La Medicina Sexual en la Historia. Avances y controversias (Parte II) / Sexual Medicine beyond History. Advances and controversies (Part II)

El recorrido histórico de la Medicina Sexual y la Andrología por los 2 últimos siglos permite ver cómo el desarrollo científico se ha acelerado hasta un nivel que hubiera parecido imposible a nuestros predecesores. A ello han contribuido en gran parte los logros en la comprensión de la fisiología y, desde luego, la cirugía, con el descubrimiento de la anestesia y el control de las infecciones y la hemostasia, pero, sin duda, también han sido parte importante en esta historia la nueva mentalidad de trabajo en equipo y el intercambio de información, disponible de modo cada vez más dinámico y con una amplitud insospechada tan solo hace unas décadas. Por otra parte, estos avances en muchas ocasiones no han sido fáciles para quienes los han impulsado, y diferentes controversias han puesto de relieve tanto la necesidad de veracidad en la investigación realizada como la perseverancia ante las dificultades e incomprensiones. Por ello, el presente trabajo de investigación intenta recuperar la importancia del factor humano y las decisiones personales como ejes clave del avance científico, también en lo que corresponde al estudio y tratamiento de los problemas de la sexualidad humana (AU)

The historical journey of Sexual Medicine and Andrology over the last 2 centuries makes it possible to illustrate how scientific development has grown to such a level that would have seemed impossible to our ancestors. This growth has largely contributed to the understanding of the physiology and, of course, the surgery, with the discovery of anesthesia, infection control and hemostasis. However, undoubtedly, the new culture of teamwork and the new possibilities of an increasingly dynamic exchange of information having an extension that was unsuspected only a few decades ago has also played an important part in this history.Moreover, in many cases these advances have not been easy for those who have encouraged them. Different controversies have highlighted both the need for accuracy in the research and perseverance against difficulties and misunderstandings. Therefore, the present research work has tried to recover the importance of the human factor and personal decisions as a key to scientific advance, as well as in that corresponding to the study and treatment of the issues of human sexuality (AU)

A new method to estimate quantitatively seminal vesicle and prostate gland contributions to ejaculate.

AIMS: We sought to optimize a quantitative noninvasive method to determine the concentration in their glands of origin of biochemical markers of compartments of the male genital tract as the first step towards validation of a novel method for estimation of drug concentrations in these male genital tract compartments. METHODS: Sixty-eight men participated. We compared four collection devices to split ejaculate into fractions. Fractions were assayed for fructose and prostate specific antigen (PSA) as unique markers of the seminal vesicle and prostate, respectively. Seminal vesicle fructose and prostatic PSA were estimated using a linear regression method, based on fructose-PSA axis intercepts, and compared with an older method which solves a simultaneous series of equations. RESULTS: A five-compartment collection device performed best with mean (95% confidence interval) PSA vs. fructose r(2) of 0.84 (0.71, 0.98, P < 0.001). Using resampling simulations, glandular PSA and fructose estimates were highly variable and often implausible when using only two fractions. Using our method, the prostate contributed 37-44% to the whole ejaculate and the seminal vesicle contributed 55-61%. The novel regression method was highly correlated (r(2) > or = 0.98) with older methods. CONCLUSIONS: We developed a noninvasive quantitative method of male genital tract biochemical marker estimation using a five-compartment tray to collect three to five ejaculate fractions. Our novel regression method is quantitative and more fully developed than older methods. This noninvasive method for determining glandular marker concentrations should be useful to provide quantitative estimates of drug concentrations in these glands.

Evaluation of the Sexual Assessment Monitor, a diagnostic device used to electronically quantify ejaculatory latency time: findings from three studies.

OBJECTIVE: To validate the Sexual Assessment Monitor (SAM), a novel apparatus designed to collect electronic data on ejaculatory latency time (ELT) for diagnosing premature ejaculation (PE), and for accurately measuring treatment outcomes in clinical trials. PATIENTS, SUBJECTS AND METHODS: Men with PE, and healthy volunteers aged 18-75 years, were enrolled in three open-label studies, conducted in the UK. The SAM, which consists of a control box with two front attachments, a vibrator and sensor, was attached to the penis. The vibrator, which provides stimulation, was positioned at the frenulum using a soft cuff; the vibrator intensity was set at 80 units for most subjects. The sensor is an indium-gallium elasticated loop, which was positioned around the base of the penis to detect ejaculatory pulses. These pulses were transmitted to a data recorder in the control box. The data, which are displayed graphically as traces, were automatically classified by a computer-generated algorithm to quantify ELT. RESULTS: In all, 53 healthy volunteers and 58 men with PE provided 213 and 195 evaluable records, respectively. Most were complete records (99% and 96%). The pooled data showed that the ELT was much higher for healthy volunteers than for men with PE (geometric means: 687 vs 169 s, respectively), with a healthy volunteer to PE patient ratio of 2.87 (P < 0.001). Only 6.3% of subjects reported mild adverse events, which were unrelated to the SAM. CONCLUSIONS: These open-label studies show that the SAM can consistently and safely measure times to erection (from the start of vibration) and ejaculation, and ELT in healthy volunteers and men with PE. These findings show that the SAM has the potential to become the 'gold standard' in the diagnosis of PE and in clinical trials design.