 2005 Dec 13;.

OBJECTIVES: To describe the range of sexual problems, as reported by men calling a help-line and to investigate factors associated with help seeking behaviour. METHODS: The study included all calls between 1999 and 2004. The information used for analysis comprised caller's demographic characteristics, the sexual problem reported, previous doctor contacts, coexisting physical and mental health problems. RESULTS: Erectile dysfunction (ED) and premature ejaculation (PE) were the most frequently reported problems (57 and 19.2% respectively). ED-reporting callers were older (OR 0.63 for the ages of 50-59 yrs), with co-morbidities (OR 1.75) and in stable relationship (OR 0.46), while PE-reporting callers were younger (OR 5.83 for the ages of 20-29 yrs), relatively healthy and more likely single (OR 2.62 and OR 2.92 respectively). Type and duration of sexual concern, age, coexisting health problems and marital status relate significantly (p<0.01) with willingness to seek medical help. CONCLUSIONS: The study demonstrates that ED and PE are men's major sexual concerns with personal and interpersonal factors influencing their help-seeking behaviour. Help-lines can serve as a link between health services and callers, while provide useful information for policy formation and improvement of support services.

Efficacy and tolerability of vardenafil in men with mild depression and erectile dysfunction: the depression-related improvement with vardenafil for erectile response study.
Rosen R, Shabsigh R, Berber M, Assalian P, Menza M, Rodriguez-Vela L, Porto R, Bangerter K, Seger M, Montorsi F
Am J Psychiatry. 2006 Jan;163(1):79-87.

OBJECTIVE: Erectile dysfunction and depression are highly associated. Previous studies have shown benefits of phosphodiesterase-5 inhibitor treatment for erectile dysfunction associated with antidepressant therapy or subsyndromal depression. The present study assessed the safety and efficacy of vardenafil in men with erectile dysfunction and untreated mild depression. METHOD: In this 12-week, multicenter, randomized, flexible-dose, parallel-group, double-blind study, 280 men with erectile dysfunction for at least 6 months and untreated mild major depression received placebo or vardenafil, 10 mg/day, for 4 weeks, with the option to titrate to 5 mg/day or 20 mg/day after each of two consecutive 4-week intervals. Endpoints included International Index of Erectile Function erectile function domain and 17-item Hamilton Depression Rating Scale (HAM-D) scores. RESULTS: Vardenafil produced statistically significant and clinically meaningful improvement in all erectile function parameters. The International Index of Erectile Function erectile function domain score was 22.9 with vardenafil compared to 14.9 with placebo. The HAM-D score was lower in the vardenafil group (7.9) than in the placebo group (10.1). Treatment with vardenafil was the most important predictor for return to normal erectile function. Improvement in International Index of Erectile Function erectile function domain score was the most important predictor of remission in depressive symptoms. CONCLUSIONS: Vardenafil was well tolerated and highly efficacious in men with erectile dysfunction and untreated mild major depression. Significant improvements in erectile function and depression were observed in patients treated with vardenafil versus placebo. Erectile dysfunction treatment should be considered a component of therapy for men with depression and erectile dysfunction.

Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse: a comparison.
Jeng CJ, Yang YC, Tzeng CR, Shen J, Wang LR
J Reprod Med. 2005 Sep;50(9):669-74.

OBJECTIVE: To examine changes in sexuality after total vaginal hysterectomy (TVH) or transvaginal sacrospinous uterine suspension (SSUS)for uterine prolapse. STUDY DESIGN: One hundred fifty-eight women with moderate to severe uterine prolapse undergoing TVH (78) or SSUS (80) were included in a prospective study from January 2001 to June 2002. All women were <50 years old and sexually active within the last 6 months before surgical intervention. None had major medical disorders. Sexual functioning before and 6 months after surgery was examined via a face-to-face questionnaire. Sexual interest, sexual satisfaction, frequency of sexual intercourse and frequency of orgasm were measured using an analogue scale. RESULTS: Of women undergoing TVH, 5.1% had decreased sexual interest, and 21% had less frequent orgasms postoperatively. For women undergoing SSUS, 13% had decreased sexual interest, and 20% had less frequent orgasms postoperatively. Frequency of orgasm was the only parameter that changed significantly after surgery in the 2 groups. All women with less frequent orgasms said that they were afraid of wound disruption or disease recurrence and so refrained from vigorous or exciting sexual intercourse. About four-fifths of the women in both groups accepted or were satisfied with their sexuality after surgery. For women undergoing TVH, 2.6% had increased frequency of orgasm, and 5% had better overall sexual satisfaction postoperatively. For women undergoing SSUS, 10% had increased sexual satisfaction postoperatively. There was a 2.5% and 2.6% increase in postoperative sexual interest in the SSUS and TVH groups, respectively. The sexual functioning scores were not different before or after surgical intervention in either group. CONCLUSION: There is a decrease in thefrequency of orgasm after both TVH and SSUS. However, there is no significant difference in postoperative sexual functioning between women with and without preservation of the uterus in correcting uterine prolapse.

Premenstrual symptoms and perimenopausal depression.
Richards M, Rubinow DR, Daly RC, Schmidt PJ
Am J Psychiatry. 2006 Jan;163(1):133-7.

OBJECTIVE: The role of ovarian steroids in both premenstrual dysphoria and perimenopausal depression has led to the suggestion that these conditions represent expressions of the same underlying disorder. Premenstrual mood symptoms were evaluated in women with perimenopause-related depression. METHOD: Self-reports and daily symptom ratings during one menstrual cycle were examined in 70 depressed perimenopausal women attending a menopause clinic and 35 nondepressed perimenopausal women. RESULTS: Twenty-six percent of the depressed and 9% of the nondepressed women reported premenstrual symptoms. Thirty-one percent of the depressed and 20% of the nondepressed women met criteria for significant menses-related symptom cyclicity (at least a 30% increase in the average ratings of at least two of four measured negative mood symptoms in the premenstrual versus the postmenstrual week); 5 of these depressed women and none of the comparison subjects described premenstrual symptoms on self-reports. Finally, 21% of the depressed and 3% of the nondepressed women met criteria for premenstrual dysphoria (symptom cyclicity and at least moderate severity, with symptoms exceeding a minimum luteal symptom severity threshold of 2.5). CONCLUSIONS: A higher-than-expected rate of menses-related symptom cyclicity and premenstrual dysphoria was observed in perimenopausal depressed women. However, neither menses-related symptom cyclicity nor premenstrual dysphoria was an invariant accompaniment of perimenopausal depression. Additionally, the rate of premenstrual dysphoria was not predicted by initial self-reports.

Sexual function after partial cystectomy and urothelial stripping in a 32-year-old woman with radiation cystitis.
Elzevier HW, Gaarenstroom KN, Lycklama a Nijeholt AA
Int Urogynecol J Pelvic Floor Dysfunct. 2005 Sep-Oct;16(5):412-4. Epub 2005 Jan 13.

We report a case of a 32-year-old woman who underwent a partial cystectomy to preserve sexual function. After radiotherapy for stage IB1 cervical cancer, cystectomy was indicated because of severe radiation cystitis. During this procedure we resected the upper part of the bladder followed by stripping off urothelium of the remaining bladder to spare the neurovascular bundle. Follow-up after 3 months indicated intact sexual function including orgasm. In our opinion the cystectomy procedure described in this case report is a good, novel option in women who are candidates for cystectomy because of a crippled bladder, after radiotherapy, and want to retain sexual function.

Sexual health and the gender gap.
Pauls RN
Int Urogynecol J Pelvic Floor Dysfunct. 2005 Dec 13;.

Premature ejaculation: presentation and associations. An audit of patients attending a sexual problems clinic.
Riley A, Riley E
Int J Clin Pract. 2005 Dec;59(12):1482-7.

The diagnostic register and case summaries of all male and female patients who attended the clinic on account of one or more sexual symptoms or relationship problems between 1 January 1992 and 31 December 1997 were reviewed. The index symptom or problem was considered the complaint that caused the patient most concern. When patients or couples were experiencing more than one sexual problem, the concomitant problems were tabulated against the index symptom. During this period, 1,056 (440 men and 616 women) patients with sexual symptoms were seen and 131 couples attended primarily with relationship problems. Overall, 18.2% of men referred to the clinic with sexual problems had premature ejaculation (PE), but this was the index symptom in only 11.6% of men. There was a high occurrence of PE in the partners of women presenting with sexual symptoms. Among couples presenting with relationship dissatisfaction or conflict, 18.3% of the male partners had ongoing PE.

Sexual abuse history: prevalence, health effects, mediators, and psychological treatment.
Leserman J
Psychosom Med 2005 Nov-Dec;67(6):906-15.

OBJECTIVE: Lifetime history of sexual abuse is estimated to range between 15% and 25% in the general female population. People who are sexually abused are at greater risk for a whole host of physical health disorders that may occur many years after the abusive incident(s). Despite the high prevalence of this trauma and its association with poor health status, abuse history often remains hidden within the context of medical care. The aims of this review are to determine which specific health disorders have been associated with sexual abuse in both women and men, to outline the types of sexual abuse associated with the worst health outcome, to discuss some possible explanations and mediators of the abuse/health relationship, to discuss when and how to talk about abuse within a clinical setting, and to present evidence for which psychological treatments have been shown to improve the mental health of patients with past sexual abuse. METHOD: To meet these objectives, we have reviewed a wide literature on the topic of sexual abuse. RESULTS: We demonstrate that abuse appears to be related to greater likelihood of headache and gastrointestinal, gynecologic, and panic-related symptoms; that the poor health effects associated with abuse are also seen in men; that abuse involving penetration and multiple incidents appears to be the most harmful, and that exposure-type therapies with and without cognitive behavioral therapy hold promise for those with abuse history. CONCLUSION: We need more research examining psychological treatments that might be efficacious in treating the physical health problems associated with sexual abuse history.

Genital herpes: a review.
Beauman JG
Am Fam Physician 2005 Oct 15;72(8):1527-34.

