Bi-national outbreak of Salmonella Newport infections linked to onions: the United States experience.

From 2016-2019, dry bulb onions were the suspected cause of three multistate outbreaks in the United States. We investigated a large multistate outbreak of Salmonella Newport infections that caused illnesses in both the United States and Canada in 2020. Epidemiologic, laboratory and traceback investigations were conducted to determine the source of the infections, and data were shared among U.S. and Canadian public health officials. We identified 1127 U.S. illnesses from 48 states with illness onset dates ranging from 19 June to 11 September 2020. Sixty-six per cent of ill people reported consuming red onions in the week before illness onset. Thirty-five illness sub-clusters were identified during the investigation and seventy-four per cent of sub-clusters served red onions to customers during the exposure period. Traceback for the source of onions in illness sub-clusters identified a common onion grower in Bakersfield, CA as the source of red onions, and onions were recalled at this time. Although other strains of Salmonella Newport were identified in environmental samples collected at the Bakersfield, CA grower, extensive environmental and product testing did not yield the outbreak strain. This was the third largest U.S. foodborne Salmonella outbreak in the last 30 years. It is the first U.S. multistate outbreak with a confirmed link to dry bulb onions, and it was nearly 10-fold larger than prior outbreaks with a suspected link to onions. This outbreak is notable for its size and scope, as well as the international data sharing that led to implication of red onions as the primary cause of the outbreak. Although an environmental assessment at the grower identified several factors that likely contributed to the outbreak, no main reason was identified. The expedient identification of the outbreak vehicle and response of multiple public health agencies allowed for recall and removal of product from the marketplace, and rapid messaging to both the public and industry on actions to protect consumers; these features contributed to a decrease in cases and expeditious conclusion of the outbreak.

Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey.

OBJECTIVE: To estimate the prevalence of painful sex among women in Britain, and to explore associated sexual, relationship and health factors that should be considered in assessment. DESIGN: Multi-stage, clustered and stratified population probability sample survey, using computer-assisted self-interview. Sample frame was the British Postcode Address File. SETTING: Participants interviewed at home between 2010 and 2012. SAMPLE: A total of 15 162 adults aged 16-74 years (8869 women). Data reported from 6669 sexually active women. METHODS: Age-adjusted logistic regressions to examine associations between painful sex and indicators of sexual, relational, mental and physical health. MAIN OUTCOME MEASURE: Physical pain as a result of sex for ≥3 months in the past year, plus measures of symptom severity. RESULTS: Painful sex was reported by 7.5% (95% CI 6.7-8.3) of sexually active women, of whom one-quarter experienced symptoms very often or always, for ≥6 months, and causing distress. Reporting painful sex was strongly associated with other sexual function problems, notably vaginal dryness (age adjusted odds ratio 7.9; 6.17-10.12), anxiety about sex (6.34; 4.76-8.46) and lacking enjoyment in sex (6.12; 4.81-7.79). It was associated with sexual relationship factors [such as not sharing same level of interest in sex (2.56; 1.97-3.33)], as well as with adverse experiences such as non-volitional sex (2.17; 1.68-2.80). Associations were also found with measures of psychological and physical health, including depressive symptoms (1.68; 1.28-2.21). CONCLUSION: Painful sex is reported by a sizeable minority of women in Britain. Health professionals should be supported to undertake holistic assessment and treatment which takes account of the sexual, relationship and health context of symptoms. TWEETABLE ABSTRACT: Painful sex-reported by 7.5% of women in Britain-is linked to poorer sexual, physical, relational and mental health.

Sexual function, mood and menopause symptoms in Lithuanian postmenopausal women.

