Female sexual dysfunction in an outpatient andrology clinic—A therapeutic opportunity? / Disfunción sexual femenina en clínica de andrología. ¿Una oportunidad terapéutica?

Introduction: The sexual life of a couple is a dynamic entity, in which the two influence each other mutually, thus the existence of female sexual dysfunction (FSD) can influence the treatment of the man who seeks clinical help. Identify sexual dysfunction in female partners of patients attending an andrology clinic may provide a therapeutic opportunity. The authors aim to assess proportion of FSD in this population by comparison with a control group. Material and methods: A longitudinal study over 12 months timespan. The female partners of patients attending the andrology clinic participating in the study (study group – SG) completed the Female Sexual Function Index (FSFI), as did the women serving as controls (control group – CG). Further data such as age, duration and quality of the relationship and previous relationships was also collected. Results: Of the 30 women included in the SG, 14 (46.6%) considered that their current sex life was worse than in previous relationships. Of the 20 women in the CG, 60% considered that their current sex life was better. In the SG, 22 (73.3%) had FSD, with a mean score in the FSFI of 20.5, whereas only 3 women in the CG (15%) had FSD, with a mean score of 30.7 (p<0.01). Conclusions: Our study demonstrated that the proportion of FSD in female partners of patients attending an andrology clinic is significantly higher than control group. FSD treatment should be considered as a therapeutic opportunity for the couple in this setting. (AU)

Introducción: La vida sexual de una pareja es una entidad dinámica, en la que ambos se influyen mutuamente, por lo que la existencia de disfunción sexual femenina (DSF) puede influir en el tratamiento del hombre que busca ayuda clínica. Identificar la disfunción sexual en las parejas femeninas de los pacientes que asisten a una Clínica de Andrología puede brindar una oportunidad terapéutica. Los autores pretenden evaluar la proporción de DSF en esta población comparándola con un grupo de control. Material y métodos: Estudio longitudinal durante 12 meses. Las parejas femeninas de los pacientes que asistieron a la Clínica de Andrología y que participaron en el estudio (grupo de estudio) completaron el Índice de Función Sexual Femenina, de la misma forma que las mujeres, que sirvieron como control (grupo de control). También se recopilaron datos adicionales como edad, duración, calidad de la relación y las relaciones entre los anteriores. Resultados: De las 30 mujeres incluidas en el grupo de estudio, 14 (46,6%) consideraron que su vida sexual actual era peor que en relaciones anteriores. De las 20 mujeres del grupo control, el 60% consideró que su vida sexual actual era mejor. En el grupo de estudio, 22 (73,3%) tenían DSF, con una puntuación media de Índice de Función Sexual Femenina de 20,5, mientras que solo 3 mujeres en el grupo control (15%) tenían DSF, con una puntuación media de 30,7 (p <0,01). Conclusiones: Nuestro estudio demostró que la proporción de DSF en parejas femeninas de pacientes que acuden a una Clínica de Andrología es significativamente mayor que en el grupo control. El tratamiento de la disfunción sexual femenina debe considerarse como una oportunidad terapéutica para la pareja en este escenario. (AU)

Consensos em HPV Masculino da Sociedade Portuguesa de Andrologia, Medicina Sexual e Reprodução: Seguimento / Consensus on Male HPV from the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Follow-up

Os doentes com lesão genital por HPV, assim como os parceiros de doentes HPV positivo, apresentam normalmente um stress psicológico superior às reais consequências médicas da lesão. O seguimento desses doentes deve basear-se na educação e no aconselhamento. Os testes de tipagem molecular HPV não são recomendados como teste de seguimento, ou para rastreio dos parceiros. Aconselha-se o desenvolvimento e a implantação de protocolos próprios, por parte dos centros ou unidades que acompanhem esses doentes. (AU)

Patients with genital HPV lesion, as well as partners, usually present higher psychological stress, than the actual medical consequences of the lesion. Follow-up of these patients should be based on education and counseling. HPV molecular tests are not recommended as a follow-up test, or for screening partners. Development and implementation of protocols, by the centers or units, that follow these patients, are recommended. (AU)

Is there a relationship between infertility and fertilin β protein distribution? / ¿Existe relación entre la infertilidad y la distribución de la proteína fertilin β?

Introduction: Fertilin β is a sperm surface protein that can mediate sperm-egg membrane interaction. This study was conducted to determine whether the expression of fertilin β after intrauterine insemination (IUI) in donors with normal parameters after standard semen analysis is related to low success rate or failure of fertilization. Methods: We examined the sperm of 30 male donors who have normal as controls, oligozoospermia, and unexplained infertility as the clinically indication for IUI. Fertilin β has been labeled with the ADAM2 antibody by indirect immunofluorescence (IF) assay. To evaluate the reproducibility of the test, we selected four sperm samples scale of 0 to +++ according to the distribution of fluorescence label. Results: The results were highly correlated with the corrected total cell fluorescence (CTCF) (Rp=0.9972, P<0.05). We suggest that the relationship between infertility and fertilin β may be due to the distribution of this protein on the sperm surface. Male partners of couples with unexplained infertility showed a low distribution of fertilin β by a decrease of the fluorescence signal in the IF labeling (scale of +++ by 7.4±10.32%, P<0.0001, ±SD). Discussion: Abnormal fertilin β function may be a potential mechanism that could lead to fertilization failure. (AU)

