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Self-ratings of genital anatomy, sexual sensitivity and function in men using the 'Self-Assessment of Genital Anatomy and Sexual Function, Male' questionnaire

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Abstract

To assess the perceptions of healthy men of their genital anatomy and sexual sensitivity, along with the re-test reliability of these ratings, in a new self-reported questionnaire, the Self-Assessment of Genital Anatomy and Sexual Function, Male (SAGASF-M). Eighty-one healthy, sexually active, men aged 22-57 years (median 33), with no history of genital surgery, completed the SAGASF-M. This questionnaire comprises written text and images enabling men to rate details of their genital appearance, overall genital erotic and pain sensitivity, orgasm intensity, and effort required for achieving orgasm through stimulation of specified areas around the glans and shaft of the penis, scrotum and anus, along with the contribution of other sexually sensitive areas of the body. Anatomical locations were compared for the functional ratings by mixed-model analysis of variance (anova). A second sample of 38 healthy men (median age 26 years, range 22-64) from the same source completed the SAGASF-M twice with an interval of 2 weeks. There was little variability in anatomy ratings. Ratings of overall penile sensitivity to sexual stimulation gave higher values of 'sexual pleasure' for penile stimulation by the partner than by self (P = 0.002) and marginally higher ratings of 'orgasm intensity' by partner stimulation (P = 0.077), but there were no corresponding differences on ratings of 'effort needed to reach orgasm' or of 'discomfort/pain'. Overall discrimination between genital areas was highly significant (mixed-model anova, P = 0.001) for ratings of 'sexual pleasure', 'orgasm intensity' and 'orgasm effort', but was not significant for 'discomfort/pain'. Ranked by degree of 'sexual pleasure', the area 'underside of the glans' was highest, followed by 'underside of the penile shaft', 'upper side of the glans', 'left and right sides of the glans', 'one or both sides of the penis', 'upper side of the penile shaft', 'foreskin' (11 subjects), 'skin between the scrotum and anus', 'back side of the scrotum', 'front side of the scrotum', and 'around anus', but not all pair differences were significant. The rank order was similar for 'orgasm intensity', but less similar and with fewer significant pair differences for 'orgasm effort'. Overall discrimination of other body parts that help orgasm when touched/stimulated was also highly significant (P = 0.001) and included (in order of degree) scrotum, ear, skin between scrotum and anus, neck, breast/nipples, buttocks, anus (exterior skin), anus (inside with penetration), wrist, and axilla, but many pair differences were not significant. In the reliability study, which was limited to the 45 function items with sufficient variability and sample size, the re-test reliability values (Pearson r) were distributed as follows: seven were >or=0.80, 16 >or=0.70, 15 >or=0.60, four >or=0.50, two >or=0.40, and one >or=0.30. The SAGASF-M discriminates reasonably well between various genital and nongenital areas in terms of erotic sensitivity, when administered to genitally unoperated men varying widely in age and socio-economic level.

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... They concluded that the glans and underside of the proximal shaft, not the foreskin, were the critical sites determining erogenous sensation. 71 In stating that "genital corpuscles are the only mediators of sexual response", they pointed to data showing that, "the glans has a unique corpuscular receptor, consisting of axon terminals that resemble the tangled skein of free nerve endings and that [these] are probably derived from Krause's end bulbs", 72 and that erogenous sensation is attributed to corpuscular end bulbs, which are concentrated in the corona and near to (not in) the frenulum. 73 Manipulation of the frenulum would stimulate the highly erogenous underside of the glans. ...
... In contrast, Bonferroni correction was performed in the study that had formulated the questionnaire. 71 While statistically significant, the critics considered it unlikely that differences of between 1% and 11% reported for all items but 2 (which showed "unusual sensations intensity" to be 37% lower for the dorsal penile shaft and 31% lower for lateral penile shaft of the circumcised men, ie, favoring the circumcised penis) of the 21 out of 42 items scored (and not corrected for multiple testing) would be biologically significant. 99 The critics also considered it would not be likely that a man might be capable of knowing accurately whether orgasm intensity varied according to the specific stimulation site, for example, whether intensity would be greater for stimulation of just the lateral shaft of his penis. ...
... Such data were included by the study in which the questionnaire was developed. 71 It was also curious that while the statistical significance of some differences of only 1% or 2% (and which favored the uncircumcised penis) were high, substantial differences (favoring the circumcised penis) were either not significant (namely, in uncircumcised men, 31% higher "unusual sensations intensity" of the lateral penile shaft) or marginally significant (namely, again in the uncircumcised men, 37% higher "unusual sensations intensity" of the dorsal shaft," P ¼ .039). The critics also noticed that the questionnaire (developed earlier by the article's second author, Justine Schober) had included questions on the foreskin and were used in Schober's 2009 US study. ...
Article
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Introduction Active debate concerns whether male circumcision (MC) affects sexual function, penile sensation, or sexual pleasure. Aim To perform a systematic review examining the effect of MC on these parameters. Methods PRISMA-compliant searches of PubMed, EMBASE, the Cochrane Library, and Google Scholar were performed, with “circumcision” used together with appropriate search terms. Articles meeting the inclusion criteria were rated for quality by the Scottish Intercollegiate Guidelines Network system. Main Outcome Measure Evidence rated by quality. Results Searches identified 46 publications containing original data, as well as 4 systematic reviews (2 with meta-analyses), plus 29 critiques of various studies and 15 author replies, which together comprised a total of 94 publications. There was overall consistency in conclusions arising from high- and moderate-quality survey data in randomized clinical trials, systematic reviews and meta-analyses, physiological studies, large longitudinal studies, and cohort studies in diverse populations. Those studies found MC has no or minimal adverse effect on sexual function, sensation, or pleasure, with some finding improvements. A consensus from physiological and histological studies was that the glans and underside of the shaft, not the foreskin, are involved in neurological pathways mediating erogenous sensation. In contrast to the higher quality evidence, data supporting adverse effects of MC on function, sensation, or pleasure were found to be of low quality, as explained in critiques of those studies. Conclusion The consensus of the highest quality literature is that MC has minimal or no adverse effect, and in some studies, it has benefits on sexual functions, sensation, satisfaction, and pleasure for males circumcised neonatally or in adulthood. Morris BJ, Krieger JN. The Contrasting Evidence Concerning the Effect of Male Circumcision on Sexual Function, Sensation, and Pleasure: A Systematic Review. Sex Med 2020;8:577–598.
... A nonvalidated "Self-Assessment of Genital Anatomy and Sexual Function, Male" questionnaire was administered to 70 circumcised and 11 uncircumcised U.S. men aged 22-57 years (mean = 33 years) [51]. The authors found that penile sensitivity to sexual stimulation (i.e., "sexual sensation" by our terminology) was highest for the underside of the glans, followed by the underside of the shaft, upper side of the glans, left and right side of the glans, one or both sides of the penis, and upper side of the penile shaft. ...
... A Belgian survey that reported lower sexual sensation in circumcised men [25] was rated as SIGN 2− for the following reasons: Although the paper reported the percentage of uncircumcised men who rated sexual pleasure and orgasm intensity as "mild" to "very strong," the percentages for circumcised men were not stated. The statistical analyses did not correct for multiple testing whereas a Bonferroni correction was performed in the study that developed the questionnaire used [51]. It is doubtful that the small statistically significant differences of 1% to 11% for all but one (of 37%) identified in uncorrected statistical tests are biologically significant [55]. ...
