Impaired Prefrontal-Amygdala Pathway, Self-Reported Emotion, and Erection in Psychogenic Erectile Dysfunction Patients With Normal Nocturnal Erection

Abstract

Background: Neuroimaging studies have demonstrated that the prefrontal cortex and amygdala play an important role in sexual arousal (SA). However, little is known about the interactions between the prefrontal and cortex amygdala, which mediate the cognitive regulation of emotion and SA.Objective: We seek to determine whether nocturnal erection of psychogenic erectile dysfunction (pED) patients are normal and whether there are changes of topological organization in the prefrontal-amygdala pathway of brain network in pED. In addition, whether there are correlations between network property changes and self-reported emotion and erection.Design, setting, and participants: We used the RigiScan device to evaluate erectile function of patients and employed diffusion MRI and graph theory to construct brain networks of 21 pED patients and 24 healthy controls.Outcome measurements and statistical analysis: We considered four nodal metrics and their asymmetry scores, and nocturnal penile tumescence (NPT) parameters, to evaluate the topological properties of brain networks of pED and their relationships with the impaired self-reported emotion and erection.Results and limitations: All the pED patients showed normal nocturnal penile erection, however impaired self-reported erection and negative emotion. In addition, patients showed lower connectivity degree and strength in the left prefrontal-amygdala pathway. We also found that pED exhibited lower leftward asymmetry in the inferior frontal gyrus. Furthermore, patients showed more hub regions and fewer pivotal connections. Moreover, the degree of the left amygdala of pED showed significantly negative correlation with the self-reported erection and positive correlation with the self-reported negative emotion.Conclusions: Together, these results suggest normal nocturnal erection in pED. However, abnormalities of brain network organization in pED, particularly in the left prefrontal-amygdala pathway, are associated with the impaired self-reported erection and negative emotion.

Reduced segregation and integration of structural brain network associated with sympathetic and dorsal penile nerve activity in anejaculation patients: a graph‐based connectome study

“…AE patients with psychogenic factors are characterized by a preserved genital reaction but a decreased subjective reaction (Waldinger & Schweitzer, ). The processes of erection and ejaculation are found to be related with both peripheral neural pathways and cerebral neural system (Clement & Giuliano, ; Chen et al ., ,b,c; Priviero et al ., ). The results of our previous studies showed that psychological factors were correlated with the pathophysiology of psychogenic erectile dysfunction, which is considered as a ‘brain disorder’ with impaired sexual arousal, cognitive, and affective processing in the brain (Chen et al ., , 2018a, 2018b, 2018c).…”

“…The processes of erection and ejaculation are found to be related with both peripheral neural pathways and cerebral neural system (Clement & Giuliano, ; Chen et al ., ,b,c; Priviero et al ., ). The results of our previous studies showed that psychological factors were correlated with the pathophysiology of psychogenic erectile dysfunction, which is considered as a ‘brain disorder’ with impaired sexual arousal, cognitive, and affective processing in the brain (Chen et al ., , 2018a, 2018b, 2018c). Moreover, many brain structures are involved in the sexual response, such as the pre‐frontal cortex, parietal lobe, cingulate gyrus, amygdala, thalamic, and hypothalamic (Ruesink & Georgiadis, ; Georgiadis & Kringelbach, ).…”

The Science of Auricular Microsystem Acupuncture: Amygdala Function in Psychiatric, Neuromusculoskeletal, and Functional Disorders

“…30 Chen et al investigated psychogenic components of ED and determined that amygdala abnormalities could be a factor. 31 Although the aforementioned studies primarily focused on neuropharmacologic advancement, their findings provided a rationale for addressing auricular-acupuncture projections of the amygdala as part of protocols for patients with ED who desire this treatment. In a 2007 article, Soliman proposed auricular therapy for somatotopic projection of the amygdala in the Phase 3 zone (in addition to various other projections).…”

The central mechanism of tadalafil vs Chaihu-Shugan-San capsule for psychogenic erectile dysfunction: a magnetic resonance imaging study protocol of a randomized placebo-controlled trial

“…There are many studies on the brain MRI of psychogenic ED [7,[19][20][21][22][23][24][25][26][27][28][29][30][31]. Despite significant progress, the mechanism aiming at CNS targets treated by tadalafil is still unknown.…”

“…Normal erectile function is a result of the harmonious regulation and control of the central nervous system (CNS), which includes the supraspinal centres, the spinal cord and peripheral nerves. In the last two decades, exploring the role of CNS in sexual arousal by functional and structural neuroimaging studies, the magnetic resonance imaging (MRI) [20] such as diffusion tensor imaging (DTI) [21,[23][24][25], functional MRI (fMRI) and resting-state fMRI attracted many researchers [23][24][25]. Since 2002, compared with healthy subjects (HS), much researchers have found that psychologic ED patients showed significant changes in cerebral functions.…”