Genital herpes simplex virus infection is a recurrent, lifelong disease with no cure. The strongest predictor for infection is a person's number of lifetime sex partners. The natural history includes first-episode mucocutaneous infection, establishment of latency in the dorsal root ganglion, and subsequent reactivation. Most infections are transmitted via asymptomatic viral shedding. Classic outbreaks consist of a skin prodrome and possible constitutional symptoms such as headache, fever, and inguinal lymphadenopathy. As the infection progresses, papules, vesicles on an erythematous base, and erosions appear over hours to days. These lesions usually crust, re-epithelialize, and heal without scarring. First-episode infections are more extensive: primary lesions last two to six weeks versus approximately one week for lesions in recurrent disease. Atypical manifestations are common. Infected persons experience a median of four recurrences per year after their first episode, but rates vary greatly. Genital herpes simplex virus type 2 recurs six times more frequently than type 1. Viral culture is preferred over polymerase chain reaction testing for diagnosis. Serologic testing can be useful in persons with a questionable history. Effective oral antiviral medications are available for initial, episodic, and suppressive therapy but are not a cure. There is some evidence that alternative therapies such as L-lysine, zinc, and some herbal preparations may offer some benefit. Counseling patients about the risk of transmission is crucial and helps prevent the spread of disease and neonatal complications.

Diverse and Changing Perceptions of the Body: Communicating Illness, Health, and Risk in an Age of Medical Pluralism.
Agdal R
J Altern Complement Med 2005;11(supplement 1):s67-s75.

There has been a marked increase in the use of complementary and alternative medicine (CAM) in the West since the 1970s. However, biomedicine is still prevailing within public health services and health services covered by private insurance. Different therapies, conventional and CAM, represent different perceptions of the the body. Perceptions of the body are closely related to perceptions of illness, health, disease, and risk. The cultural models of the body are related to social organization and the development of technologies. In a study on spiritual healers and their clients in Norway, I found that clients adapted to a multitude of medical regimes by processes of recognition through cognitive models, learning, and socialization. I describe five models that are evident in communication between healers and clients; the model of the body as machine, plumbing system, energetic, programmable, and as wireless network. People hold diverse perceptions of health, illness, body, and risk, which influence attitudes and behavior. Changes in perceptions of body, health, and illness may be one factor enforcing that CAM is increasingly becoming a first-line intervention. Health authorities meet this challenge emphasizing the regulation of CAM to safeguard patients but could also choose to focus on what clients define as their needs. The shift in cultural understandings of the body, and how people cope with this diversity, ought to be an area for further investigation, as it may affect the choices citizens make and the legitimacy of health authorities.

Management of unprotected sexual encounters.
Couldwell DL
Med J Aust 2005 Nov 21;183(10):525-528.

After "unprotected" sexual encounters, sexual history guides risk assessment and testing for sexually transmissible infections (STIs). Chlamydia trachomatis infection is the most prevalent bacterial STI. Sexually active young people (aged < 25 years) should have annual chlamydia testing. Opportunistic STI testing is indicated for population groups at increased risk of STI, including young people, gay and other homosexually active men, and Indigenous people. Gay and other homosexually active men should be regularly tested for HIV, syphilis, chlamydia and gonorrhoea. Indigenous people should be regularly tested for syphilis, chlamydia and gonorrhoea. Postexposure antiretroviral prophylaxis may be indicated after high-risk sexual encounters.

Family violence.
Tolan P, Gorman-Smith D, Henry D
Annu Rev Psychol 2006;57:557-83.

Family violence occurs in many forms; the most prominent are domestic violence, child abuse, and elder abuse. Family violence affects many persons at some point in their life and constitutes the majority of violent acts in our society. Although there has been considerable study of the patterns, risk factors, and interventions for each form of family violence, great controversy still exists within each area. There is growing recognition of an overlap in the patterns, causes, and effective interventions across types of family violence. There is also an increasing awareness of the value of greater integration of theory and research across areas into a family violence approach through an ecological perspective. This review focuses on current knowledge related to these problems and suggests integrative steps to advance knowledge.

The internet as psychological laboratory.
Skitka LJ, Sargis EG
Annu Rev Psychol 2006;57:529-55.

This chapter reviews studies published in American Psychological Association (APA) journals from 2003-2004 and additional studies (received in response to listserv requests) that used the Internet to collect data (N=121 total studies). Specific examples of three kinds of Web-based research are reviewed: (a) translational (established methods and research questions are adapted to the Web), (b) phenomenological (behavior on the Web is the focus of study), and (c) novel (methodologically innovations unique to Web-based research). Among other findings, our review indicated that 21% of APA journals published at least one article that reported on Web-based research, most Web-based psychological research uses experimental methods, a surprising number use college student samples, and deception in Web-based research is not uncommon. Strengths and weaknesses of Web-based psychological research in general, and our sample of studies in particular, are reviewed with special attention to possible concerns about sampling and the use of deception.

Effects of pregnancy and childbirth on postpartum sexual function: a longitudinal prospective study.
Connolly A, Thorp J, Pahel L
Int Urogynecol J Pelvic Floor Dysfunct 2005 Jul-Aug;16(4):263-7. Epub 2005 Apr 19.

This study was conducted to evaluate the effects of pregnancy and childbirth on postpartum sexual function. Nulliparous, English-literate women were enrolled who had presented to the UNC Hospital's obstetrical practice; these women were 18 years of age and older and at 30-40 weeks' gestation. Questionnaires were completed regarding sexual function prior to pregnancy, at enrollment, and at 2, 6, 12, and 24 weeks postpartum. Demographic and delivery data were abstracted from the departmental perinatal database. One hundred and fifty women were enrolled. At 6, 12, and 24 weeks postpartum, 57, 82, and 90% of the women had resumed intercourse. At similar postpartum timepoints, approximately 30 and 17% of women reported dyspareunia; less than 5% described the pain as major. At these times, 39, 60, and 61% of women reported orgasm. Orgasmic function was described as similar to that prior to pregnancy or improved by 71, 77, and 83%. Delivery mode and episiotomy were not associated with intercourse resumption or anorgasmia; dyspareunia was only associated with breast-feeding at 12 weeks (RR = 3.36, 95% CI = 1.77-6.37). Most women resumed painless intercourse by 6 weeks and experienced orgasm by 12 weeks postpartum. Function was described as similar to or improved over that prior to pregnancy.

Sildenafil citrate therapy for pulmonary arterial hypertension.
Galie N, Ghofrani HA, Torbicki A, Barst RJ, Rubin LJ, Badesch D, Fleming T, Parpia T, Burgess G, Branzi A, Grimminger F, Kurzyna M, Simonneau G
N Engl J Med 2005 Nov 17;353(20):2148-57.

BACKGROUND: Sildenafil inhibits phosphodiesterase type 5, an enzyme that metabolizes cyclic guanosine monophosphate, thereby enhancing the cyclic guanosine monophosphate-mediated relaxation and growth inhibition of vascular smooth-muscle cells, including those in the lung. METHODS: In this double-blind, placebo-controlled study, we randomly assigned 278 patients with symptomatic pulmonary arterial hypertension (either idiopathic or associated with connective-tissue disease or with repaired congenital systemic-to-pulmonary shunts) to placebo or sildenafil (20, 40, or 80 mg) orally three times daily for 12 weeks. The primary end point was the change from baseline to week 12 in the distance walked in six minutes. The change in mean pulmonary-artery pressure and World Health Organization (WHO) functional class and the incidence of clinical worsening were also assessed, but the study was not powered to assess mortality. Patients completing the 12-week randomized study could enter a long-term extension study. RESULTS: The distance walked in six minutes increased from baseline in all sildenafil groups; the mean placebo-corrected treatment effects were 45 m (+13.0 percent), 46 m (+13.3 percent), and 50 m (+14.7 percent) for 20, 40, and 80 mg of sildenafil, respectively (P<0.001 for all comparisons). All sildenafil doses reduced the mean pulmonary-artery pressure (P=0.04, P=0.01, and P<0.001, respectively), improved the WHO functional class (P=0.003, P<0.001, and P<0.001, respectively), and were associated with side effects such as flushing, dyspepsia, and diarrhea. The incidence of clinical worsening did not differ significantly between the patients treated with sildenafil and those treated with placebo. Among the 222 patients completing one year of treatment with sildenafil monotherapy, the improvement from baseline at one year in the distance walked in six minutes was 51 m. CONCLUSIONS: Sildenafil improves exercise capacity, WHO functional class, and hemodynamics in patients with symptomatic pulmonary arterial hypertension.

Images in clinical urology. Late complication after penile elongation.
Milhoua PM, Sergeyev I, Melman A
Urology 2005 Nov;66(5):1108.

Self-reported sexual function in women and androgen levels.
Dhatariya K
JAMA 2005 Nov 2;294(17):2167-8; author reply 2168.

Brief communication: physical abuse of boys and possible associations with poor adult outcomes.
Holmes WC, Sammel MD
Ann Intern Med 2005 Oct 18;143(8):581-6.

BACKGROUND: Men's childhood physical abuse experiences are understudied. OBJECTIVE: To obtain descriptions about men's personal childhood physical abuse histories and estimate their association with adult outcomes. DESIGN: Population-based telephone survey. SETTING: Urban areas with high frequency of domestic violence against girls and women. PARTICIPANTS: 298 men recruited through random-digit dialing. MEASUREMENTS: 6 Conflict Tactics Scale items and psychiatric, sexual, and legal history questions. RESULTS: One hundred of 197 (51%) participants had a history of childhood physical abuse. Most (73%) participants were abused by a parent. Childhood physical abuse history was associated with depression symptoms (P = 0.003), post-traumatic stress disorder symptoms (P < 0.001), number of lifetime sexual partners (P = 0.035), legal troubles (P = 0.002), and incarceration (P = 0.007) in unadjusted analyses and with depression symptoms (P = 0.015) and post-traumatic stress disorder symptoms (P = 0.003) in adjusted analyses. LIMITATIONS: There may have been inaccurate recall of past events. Lack of exposure time data disallowed direct comparison of abuse perpetration by mothers versus fathers. Other unmeasured variables related to childhood physical abuse might better explain poor adult outcomes. CONCLUSIONS: The high frequency of childhood physical abuse histories in this population-based male sample, coupled with the high proportion of parent perpetrators and the association between childhood physical abuse and adult outcomes that are often associated with perpetration of violence, argues for more study of and clinical attentiveness to potential adult outcomes of men's own childhood physical abuse histories.

Wellbeing: an idea whose time has come.
Lancet 2005 Oct 22-28;366(9495):1412.

Evaluation of the role of pudendal nerve integrity in female sexual function using noninvasive techniques.
Seftel A
J Urol 2005 Nov;174(5):1938.

Postoperative delirium in elderly patients after major abdominal surgery.
Olin K, Eriksdotter-Jonhagen M, Jansson A, Herrington MK, Kristiansson M, Permert J
Br J Surg 2005 Oct 17;.

