Penile Elastography Versus Penile Duplex Ultrasonography in Diagnosing Non-Responders to Intracavernosal Injection: A Prospective Cohort Study.

OBJECTIVES: The current study aims to investigate the value of penile elastography in assessing the fibrotic changes in the corpora cavernosa. PATIENTS AND METHODS: Eighty participants were included in the study. These were divided into two equal groups: a study group (group 1) included patients with ED who did not respond to intracavernosal injection (ICI), and an age-matched control group (group 2) included age-matched subjects with normal erection. All subjects answered an International Index of Erectile Function-5 (IIEF-5) questionnaire. The first group was evaluated by two ICI trials of 1 mL Quadmix, each took place 1 week apart, followed by a color duplex/Doppler ultrasonography (CDDU) scan using also a 1 mL Quadmix. All the above was done a week before the penile shear wave elastography (SWE) scan. It comprised a 12-section scan of both corpora cavernosa. Each corpus was scanned in three different segments (proximal, mid-shaft, and distal), and in both longitudinal and transverse axes. RESULTS: Comparisons of the laboratory data were non-significant, apart from the glycosylated hemoglobin which proved significant (P value <.001) in both groups. Also, the IIEF-5 scores were significantly lower in the study group (P value <.001). Significantly higher SWE readings (indicating higher fibrotic) were found in the study group compared with the control group in almost all of the scanned segments and their combinations (P value <.05). CONCLUSION: SWE can effectively assess the fibrotic changes occurring in the corpora cavernosa. Hence, SWE could be utilized as a modality that helps diagnose patients with ED.

Cavernous smooth muscles: innovative potential therapies are promising for an unrevealed clinical diagnosis.

While erectile dysfunction (ED) is highly prevalent worldwide, unrevealed cavernous smooth muscles (CSM) defects can confound the diagnosis of vascular ED and lead to failure of treatments. Currently, the first-line oral treatment for ED is phosphodiesterase type 5 inhibitors (PDE5Is). Patients with diabetes mellitus (DM), those who have undergone a radical prostatectomy (RP), and the elderly population are difficult to treat by the PDE5Is; unrevealed CSM defects can result in corporo veno-occlusive dysfunction (CVOD); and penile veno-ligation surgeries are currently abandoned due to high failure rates. It has been found that gene and stem cell therapies, among others, reduce cavernous tissue apoptosis and fibrosis and can specifically target CSM defects such as the nitric oxide (NO)-mediated signaling pathway, Rho-ROCK system, and transformation growth factor (TGF)-ß1/angiotensin II (Ang II) pathway, in several laboratory animals. Current data clarify the need of diagnostic techniques that can provide an initial assessment of CSM. This assessment should be essential before giving a diagnosis of vascular ED and before applying several tests searching for a specific CSM defect to guide the specific therapy. Moreover, while patients with corporal fibrosis would fail the current medical therapies, these patients can benefit from the stem cell-based therapies that induce the internal mechanisms of tissue repair. However, penile elastography can determine the stiffness of tissues and corpus cavernosum electromyography (CC-EMG) can assess the integrated activity of CSM bulk, further refinements are required for these techniques before being considered in the evaluation of patients with ED. In conclusion, on the basis of the current scientific research, it may be possible to formulate new therapies and achieve the appropriate selection of patients who can benefit from these therapies.

The Relationship of Close Marital Affairs to Healthy Women's Sexual Function: A Cross-Sectional Retrospective Study in Egypt.

INTRODUCTION: Some marriage-related factors may be associated with women's sexuality, but this topic has not been sufficiently investigated in developing countries. Indeed, these marital factors can be well planned and/or managed to achieve desirable outcomes; for instance, the legal age of marriage can be increased to 21 years. However, how this will reflect on women's sexuality should be clarified before any laws are changed. AIM: The purpose of this study was to investigate the associations of the age of marriage, number of children, educational level, duration of marriage, and aging with female sexual function among groups of Egyptian women. METHODS: We analyzed the recorded sociodemographic data and scores of the 19-item Female Sexual Function Index (FSFI) among 270 apparently healthy women aged 21-45 years. According to the studied variables, the data were divided into various subgroups. MAIN OUTCOME MEASURE: The sociodemographic data and scores of the FSFI. RESULTS: Marriage, before or after 21 years, was not correlated with sexual function. FSFI scores were significantly lower among women with ≥3 children and women who had been married for ≥10 years. FSFI scores were significantly lowest in women with the lowest educational level and those aged ≥40 years. CONCLUSION: It is important to ensure that people are equipped with accurate information. Sound knowledge can serve as the basis for informed decisions regarding the age of marriage and number of children desired. Furthermore, everyone, not just women, should be aware of the adverse sexual effects associated with long marriages and the age-related declines in sexual activity. Accordingly, women can achieve better sexual satisfaction. Hassanin AM, Kaddah AN, El-Amir MY. The Relationship of Close Marital Affairs to Healthy Women's Sexual Function: A Cross-Sectional Retrospective Study in Egypt. Sex Med 2019;7:498-504.

