French-style genetics v. 2.0: The "e-CohortE" project.

In the digital age, a genetics cohort has become much more than a simple means of determining the cause of a disease. Two-sided markets, of which 23andMe, Ancestry DNA and MyHeritage are the best known, have showed this perfectly over the last few years: a cohort has become a means of producing massive amounts of data for medical, scientific and commercial exploitation, and for genetic use in particular. French law does not currently allow these foreign private companies to develop on French national territory and also forbids the creation of similar entities in France. However, at least in theory, this same law does not preclude the creation of new types of cohorts in France inspired by the success of two-sided markets but retaining features specific to the French healthcare management system. We propose an optimal solution for France, for genomic studies associated with multi-subject questionnaires, still purely theoretical for the moment: the development, with no need for any change in the law, of France's own version of "Genetics v.2.0": "e-CohortE."

Nature and origin of "squirting" in female sexuality.

INTRODUCTION: During sexual stimulation, some women report the discharge of a noticeable amount of fluid from the urethra, a phenomenon also called "squirting." To date, both the nature and the origin of squirting remain controversial. In this investigation, we not only analyzed the biochemical nature of the emitted fluid, but also explored the presence of any pelvic liquid collection that could result from sexual arousal and explain a massive fluid emission. METHODS: Seven women, without gynecologic abnormalities and who reported recurrent and massive fluid emission during sexual stimulation, underwent provoked sexual arousal. Pelvic ultrasound scans were performed after voluntary urination (US1), and during sexual stimulation just before (US2) and after (US3) squirting. Urea, creatinine, uric acid, and prostatic-specific antigen (PSA) concentrations were assessed in urinary samples before sexual stimulation (BSU) and after squirting (ASU), and squirting sample itself (S). RESULTS: In all participants, US1 confirmed thorough bladder emptiness. After a variable time of sexual excitation, US2 (just before squirting) showed noticeable bladder filling, and US3 (just after squirting) demonstrated that the bladder had been emptied again. Biochemical analysis of BSU, S, and ASU showed comparable urea, creatinine, and uric acid concentrations in all participants. Yet, whereas PSA was not detected in BSU in six out of seven participants, this antigen was present in S and ASU in five out of seven participants. CONCLUSIONS: The present data based on ultrasonographic bladder monitoring and biochemical analyses indicate that squirting is essentially the involuntary emission of urine during sexual activity, although a marginal contribution of prostatic secretions to the emitted fluid often exists.

[Management of erectile dysfunction in daily practice--PISTES study]. / Prise en charge de la dysfonction érectile en pratique quotidienne: Etude PISTES.

INTRODUCTION: Despite the improved knowledge on erectile dysfunction and its prevalence over recent years, no pharmaco-epidemiology study on the management of erectile dysfunction in daily practice has been performed. This absence of data is all the more regrettable in view of the real revolution in the management of this disorder, leading an increasing number of patients to consult. OBJECTIVES: To determine and analyse the presenting complaints, aetiological diagnoses, and modalities of management of patients with erectile dysfunction. METHOD: PISTES pharmaco-epidemiological, prospective and transverse study of a representative national sample of 411 private or hospital urologists and sexologists between April and June 2002. RESULTS: The majority of patients (56.7%) expressed discomfort talking about this subject. Patients with mixed predominant psychogenic ED and mixed predominant organic ED represented 67.1% of the population, confirming the multifactorial aetiology. The management varies according to the aetiology. Complementary investigations are essentially hormone assays (89.6%), well ahead of provoked erection tests (21.9%). Patients are reviewed within 2 months and 65% resumed a satisfactory sexual activity. The main causes of failure are inefficacy (83.7%) and the high cost of treatment preventing purchase (56%). CONCLUSION: This study shows an effective management of erectile dysfunction, but which is still faced with difficulties of access to care for psychological or economic reasons. These difficulties concern the patient, his partner and the practitioner Although information on erectile dysfunction has been greatly improved, it does not sufficiently encourage effective therapeutic management.

Intracavernous injections of prostaglandin E1 for erectile dysfunction: patient satisfaction and quality of sex life on long-term treatment.

INTRODUCTION: Since the availability of oral type 5 phosphodiesterase (PDE5) inhibitors for the treatment of erectile dysfunction (ED), patients' views on the use of intracavernous injections (ICI) of prostaglandin E1 (PGE1) may have changed. AIM: To assess the satisfaction of patients with long-term ICI. METHODS: Patients with ED (>18 years old) who had used ICI of PGE1 for at least 3 months were asked to complete the "EASY" (Evaluation de l'Acceptation des injectionS dans la dYsfonction érectile) questionnaire. MAIN OUTCOME MEASURES: Overall patient satisfaction with ICI, impact on quality of life, ease of use, satisfaction with the quality of erections, and perceived partner satisfaction. RESULTS: Overall, 596 questionnaires met our inclusion criteria. Mean patient age was 62.1 years, mean duration of ED was 61 months, and mean duration of ICI treatment was 35 months. Before using ICI, 43% of patients had taken at least one PDE5 inhibitor; 81% discontinued PDE5 for want of efficacy. The overall satisfaction rate with ICI was 78.3%. ICI met expectations each time in 78.6% of patients and at least half the time in 90% of patients; 86% were ready to recommend ICI to friends. Patients noted improvements in their sex life (70.1%), relationship with their partner (50%), quality of life (44.8%), and confidence in attempting sexual intercourse (80.3%). The mean number of injections was 4.4 per month. Most patients (81.1%) found the injections easy to use. The mean score for pain on injection was 2.09/10 and for pain on erection was 2.15/10. Three-quarters of patients (73.1%) thought that their partners were satisfied with ICI. CONCLUSION: Patients on long-term ICI/PGE1 can recover a very satisfying sex life. ICI met patients' expectations in terms of efficacy, ease of use, tolerance, and improved sex life. These results should encourage physicians and patients to use ICI when PDE5 fails, is not well tolerated, or is contraindicated.