BACKGROUND: The aim of this study was to investigate the occurrence of postoperative delirium (POD) in elderly patients undergoing major abdominal surgery and to identify factors associated with delirium in this population. METHODS: Data were collected prospectively from 51 patients aged 65 years or more. Delirium was diagnosed by the Confusion Assessment Method and from the medical records. The Mini Mental State Examination (MMSE) was used to identify cognitive impairment. RESULTS: POD occurred in 26 of 51 patients. Delirium lasted for 1-2 days in 14 patients (short POD group) and 3 days or more in 12 patients (long POD group). The latter patients had significantly greater intraoperative blood loss and intravenous fluid infusion, a higher rate of postoperative complications, a lower MMSE score on postoperative day 4 and a longer hospital stay than patients without POD. Patients in the short POD group were significantly older than those in the long POD group and those who did not develop delirium. CONCLUSION: Approximately half of the elderly patients in this study developed POD. Bleeding was found to be an important risk factor for delirium.

Sherry DF
Annu Rev Psychol 2005 Sep 16;.

Neuroecology is the study of adaptive variation in cognition and the brain. The origin of neuroecology dates from the 1980s, when researchers in behavioral ecology began to apply the methods of comparative evolutionary biology to cognitive processes and the underlying neural mechanisms of cognition. The comparative approach is much older, however. It was a mainstay of ethology, it has been part of the study of neuroanatomy since the seventeenth century, and it was used by Darwin to marshal evidence for the theory of natural selection. Neuroecology examines the relations between ecological selection pressures and species and sex differences in cognition and the brain. The goal of neuroecology is to understand how natural selection acts on cognition and its neural mechanisms. This chapter describes the general approach of neuroecology, phylogenetic comparative methods used in the field, and new findings on the cognitive mechanisms and brain structures involved in mating systems, social organization, communication, and foraging. The contribution of neuroecology to psychology and the neurosciences is the information it provides on the selective pressures that have influenced the evolution of cognition and brain structure. Expected online publication date for the Annual Review of Psychology Volume 57 is November 30, 2005. Please see for revised estimates.

Melatonin and sleep in aging population.
Pandi-Perumal SR, Zisapel N, Srinivasan V, Cardinali DP
Exp Gerontol 2005 Sep 22;.

The neurohormone melatonin is released from the pineal gland in close association with the light-dark cycle. There is a temporal relationship between the nocturnal rise in melatonin secretion and the 'opening of the sleep gate' at night. This association, as well as the sleep promoting effect of exogenous melatonin, implicates the pineal product in the physiological regulation of sleep. Aging is associated with a significant reduction in sleep continuity and quality. A decreased production of melatonin with age is documented in a majority of studies. Diminished nocturnal melatonin secretion with severe disturbances in sleep/wake rhythm has been consistently reported in Alzheimer's disease (AD). A recent survey on the effects of melatonin in sleep disturbances, including all age groups, failed to document significant and clinically meaningful effects of exogenous melatonin on sleep quality, efficiency and latency. However, in clinical trials involving elderly insomniacs and AD patients suffering from sleep disturbances exogenous melatonin has repeatedly been found to be effective in improving sleep. The results indicate that exogenous melatonin is more effective to promote sleep in the presence of a diminished production of endogenous melatonin. A MT(1)/MT(2) receptor analog of melatonin (ramelteon) has recently been introduced as a new type of hypnotics with no evidence of abuse or dependence.

Sexual function and pelvic floor disorders.
Achtari C, Dwyer PL
Best Pract Res Clin Obstet Gynaecol 2005 Sep 23;.
Sexual wellbeing is an important aspect of women's health. Female sexual dysfunction is multifactorial and involves physical, social and psychological dimensions. Dysfunction may result from lack of sexual desire, sexual pain or arousal, and orgasmic problems. Sexual dysfunction is common and increases with age and pelvic floor disorders such as urinary incontinence and pelvic organ prolapse. Surgical treatment of pelvic floor disorders has been poorly studied but has the potential to improve sexual satisfaction or to cause sexual difficulties. New instruments such as condition-specific sexual questionnaires have recently been developed and will help us to better evaluate the results of incontinence and prolapse surgery on sexual function.

Sexual dysfunction: treat or refer.
Sarrel PM
Obstet Gynecol 2005 Oct;106(4):834-9.

Sexual dysfunction is common in postmenopausal women, but because this problem may be caused by several factors, the primary need for these patients is an initial assessment and accurate diagnosis by the primary care provider. Listening to the patient and clarifying her concerns are important for defining the nature of the problem, its severity and duration, and her motivation for treatment. A complete physical evaluation, including a pelvic examination and measurement of postmenopausal hormone levels, may provide important information for structuring a treatment plan to address the patient's concerns. Providing postmenopausal women with reassuring reading materials and focusing on their specific concerns about sexual dysfunction will help reduce anxiety, as will physician suggestions keyed to the patient's individual needs. Alleviation of some menopause-related sexual function difficulties with prescription medications may be warranted, and referral to a specialist for further treatment and counseling may often be the best course of action for a primary care provider. Sexual problems in postmenopausal women are usually amenable to fairly simple interventions that are within the competence of primary care professionals. This paper provides the primary care provider with a perspective on the appropriateness of treatment compared with referral for women experiencing postmenopausal sexual dysfunction.

Family Violence.
Tolan P, Gorman-Smith D, Henry D
Annu Rev Psychol 2005 Aug 31;.

Family violence occurs in many forms; the most prominent are domestic violence, child abuse, and elder abuse. Family violence affects many persons at some point in their life and constitutes the majority of violent acts in our society. Although there has been considerable study of the patterns, risk factors, and interventions for each form of family violence, great controversy still exists within each area. There is growing recognition of an overlap in the patterns, causes, and effective interventions across types of family violence. There is also an increasing awareness of the value of greater integration of theory and research across areas into a family violence approach through an ecological perspective. This review focuses on current knowledge related to these problems and suggests integrative steps to advance knowledge. Expected online publication date for the Annual Review of Psychology Volume 57 is November 30, 2005. Please see for revised estimates.

Are reports of childhood abuse related to the experience of chronic pain in adulthood? A meta-analytic review of the literature.
Davis DA, Luecken LJ, Zautra AJ
Clin J Pain 2005 Sep-Oct;21(5):398-405.

BACKGROUND: Recent empirical evidence suggests that childhood abuse may be related to the experience of chronic pain in adulthood. To date, a systematic quantitative review of the literature has not been presented. OBJECTIVES: The purpose of this study was to use meta-analytic procedures to evaluate the strength of existing evidence of the association between self-reports of childhood abuse and the experience of chronic pain in adulthood. METHODS: Analyses were designed to test the relationship across several relevant criteria with 4 separate meta-analyses. RESULTS: Results of the analyses are as follows: 1) individuals who reported being abused or neglected in childhood also reported more pain symptoms and related conditions than those not abused or neglected in childhood; 2) patients with chronic pain were more likely to report having been abused or neglected in childhood than healthy controls; 3) patients with chronic pain were more likely to report having been abused or neglected in childhood than nonpatients with chronic pain identified from the community; and 4) individuals from the community reporting pain were more likely to report having been abused or neglected than individuals from the community not reporting pain. CONCLUSION: Results provide evidence that individuals who report abusive or neglectful childhood experiences are at increased risk of experiencing chronic pain in adulthood relative to individuals not reporting abuse or neglect in childhood.

Is self-reported childhood abuse history associated with pain perception among healthy young women and men?
Fillingim RB, Edwards RR
Clin J Pain 2005 Sep-Oct;21(5):387-97.

OBJECTIVE: A self-reported history of childhood physical and/or sexual abuse is frequently reported among chronic pain populations and has been associated with poorer adjustment to pain. In addition, self-reported abuse history has been related to increased pain complaints in population-based studies. One possible explanation for the association between abuse and clinical pain is that abuse victims may display enhanced sensitivity to painful stimuli, which increases the risk of developing clinical pain. However, the limited evidence addressing this issue has been mixed. The purpose of this study was to examine the association between self-reported history of childhood sexual or physical abuse and experimental pain responses in a nonclinical sample of generally healthy young adults. DESIGN: Participants were 110 (56 female, 54 male) college students who completed a series of questionnaires assessing abuse history, recent pain, health care utilization, perceived health, and psychologic variables. Also, measures of thermal and ischemic pain threshold and tolerance were obtained in all participants. In addition, a procedure assessing temporal summation of heat pain was conducted in which intensity and unpleasantness ratings of repetitive thermal stimuli were obtained. Systolic and diastolic blood pressure and heart rate were assessed at resting and during the ischemic pain task. RESULTS: Participants with a positive childhood abuse history were oversampled, yielding 21 out of 56 (37.5%) women with a positive history of abuse and 13 out of 54 (24.1%) PHA men. No abuse group differences emerged for thermal or ischemic pain thresholds or tolerances (P values>0.05). However, compared to women with no childhood abuse history, women with a positive history of abuse provided significantly lower average pain unpleasantness and peak pain unpleasantness ratings and lower unpleasantness ratings of the first trial during the temporal summation procedure, whereas no abuse group differences emerged for men. Also, compared to participants with no childhood abuse history, participants of both genders with a positive history of abuse demonstrated smaller increases (ie, less temporal summation) in pain unpleasantness ratings across trials of thermal stimulation, and participants with a positive history of abuse showed greater decreases in pain intensity and unpleasantness after reaching their peak pain level (ie, greater wind-down) compared to participants with no childhood abuse history. In addition, participants with a positive history of abuse reported more sites of recent pain, poorer perceived health, greater somatization, and more negative affect. No group differences in resting cardiovascular measures or cardiovascular reactivity were observed. CONCLUSION: These findings indicate that a self-reported history of childhood abuse is associated with decreased sensitivity to experimentally induced pain, especially among women. However, abuse history was associated with increased pain complaints, poorer self-reported health, and greater negative affect. These data highlight the complexity of the relationship between abuse history and pain and illustrate the need for further investigation of potential pain-related correlates of abuse.

Sexual and physical abuse in women with fibromyalgia syndrome: a test of the trauma hypothesis.
Ciccone DS, Elliott DK, Chandler HK, Nayak S, Raphael KG
Clin J Pain 2005 Sep-Oct;21(5):378-86.