... The n values for each of the 42 measurements made in each group were not stated. Nor was variance such as ±SD reported, whereas it was in the study that developed the questionnaire used [51]. Curiously, while some differences of 1% or 2% (favoring the uncircumcised) were highly significant, a difference of 39% showing higher "unusual sensations intensity" of the lateral penile shaft of uncircumcised men was not significant, whereas a 37% greater difference for the dorsal shaft was (P = 0.039). ...
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Circumcision of males is commonly carried out worldwide for reasons of health, medical need, esthetics, tradition, or religion. Whether circumcision impairs or improves male sexual function or pleasure is controversial. The study aims to conduct a systematic review of the scientific literature. A systematic review of published articles retrieved using keyword searches of the PubMed, EMBASE, and Cochrane databases was performed. The main outcome measure is the assessment of findings in publications reporting original data relevant to the search terms and rating of quality of each study based on established criteria. Searches identified 2,675 publications describing the effects of male circumcision on aspects of male sexual function, sensitivity, sensation, or satisfaction. Of these, 36 met our inclusion criteria of containing original data. Those studies reported a total of 40,473 men, including 19,542 uncircumcised and 20,931 circumcised. Rated by the Scottish Intercollegiate Guidelines Network grading system, 2 were 1++ (high quality randomized controlled trials) and 34 were case-control or cohort studies (11 high quality: 2++; 10 well-conducted: 2+; 13 low quality: 2-). The 1++, 2++, and 2+ studies uniformly found that circumcision had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration. Support for these conclusions was provided by a meta-analysis. Impairment in one or more parameters was reported in 10 of the 13 studies rated as 2-. These lower-quality studies contained flaws in study design (11), selection of cases and/or controls (5), statistical analysis (4), and/or data interpretation (6); five had multiple problems. The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction. Morris BJ and Krieger JN. Does male circumcision affect sexual function, sensitivity, or satisfaction?-A systematic review. J Sex Med **;**:**-**.
... Theoretically, any reduction of penile sensory capacity exceeding an unknown margin of safety could negatively impact sexual sensation and function by critically interrupting afferent pathways of sexual reflexes. The distal ventral penile aspect (Fig. 1B) is a region of special interest for being a highly erogenous [9,41], well-defined zone for generating sexual reflexes, as evidenced by clinical observations in spinal cord-injured men [32,33]. Although chronic supraspinal descending serotonergic disinhibition can facilitate erection in these patients by augmentation of penile reflexes [42], the local, tissular causes of this phenomenon and their implications for normal erectile physiology have not been adequately explored. ...
... Adult corpuscular receptor, nerve bundle and fetal nerve densities were consistently higher at this level and reduced proximally. This anatomical region includes the glans underside and frenulum, which have been considered in classical [52][53][54] and recent literature [9,41,55,56] zones of acute or heightened sexual sensation. In light of our data, the embryological base of its increased neural density seems to be a greater ventral axonal development of thin nerve fibers concurrent with lesser fasciculation (as opposed to greater dorsal fasciculation), reflected in impressive preputial PGP9.5+ and pan-TRK+ intraepithelial fibers at 16 weeks post-fertilization. ...
Article
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Immunohistological patterns of density and distribution of neural tissue in the human penis, including the prepuce, are not fully characterized, and effects of circumcision (partial or total removal of the penile prepuce) on penile sexual sensation are controversial. This study analyzed extra- and intracavernosal innervation patterns on the main penile axes using formalin-fixed, paraffin-embedded human adult and fetal penile tissues, single- and double-staining immunohistochemistry and a variety of neural and non-neural markers, with a special emphasis on the prepuce and potential sexual effects of circumcision. Immunohistochemical profiles of neural structures were determined and the most detailed immunohistological characterizations to date of preputial nerve supply are provided. The penile prepuce has a highly organized, dense, afferent innervation pattern that is manifest early in fetal development. Autonomically, it receives noradrenergic sympathetic and nitrergic parasympathetic innervation. Cholinergic nerves are also present. We observed cutaneous and subcutaneous neural density distribution biases across our specimens towards the ventral prepuce, including a region corresponding in the adult anatomical position (penis erect) to the distal third of the ventral penile aspect. We also describe a concept of innervation gradients across the longitudinal and transverse penile axes. Results are discussed in relation to the specialized literature. An argument is made that neuroanatomic substrates underlying unusual permanent penile sensory disturbances post-circumcision are related to heightened neural levels in the distal third of the ventral penile aspect, which could potentially be compromised by deep incisions during circumcision.
... This appears consistent with other data indicating 10 of 67 women were unsure if they had orgasms (Clifford, 1978). The area that contributed ''the most'' was the clitoral glans, or skin directly over the glans (prepuce: n ¼ 22 [66.7%]), which is consistent with studies of genital sensitivity (Schober, Meyer-Bahlburg, & Dolezal, 2009). Other women indicated that the inside front wall of their vagina (n ¼ 7 [21.2%]) ...
... Older women, particularly postmenopausal, exhibit increased touch/pressure thresholds in the vulva (Romanzi, Groutz, Feroz, & Blaivas, 2001; Vardi, Gruenwald, Sprecher, Gertman, & Yartnitsky, 2000). Sensitivity has not been examined prospectively, but may change differentially in areas typically reported to induce sexual arousal in women over time within a woman (Schober et al., 2009). For example, the clitoral structure may be more exposed to trauma from bike riding (Guess et al., 2006) or chafing (Goodman, 2011) than the vagina, which may differentially change sensitivity over time. ...
Article
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Orgasm is assumed to be the height of sexual pleasure, reinforcing the recurrence of sexual behaviors. Surprisingly, data supporting the role of orgasm as a reward in women appear lacking. The most likely psychological function of orgasm in women, consistent with the very limited empirical information, is as a secondary reinforcer. In other words, sexual arousal is the primary reward for sexual behavior in women and orgasm associates sexual arousal with the partner. Data from a small (n = 38 women) pilot are presented to highlight the challenges of studying female orgasm. Challenges include differentiating vaginally- or clitorally-generated orgasms by self-report and the large proportion of women who are unsure if they experience orgasms. Finally, the recent spate of publications purporting to show differences in penile-vaginal intercourse induced orgasms is critiqued in light of the information reviewed.
... Genital vibratory stimulation is commonly used for sexual stimulation in research [86,[88][89][90][91][92][93][94][95][96][97][98]. The vibrator is placed on areas self-reported to best provoke the sexual response in men (under the penile glans, [99]) and women (over the clitoral hood [100]). Commercial genital stimulation devices vary widely in their motor characteristics, and testing pointed to the selection of higher displacement devices for research purposes [101]. ...
... For men, a sheath that surrounds the penis, the Hummingbird (Love Products) was attached. While men generally indicate greater orgasm sensitivity at the glans [99], the flaccid penis is generally too short to distinguish glans and shaft in the placement of a wide device. Thus, men were instructed only to insert their penis into the attachment. ...
Article
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Theta burst stimulation (TBS) is thought to affect reward processing mechanisms, which may increase and decrease reward sensitivity. To test the ability of TBS to modulate response to strong primary rewards, participants hypersensitive to primary rewards were recruited. Twenty men and women with at least two opposite-sex, sexual partners in the last year received two forms of TBS. Stimulations were randomized to avoid order effects and separated by 2 hours to reduce carryover. The two TBS forms have been demonstrated to inhibit (continuous) or excite (intermittent) the left dorsolateral prefrontal cortex using different pulse patterns, which links to brain areas associated with reward conditioning. After each TBS, participants completed tasks assessing their reward responsiveness to monetary and sexual rewards. Electroencephalography (EEG) was recorded. They also reported their number of orgasms in the weekend following stimulation. This signal was malleable by TBS, where excitatory TBS resulted in lower EEG alpha relative to inhibitory TBS to primary rewards. EEG responses to sexual rewards in the lab (following both forms of TBS) predicted the number of orgasms experienced over the forthcoming weekend. TBS may be useful in modifying hypersensitivity or hyposensitivity to primary rewards that predict sexual behaviors. Since TBS altered the anticipation of a sexual reward, TBS may offer a novel treatment for sexual desire problems.
