[Uterine transplantation, ethical and social aspects]. / Aspects éthiques et sociaux de la transplantation utérine.

Uterine transplantation is now a possible treatment for absolute uterine infertility. It is currently proposed to women with Mayer-Rokitansky-Küster-Hauser syndrome but indications will likely to expand in the upcoming years. Despite the progressive standardization of the surgical technique and the reduction in perioperative morbidity for both donors and recipients, the number of transplants performed worldwide remains very low compared to the number of women potentially in need. This is partly due to the singularity of uterine transplantation: the uterus is not a vital organ since one can live without a uterus. It is a temporary transplantation that is not performed to extend life but to improve its quality, responding above all to a desire to conceive and bear a child. Beyond the strictly technical aspect, these particularities raise many ethical questions, both on an individual and social level, which should make us question the real place uterine transplantation should take in our society. Answering these questions will allow us to provide better guidance for future eligible couples and to anticipate ethical problems on the long run.

[An exploration of sexual desire and sexual activities of women with psychosis]. / Désir et pratiques sexueues chez les femm-es souffrant de psychose.

Most clinicians avoid discussing sexuality with patients with severe mental disorders. Sexual disturbances can be related to medication, to psychological issues such as self-stigma and anhedonia, and to the social context. We studied desire and sexual practices in women suffering from schizophrenia, in comparison with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. This finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.

Prospective evaluation of early postoperative male and female sexual function after radical prostatectomy with erectile nerves preservation.

Prostate cancer screening has led to the diagnosis of localized prostate cancer in increasingly young and sexually active men. Accordingly, the impact of cancer treatment on sexual function is gaining more attention. To prospectively evaluate the impact of radical prostatectomy (RP) on male, female and conjugal sexual function. Patients were prospectively assessed by an urologist and a sexologist before and 6 months after robot-assisted laparoscopic RP (RALP). RALP was performed with uni- or bilateral neurovascular bundle preservation by a single surgeon. Postoperatively, all patients were prescribed tadalafil 20 mg, 3 times a week during 6 months. Male and female sexual functions were evaluated by using the International Index of Erectile Function (IIEF-5), the Female Sexual Function Index (FSFI) and the Lock-Wallace Marital Adjustment Test (MAT). Continuous variables were analyzed with rank-sum and t-tests, as needed, and categorical variables with chi-squared tests. All tests were two-sided, with a P-value ⩽ 0.05 considered significant. Twenty-one couples were included. Mean patient male and female age was 62.4 and 60.7 years, respectively. Bilateral nerve sparing was performed in 12/21 (57%) patients. Median preoperative IIEF-5 was 20/25, corresponding to mild erectile dysfunction (ED). Median preoperative FSFI and MAT were both within normal range (28/36 and 114/158, respectively). Six months following surgery, both IIEF-5 (11/25) and FSFI (25/36) had significantly dropped (P=0.007 and 0.003, respectively). Postoperative decreases in IIEF-5 and FSFI scores were associated within couples. MAT scores (115/158), however, remained unaffected by RALP, showing an unmodified relationship satisfaction postoperatively. Finally, bilateral nerve sparing surgery preserved not only male but also female sexual function. This study shows that the expected short-term post-RALP ED is associated with a worsening of female sexual function, whereas nerve sparing surgery has a protective effect on both the patient's and his partner's sexual function with a significant effect of bilateral over unilateral neurovascular bundle preservation. Furthermore, we found that conjugal complicity remains stable throughout the first semestrial postoperative period despite the decrease in sexual function.

Neurobiology of DHEA and effects on sexuality, mood and cognition.