OBJECTIVES: According to the trauma hypothesis, women with fibromyalgia syndrome (FMS) are more likely to report a history of sexual and/or physical abuse than women without FMS. In this study, we rely on a community sample to test this hypothesis and the related prediction that women with FMS are more likely to have posttraumatic stress disorder than women without FMS. METHODS: Eligibility for the present study was limited to an existing community sample in which FMS and major depressive disorder were prevalent. The unique composition of the original sample allowed us to recruit women with and without FMS from the community. A total of 52 female participants were enrolled in the present FMS group and 53 in the control (no FMS) group. Sexual and physical abuse were assessed retrospectively using a standardized telephone interview. RESULTS: Except for rape, sexual and physical abuse were reported equally often by women in the FMS and control groups. Women who reported rape were 3.1 times more likely to have FMS than women who did not report rape (P<0.05). There was no evidence of increased childhood abuse in the FMS group. Women with FMS were more likely to have posttraumatic stress disorder symptoms (intrusive thoughts and arousal) as well as posttraumatic stress disorder diagnosis (P<0.01). DISCUSSION: With the exception of rape, no self-reported sexual or physical abuse event was associated with FMS in this community sample. In accord with the trauma hypothesis, however, posttraumatic stress disorder was more prevalent in the FMS group. Chronic stress in the form of posttraumatic stress disorder but not major depressive disorder may mediate the relationship between rape and FMS.

Documented and self-reported child abuse and adult pain in a community sample.
Brown J, Berenson K, Cohen P
Clin J Pain 2005 Sep-Oct;21(5):374-7.

OBJECTIVES: To examine the association of chronic pain in young adults with childhood exposure to maltreatment and to determine whether depressive symptoms mediate such an association. DESIGN: A total of 649 members of a randomly selected cohort of young adults from a multiwave, multi-informant epidemiological study were interviewed with regard to chronic pain and symptoms of major depressive disorder. Maltreatment was measured both by retrospective self-report and by official records of substantiated child maltreatment. OUTCOME MEASURES: Current complaints of frequent pain and functionally impairing chronic pain were assessed in young adult interviews at mean age 22. RESULTS: Net of demographic factors, adult chronic pain was associated with self-reported sexual abuse. This association persisted after the contribution of concurrent depression was statistically controlled. Elevations of pain attributable to documented maltreatment were comparatively modest and below the threshold of statistical significance. Pain complaints in participants who self-reported physical abuse were not significantly elevated. CONCLUSIONS: Overall, results show an association between self-reported sexual abuse history and adult pain complaints in this general population sample, which was not attributable to symptoms of depression at the time of such reports.

Prognosis of depression in old age compared to middle age: a systematic review of comparative studies.
Mitchell AJ, Subramaniam H
Am J Psychiatry 2005 Sep;162(9):1588-601.

OBJECTIVE: Depression in old age has a poor long-term prognosis; equal evidence shows that the same is true of depression in middle age. The authors sought to identify research that has compared the prognosis of depression in late life with depression in midlife under similar conditions. METHOD: The authors separated studies that examined age at presentation/recruitment from studies of age at first episode of depression, studies that examined remission/response from those that examined relapse/recurrence, and those that examined mortality/risk of dementia. RESULTS: Evidence suggests that response and remission rates to pharmacotherapy and ECT are not sufficiently different in old-age depression and middle-age depression to be clinically significant. Older patients at study entry appear to have a higher risk of further episodes, which informs the debate about the duration of continuation treatment for depression in older people. However, older patients and patients with late-onset depression are at increased risk of medical comorbidity. Medical comorbidity is a risk factor for inferior treatment response and poor antidepressant tolerability. Elderly patients with early-onset depression are more likely to have had a higher number of previous episodes, which also adversely influences prognosis compared to elderly depressed patients with late onset of illness. CONCLUSIONS: With control for confounding variables, remission rates of depression in patients in late life are little different from those in midlife, but relapse rates appear higher. Findings underline the importance of assessing factors related to patient age and not just to age itself in evaluations of risk factors for poor prognosis.

The Assessment of Sexual Functions in Women With Male Partners Complaining of Erectile Dysfunction: Does Treatment of Male Sexual Dysfunction Improve Female Partner's Sexual Functions?
Seftel AD
J Urol 2005 Oct;174(4 Pt 1):1364.

The metabolic syndrome: a cause of sexual dysfunction in women.
Seftel AD
J Urol 2005 Oct;174(4 Pt 1):1364-5.

Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?
Masood S, Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK
Urol Int 2005;75(1):62-6.

OBJECTIVES: Currently no consensus exists about the role of the foreskin or the effect circumcision has on penile sensitivity and overall sexual satisfaction. Our study assesses the effect of circumcision on sexually active men and the relative impact this may have on informed consent prior to surgery. MATERIALS AND METHODS: One hundred and fifty men between the ages of 18 and 60 years were identified as being circumcised for benign disease between 1999 and 2002. Patients with erectile dysfunction were excluded from the study. The data was assessed using the abridged, 5-item version of the International Index of Erectile Function (IIEF-5). Questions were also asked about libido, penile sensitivity, premature ejaculation, pain during intercourse and appearance before and after circumcision. IIEF-5 data was analysed using two-tailed paired t test to compare pre-operative and post-operative score changes across the study group. For the rest of the questions, data was analysed using 'Sign Test', calculating two-sided p values and 95% confidence intervals. RESULTS: Fifty-nine percent of patients (88/150) responded. The total mean IIEF-5 score was 22.41 +/- 0.94 and 21.13 +/- 3.17 before and after circumcision, respectively (p = 0.4). Seventy-four percent of patients had no change in their libido levels, 69% noticed less pain during intercourse (p < 0.05), and 44% of the patients (p = 0.04) and 38% of the partners (p = 0.02) thought the penis appearance improved after circumcision. Penile sensation improved after circumcision in 38% (p = 0.01) but got worse in 18%, with the remainder having no change. Overall satisfaction was 61%. CONCLUSIONS: Penile sensitivity had variable outcomes after circumcision. The poor outcome of circumcision considered by overall satisfaction rates suggests that when we circumcise men, these outcome data should be discussed during the informed consent process.

Dating violence in college women: associated physical injury, healthcare usage, and mental health symptoms.
Amar AF, Gennaro S
Nurs Res 2005 Jul-Aug;54(4):235-42.

BACKGROUND: College-aged women report experiencing violence from a partner within the dating experience. OBJECTIVES: This study used a correlational design, to report physical injury, mental health symptoms, and healthcare associated with violence in the dating experiences of college women. METHODS: A convenience sample of 863 college women between 18 and 25 years of age from a private, historically Black university in the South, and a private college in the mid-Atlantic completed the Abuse Assessment Screen, a physical injury checklist, and the Symptom Checklist-R-90. Data analysis consisted of frequencies, ANOVA, and MANOVA. RESULTS: Almost half (48%) (n = 412) reported violence and, of these, 39% (n = 160) reported more than one form of violence. The most commonly reported injuries were scratches, bruises, welts, black eyes, swelling, or busted lip; and sore muscles, sprains, or pulls. Victims had significantly higher scores on depression, anxiety, somatization, interpersonal sensitivity, hostility, and global severity index than nonvictims. Victims of multiple forms of violence had significantly higher mental health scores and reported greater numbers of injuries than victims of a single form of violence. Less than half of those injured sought healthcare for injuries and less than 3% saw a mental health professional. DISCUSSION: Study findings suggest the importance of screening and identification of victims of violence. Knowledge of physical and mental health effects of violence can guide intervention, prevention, and health promotion strategies. Future research is needed to describe barriers to seeking healthcare, screening practices of college health programs, and programs to identify victims.

A study of finger lengths, semen quality and sex hormones in 360 young men from the general Danish population.
Bang AK, Carlsen E, Holm M, Petersen JH, Skakkebaek NE, Jorgensen N
Hum Reprod 2005 Jul 8;.

BACKGROUND: It has been suggested that finger length may correlate with function or disorders of the male reproductive system. This is based on the HOXA and HOXD genes' common embryological control of finger development and differentiation of the genital bud. The objective of this study was to explore the association between the ratio of 2nd to 4th finger length (2D:4D ratio) and testis function in a sample of young Danish men from the general population. METHODS: Semen samples and finger measurements were obtained from a total of 360 young Danish men in addition to blood samples for sex hormone analysis to describe the possible association between 2D:4D and semen and sex-hormone parameters. RESULTS: A statistically significant inverse association with the 2D:4D was found only in relation to hormone levels of FSH in the group of young men with a 2D:4D > 1 (P = 0.036) and a direct association with the total sperm count in the group of young men with a 2D:4D </= 1 (P = 0.045). CONCLUSION: The statistically significant results may be 'false positives' (type I error) rather than representing true associations. This relatively large study of young, normal Danish men shows no reliable association between 2D:4D finger ratio and testicular function. Measurements of finger lengths do not have the power to predict the testicular function of adult men.

Personality factors as determinants of depression in postpartum women: a prospective 1-year follow-up study.
Verkerk GJ, Denollet J, Van Heck GL, Van Son MJ, Pop VJ
Psychosom Med 2005 Jul-Aug;67(4):632-7.

OBJECTIVE: Personality has been associated with clinical depression in general. However, few studies have investigated personality in relation to postpartum depression, and these studies reported inconclusive findings. Therefore, the present study focused on neuroticism and introversion in the prediction of postpartum depression. METHOD: In a population-based prospective study, women were screened during mid-pregnancy on standard risk factors for depression. In a group of randomly selected women (n = 277), neuroticism and introversion were measured at 32 weeks gestation. Clinical depression (Research Diagnostic Criteria) and depressive symptoms (Edinburgh Postnatal Depression Scale) were measured at 32 weeks gestation and at 3, 6, and 12 months postpartum. RESULTS: High neuroticism was associated with an increased risk of clinical depression and depressive symptoms during the postpartum period. The combination of high neuroticism and high introversion was the only independent predictor of clinical depression across the first year postpartum (odds ratios: 3.08, 4.64, and 6.83 at 3, 6, and 12 months postpartum, respectively, p < .05-.01), even when controlling for clinical depression during pregnancy. History of depression was the only other independent predictor during the early but not during the late postpartum. Inclusion of personality not only significantly improved the detection of women at increased depression risk but also the identification of women with an extremely low depression risk. CONCLUSIONS: Personality may be an important and stable determinant of postpartum depression. The combination of high neuroticism and high introversion considerably improved the risk estimates for clinical depression across the first year postpartum.

Prenatal stress alters cytokine levels in a manner that may endanger human pregnancy.
Coussons-Read ME, Okun ML, Schmitt MP, Giese S
Psychosom Med 2005 Jul-Aug;67(4):625-31.