... Genital vibratory stimulation is commonly used for sexual stimulation in research [86,[88][89][90][91][92][93][94][95][96][97][98]. The vibrator is placed on areas self-reported to best provoke the sexual response in men (under the penile glans, [99]) and women (over the clitoral hood [100]). Commercial genital stimulation devices vary widely in their motor characteristics, and testing pointed to the selection of higher displacement devices for research purposes [101]. ...
... For men, a sheath that surrounds the penis, the Hummingbird (Love Products) was attached. While men generally indicate greater orgasm sensitivity at the glans [99], the flaccid penis is generally too short to distinguish glans and shaft in the placement of a wide device. Thus, men were instructed only to insert their penis into the attachment. ...
... Conventional tests are generally more difficult for patients to accept and are susceptible to variability in the detection environment and operation. Therefore, self-reporting from patients based on validated questionnaire tools is an irreplaceable method for detecting GS function (60). Although there are already several standardized questionnaires for evaluating a male sexual function, such as the International Index of Erectile Function (IIEF), the Brief Male Sexual Function Inventory (BMSFI), and the Derogatis Sexual Functioning Inventory (DFSI) (61), few tools are designed to assess sexual sensations, especially GS. ...
... The SAGASF-M is a self-evaluation tool proposed by Schober et al. to assess the effects of genital surgery on appearance, sensitivity, and sexual function (60). Unlike traditional questionnaires, SAGASF-M uses many detailed genital pictures and descriptive phrases, which makes selfreporting more accurate and systematic. ...
Article
Genital sensation (GS) is an essential component of male sexual function. Genital sensory disturbance (GSD) caused by spinal cord injury (SCI) has a severe impact on the patients' sexual function but has garnered little research focus. Under normal conditions, GS encompasses the erection, ejaculation, sexual arousal, and orgasm courses associated with physiological and psychological responses in male sexual activity. However, in SCI patients, the deficiency of GS makes the tactile stimulation of the penis unable to cause sexual arousal, disturbs the normal processes of erection and ejaculation, and decreases sexual desire and satisfaction. To provide an overview of the contemporary conception and management of male GS after SCI, we review the innervation and sexual function of male GS in this article, discuss the effects of GSD following SCI, and summarize the current diagnosis and treatment of GSD in male SCI patients.
... Median (IQR) operative time was 390 (330-499) min. Median (IQR) hospital stay was 16 (15)(16)(17)(18) days. Median (IQR) follow-up was 33 (14-80) months. ...
... Usually, the glans is (at least partially) available and incorporated into the base of the phallus. Many studies support that the glans is the most sensitive part of the male external genitalia [17]. Therefore, incorporating the native genital tissue in order to maximize genital sensitivity and enhance the chances of achieving orgasm is logical. ...
Article
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Phalloplasty is the gold-standard treatment for cis-men with penile insufficiency, which is often secondary to congenital conditions. The study-objective is to evaluate the functional outcomes and surgical complications in this population. A retrospective database comprised of cis-men undergoing a phalloplasty at a tertiary referral center from 2004 to 2019 was created. Phalloplasty was performed with various flaps. The tube-within-tube-technique was used for urethroplasty when possible. Complications <30 days postoperative were categorized according to Clavien–Dindo. Functional outcomes were assessed by bladder emptying and ability to achieve orgasm. Thirty patients were included. Nineteen of them needed urethroplasty, the remaining 11 patients had a catheterizable stoma. Within 30 days postoperative, 3 patients (10%) developed partial-flap necrosis (Clavien-Dindo III), 1 patient (3.3%) developed graft failure (Clavien-Dindo III), 2 patients (6.6%) developed infected hematomas (Clavien–Dindo III) and 1 phalloplasty (3.3%) was complicated by hematuria (Clavien-Dindo II). In the long-term, 10 patients (33%) developed fistulae, 6 (20%) requiring urethroplasty. Seven patients (23%) had urethral strictures, all needing urethroplasty or urethrotomy. Sixteen patients (84%) emptied their bladder per urethra, the three remaining necessitated conversion to perineostomy. Median (IQR) Qmax on uroflow was 15.7 (11.9–19.2)mL/s with median (IQR) voiding volume of 259 (137–307) mL and median (IQR) residual volume of 11.5 (0–20) ml on ultrasound. All patients but 1 (97%) reported ability to achieve orgasm. RFFA and ALT result in phalli with great ability to achieve orgasm but urethral complications are frequent.
... Several standardized self-reporting questionnaires are currently in use for patient-report-based assessment of sexual function in anatomically normal women (Fisher et al., 2011 ). Self-Assessment of Genital Anatomy and Sexual Functioning for Females (SAGASF-F), a tool specifically designed to assess patient-perceived outcome of feminizing genitoplasty in terms of appearance, sensitivity, and sexual function , has been piloted (Schober et al., 2004) and its reliability has been established (Meyer-Bahlburg et al., 2006; Schober et al., 2009). All women in the present study were given a slightly shortened version of the SAGASF-F (Schober et al., 2004) to complete at home and to deposit in a box at the hospital, without identifying information. ...
Article
Background: Societal changes are increasingly moving the conceptualization of gender from a set of binary categories towards a bimodal continuum, which along with the cautious conclusions resulting from the 2005 Consensus Conference influences gender-related clinical work with patients with disorders of sex development. Objective: This article provides an update of these developments over the past decade along with an overview of pertinent new data. Conclusion: Considerably more research is needed on larger sample sizes with systematic long-term follow-up to ground the emerging trends in clinical management of the highly diverse disorders of sex development syndromes in a solid empirical basis.
... Scientific evidence regarding the sexual effects of MC does not substantiate the purported harms to sexual pleasure. The better-quality studies (in terms of sample size, rigor of methodology, accuracy of analysis of findings , and generalizability of results) have found no adverse effect of MC on penile sensitivity [151,161162163, sensation during arousal [164], sexual satisfaction [146,151], premature ejaculation [165] , intravaginal ejaculatory latency time [166,167], or erectile function [147,149150151152. Two RCTs found MC does not adversely affect sexual function, sensitivity or satisfaction [45,153], with one of these studies showing that the sexual experience of most men was enhanced after circumci- sion [45]. ...
Article
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Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used. Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.
... In claiming that medical MC impairs sexual function Forbes cites an anomalous Korean study () that has been shown to be flawed (Willcourt, 2007). In a small study of 70 circumcised and 11 uncircumcised US men, each ranked the ventral surface of the penis (underside of glans and shaft) highest for degree of " sexual pleasure " and " orgasm intensity " , followed by the upper surface and sides of the penis, the foreskin being less important (Schober, Meyer-Bahlburg & Dolezal, 2009). In another study, sensation of the penis during arousal did not differ between circumcised and uncircumcised men aged 18–45 (Payne, Thaler, Kukkonen, Carrier & Binik, 2007). ...