Introducción: La fertilinβ es una proteína de la superficie del esperma que puede mediar entre la interacción del espermatozoide y la membrana del óvulo. Este estudio se realizó para determinar si la expresión de fertilinβ después de la inseminación intrauterina (IIU) en donantes con parámetros normales después del análisis estándar de semen está relacionada con una baja tasa de éxito o fracaso de la fertilización. Métodos: Examinamos los espermatozoides de 30 donantes masculinos que tenían controles normales, oligozoospermia e infertilidad inexplicable como indicación clínica de IIU. La fertilinβ ha sido etiquetada con el anticuerpo ADAM2 mediante un ensayo de inmunofluorescencia indirecta (IF). Para evaluar la reproducibilidad de la prueba, seleccionamos cuatro muestras de esperma en una escala de 0 a +++ según la distribución de la etiqueta de fluorescencia. Resultados: Los resultados estuvieron altamente correlacionados con la fluorescencia celular total corregida (Rp=0,9972, p<0,05). Sugerimos que la relación entre la infertilidad y la fertilinβ puede deberse a la distribución de esta proteína en la superficie del esperma. Los compañeros masculinos de parejas con infertilidad inexplicable mostraron una baja distribución de fertilinβ por una disminución de la señal de fluorescencia en el etiquetado IF (escala de +++ en 7,4 ±10,32%, p<0,0001, ±DE). Conclusión: La función anormal de la fertilinβ puede ser un mecanismo potencial que podría conducir al fracaso de la fertilización. (AU)

Importancia de la formación médico-quirúrgica andrológica para los residentes de Urología / The value of andrology medical-surgical training programs for Urology residents

Actualmente es necesaria una formación específica en Andrología dentro de la formación en Urología. Dicha formación, tanto en el programa MIR como una vez terminada la especialidad, debe ser dirigida y multidisciplinar. De hecho, el programa de formación andrológica del urólogo no termina con su periodo de residencia. Los avances en conocimientos relacionados con la infertilidad, la reproducción, la medicina sexual y la cirugía reconstructiva requieren un alto grado de dedicación y un esfuerzo permanente de formación continuada. El campo de la Andrología ha evolucionado significativamente tanto en Europa como en los Estados Unidos en los últimos 30 años. Aunque los programas de formación andrológica en estas 2regiones comparten algunos aspectos comunes, también existen diferencias sustanciales. Se revisan en este capítulo los modelos formativos en nuestro entorno internacional, así como el desarrollo habitual en España, para así entender la importancia de la formación médico-quirúrgica andrológica para los residentes de Urología

Nowadays, sub-specialty expertise in andrology is required within the Urology training program. These practices -during the MIR (Medical Intern Residency) program and once the specialty studies are over- should be performed under supervision and have a multidisciplinary nature. In fact, the urologist's andrology training program does not finish with his residency period. The unceasingly increasing knowledge related to infertility, reproduction, sexual medicine and reconstructive surgery require a high level of dedication and engagement with continuing education. The field of Andrology has evolved significantly in Europe and in the United States in the past 30 years. Although the andrology training programs in these 2 regions share some common aspects, there are also substantial differences between them. This chapter includes a review of the Spanish training programs and those in our international environment, with the objective to comprehend the importance of andrology medical-surgical training for Urology residents

Andrología y cáncer de pene. Recomendaciones durante la pandemia COVID-19 / Andrology and penile cancer. Recommendations during COVID-19 pandemia

INTRODUCCIÓN: La pandemia COVID-19 que ha afectado a España desde comienzos de 2020 obliga a definir unas recomendaciones para la práctica de la Andrología en la actualidad. MATERIAL Y MÉTODOS: Se realiza una búsqueda web en inglés y español y se define una propuesta conjunta por parte de expertos en Andrología de distintas regiones de España. RESULTADOS: La mayor parte de los procedimientos diagnósticos y terapéuticos en Andrología pueden ser demorados con seguridad durante la pandemia COVID-19. Se debe fomentar la consulta telemática y la cirugía ambulatoria. Las urgencias andrológicas y el manejo del cáncer de pene deben considerarse una prioridad alta, diagnosticándose y tratándose con brevedadi ncluso en las fases más severas de la pandemia

PURPOSE: The COVID-19 pandemic which has affected Spain since the beginning of 2020 compels us to determine recomendations for the practice of Andrology in present times. MATERIALS AND METHODS: A web search is carried out in English and Spanish and a joint proposal is defined by experts in Andrology from different regions of Spain. RESULTS: Most diagnostic and therapeutic procedures in Andrology can be safey postponed during the COVID-19 pandemic. Online consultations and outpatient surgeries must be encouraged. Andrologic emergencies and penile cancer management should be considered high priority, and should be diagnosed and treated promptly even in the most severe phases of the pandemic

Breve visión histórica de la reproducción desde una óptica andrológica / An historical overview of reproduction from an andrological perspective

No disponible

Recomendaciones para el mantenimiento de equipos en el Laboratorio de Andrología y Embriología. Segunda parte. Equipos auxiliares / Recommendations for the maintenance of equipment in the Andrology and Embryology Laboratory. Second part. Auxiliary equipment

Segundo de la serie de la Comisión de Andrología y Técnicas de Reproducción Asistida elaborada para facilitar el correcto mantenimiento, control y ajuste de los equipos que se utilizan en el Laboratorio de Andrología y Embriología. Se centra en los equipos auxiliares que dan soporte a los diferentes procesos de reproducción asistida. Incluye un programa de control para equipos de seguimiento y medición con frecuencias de revisión y criterios de aceptación

The second in the series of the Committee of Andrology and Techniques of Assisted Reproduction Committee, is prepared in order to carry out the correct maintenance, control and adjustment of the equipment used in the Andrology and Embryology laboratory. It focuses on the auxiliary equipment that supports the different processes of assisted reproduction. It includes a control program for monitoring and measuring equipment with revision frequencies and acceptance criteria

A referenciação para a consulta de andrologia - Quem e como são referenciados? / Andrology - Whom and how are patients being referred?