OBJECTIVE: Recent data suggest that prenatal stress negatively affects pregnancy and infant outcome. Existing studies implicate dysregulation of the immune and endocrine systems in stress-related increases in premature labor and poor birth outcome, but no published studies have directly addressed the relationships among these variables during pregnancy. We sought to test the hypothesis that high levels of psychosocial stress and low levels of social support during pregnancy alter maternal cytokine profiles in a manner that contributes to poor birth outcomes. METHODS: Psychosocial stress and social support were measured in 24 women with overtly normal pregnancies once during each trimester of pregnancy. Levels of interleukin-10 (IL-10), IL-6, and tumor necrosis factor-alpha (TNF-alpha) were assessed concurrently with stress and support measurements. RESULTS: High social support was associated with low stress scores. Elevated stress scores were positively correlated with higher levels of the proinflammatory cytokines IL-6 and TNF-alpha, and with low levels of the antiinflammatory cytokine IL-10. CONCLUSIONS: These findings provide initial support for our hypothesis that stress-related neural immune interactions may contribute to pregnancy complications and poor outcome, but require further study to determine the mechanism and significance of these effects.

The relationships among risk recognition, autonomic and self-reported arousal, and posttraumatic stress symptomatology in acknowledged and unacknowledged victims of sexual assault.
Marx BP, Soler-Baillo JM
Psychosom Med 2005 Jul-Aug;67(4):618-24.

OBJECTIVE: This study examined differences among acknowledged sexual assault victims, unacknowledged sexual assault victims, and nonvictims in risk recognition and its psychophysiological correlates. METHODS: Acknowledged and unacknowledged victims of sexual assault and nonvictims (n = 97) listened to a hypothetical date rape interaction and were asked to indicate the point at which the man had become sexually inappropriate. Self-report and physiological measures of emotional responding and a measure of risk recognition were used to evaluate both between- and within-subjects' differences. RESULTS: Relative to nonvictims and acknowledged victims, unacknowledged victims of sexual assault took significantly longer to recognize risk. Acknowledged victims displayed decreased heart rate activity to a portion of the hypothetical interaction, but self-reported greater arousal in response to the interaction and greater posttraumatic stress arousal symptomatology relative to nonvictims only. Posttraumatic stress symptomatology was related to self-reported emotional reactivity and response latency. CONCLUSIONS: The findings suggest that acknowledged and unacknowledged victims exhibit specific autonomic and behavioral response patterns that may perpetuate the cycle of traumatization.

Effects of partner support on resting oxytocin, cortisol, norepinephrine, and blood pressure before and after warm partner contact.
Grewen KM, Girdler SS, Amico J, Light KC
Psychosom Med 2005 Jul-Aug;67(4):531-8.

OBJECTIVE: We examined whether the magnitude of plasma oxytocin (OT), norepinephrine (NE), cortisol, and blood pressure (BP) responses before and after a brief episode of warm contact (WC) with the spouse/partner may be related to the strength of perceived partner support. METHODS: Subjects were 38 cohabiting couples (38 men, 38 women) aged 20 to 49 years. All underwent 10 minutes of resting baseline alone, 10 minutes of WC together with their partner, and 10 minutes of postcontact rest alone. RESULTS: Greater partner support (based on self-report) was related to higher plasma oxytocin in men and women across the protocol before and after WC. In women, higher partner support was correlated with lower systolic blood pressure (SBP) during solitary rest after WC but not before. Also, higher OT in women was linked to lower BP at baseline and to lower NE at all 4 measurements. CONCLUSION: Greater partner support is linked to higher OT for both men and women; however, the importance of OT and its potentially cardioprotective effects on sympathetic activity and BP may be greater for women.

Psychological distress as a predictor of CHD events in men: the effect of persistence and components of risk.
Nicholson A, Fuhrer R, Marmot M
Psychosom Med 2005 Jul-Aug;67(4):522-30.

OBJECTIVE: This paper examines the role of psychological distress in the etiology of coronary heart disease (CHD), with particular reference to the persistence of distress symptoms, the contribution that undetected CHD at baseline makes to the observed associations and to the effect of separate components of psychological distress. METHOD: 5449 men in an occupational cohort (79% of the total), with at least two prior measurements of the General Health Questionnaire (GHQ-30), were followed for CHD events (including CHD death, nonfatal myocardial infarction (MI), and angina) for (mean) 6.8 years. Psychological distress was measured using the GHQ-30, and general/anxiety, depression and sleep subscales were created based on a principal components analysis. RESULTS: Psychological distress increased the risk of CHD events, with the risk highest in men with recent onset of distress. Age-adjusted hazard ratios were 1.48 (1.03-2.13) for persistent and 1.77 (1.13-2.78) for new distress. Angina events accounted for much of the observed associations. This increased risk was independent of conventional CHD risk factors, markers of underlying CHD, or measures of reporting bias, and it was related to anxiety items and sleep disturbance rather than depressive symptoms. CONCLUSIONS: Psychological distress increases the risk of a future diagnosis of angina in men. This risk is not accounted for by the presence of underlying CHD. These results highlight the importance of identifying both the role of underlying atherosclerosis in the pathway linking distress to heart disease and the timing of action of the components of psychological distress.

Depressive symptoms are associated with increased systemic vascular resistance to stress.
Matthews SC, Nelesen RA, Dimsdale JE
Psychosom Med 2005 Jul-Aug;67(4):509-13.

OBJECTIVE: The deleterious effects of major depressive disorder on cardiovascular (CV) functioning are well known. However, the etiologic mechanisms underlying this association are incompletely understood. In the current study, subjects with varying degrees of depressive symptoms performed a stress task while CV reactivity was measured. We hypothesized that high levels of depressive symptoms would be associated with altered CV reactivity. METHODS: Ninety-one healthy volunteer subjects performed reactivity testing while measures of impedance cardiography and autonomic nervous system function were obtained. Subjects completed the Center for Epidemiological Studies Depression Scale (CES-D) and were categorized into either the high depressive (i.e., CES-D > or =16) or low depressive (i.e., CES-D <16) symptoms group. RESULTS: Task performance was associated with increases in systemic vascular resistance (SVR) (p = .001), mean arterial pressure (p = .001), and heart rate (p = .005), and decreases in cardiac output (p = .001), heather index (p = .001), and stroke volume (p = .05). After controlling for screening mean arterial pressure, an interaction effect of stress by mood group on SVR (p = .01) was observed; subjects with high amounts of depressive symptoms manifested significantly greater SVR at baseline and in response to a stressor task than did subjects with low amounts of depressive symptoms. CONCLUSIONS: These results suggest a mechanism that may partially explain the increased CV morbidity associated with depressive symptoms. In future studies, it may be useful to examine if treatment of depressive symptoms alters CV reactivity.

Tadalafil-Associated Priapism.
King SH, Hallock M, Strote J, Wessells H
Urology 2005 Jul 26;.

A healthy 46-year-old man presented to the Emergency Department with a 36-hour history of persistent, painful erection after taking the cyclic guanylyl monophosphate-specific phosphodiesterase 5 inhibitor tadalafil. He had no other identified contributing factors for priapism. After confirmation of ischemic priapism and failure of bedside management in the Emergency Department, the patient underwent operative caverno-spongiosal shunting. Postoperatively, the erection initially rebounded but gradually receded with manual compression over 48 hours. At outpatient follow-up, the patient remained flaccid without erections. To our knowledge, this is the first report of tadalafil-associated priapism.

Colon motility during a panic attack.
Hyman PE, Cocjin J
Psychosom Med 2005 Jul-Aug;67(4):616-7.

OBJECTIVE: To document the temporal relationship between a panic attack and high amplitude propagating contractions. METHODS: Colon manometry was used to discriminate between functional defecation problems and colon neuromuscular disease. By chance, the patent developed a panic attack during the test session. RESULTS: Coincident with the panic attack, there was a continuous series of high amplitude propagating contractions. There were 15 high amplitude propagating contractions over 45 minutes, initially at a rate of 4 per 10 minutes, gradually slowing to 1.5 per 10 minutes. CONCLUSIONS: These data may explain the cause for gastrointestinal distress and diarrhea in some patients with panic attacks.

Does vaginal reconstructive surgery with or without vaginal hysterectomy or trachelectomy improve sexual well being? A prospective follow-up study.
Stoutjesdijk JA, Vierhout ME, Spruijt JW, Massolt ET
Int Urogynecol J Pelvic Floor Dysfunct 2005 Jul 16;.

Objective: To compare sexual well being in women with pelvic organ prolapse before and after vaginal reconstructive surgery. Methods: Sixty-seven women, mean age 61 (36-85) years, who underwent vaginal reconstructive surgery, were asked to complete detailed questionnaires before and after surgery. In addition, they underwent a physical examination using the Pelvic Organ Prolapse Quantification (POPQ), before surgery and at follow-up. Results: Mean duration of follow-up was 14.4 months (6.6-27.6 months). The overall satisfaction with the operation was high with a mean of 7.5 on a visual analogue scale from 0 to 10. There was a significant improvement of dyspareunia after vaginal reconstructive surgery. The ability to have intercourse, the satisfaction with intercourse as well as the frequency of intercourse also improved although not significantly. Urine loss during intercourse improved significantly. Conclusion: Vaginal reconstructive surgery for pelvic organ prolapse has a positive effect on the sexual well being of the afflicted women.

Sexual activity and lower urinary tract symptoms.
Moller LA, Lose G
Int Urogynecol J Pelvic Floor Dysfunct 2005 Jul 29;.

Lower urinary tract symptoms (LUTS) have a profound impact on women's physical, social, and sexual well being. The LUTS are likely to affect sexual activity. Conversely, sexual activity may affect the occurrence of LUTS. The aims of the study were to elucidate to which extent LUTS affect sexual function and to which extent sexual function affect LUTS in an unselected population of middle-aged women in 1 year. A questionnaire was sent to 4,000 unselected women aged 40-60 years. All 2,284 women (57.1%) who completed a baseline questionnaire and a similar questionnaire 1-year later were included. Data comprised age, occurrence of LUTS, hormonal status, and sexual activity. A multiple conditional logistic regression model was used to analyze the relationship between sexual activity and LUTS adjusted for age and hormonal status. At baseline and 1-year later, 49 women (2.2%) had no sexual intercourse, and 298 women (13.0%) either ceased or resumed sexual relationship. Compared to women having sexual relationship, a statistically significant three to sixfold higher prevalence of LUTS was observed in women with no sexual relationship. In women who ceased sexual relationship an increase, although not statistically significant, in the de novo occurrence of most LUTS was observed. In women who resumed sexual relationship an insignificantly decrease in LUTS was observed. In women whose sexual activity was unchanged no change in the occurrence of LUTS was observed. Our study confirms a close association between sexual activity and the occurrence of LUTS. A hypothesis that sexual inactivity may lead to LUTS and vice versa cannot be rejected.