The application of spontaneous corpus cavernosum EMG to assess the status of cavernous smooth muscles, a preliminary study / La aplicación de cuerpo cavernoso EMG espontáneo para evaluar el estado de los músculos lisos cavernosos. Un estudio preliminar

Introduction: Diagnostic tests for vascular erectile dysfunction (ED) depend on cavernous smooth muscles (CSM) relaxation following an intracorporal injection (ICI). Enhanced sympathetic tone, which is not uncommon during performance of these tests, can bias its results. Also, CSM diseases can cause veno-occlusive diseases (VOD) ED. Corpus cavernosum electromyography (CC-EMG) potentials’ amplitudes represent the integrated sympathetic activity of healthy CSM. Stem-cells and gene-therapy are potential therapeutic options for impaired CSM. Objective: To utilize CC-EMG, as a new diagnostic technique that can confirm the integrity of CSM, and to identify patients with impaired CSM activity, among those diagnosed as vascular ED per Color Duplex Doppler Ultrasonography (CDDU). Patient and methods: Group 1 included 24 patients with ED and negative response to ICI. Group 2 included 10 men without ED. Patients included in group 1 had penile CDDU examination and all participants had spontaneous CC-EMG recordings. Results: According to CDDU parameters, group 1 was sub-grouped as nine arterial, ten VOD and five mixed type. CC-EMG potentials' amplitudes ranged 223-320, 179-237, 103-250 and 83-200μV for group 2 and arterial, mixed and VOD subgroups respectively. The widest ranges of potentials’ amplitudes were recorded in the subgroups of patients with an element of VOD. Four patients with ED, within these subgroups, had CC-EMG potentials’ amplitudes ranged 200-250μV that exceeded/approached the lowest value recorded from men in group 2. Conclusion: CC-EMG recordings elicited marked differences of CSM activity among patients diagnosed with an element of VOD ED per CDDU. This finding highlighted the need to utilize CC-EMG to assess the integrity of CSM. Identifying patients with impaired CSM activity may modify the chosen methods for therapeutic interventions

Introducción: Las pruebas diagnósticas para la disfunción eréctil (DE) vascular dependen de la relajación de los músculos cavernosos lisos (MCL) después de una inyección intracorporal (IIC). El tono simpático mejorado, que es frecuente durante la realización de estas pruebas, puede sesgar los resultados. Además, las enfermedades de los MCL pueden provocar DE con enfermedades venooclusivas (EVO). Las amplitudes de los potenciales de la electromiografía de los cuerpos cavernosos (CC-EMG) representan la actividad simpática integrada de los MCL sanos. Las células madre y la terapia génica son opciones terapéuticas potenciales para los MCL con discapacidad. Objetivo: Utilizar CC-EMG como una nueva técnica de diagnóstico que pueda confirmar la integridad de los MCL e identificar a los pacientes con actividad de MCL deteriorada entre los diagnosticados con DE vascular por ecografía Doppler color dúplex (CDDU, por sus siglas en inglés). Paciente y métodos: El grupo 1 incluyó a 24 pacientes con DE con una respuesta negativa a la IIC. El grupo 2 incluía a 10 varones sin DE. En los pacientes incluidos en el grupo 1 se realizó CDDU en el pene y todos los participantes presentaron grabaciones de la CC-EMG espontáneas. Resultados: De acuerdo con los parámetros CDDU, el grupo 1 se dividió en subgrupos, como 9 arteriales, 10 VOD y 5 tipos mixtos. Las amplitudes de los potenciales de la CC-EMG variaron entre 223-320, 179-237, 103-250 y 83-200μV para el grupo 2 y los subgrupos arteriales, mixtos y VOD, respectivamente. Los amplios rangos de amplitudes de los potenciales se registraron en los subgrupos de pacientes con un elemento de VOD. Cuatro pacientes dentro de estos subgrupos tenían amplitudes de potencial de la CC-EMG de 200-250μV que excedían/acercaban el valor más bajo para varones en el grupo 2. Conclusión: Las grabaciones de la CC-EMG provocaron marcadas diferencias de actividad de los MCL entre los pacientes diagnosticados con un elemento de VOD DE por CDDU. Este hallazgo destacó la necesidad de utilizar CC-EMG para evaluar la integridad de los MCL. La identificación de pacientes con actividad de CSM afectada puede modificar los métodos elegidos para las intervenciones terapéuticas

The application of spontaneous corpus cavernosum EMG to assess the status of cavernous smooth muscles, a preliminary study.