Introdução: A andrologia é uma área médica que estuda a sexualidade e a fertilidade no sexo masculino. A referenciação de utentes deve ser feita de forma criteriosa e adequada para assegurar o acesso a tratamentos diferenciados sempre que haja indicação. Objetivo: Caracterizar a referenciação específica para a consulta de andrologia no nosso centro hospitalar. Material e métodos: Avaliação retrospectiva da casuística da consulta de andrologia entre janeiro de 2014 e dezembro de 2015. Resultados: Consultaram‐se os registos clínicos de 96 das 102 consultas de primeira vez de andrologia. Cerca de 60% dos doentes foram referenciados por disfunção eréctil, 15% por curvatura peniana e 8% por disfunção ejaculatória. Apenas 27% dos doentes com disfunção eréctil já tinham efetuado prova terapêutica e 40% não tinham perfil metabólico recente. Discussão: A elevada prevalência de comorbilidades sexuais e a elevada prevalência de doentes naïve na população referenciada levam a ponderar se existe dificuldade entre os médicos referenciadores de categorizar e tratar a disfunção sexual masculina de acordo com o modelo tetrafásico da resposta sexual. A ausência de estratificação de doentes segundo os critérios de Princeton III demonstra a dificuldade na seleção de doentes que podem iniciar terapêuticas de primeira linha antes da referenciação. Conclusão: As disfunções sexuais têm uma elevada prevalência na população geral. Os cuidados de saúde necessitam de ter uma maior capacidade de intervenção diagnóstica e terapêutica

Introduction: Andrology focuses in male sexual and fertility diseases. Its referral should be thoughtful and tailored in order to select the correct cases. Objectives: The aim of this work was to evaluate the referral to our department and improvement points. Material and methods: A retrospective analysis was performed of the Andrology consults between January 2014 and December 2015. Results: We evaluated 96 of the 102 consults performed. About 60% of patients were referred with erectile dysfunction complaints, 15% with penile curvature and 8% with ejaculatory dysfunction. About 27% had previously tried phosphodiesterase 5 inhibitor, and 40% lacked recent metabolic workup. Discussion: The high prevalence of sexual complaints coupled with a high number of naïve patients could be due to difficulties by the referral doctors when analyzing and characterizing male sexual dysfunction according to the current sexual response cycle model. The lack of patient categorization accordingly to Princeton criteria (III) shows the difficulties found when selecting patients to start the first line of treatment for erectile dysfunction. Conclusion: Sexual dysfunction are highly prevalent in the general population. Healthcare providers should improve diagnostic and treatment skills in this field of Urology

Programa formativo en urología médica: perspectivas para el futuro / Training program on medical urology: Future perspectives

La Urología está definida como la especialidad médico-quirúrgica que engloba el estudio, diagnóstico y tratamiento de las afecciones médicas del aparato urinario. Queda bien especificado por la Comisión Nacional de Especialidades que debemos conocer la patología médica que nos compete. Sin embargo, en ocasiones, la formación de los residentes se centra en el ámbito quirúrgico y la patología oncológica, que, si bien es uno de los grandes pilares de la especialidad, suele ser en detrimento de la formación en patología médica y funcional. Hemos realizado una encuesta a residentes de cuarto año de Urología de España, en la que preguntamos sobre la calidad de la formación en Andrología y Urología Funcional. La media de tiempo de rotación es de 3,5 meses en cada unidad. Solo un 20% considera que su formación es satisfactoria y suficiente en Andrología. El 75% de los residentes encuestados considera que su formación en Urología Funcional es aceptable o suficiente, tanto a nivel médico como quirúrgico. Existen numerosos campos de actuación para la mejora de la formación de los residentes y jóvenes urólogos de este país en el manejo de la patología médica urológica. El futuro está abierto, y está en nuestra mano configurar una formación para los residentes de urología dentro de la excelencia y que sea reconocida tanto a nivel nacional como internacional como uno de los grandes pilares de la Urología española. En este capítulo analizaremos la situación actual en la formación de los Residentes de Urología españoles en la patología médica urológica, y nos vamos a centrar en la formación en urología funcional y andrología (AU)

Urology is defined as the medical-surgical specialty that includes the study, diagnosis and treatment of medical conditions of the urinary system. It is well specified by the National Commission of Specialties that we must know the medical pathology that concerns us. However, on occasions, resident training focuses on the surgical field and oncological pathology, which, although one of the main pillars of the specialty, is usually to the detriment of training in medical and functional pathology. We conducted a survey of residents in the fourth year of Urology in Spain, where we asked about the quality of training in Andrology and Functional Urology. The average rotation time is 3.5 months in each unit. Only 20% consider that their training is satisfactory and sufficient in Andrology. Seventy-five percent of residents surveyed believe that their training in Functional Urology is acceptable or sufficient, both medical and surgical. There are numerous fields of action to improve the training of residents and young urologists in this country in the management of urological medical pathology. The future is open, and it is in our hand to set up a training for urology residents within excellence and to be recognized both nationally and internationally as one of the great pillars of Spanish Urology. In this chapter we will analyze the current situation in the training of Spanish Urology Residents in urological medical pathology, and we will focus on training in functional urology and andrology (AU)

Determinantes psicossociais do funcionamento sexual e bem-estar sexual subjetivo em homens adultos portugueses / Psychosocial determinants of sexual functioning and subjective sexual well-being in portuguese adult men