OBJECTIVES: To assess sexual function in a clinical sample of Lithuanian postmenopausal women and identify the most important determinants of sexual function, including the use of hormone replacement therapy (HT), emotional status and menopausal symptoms. METHODS: Three hundred postmenopausal women who were referred to a gynecologist for a routine yearly check-up were enrolled for the study. Data for 246 women were appropriate for statistical analysis. Participants filled the Female Sexual Function Index for evaluation of sexual function, the Greene Climacteric Scale for the assessment of menopause symptoms and the Hospital Anxiety and Depression Scale for the evaluation of depression and anxiety symptoms. RESULTS: Sexual function was better in younger women and in HT users compared with non-users. Thus, to analyze the other variables, an adjustment for age was applied. HT significantly increased the likelihood of higher desire, lubrication, satisfaction, and lower pain when adjusting results for age. HT reduced the likelihood of psychological and depression symptoms and increased the likelihood of vasomotor symptoms of menopause when results adjusted for age were analyzed. HT did not appear to affect anxiety symptoms after the results were adjusted for age. CONCLUSIONS: HT increased chances for better sexual desire, lubrication, satisfaction, less pain and lower depression symptoms in postmenopausal women, even when the results were adjusted by age. HT did not improve sexual arousal, orgasm, menopausal and anxiety symptoms. Depression, anxiety, menopausal symptoms and age were the main risk factors for the possible development of sexual dysfunction.

The varied nature of women's sexuality: unresolved issues and a theoretical approach.

During the 20th century there were clear indications that the socio-cultural suppression of women's sexuality had lessened, revealing a marked variability of women's sexual expression. In this article we review the recent literature to explore explanations for this variability. It is clear that we know little about the nature of sexual desire, and in particular, what it is that is desired. There is also now substantial evidence that vaginal response, as measured by vaginal pulse amplitude, is a relatively automatic response to perception of sexual stimuli, regardless of whether these stimuli are perceived positively or result in subjective arousal. This is considered as a possible mechanism that allows vaginal intercourse without pain, even when the woman is not sexually aroused. The roles of androgens and estrogen in women's sexuality remain uncertain. The evidence is, however, consistent with there being a testosterone-dependent component of women's sexuality that is more important for some women than others. Finally, a new theoretical model is presented that aims to resolve these uncertainties and that proposes different types of women's sexuality. Once we have a better understanding of "normal" female sexuality, in its various forms, our ability to develop effective treatments for women's sexual problems should improve.

Salivary Testosterone Levels and Health Status in Men and Women in the British General Population: Findings from the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

CONTEXT: Salivary T (Sal-T) measurement by liquid chromatography-tandem mass spectroscopy resents the opportunity to examine health correlates of Sal-T in a large-scale population survey. OBJECTIVE: This study sought to examine associations between Sal-T and health-related factors in men and women age 18-74 years. DESIGN AND SETTING: Morning saliva samples were obtained from participants in a cross-sectional probability-sample survey of the general British population (Natsal-3). Self-reported health and lifestyle questions were administered as part of a wider sexual health interview. PARTICIPANTS: Study participants included 1599 men and 2123 women. METHODS: Sal-T was measured using liquid chromatography-tandem mass spectroscopy. Linear regression was used to examine associations between health factors and mean Sal-T. RESULTS: In men, mean Sal-T was associated with a range of health factors after age adjustment, and showed a strong independent negative association with body mass index (BMI) in multivariable analysis. Men reporting cardiovascular disease or currently taking medication for depression had lower age-adjusted Sal-T, although there was no association with cardiovascular disease after adjustment for BMI. The decline in Sal-T with increasing age remained after adjustment for health-related factors. In women, Sal-T declined with increasing age; however, there were no age-independent associations with health-related factors or specific heath conditions with the exception of higher Sal-T in smokers. CONCLUSIONS: Sal-T levels were associated, independently of age, with a range of self-reported health markers, particularly BMI, in men but not women. The findings support the view that there is an age-related decline in Sal-T in men and women, which cannot be explained by an increase in ill health. Our results demonstrate the potential of Sal-T as a convenient measure of tissue androgen exposure for population research.

The endocrinology of sexual arousal.

