The neurology of male sexual dysfunction and its investigation by clinical neurophysiological methods

Fowler, Clare J.

doi:10.1046/j.1464-410x.1998.00640.x

Cited by 19 publications

(20 citation statements)

References 88 publications

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“…20 Owing to this close proximity in the peripheral neural tracts, it was reported that genital-evoked EDA in patients with erectile dysfunction could reveal sympathetic involvement; however, as the clinical validity of CC-EMG was established, the value of genital-evoked EDA has been decreased. 1,3 Corpus cavernosum electromyography was usually performed with needle electrodes. Stief et al 8 first reported the possibility of activity recording by the use of surface electrodes placed on the penile skin, and surface recording yielded better results compared to needle electrodes.…”

Section: Discussionmentioning

confidence: 99%

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Role of penile electrodermal activity in the evaluation of autonomic innervation of corpus cavernosum

et al. 2004

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Electrodiagnostic tests measuring the activities of cavernous smooth muscle and sudomotor structures of penile skin are used in order to evaluate autonomic innervation of the penis. Owing to closeness of these tissues, the interference of sympathetic activity during recording is a possibility. In this study, we investigated this possibility in 10 patients whose cavernosal tissues were destroyed during penile prosthesis implantation by comparing the pre-and postoperative penile skin electrodermal activities. Penile electrodermal activities were recorded with surface electrodes before and after the operation. All of the patients had spontaneous and evoked penile electrodermal activity (EDA). The mean amplitude of evoked EDA decreased from 21597700 to 14137515 lV following penile prosthesis surgery (P ¼ 0.017). The decrease in the amplitude of penile-evoked EDA following penile prosthesis implantation suggests the contribution of cavernous smooth muscle activity to the sudomotor responses prior to operation. Although corpus cavernosum sympathetic activity contributes to the penile skin recordings, these recordings are mostly the result of penile skin sudomotor sympathetic activity. Therefore, surface potentials recorded from penile skin should not be used for the evaluation of autonomic innervation of corpus cavernosum.

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Section: Discussionmentioning

confidence: 99%

“…1 Sympathetic activity is carried to the perineal skin by sudomotor sympathetic nerve fibers and to the corpus cavernosum and other vascular structures by vasomotor sympathetic fibers. 2 Sudomotor sympathetic activity is classically recorded by surface electrodes placed over the penile skin or mons pubis.…”

Section: Introductionmentioning

confidence: 99%

Role of penile electrodermal activity in the evaluation of autonomic innervation of corpus cavernosum

et al. 2004

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“…Erectile dysfunction is defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse [1,3]. Clinical studies show that erectile dysfunction may be caused by a variety of factors: psychogenic, arteriogenic, neurogenic, endocrinologic, and cavernosal, based on the organs that are involved in penile erection.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical studies show that erectile dysfunction may be caused by a variety of factors: psychogenic, arteriogenic, neurogenic, endocrinologic, and cavernosal, based on the organs that are involved in penile erection. Amongst them, neurogenic erectile dysfunctions are an important group of organic etiologies probably because a deficiency of neurotransmitters is the final common pathway in many diseases and conditions [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

Application of Cardiac Autonomous Indices in the Study of Neurogenic Erectile Dysfunction

et al. 2010

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A research area of increasing interest consists of studying the benefits of using spectral analysis to screen neurogenic erectile dysfunctions. Our hypothesis is that spectral analysis consists of a non-invasive and simple procedure to investigate such patients. Subjects were allocated into two groups: control, no erectile dysfunction (n = 17), and patients with erectile dysfunction (n = 15). RR intervals (RRI), systolic blood pressure, diastolic blood pressure and baroreflex sensitivity recordings were performed continuously in the supine position, followed by the seated position, and finally standing position. In the supine position, the control group had a higher RRI and a lower diastolic blood pressure. For frequency domain analyses of RRI in the supine position, the erectile dysfunction group had a higher normalized low-frequency (LF) index and low-frequency/high-frequency (LF/HF) ratio while showing a lower normalized HF index. In the seated position, the erectile dysfunction group presented a higher LF/HF ratio. Regarding systolic blood pressure, the erectile dysfunction group showed lower normalized LF and higher normalized HF indices only in the supine position. The α index in HF was lower in the erectile dysfunction group in the three positions. Spectral analyses of cardiac sympathovagal drive constitute a fruitful non-invasive approach to evaluate alterations in cardiovascular autonomic modulation in neurogenic erectile dysfunction patients.

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“…1 Neurophysiological examinations which evaluate distinct divisions of the nervous system such as sympathetic, parasympathetic and somatic nerve fibres, are considered to be crucial especially if they also provide prognostic information. 2,3 Electromyographic examination (EMG) of the pelvic floor muscles is valuable in the assessment of the involvement of the lower sacral segments.…”

Section: Introductionmentioning

confidence: 99%

Electrophysiological assessment of sexual dysfunction in spinal cord injured patients

Tas

Altay

et al. 2006

Spinal Cord

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Study design: Survey. Objectives: To determine associations between sexual dysfunctions and electrophysiological examinations of the genital system in spinal cord injured patients. Setting: Ege University Hospital, Izmir, Turkey. Methods: In total, 25 patients (17 men, eight women) who were out of the spinal shock period were examined. Neurological levels were determined according to the American Spinal Injury Association (ASIA) impairment scale. Data about erection, ejaculation and vaginal lubrication were obtained via inquiry forms. Bulbocavernosus reflex (BCR), pudendal somatosensorial evoked potentials (pSEP) and perineal sympathetic skin responses (pSSR) were recorded by an electromyographer unaware of the sexual state or neurological level of the patient. Results: BCRs could be obtained from all patients with lesion levels above the sacral centre. A significant association was found between reflex erection and BCR positivity, while psychogenic erection was shown to have a significant association with the preservation of pSSR in men. Despite the lack of statistical significance due to the small sample size of the women examined, a similar association with lubrication was observed. Ejaculation and orgasm were not shown to be significantly associated with any electrophysiological examination. However, ejaculation was preserved in all men with a lesion level below T12 and with positive pSSR. There was no significant relationship between pSEP and sexual functions. The relationship between the existence of sacral sensation and pSEP positivity was statistically significant. Conclusion: This study has proved that BCR and pSSR have an important role in the estimation of the remaining sexual function in spinal cord injured patients. Statement on ethics: We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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The neurology of male sexual dysfunction and its investigation by clinical neurophysiological methods

Cited by 19 publications

References 88 publications

Role of penile electrodermal activity in the evaluation of autonomic innervation of corpus cavernosum

Role of penile electrodermal activity in the evaluation of autonomic innervation of corpus cavernosum

Application of Cardiac Autonomous Indices in the Study of Neurogenic Erectile Dysfunction

Electrophysiological assessment of sexual dysfunction in spinal cord injured patients

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