Introdução. O funcionamento sexual e o bem-estar sexual subjetivo são dimensões humanas muito importantes que contribuem para a qualidade de vida dos homens; no entanto, não existe nenhum estudo que informe acerca de medidas normativas junto de homens portugueses. Objetivos. Avaliar os níveis de funcionamento sexual e bem-estar sexual subjetivo numa amostra de homens adultos portugueses, comparar diferenças entre grupos e determinar o grau de associação entre as 2 variáveis. Material e método. Participaram no estudo 603 homens adultos (média de idades=42,05 anos; desvio padrão=13,93) que preencheram um questionário sociodemográfico, o questionário de mudanças no funcionamento sexual e o questionário de avaliação do bem-estar sexual subjetivo, medidas estas que foram disseminadas através da internet. Resultados. Os resultados obtidos permitiram produzir uma tabela de dados normativos para o funcionamento sexual e bem-estar sexual subjetivo, tendo sido encontradas diferenças estatisticamente significativas na comparação entre grupos em função da idade, escolaridade, local de residência, existência de filhos, estado civil e ocupação profissional. Verificou-se também uma forte correlação entre as 2 dimensões. Discussão e conclusões. Esta investigação permite evidenciar a importância dos determinantes psicossociais na expressão da funcionalidade sexual e bem-estar sexual subjetivo, na medida em que os técnicos que trabalhem com homens nesta área deverão estar atentos ao modo como os contextos psicossociais interferem na expressão sexual (AU)

Introduction. Sexual functioning and subjective sexual well-being are very important human dimensions that contribute to the quality of life of men; however, there are no studies to report about normative measures for the Portuguese male population. Purpose. To assess the levels of sexual functioning and subjective well-being in a sample of Portuguese adult men comparing differences between groups and determine the degree of association between the two variables. Materials and Methods. Participants in the study were 603 adult men (mean age=42.05 years, standard deviation=13.93) who completed a sociodemographic questionnaire, the changes in sexual functioning questionnaire and the subjective sexual well-being questionnaire. These measures disseminated over the internet. Results. The results obtained allowed us to produce a table of normative data for sexual functioning and subjective sexual well-being, and statistically significant differences were found when comparing groups according to age, education, place of residence, number of children, marital status and their occupation. There was also a strong correlation between the two dimensions. Discussion and Conclusions. This research allows us to highlight the importance of psychosocial determinants in the expression of sexual function and subjective sexual well-being, to the extent that the health professionals who work with men in this area should be aware of how psychosocial contexts interfere with their sexual expression (AU)

Escalas de Valoración de Excitación Sexual y Valoración de Sensaciones Genitales: propiedades psicométricas en muestras españolas / Ratings of sexual arousal and ratings of genital sensations: psychometric properties in spanish sample

Objetivo. La excitación sexual subjetiva es la percepción de excitación a nivel psicológico, siendo el Multiple Indicators of Subjective Sexual Arousal (MISSA) uno de los escasos instrumentos para evaluarla de manera situacional. El objetivo es adaptar a población española y examinar las propiedades psicométricas de dos de las escalas del MISSA: Valoración de Excitación Sexual (VES) y Valoración de Sensaciones Genitales (VSG). Material y método. Se emplearon dos muestras independientes formadas por jóvenes heterosexuales de 18-30 años de edad. En la primera muestra (n=122) se examinó la estructura factorial de la escala VES, la cual se puso a prueba en una segunda muestra (n=336) en la que se examinó la invarianza por sexo. Además, en esta segunda muestra se buscaron evidencias de validez de ambas escalas. Los participantes de ambos estudios (N=458) contestaron las escalas VES y VSG en una situación experimental de laboratorio en la que eran expuestos a films de contenido neutro y contenido sexual explícito. Resultados. La versión española de la escala VES presenta una estructura unidimensional con una adecuada fiabilidad de consistencia interna (α=0,90). Dicha estructura es invariante en cuanto al sexo, no encontrándose diferencias entre hombres y mujeres. Tanto las puntuaciones de la escala VES como de la VSG correlacionaron con la predisposición a excitarse y con la erotofilia. Conclusiones. Las escalas VES y VSG son fiables y válidas para evaluar la excitación sexual subjetiva ante estímulos sexuales, constituyendo instrumentos adecuados para su uso, tanto en el ámbito clínico como en el de la investigación (AU)

Objective. Subjective sexual arousal is the psychological perception of arousal. The Multiple Indicators of Subjective Sexual Arousal (MISSA) is one of the limited self-reported measures to evaluate it in a specific situation. The aim is to adapt and examine the psychometric properties of two scales from the MISSA: Ratings of Sexual Arousal (RSA) and Ratings of Genital Sensations (RGS) in a Spanish sample. Material and method. The measures were administered to two independent samples composed by heterosexual young individuals aged from 18 to 30 years old. In the first sample (n=122) the factorial structure of the RSA was examined, which was later confirmed in a second sample (n=336) where invariance analysis by sex and validity evidences were also analyzed. Both, the RSA and the RGS, together with other scales measuring similar constructs, were answered by participants from both studies (N=458) in a laboratory setting in which individuals were exposed to films with neutral content and explicit sexual content. Results. The Spanish version of the RSA shows a unidimensional structure with adequate reliability (α=.90). This structure showed to be invariant by sex, thus no significant differences were found between men and women. Scores from both, the RSA and the RGS correlated with higher predisposition to get excited and erotophilia. Conclusions. The RSA and RGS are reliable and valid measures to evaluate subjective sexual arousal towards sexual stimuli. Therefore, their use is suitable for both clinical and research areas (AU)

Rasgos psicopatológicos en personas con disforia de género / Psychopathological traits in people with gender dysphoria