The relevance of testosterone, oestradiol and certain peptides (oxytocin (OT), beta-endorphin and prolactin (PRL)) to sexual arousal in humans is reviewed. In addition to behavioural studies, evidence of distribution of gonadal steroid receptors in the brain and the limited evidence from brain imaging are also considered. Testosterone plays a key role in the adult male, with clear, consistent evidence from studies of hypogonadal and eugonadal men. The roles of testosterone in the development of sexual arousability, and in the aging male, are less clear. The relevance of aromatization and of non-sexual effects of testosterone which might indirectly influence sexual arousal are not well understood. Testosterone in the female presents a more complex, less consistent picture. One possible explanation is a much greater variability across women in responsiveness to testosterone. A 'desensitization hypothesis' to account for the striking gender differences is offered. There is limited evidence of a direct effect of oestradiol on sexual arousability in women. The extent to which testosterone in women acts by conversion to oestradiol or by increase of free oestradiol is not yet clear. The role of peptides in sexual arousal remains uncertain, partly because of the multiple roles and sites of action of most peptides. OT and beta-endorphin appear to have both excitatory and inhibitory effects. PRL has been proposed as an inhibitory factor via direct inhibition of dopaminergic activity, but the evidence for this is inconclusive. Whereas the traditional concept of 'hormone' continues to apply to the role of testosterone and oestradiol in sexual arousal, peptides present a more complex role.

Are the effects of androgens on male sexuality noradrenergically mediated? Some consideration of the human.

The effects of androgens on the sexuality of male rodents is likely to be mediated, at least in part, by central noradrenergic (NA) mechanisms. Davidson's group has shown this by restoring behaviour in castrated males with alpha-2 adrenoceptor antagonists. As yet, there are no comparable studies of drug administration to hypogonadal men, but relevant evidence from recent studies in eugonadal men is considered. The evidence is consistent with a role for NA mediation in human sexual arousal, but suggests that more than one NA mediated system exist, involving both central arousal and inhibition of peripheral responses such as erection. The study of spontaneous erections during REM sleep is of particular interest, as REM is accompanied by virtual cessation of peripheral sympathetic activity in relevant parts of the body. "Psychogenic" erectile dysfunction may involve a high level of central alpha-2 inhibitory tone which reduces the capacity for central arousal. On the other hand, there may be an age related loss of responsiveness to the central arousing effects of NA, suggesting that the aetiology of psychogenic erectile dysfunction may vary with age. NA mechanisms may well be involved in the mediation of androgenic effects in humans, but no simple relationship between NA and sexual response should be expected.

Central inhibition of sexual response in the male: a theoretical perspective.

A theoretical model for central inhibition of sexual response is proposed, postulating individual variability in the propensity for such inhibition. Whereas such inhibition is typically adaptive, individuals with high propensity may be vulnerable to sexual dysfunction, and those with low propensity to high risk sexual behavior. Evidence of the existence and localization of such inhibitory mechanisms from both the animal and human literature is reviewed. Evidence of central neurotransmitters with sexual inhibitory effects is substantial, though in most cases the inhibition is not specific to sexual response or behavior. Recent studies have identified centers in the brain stem and lateral hypothalamus which appear to have specific inhibitory effects on sexual response. A variety of adaptive mechanisms involving inhibition of sexual response are considered, some involving perception of threat, others occurring more directly as consequences of previous sexual activity. These different adaptive functions may well involve different inhibitory mechanisms. This theoretical model opens a new agenda for experimental research into adaptive sexual behavior, both human and animal.

The dual control model of male sexual response: a theoretical approach to centrally mediated erectile dysfunction.

A theoretical model of dual control of male sexual response is considered, based on the balancing of central excitation and inhibition, with individuals varying in their propensity for both sexual excitation and inhibition of sexual response. A questionnaire method for measuring propensities for sexual excitation and inhibition has been developed (SIS/SES questionnaire), resulting in one excitation factor (SES) and two inhibition factors (SIS1 and SIS2). Evidence for the existence of both inhibitory and excitatory tone is discussed. The first inhibition factor (SIS1) may be related to level of inhibitory tone and is associated with fear of performance failure. The second inhibition factor (SIS2) may be related to external threats (e.g. from within the sexual relationship). The implications for the treatment of centrally mediated erectile dysfunction are discussed, with predictions that high SIS2 individuals will respond to psychological treatment, whereas high SIS1 individuals will respond better to pharmacological methods of treatment.