Are There Psychosocial Differences in Diagnostic Subgroups of Children with Recurrent Abdominal Pain?
Robins PM, Glutting JJ, Shaffer S, Proujansky R, Mehta D
J Pediatr Gastroenterol Nutr 2005 Aug;41(2):216-220.

OBJECTIVES: To examine psychosocial differences in diagnostic subgroups of children with recurrent abdominal pain (RAP). METHODS: Children meeting Apley's 1975 definition of RAP were divided according to physician ratings into three subgroups, based on the Rome II diagnostic criteria of functional gastrointestinal disorders: functional dyspepsia (n = 17), irritable bowel syndrome (n = 18), and functional abdominal pain (n = 27). Groups were compared using measures of (a) child psychopathology, (b) parent psychopathology, and (c) child pain, somatization, and functional disability. RESULTS: Multivariate results from a discriminant function analysis demonstrated that children classified according to these criteria could not be differentiated with respect to parent reported child psychopathology or child pain, somatization, and functional disability. There were significant univariate differences, however, between groups on parental psychopathology (F = 4.39, P = 0.02); parents of children with functional dyspepsia reported greater parental psychopathology symptoms than the other two groups. CONCLUSIONS: This study provides a preliminary comparison of pain, somatization, functional impact, and psychopathology ratings in the Rome II diagnostic subclassifications of children with RAP. Further investigation utilizing larger sample sizes, pain measures specifying pain location, and parental modeling of somatic behavior is indicated to better understand potential similarities and differences between these subgroups.

The Treatment Satisfaction Scale: A Multidimensional Instrument for the Assessment of Treatment Satisfaction for Erectile Dysfunction Patients and Their Partners.
Dibenedetti DB, Gondek K, Sagnier PP, Kubin M, Marquis P, Keininger D, Fugl-Meyer AR
Eur Urol 2005 Jun 15;.

BACKGROUND: The development of the Treatment Satisfaction Scale (TSS) was previously reported (Kubin et al., 2004). OBJECTIVE: This article describes the psychometric validation process and psychometric properties (e.g., reliability, validity, and responsiveness) of TSS. METHODS: Initial patient and partner questionnaires were administered in a multi-national clinical trial. On the basis of exploratory analyses, iterative psychometric testing, and consideration of face validity and interpretability, the number of items was reduced, and six scales were constructed: "Satisfaction with Medication," "Ease with Erection," "Satisfaction with Erectile Function," "Pleasure from Sexual Activity," "Satisfaction with Orgasm," and either "Sexual Confidence" (for patients) or "Confidence in Completion" (for partners). RESULTS: Multi-item scales had good internal consistency reliability and concurrent validity with the IIEF. All patient scales and most partner scales were valid in relation to clinical criteria, and all tested scales were responsive to change over time. CONCLUSION: The TSS is brief, culturally valid, and the most comprehensive multidimensional measure of satisfaction with ED treatment for patients and their partners, and addresses some of the shortcomings of existing measures.

Lower Urinary Tract Symptoms in Patients with Erectile Dysfunction: Is There a Vascular Association?
El-Sakka AI
Eur Urol 2005 Jun 15;.

OBJECTIVE: To assess if there is an underlying vascular association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). MATERIALS AND METHODS: A total of 374 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. Assessments for penile vasculature using color Doppler ultrasonography and rigidometer were performed. All patients were also screened for LUTS using the International Prostate Symptoms Score. All patients underwent routine laboratory investigation, plus total testosterone and prolactin assessment. RESULTS: Mean age+/-SD was 54.4+/-8.9 years with an age range of 28-84 years. Eighty-five percent of the patients had organic causes of ED. Of the patients, 80.7% had different degrees of LUTS. There was a significant association between presence of LUTS and: arteriogenic and neurogenic causes of ED, poor response to intracorporeal injection, poor rigidity in the rigidometer, and low peak systolic velocity of the cavernosal arteries (p<0.05 for each). No significant association was found between presence of LUTS and increasing values of end diastolic velocity or decreasing values of resistive index of the cavernosal arteries (p>0.05 for each). There was a significant association between the higher degrees of LUTS and the decreasing values of peak systolic velocity (p<0.05). CONCLUSIONS: This study demonstrated that reduced peak systolic velocity of the cavernous artery does associate with LUTS in patients with erectile dysfunction. Further studies are warranted to address the underlying vascular mechanisms of ED in patients with LUTS.

Nerve Replacement Strategies for Cavernous Nerves.
May F, Vroemen M, Matiasek K, Henke J, Brill T, Lehmer A, Apprich M, Erhardt W, Schoeler S, Paul R, Blesch A, Hartung R, Gansbacher B, Weidner N
Eur Urol 2005 Jun 15;.

OBJECTIVE: This article reviews novel restorative therapies for cavernous nerves that may be used to replace resected cavernous nerves at the time of pelvic surgery. METHODS: A literature-based presentation (Medline search) on current nerve replacement strategies was conducted with emphasis on neurobiological factors contributing to the restoration of erectile function after cavernous nerve injuries. RESULTS: A promising alternative to autologous nerve grafts for extending the length of successful nerve regeneration are artificial nerve guides. The addition of neurotrophic factors, extracellular matrix components and Schwann cells has been shown to promote cavernous nerve regeneration. Neurotrophic factors can be incorporated in the scaffold or can be supplied by cells seeded into the stroma. The regenerative capacity of these cells can be further enhanced by genetic modification with neurotrophic factor encoding genes. CONCLUSIONS: Artificial nerve guides, especially biodegradable ones containing growth-promoting factors or cells, are a promising option for the repair of cavernous nerve lesions.

Liposomal Recombinant Human Superoxide Dismutase for the Treatment of Peyronie's Disease: A Randomized Placebo-Controlled Double-Blind Prospective Clinical Study.
Riedl CR, Sternig P, Galle G, Langmann F, Vcelar B, Vorauer K, Wagner A, Katinger H, Pfluger H
Eur Urol 2005 Jun 24;.

OBJECTIVE: To demonstrate the efficacy and safety of a topical gel containing liposomally encapsulated recombinant human Superoxide Dismutase (lrhSOD) in the treatment of painful Peyronie's Disease. The theoretical background is that lrhSOD, by scavenging of free oxygen radicals, might interrupt inflammatory cascades and thereby limit further disease progression. METHODS: In a placebo-controlled randomized clinical trial, 39 patients with Peyronie's Disease and significant pain symptoms were treated with lrhSOD or placebo for a 4 week period. At this time, statistical evaluation of pain resolution was performed as primary study endpoint. Patients then were continued in a cross-over study design to ensure a total of 8 weeks of lrhSOD therapy for all study participants. Pain, plaque and curvature assessment was performed at study entry and every 4 weeks until week 12. RESULTS: LrhSOD treatment resulted in a statistically significant reduction of pain (p=0.017) compared to placebo already after 4 weeks. At week 12 pain was significantly reduced in 89% of patients who all had received 8 weeks of lrhSOD therapy at that time. Response to other disease parameters was assessed at week 12: plaque size was reduced in 47% of patients, as was plaque consistence in 38%. Penile curvature was improved at 5-30 degrees in 23% of patients. The expected spontaneous disease progression rate of up to 40%, as reported by several investigators, was significantly reduced to <10% under lrhSOD therapy, and patients satisfaction was high, also consequent to the lack of therapy-related side effects observed in the present study. CONCLUSION: LrhSOD is an easily administrable, safe and effective local therapeutic for the painful phase of Peyronie's Disease.

Dorsal Onlay Graft Urethroplasty Using Penile Skin or Buccal Mucosa for Repair of Bulbar Urethral Stricture: Results of a Prospective Single Center Study.
Raber M, Naspro R, Scapaticci E, Salonia A, Scattoni V, Mazzoccoli B, Guazzoni G, Rigatti P, Montorsi F
Eur Urol 2005 Jun 18;.

OBJECTIVE: To compare the outcomes of dorsal onlay graft urethroplasty using penile skin (PS) or buccal mucosa (BM) free grafts in the repair of adult bulbourethral strictures. METHODS: From January 1998 to March 2003, 30 patients with bulbar urethral strictures underwent urethral reconstruction with PS (17) or with BM free graft (13). Follow-up was done at 6, 12 and 18 months postoperatively, and every year subsequently. Success was defined as normalization of IPSS and a stable Q(max) value >20ml/s. Any further instrumentation for stricture recurrence was considered a failure. RESULTS: Mean follow-up was 51 months (20-74). The overall success rate was 80% (85% in the BM and 76% in the PS group). Improvement of uroflowmetry, IPSS and QoL did not show a significant difference between the two groups. A significant improvement of the orgasmic function domain of the IIEF was found in patients treated with a PS graft. Post-operative complications were lip hypoesthesia (30%), retraction of the ventral skin of the penis (7%), post-voiding dribbling (8% with BM graft, and 7%, with PS graft). Six patients, 2 with BM (15%) and 4 with PS graft patch (24%) required further treatment due to stricture recurrence. CONCLUSION: Results of PS or BM graft are comparable at 18 month follow-up, although orgasmic function is significantly improved in patients receiving a PS graft. Nevertheless, with extended follow-up, the use of PS seems to be associated with a higher failure rate.

Gastrointestinal Symptoms in Spinal Cord Injury: Relationships With Level of Injury and Psychologic Factors.
Ng C, Prott G, Rutkowski S, Li Y, Hansen R, Kellow J, Malcolm A
Dis Colon Rectum 2005 Jun 16;.