Article
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Abstract A potential impediment to evidence-based policy development on medical male circumcision (MC) for HIV prevention in all countries worldwide is the uncritical acceptance by some of arguments used by opponents of this procedure. Here we evaluate recent opinion-pieces of 13 individuals opposed to MC. We find that these statements misrepresent good studies, selectively cite references, some containing fallacious information, and draw erroneous conclusions. In marked contrast, the scientific evidence shows MC to be a simple, low-risk procedure with very little or no adverse long-term effect on sexual function, sensitivity, sensation during arousal or overall satisfaction. Unscientific arguments have been recently used to drive ballot measures aimed at banning MC of minors in the USA, eliminate insurance coverage for medical MC for low-income families, and threaten large fines and incarceration for health care providers. Medical MC is a preventative health measure akin to immunisation, given its protective effect against HIV infection, genital cancers and various other conditions. Protection afforded by neonatal MC against a diversity of common medical conditions starts in infancy with urinary tract infections and extends throughout life. Besides protection in adulthood against acquiring HIV, MC also reduces morbidity and mortality from multiple other sexually transmitted infections (STIs) and genital cancers in men and their female sexual partners. It is estimated that over their lifetime one-third of uncircumcised males will suffer at least one foreskin-related medical condition. The scientific evidence indicates that medical MC is safe and effective. Its favourable risk/benefit ratio and cost/benefit support the advantages of medical MC.
... Similarly Forbes (2011) cites a Korean study (Kim & Pang, 2007) also discredited (Willcourt, 2007), as have others (Morris, Waskett, & Gray, 2012). US men ranked the ventral surface of the penis highest for ''sexual pleasure'' and ''orgasm intensity'', followed by the upper surface and sides, the foreskin being less important (Schober, Meyer-Bahlburg, & Dolezal, 2009). Sexual sensation is mediated by genital corpuscles, but these are absent from the foreskin (Rhodin, 1974). ...
... Scientific evidence regarding the sexual effects of MC does not substantiate the purported harms to sexual pleasure. The better-quality studies (in terms of sample size, rigor of methodology, accuracy of analysis of findings , and generalizability of results) have found no adverse effect of MC on penile sensitivity [151,161162163, sensation during arousal [164], sexual satisfaction [146,151], premature ejaculation [165] , intravaginal ejaculatory latency time [166,167], or erectile function [147,149150151152. Two RCTs found MC does not adversely affect sexual function, sensitivity or satisfaction [45,153], with one of these studies showing that the sexual experience of most men was enhanced after circumci- sion [45]. ...
... Therefore, self-assessment was the chosen method for the present study. Given the intimate nature of the questions and the number of respondents intended, the authors decided to create an online version of the Self-assessment of Genital Anatomy, and Sexual Function, Male questionnaire (SAGASF-M) [22]. ...
Article
Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The sensitivity of the foreskin and its importance in erogenous sensitivity is widely debated and controversial. This is part of the actual public debate on circumcision for non-medical reason. Today some studies on the effect of circumcision on sexual function are available. However they vary widely in outcome. The present study shows in a large cohort of men, based on self-assessment, that the foreskin has erogenous sensitivity. It is shown that the foreskin is more sensitive than the uncircumcised glans mucosa, which means that after circumcision genital sensitivity is lost. In the debate on clitoral surgery the proven loss of sensitivity has been the strongest argument to change medical practice. In the present study there is strong evidence on the erogenous sensitivity of the foreskin. This knowledge hopefully can help doctors and patients in their decision on circumcision for non-medical reason. Objectives: To test the hypothesis that sensitivity of the foreskin is a substantial part of male penile sensitivity. To determine the effects of male circumcision on penile sensitivity in a large sample. Subjects and methods: The study aimed at a sample size of ≈1000 men. Given the intimate nature of the questions and the intended large sample size, the authors decided to create an online survey. Respondents were recruited by means of leaflets and advertising. Results: The analysis sample consisted of 1059 uncircumcised and 310 circumcised men. For the glans penis, circumcised men reported decreased sexual pleasure and lower orgasm intensity. They also stated more effort was required to achieve orgasm, and a higher percentage of them experienced unusual sensations (burning, prickling, itching, or tingling and numbness of the glans penis). For the penile shaft a higher percentage of circumcised men described discomfort and pain, numbness and unusual sensations. In comparison to men circumcised before puberty, men circumcised during adolescence or later indicated less sexual pleasure at the glans penis, and a higher percentage of them reported discomfort or pain and unusual sensations at the penile shaft. Conclusions: This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality.
... 4. Другие ЭЗ. Среди ЭЗ мужчины также называют кожу промежности и кожу вокруг ануса [32], предстательную же лезу, которая стимулируется при анальном сексе или при давлении на основание промежности у заднего прохода [22]. Мужчины, которые сообщают об ощущениях, возникающих при стимуляции предстательной железы и семенных пу зырьков, часто описывают их как подобные тем, которые возникают у женщин при стимуляции зоны Графенберга. ...
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Definitions, classifications of erogenous zones, information about various genital and extragenital erogenous zones, results of special studies concerning the rating of the sensitivity of various erogenous zones in men and women are submitted. Key words: men, women, erogenous zones, classifications, rating. В обзорной статье приведены определения, классификации эрогенных зон, сведения о различных генитальных и экстрагенитальных эрогенных зонах, данные научных исследований относительно рейтинга чувствительности различных эрогенных зон у мужчин и женщин. Ключевые слова: мужчины, женщины, эрогенные зоны, классификации, рейтинг.
... The study found evidence that some HCWs perceived VMMC as likely to promote increased sexual risk-taking behaviours (behavioural disinhibition) amongst circumcised men as they sought to prove the belief about enhanced sexual satisfaction following VMMC. The perceptions of increased sexual satisfaction following VMMC have been investigated in several studies, with varying findings (Masood et al. 2005;Schober et al. 2009); however, increased sexual performance remains the predominant belief of most men (Fink, Carson & DeVellis 2002). This perception was also observed in the high number of HCWs who believed that circumcised men would discontinue the use of condoms and thereby increase their vulnerability to STIs and HIV infection. ...
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Background: KwaZulu-Natal province began implementation of voluntary medical male circumcision (VMMC) as an integral part of its HIV infection prevention strategy that includes other programmes such as HIV counselling and testing (HCT), screening and treatment of sexually transmitted infections and tuberculosis, and other sexual and reproductive health services. This followed randomised controlled trials that showed up to 60% HIV infection risk reduction amongst circumcised men. Implementation of the strategy occurred despite absence of knowledge of operational barriers and its acceptability to health care workers (HCWs). Objectives: The study aimed to explore HCWs’ perspectives of and barriers to strategy implementation at public sector health facilities to inform implementation policy. Method: A purposive quota sampling method was used to select HCWs for focus group discussions at three study sites. Participants were asked open-ended questions using an interview schedule based on a literature review to explore acceptability of and perceptions regarding provision of the strategy. Thematic analysis was conducted. Results: Acceptability of the strategy was high amongst the participants; however, there was limited knowledge of some key concepts of the strategy, personnel role confusion, missed opportunities for client recruitment, and infrastructural constraints. Negative perceptions included beliefs that VMMC would discourage condom use and cause stigma associated with non-circumcision of HIV-positive males, with perceptions of sexual behavioural disinhibition in circumcised men. Conclusion: There is a need to engage further with stakeholders if implementation of VMMC is to be successful. More training and support needs to be provided to HCWs at public sector facilities. Agtergrond: Die implementering van vrywillige mediese manlike besnyding (VMMC) is ’n integrale deel van KwaZulu-Natal provinsie se MIV-voorkomingstrategie, wat ander programme soos MIV-berading, siftingstoetse (HCT) en die behandeling van seksuele oordraagbare siektes (STI), asook ander seksuele en reproduksie-gesondheidsdienste (geïntegreerde VMMC) insluit. Dit volg op die resultate van ewekansige gekontroleerde steekproewe wat ’n doeltreffendheid getoon het van tot 60% vermindering in HIV-risiko onder mans wat besny is. Die implementering van die strategie het plaasgevind ten spyte van die afwesigheid van kennis van operasionele struikelblokke of aanvaarding deur gesondheidswerkers (HCWs). Doelwitte: Die studie is daarop gerig om HCW se perspektiewe en hindernisse vir die implementering van die VMMC program by die openbare sektor se gesondheidsfasiliteite te verken, ten einde die uitvoering van die beleid vas te stel. Metode: Die doelgerigte kwotasteekproefmetode is gebruik om HCW deelnemers vir fokusgroepbesprekings (FGDs) op drie studieterreine te kies. Deelnemers is oop vrae gevra met behulp van ’n onderhoudskedule gebaseer op ’n literatuuroorsig van die aanvaarbaarheid en persepsies aangaande die voorsiening van die strategie. Tematiese analise is in ooreenstemming met die doelwitte van die studie gedoen. Resultate: Die aanvaarbaarheid van VMMC was hoog onder die deelnemers, maar ’n paar probleemareas is geïdentifieer: beperkte kennis van belangrike begrippe van die strategie, personeelrolverwarring, geleenthede vir kliëntwerwing en infrastruktuurbeperkings. Negatiewe persepsies het ingesluit: oortuigings dat VMMC die gebruik van kondome sou voorkom, die stigma wat verband hou met onbesnede HIV-positiewe mans en die persepsie van onderdrukte seksuele gedrag by mans wat besny is.