The effects of exogenous testosterone on sexuality and mood of normal men.

The effects of supraphysiological levels of testosterone, used for male contraception, on sexual behavior and mood were studied in a single-blind, placebo-controlled manner in a group of 31 normal men. After 4 weeks of baseline observations, the men were randomized into two groups: one group received 200 mg testosterone enanthate (TE) weekly by im injection for 8 weeks (Testosterone Only group), the other received placebo injections once weekly for the first 4 weeks followed by TE 200 mg weekly for the following 4 weeks (Placebo/Testosterone group). The testosterone administration increased trough plasma testosterone levels by 80%, compatible with peak testosterone levels 400-500% above baseline. Various aspects of sexuality were assessed using sexuality experience scales (SES) questionnaires at the end of each 4-week period while sexual activity and mood states were recorded by daily dairies and self-rating scales. In both groups there was a significant increase in scores in the Psychosexual Stimulation Scale of the SES (i.e. SES 2) following testosterone administration, but not with placebo. There were no changes in SES 3, which measures aspects of sexual interaction with the partner. In both groups there were no changes in frequency of sexual intercourse, masturbation, or penile erection on waking nor in any of the moods reported. The Placebo/Testosterone group showed an increase in self-reported interest in sex during testosterone treatment but not with placebo. The SES 2 results suggest that sexual awareness and arousability can be increased by supraphysiological levels of testosterone. However, these changes are not reflected in modifications of overt sexual behavior, which in eugonadal men may be more determined by sexual relationship factors. This contrasts with hypogonadal men, in whom testosterone replacement clearly stimulates sexual behavior. There was no evidence to suggest an alteration in any of the mood states studied, in particular those associated with increased aggression. We conclude that supraphysiological levels of testosterone maintained for up to 2 months can promote some aspects of sexual arousability without stimulating sexual activity in eugonadal men within stable heterosexual relationships. Raising testosterone does not increase self-reported ratings of aggressive feelings.

PIP: Testosterone is necessary, though not sufficient for normal levels of sexual desire. Researchers are currently investigating the potential role of supraphysiological doses of testosterone as an hormonal contraceptive for men. This paper reports findings from such a study of the effects of supraphysiological levels of testosterone upon sex behavior and mood in 31 men. A single-blind, placebo-controlled study design was employed. The men were aged 21-41 years, healthy, and in stable heterosexual relationships. All subjects were normal on clinical examination, and their plasma testosterone and gonadotropins were within the normal range. Baseline data were gathered on the subjects over a four-week period of observation. The men were then randomized into two groups, men in one group receiving 200 mg testosterone enanthate (TE) weekly by intramuscular injection for eight weeks, and men in the other group receiving placebo injections once weekly for the first four weeks followed by TE 200 mg weekly for the following four weeks. Testosterone administration increased trough plasma testosterone levels by 80%, compatible with peak testosterone levels 400-500% above baseline. Various aspects of sexuality were assessed using sexuality experience scales (SES) questionnaires at the end of each four-week period, while sexual activity and mood states were recorded in daily dairies and self-rating scales. There was a significant increase in both groups in scores in the Psychosexual Stimulation Scale of the SES (SES 2) following testosterone administration, but not following receipt of placebo. There were no changes in the measurement of sexual interaction with the partner and no changes in either group in the frequency of sexual intercourse, masturbation, or penile erection on waking nor in any of the moods reported. The placebo/testosterone group showed an increased self-reported interest in sex during testosterone treatment, but not with placebo. SES 2 results suggest that sexual awareness and arousability can be increased by supraphysiological levels of testosterone. These changes, however, are not reflected in any change in overt sexual behavior, which in eugonadal men may be more determined by sexual relationship factors; this contrasts with hypogonadal men in whom testosterone replacement clearly stimulates sexual behavior. No evidence was found to suggest an alteration in any of the mood states studied, in particular those associated with increased aggression. The authors conclude that supraphysiological levels of testosterone maintained for up to two months can promote some aspects of sexual arousability without stimulating sexual activity in eugonadal men within stable heterosexual relationships.

