The neuroanatomical basis for the protopathic sensibility of the human glans penis

Halata, Zdeněk; Munger, Bryce L.

doi:10.1016/0006-8993(86)90357-4

Cited by 220 publications

(127 citation statements)

References 47 publications

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“…9,10 The dorsal penile nerve (pudendal nerve) is responsible for reflex erections. 11 Damage to the pudendal nerves (that is, Alcock syndrome) leads to erectile dysfunction. 12 In complete spinal cord injury above the sacral centres there are no means to evaluate sensory innervation by means of pinprick, temperature or cotton swab testing because of lack of transmission of the signals through the spinal cord.…”

Section: Erectionmentioning

confidence: 99%

Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves

et al. 2010

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Study design: Review article. Objectives: The neuroanatomy and physiology of psychogenic erection, cholinergic versus adrenergic innervation of emission and the predictability of outcome of vibration and electroejaculation require a review and synthesis. Setting: University Hospital Belgium. Methods: We reviewed the literature with PubMed 1973PubMed -2008. Results: Erection, emission and ejaculation are separate phenomena and have different innervations. It is important to realize, which are the afferents and efferents and where the motor neuron of the end organ is located. When interpreting a specific lesion it is important to understand if postsynaptic fibres are intact or not. Afferents of erection, emission and ejaculation are the pudendal nerve and descending pathways from the brain. Erection is cholinergic and NO-mediated. Emission starts cholinergically (as a secretion) and ends sympathetically (as a contraction). Ejaculation is mainly adrenergic and somatic. For vibratory-evoked ejaculation, the reflex arch must be complete; for electroejaculation, the postsynaptic neurons (paravertebral ganglia) must be intact. Conclusion: Afferents of erection, emission and ejaculation are the pudendal nerve and descending pathways from the brain. Erection is cholinergic and NO-mediated. Emission starts cholinergically (as a secretion) and ends sympathetically (as a contraction). Ejaculation is mainly adrenergic and somatic. In neurogenic disease, a good knowledge of neuroanatomy and physiology makes understanding of sexual dysfunction possible and predictable. The minimal requirement for the success of penile vibration is a preserved reflex arch and the minimal requirement for the success of electroejaculation is the existence of intact post-ganglionic fibres.

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Section: Erectionmentioning

confidence: 99%

Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves

et al. 2010

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“…In the human glans penis, the ratio of free nerve ending to corpuscular receptors is 10:1. The free nerve endings are derived from thin myelinated Aa and unmyelinated C fibers (Halata and Munger, 1986). The nerve fibers from the receptors converge to form bundles of the dorsal nerve of the penis, which joins other nerves to become the pudendal nerve.…”

Section: 001mentioning

confidence: 99%

A Novel Treatment Modality in Patients With Premature Ejaculation Resistant to Conventional Methods: The Neuromodulation of Dorsal Penile Nerves by Pulsed Radiofrequency

Başal

Göktaş

Ergin

et al. 2010

Journal of Andrology

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Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of ,1 minute that occurred in more than 90% of acts of intercourse and was resistant to conventional treatments, were enrolled in this study. Patients with erectile dysfunction were excluded. The mean age of the patients was 39 6 9 years. Before and 3 weeks after the treatment, IELT and sexual satisfaction score (SSS; for patients and their partners) were obtained. The mean IELTs before and 3 weeks after procedure were 18.5 6 17.9 and 139.9 6 55.1 seconds, respectively. Side effects did not occur. Mean SSSs of patients before and after treatment were 1.3 6 0.3 and 4.6 6 0.5, and mean SSSs of partners before and after treatment were 1.3 6 0.4 and 4.4 6 0.5, respectively. In all cases, IELT and SSS were significantly increased (P , .05). None of the patients or their wives reported any treatment failure during the follow-up period. The mean follow-up time was 8.3 6 1.9 months. It is early to conclude that this new treatment modality might be used widely for the treatment of PE; however, because it is an innovative modality, placebo-controlled studies (eg, sham procedure), with larger numbers of patients and including assessment of penile sensitivity (eg, biothesiometry), are needed.

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“…In an ana tomical study of the innervation of the human glans penis, Halata and Hunger found the most numerous nerve termi nals to be free nerve endings (AS or C type). 16 The unique corpuscular receptors of the glans penis, the so-called genital end bulbs, proved to be numerously coiled free nerve endings. From a neurophysiological viewpoint, these genital end bulbs do not differ from free nerve endings.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Biothesiometry and Neurourophysiological Investigations for the Clinical Evaluation of Patients with Erectile Dysfunction

Bemelmans¹,

Hendrikx²,

Koldewijn³

et al. 1995

The Journal of Urology

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T h e J o u r n a l o f U r o l o g y Copyright © 1995 by A m e r ic a n U r o l o g ic a l A s s o c ia t io n , I n c . Vol. 153, 1483-1486, May 1995Printed in U.S.A. COMPARISON OF BIOTHESIOMETRY AND NEURO-UROPHYSIOLOGICAL INVESTIGATIONS FOR THE CLINICAL ABSTRACTIn the literature the determination of the vibration sensitivity threshold of the penile glans by means of biothesiometry has been introduced as a cost-effective office test for the evaluation of penile neuropathy in impotent men. At our facility we have gained extensive experience with neuro-urophysiological tests for the evaluation of penile innervation. These neuro-urophysiological tests have the disadvantage of complexity, invasiveness and time consumption. In our study both methods were compared in 31 impotent patients. The results showed that penile glans biothesi ometry yields consistent results when measurements are repeated during 1 session. However, no relationship was found between the outcome of penile glans biothesiometry and neuro-urophysi ological tests of the dorsal penile nerve, which is probably due to the fact that vibration is not an adequate stimulus to the skin of the penile glans that contains free nerve endings (that is pain receptors) only, and hardly any vibration receptors. We conclude that biothesiometric investiga tion of penile glans innervation is unsuited for the evaluation of penile innervation and cannot replace neuro-urophysiological tests.K ey Words: neurophysiology, p en is, penile erection, im p o ten ce, ev oked p o te n tia ls

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The neuroanatomical basis for the protopathic sensibility of the human glans penis

Cited by 220 publications

References 47 publications

Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves

Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves

A Novel Treatment Modality in Patients With Premature Ejaculation Resistant to Conventional Methods: The Neuromodulation of Dorsal Penile Nerves by Pulsed Radiofrequency

Comparison of Biothesiometry and Neurourophysiological Investigations for the Clinical Evaluation of Patients with Erectile Dysfunction

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