INTRODUCTION: Diagnostic tests for vascular erectile dysfunction (ED) depend on cavernous smooth muscles (CSM) relaxation following an intracorporal injection (ICI). Enhanced sympathetic tone, which is not uncommon during performance of these tests, can bias its results. Also, CSM diseases can cause veno-occlusive diseases (VOD) ED. Corpus cavernosum electromyography (CC-EMG) potentials' amplitudes represent the integrated sympathetic activity of healthy CSM. Stem-cells and gene-therapy are potential therapeutic options for impaired CSM. OBJECTIVE: To utilize CC-EMG, as a new diagnostic technique that can confirm the integrity of CSM, and to identify patients with impaired CSM activity, among those diagnosed as vascular ED per Color Duplex Doppler Ultrasonography (CDDU). PATIENT AND METHODS: Group 1 included 24 patients with ED and negative response to ICI. Group 2 included 10 men without ED. Patients included in group 1 had penile CDDU examination and all participants had spontaneous CC-EMG recordings. RESULTS: According to CDDU parameters, group 1 was sub-grouped as nine arterial, ten VOD and five mixed type. CC-EMG potentials' amplitudes ranged 223-320, 179-237, 103-250 and 83-200µV for group 2 and arterial, mixed and VOD subgroups respectively. The widest ranges of potentials' amplitudes were recorded in the subgroups of patients with an element of VOD. Four patients with ED, within these subgroups, had CC-EMG potentials' amplitudes ranged 200-250µV that exceeded/approached the lowest value recorded from men in group 2. CONCLUSION: CC-EMG recordings elicited marked differences of CSM activity among patients diagnosed with an element of VOD ED per CDDU. This finding highlighted the need to utilize CC-EMG to assess the integrity of CSM. Identifying patients with impaired CSM activity may modify the chosen methods for therapeutic interventions.

The emotional burden of chronic skin disease dominates physical factors among women, adversely affecting quality of life and sexual function.

BACKGROUND: Both physical and emotional effects are linked with the natural history of chronic skin diseases (CSD). Skin lesions can be confined to covered areas or involve emotionally charged regions (genitalia/exposed areas). OBJECTIVE: To investigate the contribution of the physical effects of CSD and their emotional burden in adversely affecting the quality of life (QOL) and sexual function. METHODS: Two groups were included: A group of women suffering from CSD and a control group. All participants answered the 19-item Female Sexual Function Index (FSFI) questionnaire. Women suffering from CSD answered the 10-item Dermatology Life Quality Index (DLQI) questionnaire; this group was divided into various subgroups according to the type of disease and regional involvement. RESULTS: Neither the DLQI score (P = .06) nor the FSFI scores were significantly affected by the type of disease. The DLQI score was significantly higher in the subgroups with involvement of genitalia or exposed areas (P: < 0.001and 0.01, respectively). Moreover, genital involvement was associated with pervasive and significantly lower FSFI scores, and the arousal, satisfaction, and total scores were significantly lower among women with the involvement of exposed areas. The DLQI score was significantly negatively correlated with the FSFI scores. CONCLUSION: The emotional burden of CSD should not be overlooked as it dominates the physical effects of disease by adversely affecting QOL and sexual function among women. It is necessary to provide this information to dermatologists and patients, especially in light of effective cognitive-behavior therapy that can be undertaken to ameliorate the emotional stresses.

A Study of the Impact of the Commonly Used Female Contraceptive Methods in Egypt on Female Sexual Function.

Temporary methods of female contraception are commonly practiced in Egypt, but an increased total fertility rate was recently reported. Impaired female sexual function (FSF) due to contraceptive use can be a reason for irregular use/discontinuation. This study aimed at identifying the type(s) of the commonly used contraceptive method(s) in Egypt that can impair FSF. The sexual function of women on some form of temporary contraceptive was compared to that of women not using contraceptives. All participants answered the Arabic translation of the 19-item Female Sexual Function Index questionnaire. Furthermore, participants on contraceptives answered a global question: Did the use of the contraceptive impact your sexual function? Participants on contraceptives were subgrouped into Copper-T intrauterine devices (IUDs), progestin injectable (medroxyprogesterone 400 mg), combined oral pills (COP; 30 µg ethinylestradiol and 150 µg levonorgestrel), and progestin-only pills (POP; 750 µg levonorgestrel). According to this study, neither the IUDs nor the COP impaired FSF. However, the progestin-only contraceptives were associated with impairment of FSF; the injectable was worse than the POP. Accordingly, counseling about the potential sexual risks of the available contraceptive methods is recommended. Impaired FSF due to contraceptive use can be addressed by a trial of an alternative method to avoid discontinuation.