7Alpha-methyl-19-nortestosterone maintains sexual behavior and mood in hypogonadal men.

The synthetic steroid 7alpha-methyl-19-nortestosterone (MENT) is a potent androgen that is resistant to 5alpha-reductase. It thus has decreased activity at the prostate and may have advantages over testosterone-based regimens in long term treatment or as part of a male contraceptive. Administration to eugonadal men results in suppression of gonadotropins, but its ability to support androgen-dependent behavior has not been investigated. For sustained release administration, MENT acetate was used, because its diffusion characteristics were more suitable for use in implants. However, upon release the acetate is rapidly hydrolyzed, and MENT is the biologically active moiety in circulation. We studied the effects of MENT on sexual interest and activity, spontaneous erection, and mood states in comparison with testosterone enanthate (TE) in 20 Caucasian and Chinese hypogonadal men recruited in Edinburgh and Hong Kong (n = 10 in each center). Outcomes were measured using a combination of daily diaries, semistructured interviews, and questionnaires. Nocturnal penile tumescence (NPT) was also recorded in the Edinburgh group. After withdrawal of androgen replacement treatment (wash-out phase) for a minimum of 6 weeks, subjects were randomized to two groups in a cross-over design. Drug treatment regimens were of 6-week duration and consisted of two implants, each containing 115 mg MENT acetate, inserted s.c. into the upper arm and removed after 6 weeks and two injections of TE (200 mg, i.m.) 3 weeks apart. MENT treatment resulted in stable plasma MENT concentrations of 1.4 +/- 0.1 nmol/L after 3 weeks and 1.3 +/- 0.1 nmol/L after 6 weeks (mean +/- SEM; all men). Nadir testosterone concentrations were 3.6 +/- 0.6 nmol/L at the end of the wash-out phase and 9.4 +/- 0.6 nmol/L 3 weeks after each injection. There were no differences in hormone concentrations between centers. There were no adverse toxicological effects. There were only minor differences between the two treatments. Both MENT and TE treatment resulted in significant increases in sexual interest and activity, spontaneous erection (both by self-report and NPT measurement), and increases in positive moods, with decreases in negative moods in the Edinburgh group. In the Hong Kong group, both treatments increased waking erection, with a trend toward increased sexual interest and activity. Mood states appeared to be less affected during the wash-out phase than in Edinburgh men and showed no significant response to either treatment. These results demonstrate that MENT has similar effects on sexual activity and mood states as testosterone in hypogonadal men. As NPT is a physiological androgen-dependant outcome, these data provide further evidence for the androgenicity of MENT. The lack of detected effect of either androgen in Hong Kong men other than on waking erection illustrates the importance of the cultural context of symptomatology and its measurement. The appropriate dose of MENT remains to be determined, but these results support its development as a potential androgen replacement therapy.

Characterization of the Alu-rich 5'-flanking region of the human prothrombin-encoding gene: identification of a positive cis-acting element that regulates liver-specific expression.

The nt sequence of 6127 bp of sequence upstream of the human prothrombin-encoding gene (F2) has been determined. Since we previously characterized 417 bp of DNA immediately upstream from the transcription start point (tsp), 6544 bp of continuous flanking sequence are known. Eleven Alu repeat sequences present in this region comprise 45% of the sequence; other repetitive sequences were identified by searching GenBank. The tsp was found to be heterogeneous by exon mapping and primer extension analysis. To localize the cis-acting sequences responsible for the liver-specific expression of F2, hybrid cat genes were constructed with various lengths of F2 5'-flanking region cloned upstream from a promoterless cat gene. After transfection into HepG2 and HeLa cells, it was inferred that the region between nt -1101 and -798 was required for synthesis in HepG2 cells; no synthesis was observed using these constructs in HeLa cells. Two sequences for known liver-specific or regulatory cis-acting sequences were identified in this region.