INTRODUCTION: Previous surveys of gastrointestinal symptoms after spinal cord injury have not used validated questionnaires and have not focused on the full spectrum of such symptoms and their relationship to factors, such as level of spinal cord injury and psychologic dysfunction. This study was designed to detail the spectrum and prevalence of gastrointestinal symptoms in spinal cord injury and to determine clinical and psychologic factors associated with such symptoms. METHODS: Established spinal cord injury patients (>12 months) randomly selected from a spinal cord injury database completed the following three questionnaires: 1) Rome II Integrative Questionnaire, 2) Hospital Anxiety and Depression Scale, and 3) Burwood Bowel Dysfunction after spinal cord injury. RESULTS: A total of 110 patients participated. The prevalence of abdominal bloating and constipation were 22 and 46 percent, respectively. Bloating was associated with cervical (odds ratio = 9.5) and lumbar (odds ratio = 12.1) level but not with thoracic level of injury. Constipation was associated with a higher level of injury (cervical odds ratio = 5.6 vs. lumbar) but not with psychologic factors. In contrast, abdominal pain (33 percent) and fecal incontinence (41 percent) were associated with higher levels of anxiety (odds ratio = 6.8, and odds ratio = 2.4) but not with the level of injury. CONCLUSIONS: There is a high prevalence and wide spectrum of gastrointestinal symptoms in spinal cord injury. Abdominal bloating and constipation are primarily related to specific spinal cord levels of injury, whereas abdominal pain and fecal incontinence are primarily associated with higher levels of anxiety. Based on our findings, further physiologic and psychologic research studies in spinal cord injury patients should lead to more rational management strategies for the common gastrointestinal symptoms in spinal cord injury.

Sildenafil non-responders: haemodynamic and morphometric studies.
Wespes E, Rammal A, Garbar C
Eur Urol 2005 Jul;48(1):136-9. Epub 2005 Apr 11.

OBJECTIVES: Most of the available data on efficacy for sildenafil are based on a questionnaire and erectile dysfunction (ED) is classified with minor or severe organic factors. To better select sildenafil responders and non-responders, we have conducted a haemodynamic and morphometric study in sildenafil non-responders. METHODS: Thirty patients with ED aged from 28 to 74 years-old did not respond to 8 attempts of 100mg of sildenafil. They underwent hormonal measurements, intracavernous injection (ICI 20mug PgE(1)) followed by Doppler examination and cavernosometry. A penile biopsy was performed under local anesthesia. A quantification of the cavernous smooth muscle (SMC) was performed with a computerized image analysis after staining with actin anti-actin. RESULTS: Twenty-eight patients had a very poor ICI response. Five patients were diabetic and 2 had low testosterone level. Eight patients had arterial lesions, 15 had venous leak and 5 both lesions. They all had reduction of SMC (<35%). No biological and vascular abnormality was observed in two patients. They had a percentage of SMC of 38% and 42%. No complication was observed with the penile biopsy. CONCLUSIONS: Severe vascular lesions and atrophy of SMC are mainly observed in sildenafil non-responders. The age, diabetes and low testosterone level seem not to be related with the failures.

The Surgical Treatment of Peyronie's Disease: Replacement of Plaque by Free Autograft of Buccal Mucosa.
Shioshvili TJ, Kakonashvili AP
Eur Urol 2005 Jul;48(1):129-35. Epub 2005 Feb 9.

OBJECTIVES: The aim of this work was the evaluation of clinical results of the use of buccal mucosa for replacement of Peyronie's disease plaque. PATIENTS AND METHODS: Twenty-six patients with Peyronie's disease were under observation. All the patients underwent the following investigations before and periodically within 3 years after the treatment: International Index of Erectile Function (IIEF-5), manual examination of plaque, autophotography of erect penis, conventional and power color Doppler sonography of penis, Peno-Brachial Index (PBI) before and its increase (IPBI) after the intracavernous injection of papaverin, Peak Systolic Velocity (PSV), end diastolic velocity (EDV), Resistance Index (RI), Sexual Encounter Profile questions (SEP-2 and SEP-3), measurements of penile length and curvature angle in the phase of rigidity. After stabilization in plaque's development (mean time 2.0+/-0.1 years) the patients underwent a surgery by means of excision of plaque and its replacement by free autograft of buccal mucosa. RESULTS: After the surgical treatment (with mean follow up observation of 3.2+/-0.1 years) in 24 patients out of 26 (92.3%) the complete straightening of penis occurred, in two (7.7%) cases a residual curvature (<10 degrees ) remained, in four patients (15.4%) the shortening of penis (by 1cm) and in two patients (7.7%) a partial reduction of erectile power were observed. CONCLUSION: Buccal mucosa showed high properties of adaptation and revascularization, good anatomical and functional clinical results by replacement of indurative plaque, it kept a stable elasticity without shrinkage; the method is simple and can be recommended for wide use in clinics for surgical treatment of Peyronie's disease.

The First Human Trial for Gene Transfer Therapy for the Treatment of Erectile Dysfunction: Preliminary Results.
Melman A, Bar-Chama N, McCullough A, Davies K, Christ G
Eur Urol 2005 Jun 15;.

OBJECTIVE: To test the safety of a single intracavernous injection of a plasmid vector (hMaxi-K) that expresses the hSlo gene, that encodes the alpha-subunit of the Maxi-K channel, for the treatment of erectile dysfunction (ED). METHODS: Six men, thus far have fulfilled the entry criteria of the protocol and had gene transfer with hMaxi-K. Three received a dose of 500mug and three received a dose 1000mug of the gene product, injected intracavernously as naked DNA. Dosing at 5000mug and higher is planned. RESULTS: The primary end point of the phase I trial is safety. No drug-related adverse events or significant laboratory changes have occurred after the gene transfer. Moreover, there is no evidence of the gene in semen at the one copy per mug total DNA in any of the participants. CONCLUSION: Preliminary results indicate that, in a single dose escalation study, ion channel gene transfer with hMaxi-K can be administered safely to men with ED without adverse events.

Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied.
Spyropoulos E, Christoforidis C, Borousas D, Mavrikos S, Bourounis M, Athanasiadis S
Eur Urol 2005 Jul;48(1):121-8. Epub 2005 Mar 16.

OBJECTIVES: To report on the efficacy and safety of augmentation phalloplasty procedures in physically normal young men, to introduce a patient selection and outcome evaluation questionnaire as well as, to propose a surgical technique modification. METHODS: Eleven (11) out of 28 psychosomatically normal men (25-35 years) who presented complaining of penile dysmorphophobia (subjective perception of small penis), were subjected to: (a) penile lengthening (suprapubic skin advancement - ligamentolysis): n=5, (b) penile lengthening and shaft thickening (free dermal-fat graft shaft coverage): n=3 and (c) panniculectomy - suprapubic lipectomy and penile lengthening: n=2. A self administered questionnaire was employed in order to facilitate selection of the patients qualifying for the operation as well as to evaluate the outcome. In addition, a technical modification regarding dermal-fat graft handling was applied. RESULTS: The postoperative course was uneventful with minor complications. The mean penile length gain (flaccid - stretched penis) was 1.6cm (1-2.3cm) [p=0.0014], the mean circumference gain was 2.3cm [p=0.003] at the base and 2.6cm [p=0.0012] subcoronaly. Significant (20%-53%) [p<0.0001] sexual self-esteem and functioning improvement was reported by the majority (91%) of patients. CONCLUSIONS: Although penile size alteration was not spectacular or satisfying the patients' "great" expectations, the substantially uneventful clinical course coupled with the significant improvement in sexual self-esteem and function and the highly accepted outcome by the patients, render augmentation phalloplasty reasonable treatment modality for the management of strictly selected and thoroughly informed young adults who suffer from penile dysmorphophobia.

Transverse Retubularized Ileal Vaginoplasty: A New Application of the Monti Principle-Preliminary Report.
Trombetta C, Liguori G, Siracusano S, Bortul M, Belgrano E
Eur Urol 2005 Jun 25;.

OBJECTIVE: The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. Herein we present our successful experience with vaginal reconstruction by the use of a modified ileal segment according to the Monti principle. METHODS: Six patients aged from 23 to 41 years (mean 33 years) were referred to our institution for vaginal stenosis. In our series, ileum has been used to create the neovagina: the isolated segment has been longitudinally detubularized and transversally retubularized in order to configure the roof of the neovagina. RESULTS: The mean operating time was 220min. No intra-operative complication occurred. The mean follow-up of this series was 16 months. At the latest follow-up, all patients had patent moist neovaginas, but excessive vaginal mucous was not a problem in any patient in our series. CONCLUSIONS: Neovaginal creation using isolated ileal segments according to the Monti channel principle provide excellent tissue for vaginal replacement, providing excellent patient satisfaction and relatively low morbidity. Cosmetic, functional and anatomical results were encouraging. In our opinion our technique may be indicated for all cases of vaginal absence: congenital abnormalities in the pediatric population, vaginal stenosis after treatment of pelvic tumors, severe vaginal scarring secondary to chronic inflammatory disease or in case of secondary correction after failure gender surgery.

Proposals or Findings for a New Approach about How to Define and Diagnose Premature Ejaculation.
Wang W, Kumar P, Minhas S, Ralph D
Eur Urol 2005 Jun 17;.

PURPOSE: To review and present the proposals or findings for a new approach about how to define and diagnose premature ejaculation (PE). MATERIALS AND METHODS: Using Medline to search for international peer reviewed manuscripts published from 1996 to 2004 about the definition and diagnosis of PE. RESULTS: PE, to date, has not a universally agreed definition and diagnostic criterion. Many definitions are partial, subjective and nonspecific. An ideal definition or diagnostic criterion should consist of intravaginal ejaculatory latency time (IELT), the ability to control over ejaculation, the extent of male sexual satisfaction, the extent of female sexual satisfaction, the frequency of female sexual partner reaching orgasm and the extent of psychological and pathological factors. Therefore, the Chinese Index of Premature Ejaculation (CIPE) seems an ideal tool and criterion used to diagnose PE due to including all the elements above. In the majority of cases, PE is the result of a mix of psychogenic, physiological and organic factors. So, besides some routine tests such as urine routine test, endocrine hormone assay, psychosexual counseling, couple evaluation and physical examination, prostate examination, serum leptin assay, semen magnesium assessment and glans hypersensitivity measurement, are suggested to be performed in the diagnosis of PE. Although elucidated by two clinical trials and further confirmed, serum leptin assay seems a promising and objective marker to diagnose PE because it is related to the serotonergic system whose disorder has been confirmed to contribute to the etiology of PE. CONCLUSION: None of these definitions and diagnoses has been accepted as a universal agreement of PE. CIPE seems an ideal tool and criterion used to diagnose PE and leptin maybe become a promising and objective marker for PE.

Twenty Years Experience with Semen Cryopreservation in Testicular Cancer Patients: Who Needs It?
Magelssen H, Haugen TB, von During V, Melve KK, Sandstad B, Fossa SD
Eur Urol 2005 Jun 14;.

