Male Sexual Function And Its Disorders
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ABSTRACT
This review is designed to help the reproductive endocrinologist integrate his or her professional activity with those of other disciplines including urology, radiology, neurology, and psychology in order to successfully manage all of the inseparable aspects of male sexual and reproductive functioning. Significant advances in the field of male sexual physiology and pathophysiology and new methods of investigation and treatment of male sexual disorders are outlined. The review synthesizes available data on the following: norms of sexual organs, aging and sexuality, role of central and peripheral neurochemicals in each stage of the sexual cycle, role of corporeal smooth muscles in the hemodynamic control of erection and detumescence, influence of psychological factors, drugs, and disease on all aspects of sexual functioning, and use of nocturnal penile tumescence monitoring, imaging investigations, and neurophysiologic studies in the diagnostic workup of males with sexual dysfunction. Clinical algorithms are presented where appropriate. Extensive discussions on newly developed strategies in psychological and behavioral counseling, drug therapy, tissue engineering, nonsurgical devices, and surgical treatments for all forms of sexual disorders are also provided. Lastly, the effect of sexual dysfunction and its treatment on quality of life in affected men is addressed, along with recommendations for future research endeavors.
I. Introduction
II. Physiology of Male Sexual Function
A. Penile structure, vasculature, and innervation
B. Normal penile and testicular size in adult males
C. Local control of penile erection
D. Normal control of male sexual response
E. Penodynamic changes during the male sexual cycle
F. Nocturnal penile tumescence (NPT)
G. Male sexual function and aging
III. Disorders of Male Sexual Function
A. Disorders of desire
B. Erectile dysfunction
C. Disorders of ejaculation
D. Disorders of orgasm
E. Failure of detumescence
IV. Diagnostic Assessment of Sexual Dysfunction in the Male
A. History
B. Physical examination
C. Selective investigations for male sexual dysfunction
V. Treatment
A. Hypoactive or deficient sexual desire
B. Partial or complete erectile dysfunction
C. Disorders of ejaculation
D. Absence of orgasm
E. Failure of detumescence (priapism)
F. Effect of sexual dysfunction and its treatment on quality of life in
VI. Summary and Future Directions
INTRODUCTION
DISORDERS of sexual function are common among men of all ages, ethnicities, and cultural backgrounds. It has been recently estimated that more than 152 million men worldwide experienced erectile dysfunction in 1995, and that this number will rise by 170 million, to approximately 322 million by the year 2025 (1 ). Significant advances in the understanding of the physiology and pathophysiology of male sexual function, and in methods of its investigation and treatment, have been attained during the past three decades. In the field of physiology, the nature and elements of the normal sexual response have been delineated, and functional activities of all penile structures have been clarified and integrated. The exact role of the various components of the neural system has also become more fully understood. In the field of pathophysiology, estimations of the relative contribution of psychogenic and organic factors to genesis of the various forms of male sexual dysfunction have approached the reality; and many risk factors for development of organic dysfunction have been identified. In the field of physical and laboratory evaluation, many new psychometric, hormonal, vascular, and neurological investigative procedures have been attempted. As a result, sound techniques for accurate prediction of functional and structural changes are now emerging.
This review describes many of these recent advances in the understanding of male sexual function and its disorders. Currently available methods of investigation are outlined and clinical algorithms for their use are presented. Recently developed strategies in psychological, medical, and surgical treatments are also summarized and related to the relevant pathophysiology. It is hoped that information provided in this review will help scientists and healthcare policy makers to develop appropriate and timely strategies to meet current and future demands to prevent and/or alleviate male sexual dysfunction. It is also hoped that material provided in this review will help the reproductive endocrinologist to widen the scope of his or her professional activity from the limited focus on gonadal function to the wider consideration of all inseparable and integrated aspects of human sexual and reproductive capacities.
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