Female sexual dysfunction associated with antidepressant administration: a randomized, placebo-controlled study of pharmacologic intervention.

OBJECTIVE: Few controlled trials of pharmacologic intervention in women with antidepressant-associated sexual dysfunction have been reported, and there is uncertainty about the usefulness of putative treatments and the assessment methodologies. The authors evaluated the efficacy of buspirone and amantadine in the treatment of sexual dysfunction associated with fluoxetine administration. METHOD: Women who had been successfully treated with fluoxetine for at least 8 weeks and who had reported a deterioration in sexual function not present before the initiation of fluoxetine entered a 4-week assessment period. After assessment they were randomly assigned to an 8-week treatment trial with buspirone (N=19), amantadine (N=18), or placebo (N=20). Outcomes were assessed by using a patient-rated daily diary and a clinician-rated structured interview. RESULTS: While the amantadine-treated women did report significantly greater improvements in energy levels than women in the placebo group, all treatment groups experienced improvement in overall sexual function as well as in most individual measures. There were no statistically significant differences among the three groups. CONCLUSIONS: Neither buspirone nor amantadine was more effective than placebo in ameliorating antidepressant-associated sexual dysfunction. All groups experienced marked nonspecific improvement during treatment, which suggests the importance of placebo-controlled trials for this condition.

Menstrually Related Disorders: points of consensus, debate, and disagreement.

It seems that during the past decade we have been witnessing an evolution of a consensus on the phenomenology and time course of various types of MRDs. We are in a stage in which definitions and diagnostic criteria can be developed, but their broad acceptance is still not assured. The etiology and pathophysiology are still fiercely debated, but reasonable and feasible methods for scientific elucidation of the various hypotheses are in place and are followed by solid groups. Despite the uncertainty concerning the etiology of MRDs, reasonably efficient treatment modalities do exist, and most sufferers of MRDs should expect an eventual alleviation of their symptoms if they are treated in a specialized, established, and up-to-date program.

An investigation of optimal gold particle size for immunohistological immunogold and immunogold-silver staining to be viewed by polarized incident light (EPI polarization) microscopy.

We investigated the optimal gold particle size for use with polarized incident light (epi polarization) microscopy with immunogold immunohistological preparation in both immunogold indirect (IGS) and silver-enhanced immunogold-silver staining (IGSS) techniques. A range of gold particle sizes from 5 nm-40 nm was used along with tissue of known immunoreactivity with a well-characterized primary monoclonal antibody. Checkerboard titrations were carried out for each technique and for each particle size. The preparations were viewed using a standard polarized incident light microscope and assessed in a semi-quantitative manner. Adequate visualization of gold particles was achieved using the indirect staining method only with a particle size of 40 nm. With silver enhancement (IGSS), particles of all sizes were clearly seen. However, 5-nm particles were considered optimal for this method because of reduced background staining, high titration of antisera possible, and crisp localization of the visual signal.

Immunohistochemical pathology of the corneal endothelium in iridocorneal endothelial syndrome.

PURPOSE: To evaluate immunohistochemical staining of the endothelia of corneas from patients with clinical diagnoses of iridocorneal endothelial (ICE) syndrome. METHODS: Corneas diagnosed with ICE syndrome and removed during corneal transplantation were freshly frozen, sectioned, and stained with monoclonal antibodies to keratin subgroups, vimentin, desmin, and a series of other antibodies against intermediate filaments. Transmission electron microscopy was performed on segments of these corneas fixed in glutaraldehyde. RESULTS: There was almost universal staining of the endothelial layer with A1 and A3 keratin monoclonal antibodies and vimentin. Transmission electron microscopy of the corneas also confirmed features consistent with keratin. CONCLUSIONS: The "endothelial" cell layer in the iridocorneal endothelial syndrome has electron microscopic and immunohistochemical characteristics of epithelial-like cells, but it also cross-reacts with vimentin, suggesting that these cells retain or derive some endothelial staining characteristics as well. This "epithelialization" of the endothelial layer may explain the progressive cellular proliferation across angle and iris similar to that seen in iatrogenic epithelial downgrowth and posterior polymorphous endothelial dystrophy.