... The role of the foreskin in sexual stimulation is yet to be understood. US men ranked the ventral surface of the glans penis highest for sexual sensation, the foreskin being less important (Schober et al., 2009). ...
Article
PurposeUnderstanding the types of sensory nerve termini within the glabrous skin of the human male foreskin could throw light on surgical outcomes and therapeutic possibilities for the future. Various receptor types sense changes in temperature, position, pressure, pain, light touch, itch, burning and pleasurable sexual sensations. Similarities and differences in innervation characteristics and density might become apparent when the glans penis is compared with homologous structures in the female genitalia. The aim of this study is to document the presence and characteristics of cutaneous sensory receptors in the human penile foreskin using a histopathological study of the nerve termini to achieve a more complete understanding of sensory experiences.Methods Foreskin samples were obtained from ten boys (aged 1–9 years) who had undergone circumcision. Informed consent was obtained from the parent/legal guardian. The samples were examined after modified Bielschowsky silver impregnation of neural tissue, and immunocytochemistry against gene protein product (PGP) 9.5 and neuron-specific enolase (NSE).ResultsPGP 9.5 appeared to be the most sensitive neural marker. Free nerve endings were identified in the papillary dermis visualized as thin fibers, mostly varicose, with either branched or single processes, either straight or bent. Two types of sensory corpuscle were identified: capsulated and non-capsulated. Meissner-like corpuscles were located in the papillary dermis. Capsulated corpuscles resembled typical Pacinian corpuscles, comprising a single central axon surrounded by non-neural periaxonic cells and lamellae. The capsulated corpuscles were strongly positive for PGP 9.5 and NSE.Conclusions Free nerve endings, Meissner's corpuscles and Pacinian corpuscles are present in the human male foreskin and exhibit characteristic staining patterns. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.
... Indeed, the statement is false, but it is also irrelevant. It is erogenous sensation that matters, and this resides mostly in the glans and shaft, not the foreskin [2] [3]. Because it is irrelevant, it does not matter if some subjects get it wrong. ...
Article
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Medical male circumcision has been adopted by the WHO, and other professional public health and medical bodies, as a vital weapon in the fight against HIV. This has prompted a large body of research into the acceptability of the procedure, attitudes to it, and barriers to it. A systematic review of these studies found that satisfaction with circumcision is strongly associated with having accurate knowledge about it. A survey-based paper by Earp, Sardi and Jellison entitled “False beliefs predict increased circumcision satisfaction in a sample of US American men” is the only one to find the opposite. It therefore merits scrutiny. The present article presents the results of a critical examination of the study. Serious flaws were discovered. Half of the small number of 10 “true/false” statements used in its survey are questionable. All the large body of literature that contradicts the findings of Earp and co-workers is ignored. Importantly, the crucial question about whether dissatisfied circumcised males hold false beliefs about circumcision is not considered. Unlike most of the research on the acceptability of circumcision, the study is not motivated by a desire to evaluate the likely effectiveness of a public health measure, or how best to implement it. Rather it appears to be an attempt by a prominent anti-circumcision activist and his associates to generate a body of literature that they can then cite to further their cause. Considering this, and the serious flaws it contains, the study should be dismissed as misleading, biased and undermining public health.
... Well conducted research studies have found no adverse effect of MC on penile sensitivity [141][142][143][144], sensation [145], sexual satisfaction [142,146], premature ejaculation [147], intravaginal ejaculatory latency time [148,149], and erectile function [78,142,[150][151][152]. Such findings have now been supported by two large RCTs [153,154]. ...
Article
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Here we review the international evidence for benefits and risks of infant male circumcision (MC) and use this to develop an evidence-based policy statement for a developed nation setting, fo-cusing on Australia. Evidence from good quality studies that include meta-analyses and randomi-zed controlled trials showed that MC provides strong protection against: urinary tract infections and, in infancy, renal parenchymal disease; phi-mosis; paraphimosis; balanoposthitis; foreskin tearing; some heterosexually transmitted infections including HPV, HSV-2, trichomonas, HIV, and genital ulcer disease; thrush; inferior hygiene; penile cancer and possibly prostate cancer. In women , circumcision of the male partner protects against HPV, HSV-2, cervical cancer, bacterial va-ginosis, and possibly Chlamydia. MC has no adverse effect on sexual function, sensitivity, pe-nile sensation or satisfaction and may enhance the male sexual experience. Adverse effects are uncommon (<1%), and virtually all are minor and easily treated. For maximum benefits, safety, convenience and cost savings, MC should be performed in infancy and with local anesthesia. A risk-benefit analysis shows benefits exceed risks by a large margin. Over their lifetime up to half of uncircumcised males will suffer a medical condition as a result of retaining their foreskin. The ethics of infant MC and childhood vaccination are comparable. Our analysis finds MC is beneficial , safe and cost-effective, and should optimally be performed in infancy. In the interests of public health and individual wellbeing, adequate parental education, and steps to facilitate access and affordability should be encouraged in developed countries.
... Several standardized self-reporting questionnaires are currently in use for patient-report-based assessment of sexual function in anatomically normal women (Fisher et al., 2011). Self-Assessment of Genital Anatomy and Sexual Functioning for Females (SAGASF-F), a tool specifically designed to assess patient-perceived outcome of feminizing genitoplasty in terms of appearance, sensitivity, and sexual function, has been piloted (Schober et al., 2004) and its reliability has been established (Meyer-Bahlburg et al., 2006;Schober et al., 2009). All women in the present study were given a slightly shortened version of the SAGASF-F (Schober et al., 2004) to complete at home and to deposit in a box at the hospital, without identifying information. ...