PURPOSE: To evaluate the role of semen cryopreservation (SCP) in the fertility saving management of testicular cancer (TC) patients, treated at the Norwegian Radium Hospital between 1983 and 2002. PATIENTS AND METHODS: 422 of 1388 newly diagnosed TC patients had SCP All patients were followed up for post-treatment paternity. RESULTS: During the 20 years study period, by 2002 an increasing percentage of patients had pre-treatment SCP, reaching 43% after 1994. Twenty-nine (7%) of the 422 patients with SCP had used their frozen semen for assisted reproductive techniques (ART) at least once to achieve fatherhood. Pregnancies were achieved in 16 of these patients' partners, but two of these pregnancies ended in abortions. 67(17%) of 393 men with SCP fathered at least one child without use of frozen semen. The comparable figures for those without SCP were 205 out of 966(21%). Twenty years after orchiectomy the cumulative incidence of first post-treatment fatherhood was 47% for the 393 patients who had SCP but did not use it for ART, and 34% for the 966 patients without SCP (p=0.12). CONCLUSION: If offered, about 50% of the young and middle-aged patients newly diagnosed with TC are interested in pre-treatment SCP. Though our study reveals that a considerable number of TC patients referred to SCP, achieve fatherhood without the use of frozen semen, the psychological impact of pre-treatment cryopreservation is undeniable. Furthermore, for some TC survivors ART with cryopreserved sperm offers the only chance of post-treatment paternity.

Development and Validation of a Risk Score for Somatic Erectile Dysfunction: Combined Results from Three Cross-Sectional Surveys.
Hellmich M, Evers T, Kubin M, Merchant S, Lehmacher W, Engelmann U, Braun M
Eur Urol 2005 Jun 13;.

OBJECTIVES: Some men with erectile dysfunction (ED) have difficulties discussing their condition with their physicians. Existing screening and diagnostic tools for ED often require the administration of personal questions regarding the condition. We present a simple risk score to estimate the individual likelihood of somatic ED, based on age and existing health conditions. METHODS: Data from the Cologne Male Survey (n=4396) were used to develop a multivariable logistic regression model for the individual ED likelihood. The regression equation was both internally and externally validated using data from a national study (Berlin study) and a multinational cross-sectional study (MALES study). RESULTS: A final regression equation including age, pelvic surgery, diabetes mellitus, arterial circulatory disorder, heart disease, smoking, and hypertension reached an area under the receiver operating characteristic curve of 0.84 (0.5 means random and 1.0 perfect discrimination). Internal validation did not indicate any relevant overfit and the external validation results (national data: AUC=0.75; multinational data: AUC=0.67) are similar to those of other popular risk scores. CONCLUSIONS: The validated ED risk score developed from the regression equation can be used as a screening tool to identify patients who are at a high risk of somatic ED. This tool can facilitate entering into discussions between physicians and patients regarding erectile function.

Screening for HIV: a review of the evidence for the U.S. Preventive Services Task Force.
Chou R, Huffman LH, Fu R, Smits AK, Korthuis PT
Ann Intern Med 2005 Jul 5;143(1):55-73.

BACKGROUND: HIV infection affects 850,000 to 950,000 persons in the United States. The management and outcomes of HIV infection have changed substantially since the U.S. Preventive Services Task Force issued recommendations in 1996. PURPOSE: To synthesize the evidence on risks and benefits of screening for HIV infection. DATA SOURCES: MEDLINE, the Cochrane Library, reference lists, and experts. STUDY SELECTION: Studies of screening, risk factor assessment, accuracy of testing, follow-up testing, and efficacy of interventions. DATA EXTRACTION: Data on settings, patients, interventions, and outcomes were abstracted for included studies; quality was graded according to criteria developed by the Task Force. DATA SYNTHESIS: No trials directly link screening for HIV with clinical outcomes. Many HIV-infected persons in the United States currently receive diagnosis at advanced stages of disease, and almost all will progress to AIDS if untreated. Screening based on risk factors could identify persons at substantially higher risk but would miss a substantial proportion of those infected. Screening tests for HIV are extremely (>99%) accurate. Acceptance rates for screening and use of recommended interventions vary widely. Highly active antiretroviral therapy (HAART) substantially reduces the risk for clinical progression or death in patients with immunologically advanced disease. Along with other adverse events, HAART is associated with an increased risk for cardiovascular complications, although absolute rates are low after 3 to 4 years. LIMITATIONS: Data are insufficient to estimate the effects of screening and interventions on transmission rates or in patients with less immunologically advanced disease. Long-term data on adverse events associated with HAART are not yet available. CONCLUSIONS: Benefits of HIV screening appear to outweigh harms. The yield from screening higher-prevalence populations would be substantially higher than that from screening the general population.

Prenatal screening for HIV: A review of the evidence for the U.S. Preventive Services Task Force.
Chou R, Smits AK, Huffman LH, Fu R, Korthuis PT
Ann Intern Med 2005 Jul 5;143(1):38-54.

BACKGROUND: Each year in the United States, 6000 to 7000 women with HIV give birth. The management and outcomes of prenatal HIV infection have changed substantially since the U.S. Preventive Services Task Force issued recommendations in 1996. PURPOSE: To synthesize current evidence on risks and benefits of prenatal screening for HIV infection. DATA SOURCES: MEDLINE, the Cochrane Library, reference lists, and experts. STUDY SELECTION: Studies of screening, risk factor assessment, accuracy of testing, follow-up testing, and efficacy of interventions. DATA EXTRACTION: Data on settings, patients, interventions, and outcomes were abstracted for included studies; quality was graded according to criteria developed by the Task Force. DATA SYNTHESIS: No published studies directly link prenatal screening for HIV with clinical outcomes. In developed countries, the rate of mother-to-child transmission from untreated HIV-infected women is 14% to 25%. Targeted screening based on risk factors would miss a substantial proportion of infected women. "Opt-out" testing policies appear to increase uptake rates. Standard HIV testing is highly (>99%) sensitive and specific, and initial studies of rapid HIV tests found that both types of testing had similar accuracy. Rapid testing can facilitate timely interventions in persons testing positive. Recommended interventions (combination antiretroviral regimens, elective cesarean section in selected patients, and avoidance of breastfeeding) are associated with transmission rates of 1% to 2% and appear acceptable to pregnant women. LIMITATIONS: Long-term safety data for antiretroviral agents are not yet available. Data are insufficient to accurately estimate the benefits of screening on long-term maternal disease progression or other clinical outcomes, such as horizontal transmission. CONCLUSIONS: Identification and treatment of asymptomatic HIV infection in pregnant women can greatly decrease mother-to-child transmission rates.

The effect of total hysterectomy on specific sexual sensations.
Goetsch MF
Am J Obstet Gynecol 2005 Jun;192(6):1922-7.

OBJECTIVE: Assess whether women note a change in aspects of arousal because of removal of the uterus and cervix. STUDY DESIGN: Between 1990 and 1992, 105 women were asked to report on their sexual function before and at 3, 8, and 18 months after undergoing a total hysterectomy. Results were analyzed by chi 2 . RESULTS: Hysterectomies were abdominal or vaginal, and 42% of subjects had ovaries removed and initiated estrogen replacement. Ease of arousal diminished in 24% and improved in 11%. Intensity of orgasms decreased in 15% and increased in 14%. Effects of nipple stimulation were usually preserved. Sexual satisfaction increased significantly. Seven women noted distinctly worse sexual function. CONCLUSION: An indicated total hysterectomy will likely increase sexual satisfaction and not change the effect of breast stimulation. The few women with disturbingly reduced sexual sensation deserve assessment and treatment.

Circulating androgen levels and self-reported sexual function in women.
Davis SR, Davison SL, Donath S, Bell RJ
JAMA 2005 Jul 6;294(1):91-6.

CONTEXT: It has been proposed that low sexual desire and sexual dysfunction are associated with low blood testosterone levels in women. However, evidence to support this is lacking. OBJECTIVE: To determine whether women with low self-reported sexual desire and sexual satisfaction are more likely to have low serum androgen levels than women without self-reported low sexual desire and sexual satisfaction. DESIGN, SETTING, AND PARTICIPANTS: A community-based, cross-sectional study of 1423 women aged 18 to 75 years, who were randomly recruited via the electoral roll in Victoria, Australia, from April 2002 to August 2003. Women were excluded from the analysis if they took psychiatric medication, had abnormal thyroid function, documented polycystic ovarian syndrome, or were younger than 45 years and using oral contraception. MAIN OUTCOME MEASURES: Domain scores of the Profile of Female Sexual Function (PFSF) and serum levels of total and free testosterone, androstenedione, and dehydroepiandrosterone sulfate. RESULTS: A total of 1021 individuals were included in the final analysis. No clinically significant relationships between having a low score for any PFSF domain and having a low serum total or free testosterone or androstenedione level was demonstrated. A low domain score for sexual responsiveness for women aged 45 years or older was associated with higher odds of having a serum dehydroepiandrosterone sulfate level below the 10th percentile for this age group (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.54-9.81; P = .004). For women aged 18 to 44 years, having a low domain score for sexual desire (OR, 3.86; 95% CI, 1.27-11.67; P = .02), sexual arousal (OR, 6.39; 95% CI, 2.30-17.73; P<.001), and sexual responsiveness (OR, 6.59; 95% CI, 2.37-18.34; P<.001) was associated with having a dehydroepiandrosterone sulfate level below the 10th percentile. CONCLUSIONS: No single androgen level is predictive of low female sexual function, and the majority of women with low dehydroepiandrosterone sulfate levels did not have low sexual function.

[Erectile dysfunction: a sentinel symptom?]
Costa P, Grivel T, Giuliano F, Pinton P, Amar E, Lemaire A
Prog Urol 2005 Apr;15(2):203-7.

Erectile dysfunction (ED) is a frequent disorder affecting the man's sexual and relational quality of life. French epidemiological studies estimate that the prevalence of ED is between 11% and 44% and prevalence surveys show a correlation between ED and age: the relative risk of erectile dysfunction increases by a factor of 2 to 4 between the ages of 40 and 70 years. Few patients consult their doctor and only a small proportion of them receive treatment and few doctors take the initiative to discuss the question of their patients' sex life. Doctors should now have a good understanding of erectile dysfunction and must be aware of the importance of detecting or at least investigating any erectile dysfunction, which can be the first symptom of an underlying disease such as cardiovascular disease, diabetes, depression, benign prostatic hyperplasia, prostate cancer, androgen deficiency or a drug-induced effect. Demonstration of erectile disorders therefore represents an excellent opportunity to conduct a general work-up, as more than one-third of patients with ED ignore their underlying health problem and management of ED is therefore an integral part of preventive medicine.