Differential effects of warfarin on the intracellular processing of vitamin K-dependent proteins.

The vitamin K-dependent carboxylation of specific glutamyl residues to gamma-carboxyglutamyl residues occurs during the endoplasmic reticulum processing of a limited number of proteins. The fate of the under-gamma-carboxylated proteins during protein processing was studied. When human hepatoma (HepG2) cells were grown in the presence of warfarin, under-gamma-carboxylated prothrombin was secreted into the medium. In contrast, prothrombin secretion from a rat hepatoma (H-35) cell line was blocked by warfarin, and intracellular forms which were retained were degraded. When rat prothrombin (rFII) was stably transfected into warfarin treated HepG2 cells, endogenous human prothrombin (hFII) was secreted in an under-gamma-carboxylated form, while rFII accumulated intracellularly. These data indicate that retention and degradation of under-gamma-carboxylated prothrombin by human hepatocytes is related to a structural difference in rFII and hFII. When rFII and hFII were transfected into a warfarin treated transformed human embryonic kidney cell line (293), both proteins were secreted in an under-gamma-carboxylated form and intracellular retention was not observed. However, the secretion of rFII was greatly diminished. Cellular retention of under-gamma-carboxylated forms is therefore tissue specific, but degradation is not.

Endocrine changes in male sexual deviants after treatment with anti-androgens, oestrogens or tranquillizers.

The endocrine effects of drugs on two groups of 12 male sexual offenders in a special hospital were studied. In the first study benperidol, chlorpromazine and placebo were compared and in the second ethynyl oestradiol and cyproterone acetate were compared with no treatment. In the first study there was no difference between the three drugs in their effects on plasma testosterone or luteinizing hormone (LH). In the second study cyproterone acetate produced a reduction in plasma testosterone, LH and follicle-stimulating hormone (FSH). Ethynyl oestradiol produced a rise in plasma testosterone and LH, and no change in FSH. Neither drug changed total plasma oestrogen levels. The unexpected effects of ethynyl oestradiol were attributed to an increase in sex hormone-binding globulin (SHBG) leading to a rise in bound, inactive testosterone. Direct measurement showed a two- to threefold increase in SHBG with ethynyl oestradiol treatment and no change in SHBG with cyproterone acetate treatment. In spite of these contrasting endocrine effects, ethynyl oestradiol, cyproterone acetate and benperidol produced similar behavioural changes.

Impact of environment, stress, occupational, and other hazards on sexuality and sexual behavior.

Sexual health is important for general as well as reproductive health. The effects of the environment on sexual health are complex, however, because of the psychosomatic nature of human sexuality. The effects of any specific environmental agent on sexual function will therefore be modified or amplified by psychosocial factors, and any assessment of the effects of the agent will need to take those factors into account. As a consequence, we have little direct evidence of the adverse effects of the environment on sexuality. This paper therefore considers a) the aspects of sexuality that may by susceptible to environmental effects and the likely mediating mechanisms. These are considered under three headings: psychophysiological, endocrine, and subjective/interpersonal; b) the types of relevant environmental factors, including toxic pollutants, self-administered toxins, diet, situational factors, adversity, stress, and social and cultural factors. As yet research has not controlled adequately for the various confounding factors. It is suggested that a first step is to investigate the effects of work stress (e.g., shift and night work) on sexual relationships, comparing the effects across contrasting cultural settings. Such research would then provide a basis for cross-cultural study of other environmental factors.

Testosterone and erectile function, nocturnal penile tumescence and rigidity, and erectile response to visual erotic stimuli in hypogonadal and eugonadal men.

Further evidence that nocturnal erections are androgen-dependent and erectile responses to visual erotic stimuli are androgen-independent is presented from six men with secondary hypogonadism and six eugonadal controls. Erections during sleep were substantially less in the hypogonadal men, in terms of both tumescence and rigidity. In response to visual erotic stimuli, the percentage increase in circumference over baseline and the increase in rigidity were similar for the two groups.