Dehydroepiandrosterone (DHEA) and its sulfate ester, DHEAS, are the most abundant steroid hormones in the humans. However, their physiological significance, their mechanisms of action and their possible roles as treatment are not fully clarified. Biological actions of DHEA(S) in the brain involve neuroprotection, neurite growth, neurogenesis and neuronal survival, apoptosis, catecholamine synthesis and secretion, as well as anti-oxidant, anti-inflammatory and antiglucocorticoid effects. In addition, DHEA affects neurosteroidogenis and endorphin synthesis/release. We also demonstrated in a model of ovariectomized rats that DHEA therapy increases proceptive behaviors, already after 1 week of treatment, affecting central function of sexual drive. In women, the analyses of clinical outcomes are far from being conclusive and many issues should still be addressed. Although DHEA preparations have been available in the market since the 1990s, there are very few definitive reports on the biological functions of this steroid. We demonstrate that 1 year DHEA administration at the dose of 10mg provided a significant improvement in comparison with vitamin D in sexual function and in frequency of sexual intercourse in early postmenopausal women. Among symptomatic women, the spectrum of symptoms responding to DHEA requires further investigation, to define the type of sexual symptoms (e.g. decreased sexual function or hypoactive sexual desire disorder) and the degree of mood/cognitive symptoms that could be responsive to hormonal treatment. In this regard, our findings are promising, although they need further exploration with a larger and more representative sample size. This article is part of a Special Issue entitled: Essential role of DHEA.

[Sexuality, heart and chocolate]. / Sexualité, coeur et chocolat.

All along the history, many kinds of magic and aphrodisiac properties were attributed to the chocolate. Because of the presence of certain active substances, cacao and chocolate are supposed to have some potentially beneficial effects on human health, particularly on cardiovascular system. Containing flavoniods, cacao and its products have antioxidant, anti-inflammatory, anti-atherogenic, anti-thrombotic, antihypertensive and neuroprotective effects, as well as influence on insulin sensitivity, vascular endothelial function, and activation of nitric oxide. Other molecules, like methyxantin, biogenic amines and cannabinoid-like fatty acids, may have a psychoactive action. Synergic effect of all these substances could have a positive direct and indirect influence on sexual health and function. Nevertheless, randomized studies are needed to confirm these hypotheses and to elaborate recommendations about cacao consumption.

[Neuropsychiatry of sexual desire]. / Neuropsychiatrie du désir sexuel.

Inspired by the basic concepts of neuroscience, neuropsychiatry is a discipline at the interface between psychiatry, psychology, neurology and neuropathology. Interestingly, neuropsychiatry can also include specialized disciplines, such as developmental psychology, endocrinology and sexology. In this article, we describe the neuropsychiatric approach and present how it may be related to social neuroscience, and apply to sexual medicine by describing its importance for sexual dysfunctions and sexual desire.

[Hypoactive sexual desire disorder in men: clinical approach in sexual medicine]. / Désir sexuel hypoactif chez l'homme: prise en charge en médecine sexuelle.

Hypoactive sexual desire disorder in men: clinical approach in sexual medicine Hypoactive sexual desire disorder (HSDD) has a high prevalence in the population, representing an important cause of consultations in sexual medicine. Although HSDD affects women mostly, it also affects men. HSDD in men can be due to different factors. A precise medical evaluation of these factors is needed to start an efficient therapy. Along these lines, HSDD evaluation must follow a precise schema that integrates psychological factors and also endocrinological, toxic and psychiatric factors. A specific formation in sexual medicine is recommended for an optimal evaluation of HSDD. The present article describes the milestones of the adequate evaluation of HSDD to help the physicians in their daily clinical practice.

[Temporal evolution of passionate brain states in long-term couple relationships]. / Evolution temporelle de l'état passionnel dans la relation de couple.

A growing body of evidence proposes that passion is a function of change in intimacy between spouses. In mathematical terms, passion is a function of the first derivative of intimacy over time. High passion occurs when intimacy is felt to be rising. Low passion occurs when intimacy is stable (either high or low). In the present article, we review the experimental evidences that attribute changes in passion in couple-longitudinal patterns as a function of a triadic model between passion, intimacy and personality traits. In light of this, future studies in couple therapy and human sexuality would need to take account of the consequences of both standard approaches in sexology and this triadic model in the understanding and treatment of decreases in frequency of sexual relationships in long-term relationships.

[Sexual function after radical prostatectomy: update of 2009]. / Fonction sexuelle après prostatectomie radicale: revue et prise en charge en 2009.

Prostate cancer is more frequently diagnosed in young males. It is then of utmost importance to improve preservation and recovery of sexual function. The surgical technique of radical prostatectomy has evolved and erectile nerve sparing allows now to achieve recovery in an important proportion of selected patients. However, rehabilitation and sexual counselling protocols are rare and may not include the partner. This has led us to propose a specific urologic and sexologic associated management.

[Heart failure and sexual dysfunction]. / Insuffisance cardiaque et dysfonctions sexuelles.