Article
Patient perceptions of genital esthetics are motivating requests for plastic surgeries that could change sexual sensitivity. There is little information about the sensitivities of labial and introital sites. The aim of this study is to assess the relationship between sexual sensitivity and self-reported sizes of labial and introital sites. Sixty-two healthy, sexually active, adult women (mean age 37.9, range 21-60) with no history of genital or vaginal surgery gave written consent to participate in this study. A modified version of Self-Assessment of Genital Anatomy and Sexual Function (L-SAGASF-F) was used to assess labial and introital size. Site-specific sensation was rated on Likert scales of 1-5. Anatomical locations were compared for ratings. Of 62 responders, 84% (52) described their labia as "average-sized," 11% (7) described their labia minora and 13% (8) their labia majora as "large", and 3% (2) and 5% (3) as "small". Sexual pleasure ratings were "moderate" (median value: 3.0 for external genitalia and vaginal lumen) or "strong" (median value: 4.0 for the interior vagina). Significantly higher rankings related to the vaginal opening (P = 0.007). Orgasm intensity for stimulation of the external genitalia progressively increased toward the vaginal opening, from 1.0 to 3.0 (P = 0.001); vaginal ratings showed a similar progression, from 2.0 at the external luminal margin to 3.0 in the deep interior (P < 0.0001). Orgasm effort scores were intermediate (median: 3.0), uniform throughout the external and internal areas (P = 0.626). Ratings for labial and introital sensitivity, regardless of self-reported size, were very similar to those at other genital sites for sexual pleasure. Surgical excision of labial and introital structures could modify sexual sensation. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.
... Phimosis was present in 89% of men in the study, 50% of whom experienced pain during intercourse prior to MC, falling to 6.5% after MC. 67 The Belgian survey reporting lower sexual sensation in circumcised men 68 was rated as low quality (2-) in a systematic review 69 because (i) it reported the percentage of uncircumcised, but not circumcised, men who rated sexual pleasure and orgasm intensity as "mild" to "very strong"; (ii) the statistical analyses did not correct for multiple testing, (iii) it was doubtful that statistically significant differences of 1-11% for all but one item (37%) identified in uncorrected statistical tests would be biologically meaningful, (iv) it seemed unlikely that a man could accurately know whether orgasm intensity was greater for stimulating, say, the lateral shaft of his penis by itself, (v) the n values for each of the 42 measurements made in each group were not stated, (vi) while some differences of 1% or 2% (favoring the uncircumcised) were highly significant, a difference of 39% showing higher, "unusual sensations intensity" of the lateral penile shaft of uncircumcised men was not significant. 70 The questionnaire used included questions on the foreskin, but unlike co-author Schober's 2009 study, 71 Bronselaer et al. did not present foreskin data or whether the latter differed from other sites on the penis in uncircumcised men. The proportion of men who were circumcised (23%) and the proportion who were homosexual (12.1%) was much higher than prevalences in Europe generally, consistent with bias in the self-selected convenience sample surveyed. ...
Article
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We critically evaluate arguments in a recent Journal of Law, Medicine & Ethics article by Svoboda, Adler, and Van Howe disputing the 2012 affirmative infant male circumcision policy recommendations of the American Academy of Pediatrics. We provide detailed evidence in explaining why the extensive claims by these opponents are not supported by the current strong scientific evidence. We furthermore show why their legal and ethical arguments are contradicted by a reasonable interpretation of current U.S. and international law and ethics. After all considerations are taken into account it would be logical to conclude that failure to recommend male circumcision early in infancy may be viewed as akin to failure to recommend childhood vaccination to parents. In each case, parental consent is required and the intervention is not compulsory. Our evaluation leads us to dismiss the arguments by Svoboda et al. Instead, based on the evidence, infant male circumcision is both ethical and lawful.
... Put another way, asking women to make a forced choice between clitoral and vaginal orgasm might be similar to asking men to make a forced choice between a "penile glans" or a "penile shaft" orgasm. 8 Many men report that their shaft and glans are important in orgasm, 55 just as many women in our study reported that the clitoris and the vagina are important as primary or secondary sources of orgasm. Men also were surveyed in this study (full results to be reported elsewhere). ...
Article
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Introduction: Most women report that clitoral stimulation is an integral aspect of their orgasm experience. Thus, recent claims that vaginal stimulation and vaginally generated orgasms are superior to clitoral stimulation and clitorally generated orgasms pathologize most women and maintain a clitoral vs vaginal dichotomy that might not accurately reflect the complexity of women's sexual experience. Aim: To have women report on their experienced source of orgasm, including combinations of vaginal and clitoral stimulation, the solo or partnered context of the stimulation, and the intensity of the orgasms from different sources and to predict indicators of mental health and sexual health using the orgasm source. Methods: Eighty-eight women 18 to 53 years old answered detailed questions about their usual and recent orgasm experiences, sexual history, depression, and anxiety. Then, they viewed a series of neutral and sexual films. They were instructed to increase or decrease their sexual arousal or respond "as usual" to the sexual films. They reported their sexual arousal after each film. Main outcome measures: Outcomes assessed included mental health (depression and anxiety) and sexual health (orgasm quality, ability to regulate sexual response to sex films). Reported sexual arousal was analyzed for the regulation task. Results: Most women (64%) reported that clitoral and vaginal stimulation contributed to their usual method of reaching orgasm. Women who reported that clitoral stimulation was primarily responsible for their orgasm reported a higher desire to self-stimulate and demonstrated greater control over their self-reported sexual arousal. The primary stimulation site for orgasm was unrelated to measurements of depression or anxiety despite sufficient statistical power. Conclusion: Most women reported that clitoral and vaginal stimulation is important in orgasm. Women experience orgasms in many varied patterns, a complexity that is often ignored by current methods of assessing orgasm source. The reported source of orgasm was unrelated to orgasm intensity, overall sex-life satisfaction, sexual distress, depression, or anxiety. Women who reported primarily stimulating their clitoris to reach orgasm reported higher trait sexual drive and higher sexual arousal to visual sexual stimulation and were better able to increase their sexual arousal to visual sexual stimulation when instructed than women who reported orgasms primarily from vaginal sources.
... A study of 81 sexually active 22-to 57-year-old men was performed using the Self-Assessment of Genital Anatomy and Sexual Function -Male (SAGAF-M) [41]. This questionnaire comprises written text and images enabling men to rate details of their genital appearance, overall genital erotic and pain sensitivity, orgasm intensity, and effort required to achieve orgasm through stimulation of the glans and shaft of the penis, scrotum, and anus, along with the contribution of other sexual sensitive areas of the body. ...
Article
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Breasts, including the nipple and areola, have two functions: lactation and as an erogenous area. Male breasts are much less studied that those of women. In men, breasts have only an erotic function. Because there is dense and very well organized innervation of the nipple-areola complex in men, nipple erection occurs frequently and via different mechanisms from penile erection. Although it seems to be less important for men than for women and it is poorly studied, the erotic value of breast stimulation is notable. Consequently, there is a need to include this aspect in sexological and andrological studies and to preserve breasts and their innervation or to reconstruct them in cases of surgical intervention.
... Aside from whether or not it is "often preserved in adult circumcision," is there evidence that the frenulum is "highly erogenous"? Schober et al. found the underside of the glans to be the most erogenous area [79]. The study involved 70 circumcised and 11 uncircumcised American men. ...
... Pain Disability Questionnaire focuses on pain localization and radiation; time of the first episode of pain; previous events; pain description through adjectives; interference of pain with work, school, social life, family, sport, and or any other daily activity; previous therapies or medical examinations; efficacy of medication intake. Sexual functioning self-assessment is also available for both male and female patients [113,114]; it might be worth evaluating this feature as well, as sexual function abnormalities are relatively frequent in CPP/CPPS patients of both genders. ...
Article
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Chronic Pelvic Pain (CPP) and Chronic Pelvic Pain Syndrome (CPPS) have a significant impact on men and women of reproductive and nonreproductive age, with a considerable burden on overall quality of life (QoL) and on psychological, functional, and behavioural status. Moreover, diagnostic and therapeutic difficulties are remarkable features in many patients. Therefore evaluation, assessment and objectivation tools are often necessary to properly address each patient and consequently his/her clinical needs. Here we review the different tools for pain assessment, evaluation, and objectivation; specific features regarding CPP/CPPS will be highlighted. Also, recent findings disclosed with neuroimaging investigations will be reviewed as they provide new insights into CPP/CPPS pathophysiology and may serve as a tool for CPP assessment and objectivation.