Objetivos. En primer lugar, el objetivo es evaluar los rasgos psicopatológicos en personas con disforia de género y, en segundo lugar, establecer si existen diferencias entre los grupos de hombre a mujer y de mujer a hombre. Participantes y método. Se aplicó el Inventario clínico multiaxial de Millon (MCMI-II) a 32 sujetos con disforia de género, de los cuales 20 pertenecen al grupo de hombre a mujer y 12 al de mujer a hombre. Los participantes fueron seleccionados de forma intencional. Resultados. No se encuentran alteraciones psicopatológicas significativas. Las puntuaciones más elevadas se obtuvieron en los rasgos esquizoide, paranoide y delirante. Hay diferencias estadísticamente significativas entre los grupos de hombre a mujer y de mujer a hombre en los patrones clínicos de la personalidad esquizoide (p = 0,012), compulsiva (p = 0,047) y autodestructiva (p = 0,040) y en el síndrome clínico de gravedad moderada abuso de alcohol (p = 0,000). Conclusiones. Las personas con disforia de género no se caracterizan por alteraciones psicopatológicas. Los rasgos con puntuaciones más elevadas se corresponden con los señalados en estudios anteriores. Se aprecian diferencias por grupos, aunque solo en determinadas escalas (AU)

Objectives. Firstly, the aim is to evaluate psychopathological traits in people with gender dysphoria, and secondly, to establish if there are differences between groups of male to female and female to male. Participants and method. The Millon clinical multiaxial inventory (MCMI-II) was applied to 32 subjects with gender dysphoria, of which 20 belong to the group of male to female and 12 to the group female to male. Participants were selected intentionally. Results. No significant psychopathological alterations are found. The highest scores were obtained in the schizoid, paranoid and delusional traits. There are statistically significant differences between the male to female and female to male in clinical patterns of schizoid (P=.012), compulsive (P=.047) and self-destructive personality (P=.040), and in moderate clinical syndrome, abuse of alcohol (P=.000). Conclusions. People with gender dysphoria are not characterized by psychopathological alterations. The traits with higher scores correspond with those pointed out in previous studies. Differences were appreciated between groups, but only in certain scales (AU)

Prevalencia de microdeleciones del cromosoma Y en hombres chilenos infértiles / Y chromosome microdeletion prevalence in infertile Chilean men

Objetivo. El objetivo de este estudio es determinar la prevalencia de microdeleciones del cromosomaY en hombres chilenos infértiles. Material y métodos. Se incluyeron 102 hombres con diagnóstico de azoospermia u oligozoospermia severa que consultaron en la Unidad de Andrología por infertilidad. Se llevó a cabo análisis de microdeleciones de la región del factor de azoospermia (AZF) del cromosomaY a través de reacción en cadena de la polimerasa, utilizando ADN genómico extraído de leucocitos de sangre periférica. Cada paciente fue analizado utilizando sequence tagged sites para las regiones AZFa, AZFb y AZFc. Resultados. Sesenta y siete pacientes presentaron azoospermia y 35 oligozoospermia severa. Se encontraron microdeleciones del cromosomaY en el 9,8% de los pacientes. La mutación más prevalente fue AZFc, afectando al 3,9% de la muestra, seguida por AZFbc (2,9%), AZFa (2,0%) y AZFb (1,0%). Solo los hombres azoospérmicos presentaron las mutaciones. Conclusiones. La prevalencia de microdeleciones del cromosomaY en hombres chilenos infértiles es similar a la presentada en estudios internacionales. Estas mutaciones deben ser buscadas cuando se enfrenta a un paciente infértil con alteraciones cuantitativas severas del seminograma, ya que AZFa y AZFb están asociados con ausencia completa de gametos viables, y la portación de AZFc tiene importantes consecuencias en el potencial de fertilidad de la descendencia masculina (AU)

Objective. The aim of this study is to determine the prevalence of Ychromosome microdeletions in infertile Chilean men. Material and methods. A group of 102 infertile men with azoospermia or severe oligozoospermia were screened while attending a fertility clinic for microdeletions in the azoospermia factor (AZF) region of Ychromosome by multiplex polymerase chain reaction. Genomic DNA was extracted from peripheral blood samples. Each patient was analysed for the presence of sequence tagged sites in the AZFa, AZFb, and AZFc regions. Results. Azoospermia and severe oligozoospermia was found in 67 and 35 patients, respectively. Microdeletions were found in 9.8% of patients. The most prevalent mutation was AZFc, affecting 3.9% of the sample. This was followed by AZFbc with 2.9%, AZFa with 2.0%, and AZFb with 1.0%. Only azoospermic men were found to have these genetic alterations. Conclusions. Prevalence of Ychromosome microdeletions in infertile Chilean men is similar to the prevalence presented in international studies. As AZFa and AZFb mutations are associated with complete absence of viable gametes, and AZFc has important consequences in the fertility potential of the offspring, these mutations have to be searched when presented with an infertile patient with severe sperm alterations (AU)

Presencia o ausencia de espermatozoides en el líquido preeyaculatorio / Presence or absence of sperm in the pre ejaculatory fluid

Objetivo. Determinar la presencia o ausencia de espermatozoides en el líquido preeyaculatorio. Material y métodos. Estudio descriptivo, transversal, realizado en 25 varones universitarios, voluntarios, entre 18-25 años en Barranquilla, Colombia. A cada sujeto se le entregaron 2 portaobjetos para la toma del líquido preeyaculatorio y un recipiente para la toma de muestra del líquido seminal; se tomó primero y por autoestímulo la muestra preeyaculatoria y posteriormente la muestra para el espermiograma; la búsqueda de espermatozoides en el líquido preeyaculatorio se realizó en al menos 10 campos a un aumento de ×20 y en los 2 portaobjetos. El líquido seminal se procesó según normas de la OMS. Resultados. Los líquidos preeyaculatorios examinados no tenían espermatozoides. Todos los sujetos del estudio tenían espermiogramas con recuento total de espermatozoides superiores a 100 millones de espermatozoides, una movilidad superior al 50%; el pH promedio fue de 8,2±0,5. Conclusiones. El líquido preeyaculatorio secretado por las glándulas de Cowper y Littre durante la estimulación sexual no contiene espermatozoides, siempre que haya al menos 2 días de abstinencia eyaculatoria previa y, por lo tanto, no puede ser responsable de los embarazos ocurridos en la práctica del contacto sexual del pene sobre los genitales externos femeninos ni en la práctica del coito interrumpido como método anticonceptivo (AU)