Most patients with chronic heart failure (CHF) can safely engage in sexual activity and be treated for erectile dysfunction with sildenafil, provided that they do not have active coronary ischemia and do not require treatment with nitrates. Clinicians should know the physiological requirements for sexual activity and the impact chronic heart failure has on sexual performance. Fear of cardiac events during intercourse can interfere with patients' ability to perform and enjoy sex, and thus, it is important that the physician be able to counsel patients with chronic heart failure about sexual activity.

[A socio-cognitive approach of human sexual desire]. / Approche sociocognitive du désir sexuel.

The ability to direct motivational feelings towards another person, and develop an intimate partner-relationship is important for social interaction, notably for sexual desire (SD). The recent discovery of a brain network for SD recruiting higher-order cognitive brain areas (angular gyrus), in addition to emotional limbic brain regions, suggests that SD is sustained by cognitive mechanisms, rather than by instinct only. Critically recent studies in social cognitive neuroscience support the interaction between SD and a self expansion model. The findings we report here are important theoretically and practically.

The neural basis of love as a subliminal prime: an event-related functional magnetic resonance imaging study.

Throughout the ages, love has been defined as a motivated and goal-directed mechanism with explicit and implicit mechanisms. Recent evidence demonstrated that the explicit representation of love recruits subcorticocortical pathways mediating reward, emotion, and motivation systems. However, the neural basis of the implicit (unconscious) representation of love remains unknown. To assess this question, we combined event-related functional magnetic resonance imaging (fMRI) with a behavioral subliminal priming paradigm embedded in a lexical decision task. In this task, the name of either a beloved partner, a neutral friend, or a passionate hobby was subliminally presented before a target stimulus (word, nonword, or blank), and participants were required to decide if the target was a word or not. Behavioral results showed that subliminal presentation of either a beloved's name (love prime) or a passion descriptor (passion prime) enhanced reaction times in a similar fashion. Subliminal presentation of a friend's name (friend prime) did not show any beneficial effects. Functional results showed that subliminal priming with a beloved's name (as opposed to either a friend's name or a passion descriptor) specifically recruited brain areas involved in abstract representations of others and the self, in addition to motivation circuits shared with other sources of passion. More precisely, love primes recruited the fusiform and angular gyri. Our findings suggest that love, as a subliminal prime, involves a specific neural network that surpasses a dopaminergic-motivation system.

[Male sexual function after stroke]. / Fonction sexuelte masculine après accident vasculaire cérébral.

Stroke represents the third leading cause of death, ranking behind heart disease and cancer and it is the major cause of worldwide long-term disability after the age of 65. Stroke has an important psychological and emotional impact on the patient and his environment. Some trials show the substantial lowering of libido, of the frequency of sexual intercourse, the presence of erectile dysfunction and reduced sexual satisfaction. After stroke it is important to evaluate the relational and sexual aspects of the patient and his sexual partner. A specialized consultation should be proposed when necessary to optimise the patient's post-stroke rehabilitation.

[Erectile dysfunction: a potential useful marker for cardiovascular disease]. / La dysfonction érectile: un possible marqueur de maladies cardiovasculaires.

Erectile dysfunction is defined as the inability to achieve and/or maintain an erection sufficient to permit satisfactory sexual intercourse. Most cases of erectile dysfunction have a vascular etiology and, in patients with known cardiovascular disease, the degree of erectile dysfunction correlates with severity of that disease. In addition, cardiovascular disease and erectile dysfunction share the same risk factors for atherosclerosis and have a common pathophysiology (endothelial dysfunction); thus, erectile dysfunction appears as an early and sentinel symptom in patients with occult vascular disease, of the coronary or carotid arteries.

[The neurophysiology of the female orgasm]. / Le cerveau au coeur du plaisir féminin.

The way women experience orgasm during passionate sexual activity has been of interest throughout the ages. The astonishing advances of functional imaging techniques recently allowed unravelling the neuroanatomy of female orgasm within a distributed corticosubcortical neural network. In the present article, we review the clinical and experimental evidence that attributes orgasm not only a peripheral but also a central origin. We thus outline the importance of integrating orgasm as a complex process involving the entire woman, mind and body. In light of this, future studies in female sexuality would need to take account of the consequences of both standard approaches in sexology and functional imaging results in the understanding of the human sexual function and in the treatment of sexual dysfunctions.