... Although the EZMs for the masturbation condition covered practically all of the body except lower legs, touching was considered as sexually arousing in significantly larger areas while having sex with a partner rather than masturbating (Fig. 4). The only regions more consistently triggering sexual arousal by self-stimulation versus stimulation by partner were the genitals and male anus (but see Schober, Meyer-Bahlburg, & Dolezal, 2009 for opposite findings). Masturbation occurs frequently in both human and nonhumanprimatesevenwhenopportunitiesforcopulationexist (Ford & Beach, 1951;Oliver & Hyde, 1993) and male masturbation (leading to ejaculation and wasting of sperm) across a variety of species has been proposed to increase sperm fit without increasing the number of sperm in the female tract (Baker & Bellis, 1993). ...
Article
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Touching is a powerful means for eliciting sexual arousal. Here, we establish the topographical organization of bodily regions triggering sexual arousal in humans. A total of 704 participants were shown images of same and opposite sex bodies and asked to color the bodily regions whose touching they or members of the opposite sex would experience as sexually arousing while masturbating or having sex with a partner. Resulting erogenous zone maps (EZMs) revealed that the whole body was sensitive to sexual touching, with erogenous hotspots consisting of genitals, breasts, and anus. The EZM area was larger while having sex with a partner versus while masturbating, and was also dependent on sexual desire and heterosexual and homosexual interest levels. We conclude that tactile stimulation of practically all bodily regions may trigger sexual arousal. Extension of the erogenous zones while having sex with a partner may reflect the role of touching in maintenance of reproductive pair bonds.
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Male circumcision (MC) is common in many countries. Despite clear health benefits, ethical arguments have been invoked opposing MC, especially when performed neonatally (NMC). NMC is when most MCs are performed in developed countries. Here we provide the first PRISMA-compliant systematic review of the disparate evidence of ethical and legal arguments concerning NMC and MC of older boys. Searches were performed of PubMed, Embase and Scopus for publications relevant to ethical and legal aspects of MC in developed Anglophone and European countries. This led to retrieval of 48 articles meeting the inclusion criteria. A further 18 articles and 16 Internet publications were identified from searches of bibliographies of articles retrieved. Two more were supplied by a legal academic colleague. In total 84 publications were reviewed. The literature revealed arguments by some that parent-approved MC of a nonconsenting child is unethical. But parental consent also applies to vaccination and all other medical therapies in children. Strong data support a conclusion that: (1) NMC is low risk, (2) NMC provides immediate and lifetime medical and health benefits, and (3) NMC has no adverse effect on sexual function and pleasure. The United Nations Convention on the Rights of the Child articulates the right to health and focuses on the best interests of the child as its guiding principle. Discouraging or denying MC to neonates is arguably unethical, given the overwhelming health benefits. Legal scholars regard case-law as supporting the legality of NMC. Ethical and legal arguments support the rights of males of all ages to lifetime protection against infection and diseases caused by lack of MC. Arguments opposing NMC generally involve distortion of the medical evidence, poorly designed studies and opinions. Opposition to NMC goes against the principles of evidence-based medicine used in reviews conducted to develop pediatric policies in support of optimum public health, sexual health, mental health, and human rights.
Article
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Infant male circumcision (MC) is an important issue guided by Royal Australasian College of Physicians (RACP) policy. Here we analytically review the RACP's 2010 policy statement 'Circumcision of infant males'. Comprehensive evaluation in the context of published research was used. We find that the Statement is not a fair and balanced representation of the literature on MC. It ignores, downplays, obfuscates or misrepresents the considerable evidence attesting to the strong protection MC affords against childhood urinary tract infections, sexually transmitted infections (human immunodeficiency virus, human papilloma virus, herpes simplex virus type 2, trichomonas and genital ulcer disease), thrush, inferior penile hygiene, phimosis, balanoposthitis and penile cancer, and in women protection against human papilloma virus, herpes simplex virus type 2, bacterial vaginosis and cervical cancer. The Statement exaggerates the complication rate. Assertions that 'the foreskin has a functional role' and 'is a primary sensory part of the penis' are not supported by research, including randomised controlled trials. Instead of citing these and meta-analyses, the Statement selectively cites poor quality studies. Its claim, without support from a literature-based risk-benefit analysis, that the currently available evidence does 'not warrant routine infant circumcision in Australia and New Zealand' is misleading. The Statement fails to explain that performing MC in the neonatal period using local anaesthesia maximises benefits, safety, convenience and cost savings. Because the RACP's policy statement is not a fair and balanced representation of the current literature, it should not be used to guide policy. In the interests of public health and individual well-being, an extensive, comprehensive, balanced review of the scientific literature and a risk-benefit analysis should be conducted to formulate policy.
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يتكون هذا الكتاب من أبواب ثلاثة رئيسية: أولها يعرض النموذج (الباراديم) التطوري، فيبين منهج الدارونية المتأسلمة وظهورها، وثانيها يعرض النموذج التطوري في بعض صوره العملية، وقد اخترت الفيلوجيني والباليوأنثروبوجي تحديدا، وأعرض في ختامه للاستخدامات العملية لهذه النماذج في بناء الحجاج الداروني المتأسلم، ثم الثالث، وأعرض فيه النقاش الشرعي لحجج الدارونية المتأسلمة، وكذلك كتاب أبي آدم للدكتور عبد الصبور شاهين، وأخيرا، فصل الختام، وأعرض فيه ملامح النظرية الإسلامية للخلق والتطور، كي تكتمل الصورة تماما عند القارئ، إذ أنه قد يشعر في مرحلة ما أن المسألة فوضوية، وأن الجميع لا يملك صورة عن الخلق من الأساس، وذاك خطأ.
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The term differences of sex development (DSDs; also known as disorders of sex development) refers to a heterogeneous group of congenital conditions affecting human sex determination and differentiation. Several reports highlighting suboptimal physical and psychosexual outcomes in individuals who have a DSD led to a radical revision of nomenclature and management a decade ago. Whereas the resulting recommendations for holistic, multidisciplinary care seem to have been implemented rapidly in specialized paediatric services around the world, adolescents often experience difficulties in finding access to expert adult care and gradually or abruptly cease medical follow-up. Many adults with a DSD have health-related questions that remain unanswered owing to a lack of evidence pertaining to the natural evolution of the various conditions in later life stages. This Consensus Statement, developed by a European multidisciplinary group of experts, including patient representatives, summarizes evidence-based and experience-based recommendations for lifelong care and data collection in individuals with a DSD across ages and highlights clinical research priorities. By doing so, we hope to contribute to improving understanding and management of these conditions by involved medical professionals. In addition, we hope to give impetus to multicentre studies that will shed light on outcomes and comorbidities of DSD conditions across the lifespan.
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The thought came to me like the proverbial thunderclap: No psychological study has ever concluded that circumcision is beneficial to a boy's psyche. But was my sudden hypothesis true? What I discovered after an exhaustive search of the literature was that more than one hundred scientific studies found circumcision painful, traumatic, or psychologically harmful to men and boys, but not one peer-reviewed study has shown it benefits the male psyche.