Objective. To determine the presence or absence of sperm in pre ejaculate fluid. Material and methods. A descriptive, cross-sectional study in 25 college male volunteers, aged between 18 and 25 in Barranquilla (Colombia). Each subject was given two slides for making pre-ejaculatory fluid and a container for sampling of seminal fluid; pre-ejaculatory sample was taken first by self-stimulation, and subsequently the sample for semen analysis was collected. Search for sperm in pre-ejaculatory liquid was held in at least 10 fields at ×20 magnification and the two slides. The seminal fluid was processed according to WHO standards. Results. None of the pre-ejaculatory fluids examined had sperm. All study subjects had spermiograms with total count in excess of 100 million sperm mobility greater than 50%; the average pH was 8.2±0.5. Conclusions. Pre-ejaculatory fluid secreted by the glands of Cowper and Littre during sexual stimulation, does not contain sperm and therefore cannot be responsible for pregnancies occurring in the practice of sexual intercourse where the penis is in contact with the external female genitalia or in practice of withdrawal as a contraceptive method (AU)

Estudio caso-control en hombres con liquen escleroso y atrófico genital / Case control study in men with sclerosus and atrophic genital lichen

Objetivo. Comparar los datos epidemiológicos de una muestra de pacientes con liquen escleroso genital versus un grupo control sin liquen escleroso genital. Material y métodos. Estudio caso-control que incluye 50 pacientes divididos en 2 grupos; grupo 1: 30 pacientes con liquen escleroatrófico genital y grupo 2: 20 pacientes sin liquen escleroatrófico. Se han estudiado variables clínicas, analíticas, antecedentes personales y hábitos de vida. El análisis estadístico se ha llevado a cabo mediante el programa SPSS 20.0, siendo la significación estadística p≤0,05. Resultados. La edad media de los pacientes del grupo 1 fue de 54,7años versus 52,5años en el grupo 2, sin que se observaran diferencias estadísticamente significativas. La principal diferencia observada entre los pacientes del grupo 1 y los del grupo 2 fue el índice de masa corporal, que fue más elevado en el grupo 1, 28,4kg/m2, con respecto al grupo 2, 23,4kg/m2 (p=0,0001), y el estado civil. No se observó una mayor prevalencia significativa en enfermedades autoinmunes en el grupo 1 respecto al grupo 2. Conclusión. Los pacientes con liquen escleroatrófico genital parecen tener mayor índice de masa corporal que los pacientes sin liquen, sin que exista una clara asociación con enfermedades autoinmunes, según los resultados de nuestro estudio (AU)

Objective. To compare epidemiologic dates in patients with sclerosus genital lichen versus control group without sclerosus genital lichen. Material and methods. Case-control study including 50 patients divided into 2 groups: Group 1: 30 patients with sclerosus and atrophic genital lichen and group 2: 20 patients without lichen sclerosus. Study of clinical variables, laboratory, medical history and lifestyle. Statistical analysis with SPSS 20.0 software and statistical significance P≤.05. Results. The mean age of patients in group 1 was 54.7 years versus 52.5 years in group 2, no statistically significant differences were observed. The main difference observed between patients in group 1 and group 2 was the BMI, which was higher in group 1, 28.4kg/m2, compared to group 2, 23.4kg/m2 (P=.0001) and marital status. It has not been observed significantly higher prevalence in autoimmune diseases in group 1 compared with group 2. Conclusion. Patients with genital sclerosus and atrophic lichen seem to be more body mass index than patients without lichen, without a clear association with autoimmune diseases according to the results of our study (AU)

Propriedades psicométricas da versão portuguesa da Nova Escala de Satisfação Sexual - versão curta / Psychometric properties of the Portuguese version of the New Sexual Satisfaction Scale - Short

Introdução. A satisfação sexual constitui atualmente um constructo essencial no campo do estudo da sexualidade humana. Objetivo. A presente investigação teve como objetivo proceder à validação da versão portuguesa da Nova Escala de Satisfação Sexual - versão curta (NSSS‐S), instrumento em formato curto que avalia a satisfação sexual em homens e mulheres. Material e métodos. Recorreu‐se a um total de 298 participantes de ambos os sexos, os quais preencheram o questionário com a tradução para português da NSSS‐S. Resultados. Foram demonstradas as principais propriedades psicométricas da validação da NSSS‐S, das quais se destacaram a estrutura fatorial bidimensional e o alfa de Cronbach (≥0,89). Discussão. A NSSS‐S revelou ter a estrutura bidimensional da NSSS original e obtiveram‐se valores bons a nível de consistência interna, de validade convergente, de validade divergente e de validade concorrente. Conclusões. As boas propriedades psicométricas encontradas justificam e reforçam a recomendação de utilização da NSSS‐S na população portuguesa (AU)

Introduction. Sexual satisfaction is an essential construct in the study of human sexuality. Objective. The aim of the present study was to validate the Portuguese version of the New Sexual Satisfaction Scale-Short (NSSS‐S), a short form scale that assesses sexual satisfaction among men and women. Material and methods. A total of 298 participants completed the Portuguese version of the NSSS‐S. Results. The main psychometric properties of the Portuguese version of the NSSS‐S were assessed, most importantly the two‐factor structure and Cronbach's alpha (≥0.89). Discussion. The NSSS‐S revealed the bidimensional structure of the original NSSS and good values were obtained in terms of internal consistency, convergent validity, divergent validity and concurrent validity. Conclusions. The use of the Portuguese version of the NSSS‐S is justified and reinforced since it has sound psychometric properties (AU)

A case of Fournier's gangrene after inguinal hernia repair / Un caso único de la gangrena de Fournier después de la reparación de la hernia inguinal

Fournier's gangrene is a polymicrobial infection of perineal and scrotal regions that manifests as a rapidly progressive necrotizing fasciitis. Fournier's gangrene following a surgical procedure is not frequently seen. We report a very rare case of Fournier's gangrene following inguinal hernia repair (AU)

La gangrena de Fournier es una infección polimicrobiana de la región perineoescrotal, que se manifiesta como una fascitis necrosante, rápidamente progresiva. La gangrena de Fournier, después de un procedimiento quirúrgico no se ve con frecuencia. Se presenta un caso muy raro de la gangrena de Fournier después de la reparación de la hernia inguinal (AU)

Mean platelet volume and platelet distribution as a diagnostic marker for penile vascular disease in patients with erectile dysfunction / Volumen medio de plaquetas y distribución de plaquetas como marcador diagnóstico para la enfermedad vascular peneana en pacientes con disfunción eréctil

Objective. To investigate the relationship between platelet activation parameters that are involved in the vascular response, the atherothrombotic process, and erectile function, in which epithelial dysfunction plays a significant role. Materials and methods. A study was performed on patients who had a color Doppler ultrasound (CDUS) of the penis due to erectile dysfunction. The patients were divided into two groups: those with normal CDUS findings, and those with vascular dysfunction on CDUS. Patients were also divided into two groups according to their scores using the International Index of Erectile Function (IIEF). The relationships between platelet activation factors, vascular parameters, and severity of the disorder were analyzed. Results. A total of 91 patients who fulfilled the inclusion criteria were included in the study. CDUS showed vascular dysfunction in 55 patients (Group I), while the findings were normal in 36 patients (Group II). Age, cholesterol level, disease duration, mean platelet volume (MPV), and platelet distribution width (PDW) were compared between Groups I and II, with Group I showing significantly higher values. The parameters that could affect Doppler ultrasound results were analyzed using multivariate regression analysis. This showed that PDW and disease duration were independent prognostic factors (p = .021 and p = .005, respectively). When the patients were divided into two groups according to their IIEF scores, in those with mild (Group A) and severe disease (Group B), it was found that there were significant differences between the groups with age, disease duration, and PDW, while two groups were found similar in terms of MPV, cholesterol levels, and hormone parameters. Conclusion. It is supposed that increased platelet activation parameters, and PDW in particular, give important information for disease progression and follow-up of vascular dysfunction in erectile dysfunction (AU)

Objetivo. Investigar la relación entre los parámetros de activación de plaquetas involucrados en la respuesta vascular, el proceso aterotrombótico y la función eréctil, en la que la disfunción endotelial desempeña un papel importante. Material y métodos. Se analizaron los pacientes en los que se realizó una ecografía Doppler color (EDC) del pene por disfunción eréctil. Los pacientes fueron divididos en 2 grupos: con resultados normales en la EDC y con disfunción vascular en la EDC. Los pacientes fueron asimismo divididos en 2 grupos en función de las puntuaciones del Índice Internacional de Función Eréctil (IIFE). Se analizaron las relaciones entre los factores de activación plaquetaria, los parámetros vasculares y la gravedad del trastorno. Resultados. Un total de 91 pacientes que cumplieron los criterios de inclusión fueron incluidos en el estudio. La EDC mostró disfunción vascular en 55 pacientes (grupo i), mientras que los resultados fueron normales en 36 pacientes (grupo ii). La edad, el nivel de colesterol, la duración de la enfermedad, el volumen medio de plaquetas (VMP) y la anchura de distribución de las plaquetas (ADP) se compararon entre los grupos i y ii; además, los valores fueron expresivamente más altos en el grupo i. Los parámetros que podrían afectar los resultados de la EDC se valoraron con el análisis de regresión multivariante, lo que demostró que la ADP y la duración de la enfermedad fueron factores pronósticos independientes (p = 0,021 y p = 0,005, respectivamente). Cuando los pacientes fueron divididos en 2 grupos en función de las puntuaciones IIFE, en aquellos con enfermedad leve (grupo A) y enfermedad grave (grupo B) se encontraron diferencias significativas entre los grupos con la edad, la duración de la enfermedad y la ADP, mientras que ambos grupos fueron similares en términos de VMP, de niveles de colesterol y de parámetros hormonales. Conclusión. Al parecer, el aumento de los parámetros de activación plaquetar, y especialmente la ADP, proporcionan una importante información para la progresión de la enfermedad y el seguimiento de la disfunción vascular en la disfunción eréctil (AU)

Associations between oxidative stress biomarkers in different body fluids and reproductive parameters in male partners of subfertile couples / Asociaciones entre biomarcadores de estrés oxidativo en diferentes fluidos biológicos y parámetros reproductivos en varones de parejas subfértiles

Objective. To evaluate the relationships between oxidative stress (OS) biomarkers and total antioxidant capacity (TAC) in blood serum and seminal plasma, and their associations with semen quality and serum reproductive hormone concentrations in potential subfertile men. Material and method. A cross-sectional study was conducted on men (n = 122) attending an infertility clinic in the Murcia Region (Southern Spain) between 2012 and 2013. Concentrations of malondialdehyde (MDA), nitric oxide (NO) and TAC were measured in blood and semen. Follicle-stimulating hormone, luteinising hormone, testosterone, prolactin and oestradiol concentrations were measured in serum. Semen analyses were performed according to World Health Organization criteria. Correlation analysis and multiple linear regression models were performed, controlling for important covariates. Results. There was a significant inverse association between serum MDA concentrations and all sperm parameters, except for seminal volume. Serum TAC concentrations were positively related to sperm count and motility. A positive association was observed between seminal plasma NO levels and the percentage of morphologically normal sperm. With regard to reproductive hormones, serum MDA concentrations were positively related to FSH and LH levels, and TAC inversely associated with FSH levels. Conclusions. Our results suggest that oxidative stress may be associated with semen parameters and reproductive hormone levels in male partners of couples seeking infertility treatment. However, further studies are needed to confirm and extend these findings, in particular, with regard to serum reproductive hormones (AU)

Objetivo. Evaluar las correlaciones entre marcadores de estrés oxidativo (OS) y capacidad antioxidante total (TAC) en suero sanguíneo y plasma seminal, y sus asociaciones con calidad seminal y hormonas reproductivas en varones potencialmente subfértiles. Material y método. Estudio transversal realizado en varones (n = 122) que acudían a un servicio de infertilidad de Murcia entre 2012-2013. Las concentraciones de malondialdehído (MDA), óxido nítrico (NO) y TAC se midieron en sangre y semen. Se analizaron los niveles séricos de las hormonas foliculoestimulante, luteinizante, testosterona, prolactina y estradiol. Los análisis espermáticos se llevaron a cabo siguiendo las normas de la Organización Mundial de la Salud. Se utilizaron análisis de correlación y modelos de regresión lineal múltiple ajustando por covariables importantes. Resultados. Se mostró una asociación inversa significativa entre las concentraciones séricas de MDA y todos los parámetros espermáticos, excepto el volumen seminal. Las concentraciones séricas de TAC se relacionaron positivamente con el recuento y la movilidad espermática. Los niveles de NO en plasma seminal se asociaron directamente con el porcentaje de espermatozoides morfológicamente normales. Con respecto a las hormonas reproductivas, las concentraciones séricas de MDA se asociaron positivamente con los niveles de FSH y LH, y las de TAC se asociaron inversamente con los niveles de FSH. Conclusiones. Nuestros resultados sugieren que el estrés oxidativo estaría asociado con los parámetros seminales y hormonales en varones de parejas que consultan por problemas de infertilidad. Sin embargo, son necesarios más estudios para confirmar estos hallazgos, en particular con respecto al papel de las hormonas reproductivas (AU)

Comportamento sexual de estudantes de medicina portugueses e seus fatores preditivos / Sexual patterns in Portuguese medical students and its predictive factors

Objetivo. Avaliar a prevalência de comportamentos de risco, comportamento sexual e disfunções sexuais (DS) em estudantes de medicina portugueses. Materiais e métodos. Estudantes da Faculdade de Medicina do Porto foram divididos em 3 grupos de acordo com o ano académico - grupo 1 (1.°/2.° anos, n = 288), grupo 2 (3.°/4.° anos, n = 267) e grupo 3 (5.°/6.° anos, n = 250) - e convidados a preencher um questionário sobre sexualidade e comportamento de risco. A análise estatística foi efetuada com recurso ao programa SPSS®. Resultados. Responderam ao questionário 258 homens e 547 mulheres, com idade mediana de 20 anos. A idade mediana da primeira experiência sexual dos inquiridos foi 17 anos, no entanto, 33,9% dos estudantes ainda não tinha tido qualquer experiência sexual. Verificou‐se que a prática conjunta de sexo oral e vaginal foi a mais comum (56,2%). A disfunção ejaculatória foi a DS mais referida pelos homens (18,2%), seguida da disfunção erétil (DE) (7,8%), particularmente quando associada ao consumo de drogas ilícitas (22,2%). As mulheres reportaram com maior frequência dispareunia (40,8%), dificuldade em atingir um orgasmo (34,7%) e falta de lubrificação (18,5%). Conclusões. Embora os estudantes de medicina representem uma população jovem saudável, a tensão física, emocional e mental a que estão sujeitos afeta negativamente a sua sexualidade. Além disso, a autoconsciência sexual pode afetar futuras interações com doentes com DS. Este estudo transversal demonstra que esta população em particular é globalmente inexperiente, contudo, são necessários mais estudos de avaliação dos padrões sexuais na população portuguesa para melhor esclarecer o seu perfil relativamente aos restantes jovens (AU)

Objective. To assess the prevalence of risk behavior, sexual behavior and sexual dysfunctions in Portuguese medical students. Methods. Students of the Faculty of Medicine of Porto were divided into three groups according to the year they are enrolled: group 1 (1st/2nd year, n = 288), group 2 (3rd/4th year, n = 267) and group 3 (5th/6th year, n = 250). An anonymous questionnaire about sexuality and risk behavior was filled in. Statistical analysis was performed using SPSS®. Results. The questionnaire was answered by 805 students (female = 547; male = 258), with median age of 20 years. The median age of the first sexual experience was 17 years, but 33.9% of the students denied having any sexual experience. The most common sexual practice is the joint practice of oral and vaginal sex (56.2%). Ejaculatory dysfunction was the sexual dysfunction most referred by men (18.2%), followed by erectile dysfunction (7.8%), particularly when associated to illicit drugs consumption (22.2%). The sexual dysfunctions most reported by women were dyspareunia (40.8%), difficulty in attaining an orgasm (34.7%) and lack of lubrication (18.5%). Conclusions. Although medical students represent a healthy young population, the physical, emotional and mental strain they are subjected to affect negatively their sexuality. Furthermore, sexual self‐awareness may negatively impact future interactions with patients with sexual dysfunctions. This cross‐sectional study is very inclusive, and demonstrated that this population is globally inexperienced. However, more studies of Portuguese population are needed in order to better understand their profile in relation to the other youngsters (AU)