Article
In cases of severe penile inadequacy, such as in pathological conditions involving penile amputation (e.g. penile cancer), or in 46,XY disorders of sex development with severe undervirilization or maldevelopment of the penis (e.g. idiopathic micropenis, cloacal exstrophy), standard (surgical) penile lengthening techniques do not provide patients with a phallus suitable for sexual intercourse. Genital dissatisfaction can lead to low self-esteem and psychosexual dysfunction. Therefore, phalloplasty, the gold standard in transgender surgery, may provide a possibility to achieve a satisfactory genital appearance and sexual function. Small series have reported cosmetically acceptable and erogenous sensate neophalli with incorporation of a neourethra to allow voiding in a standing position and with enough bulk to allow penile prosthesis insertion for pleasurable intercourse. Although early results seem promising, further publication of series with large numbers and longer follow-up is needed to evaluate to what extent phalloplasty improves physical and sexual outcomes. Complications are of particular concern because of associated scarring and loss of sensitive tissue. Without full preoperative workups assessing patients' expectations and reasons for undergoing surgery, they may still struggle with self/penile image and with psychological barriers for engaging in sexual activity. Recommendations for the psychosocial management of boys and men with penile deficiency are suggested. © 2014 S. Karger AG, Basel.
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Male circumcision (MC) is one of the most common surgical procedures in the world, but its medical benefits remain under debate. In the context of evidence-based medicine, MC is beneficial in reducing the risks of infantile urinary tract infection, viral-mediated sexually transmitted diseases, penile/cervical cancers, and poor hygiene. The claims of opponents against MC, such as reduced sexual performance, psychological trauma, and an excess of complications, are gradually losing credibility. Possibly influenced by US troops stationed in Korea following the Korean War, MC is highly prevalent in South Korea, though it has been losing popularity recently. The practice of MC in Korea is different from that in other countries, in that most cases of MC are performed in adolescence under local anesthesia. Although this eliminates the benefit of reducing urinary tract infection in neonates, it still offers the benefits of reducing the risk of viral sexually transmitted diseases and penile/cervical cancers. Moreover, MC can lead to improved hygiene for the majority of Koreans who are willing to undergo the procedure. The practice of MC in adolescence may reduce the risk of significant complications, though the risk of bleeding may be higher than for neonates.
Article
Augmentation phalloplasty of the normal penis although is gaining popularity among a subgroup of men, is not free of complications. A 27 years old healthy man with normal functioning penis underwent a lipofilling penile augmentation. The procedure was complicated by a post-operative haematoma and infection resulting in a full thickness dorsal penile skin necrosis and a pedicled anterolateral thigh (ALT) perforator flap was required for reconstruction. His presentation, operation and final outcome are reported and the possible options for reconstruction are discussed.
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Physical contact is not necessary for male rats to display penile erection when placed in the vicinity of females in estrus (noncontact erection, NCE). The modality and reception of sensory stimuli for the induction of NCE were analyzed. Olfactory bulbectomy eliminated NCE, and destruction of olfactory mucosa by zinc sulfate solution caused a significant suppression of NCE, whereas removal of the vomeronasal organ had no effect. Fresh urine collected from estrous females, but not fresh feces, induced NCE. Neither devocalization of estrous females by cutting the inferior laryngeal nerve nor deprivation of visual cues by placing an opaque barrier between the subjects and stimulus females disrupted NCE. The results indicate that olfactory cues emitted by estrous females induce NCE via the olfactory epithelium. Contrary to what had been suggested by previous experiments, vomeronasal inputs are not indispensable for the induction of NCE.
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This study evaluated the predictive value of a newly developed measure of the propensity for sexual inhibition and excitation; the Sexual Inhibition Sexual Excitation Scales (SIS/SES). Sexual, cardiovascular, and startle responses were measured in a group of 40 sexually functional men during the presentation of threatening and nonthreatening erotic films. Two levels of performance demand were created and two films were combined with a distraction task. Participants were assigned to high and low groups for each of the three SIS/SES scales. As predicted, men with high SES scores showed generally higher sexual responses. High and low SIS1 groups did not differ in their responses. Men with high and low SIS2 scores did not differ in their responses to nonthreatening stimuli; however, low SIS2 men showed greater genital response to the threatening stimuli. The findings provide support for the value of the SIS/SES scales in predicting sexual responses.
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Labels with special instructions regarding how a prescription medication should be taken or its possible side effects are often applied to pill bottles. The goal of this study was to determine whether the addition of illustrations to these labels affects patient comprehension. Study participants (N = 130) were enrolled by approaching patients at three family practice clinics in Toronto, Canada. Participants were asked to interpret two sets of medication instruction labels, the first with text only and the second with the same text accompanied by illustrations. Two investigators coded participants' responses as incorrect, partially correct, or completely correct. Health literacy levels of participants were measured using a validated instrument, the REALM test. All participants gave a completely correct interpretation for three out of five instruction labels, regardless of whether illustrations were present or not. For the two most complex labels, only 34-55% of interpretations of the text-only version were completely correct. The addition of illustrations was associated with improved performance in 5-7% of subjects and worsened performance in 7-9% of subjects. The commonly-used illustrations on the medication labels used in this study were of little or no use in improving patients' comprehension of the accompanying written instructions.
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We present a comprehensive account of clitoral anatomy, including its component structures, neurovascular supply, relationship to adjacent structures (the urethra, vagina and vestibular glands, and connective tissue supports), histology and immunohistochemistry. We related recent anatomical findings to the historical literature to determine when data on accurate anatomy became available. An extensive review of the current and historical literature was done. The studies reviewed included dissection and microdissection, magnetic resonance imaging (MRI), 3-dimensional sectional anatomy reconstruction, histology and immunohistochemical studies. The clitoris is a multiplanar structure with a broad attachment to the pubic arch and via extensive supporting tissue to the mons pubis and labia. Centrally it is attached to the urethra and vagina. Its components include the erectile bodies (paired bulbs and paired corpora, which are continuous with the crura) and the glans clitoris. The glans is a midline, densely neural, non-erectile structure that is the only external manifestation of the clitoris. All other components are composed of erectile tissue with the composition of the bulbar erectile tissue differing from that of the corpora. The clitoral and perineal neurovascular bundles are large, paired terminations of the pudendal neurovascular bundles. The clitoral neurovascular bundles ascend along the ischiopubic rami to meet each other and pass along the superior surface of the clitoral body supplying the clitoris. The neural trunks pass largely intact into the glans. These nerves are at least 2 mm in diameter even in infancy. The cavernous or autonomic neural anatomy is microscopic and difficult to define consistently. MRI complements dissection studies and clarifies the anatomy. Clitoral pharmacology and histology appears to parallel those of penile tissue, although the clinical impact is vastly different. Typical textbook descriptions of the clitoris lack detail and include inaccuracies. It is impossible to convey clitoral anatomy in a single diagram showing only 1 plane, as is typically provided in textbooks, which reveal it as a flat structure. MRI provides a multiplanar representation of clitoral anatomy in the live state, which is a major advantage, and complements dissection materials. The work of Kobelt in the early 19th century provides a most comprehensive and accurate description of clitoral anatomy, and modern study provides objective images and few novel findings. The bulbs appear to be part of the clitoris. They are spongy in character and in continuity with the other parts of the clitoris. The distal urethra and vagina are intimately related structures, although they are not erectile in character. They form a tissue cluster with the clitoris. This cluster appears to be the locus of female sexual function and orgasm.
Article
Purpose: We studied the psychosexual adjustment, sexual behavior and genital appraisal of 9 to 18-year-old hypospadias patients. Materials and Methods: We interviewed 116 hypospadias patients and 88 comparison subjects in a semi-structured manner. Results: Hypospadias patients had a more negative genital appraisal and anticipated more ridicule by a partner because of penile appearance than comparison subjects but they did not have a different sexual adjustment. No significant impact of medical treatment (surgical procedures, number of operations or age at final surgery) was noted. Many hypospadias patients (38.8%) desired functional or cosmetic penile improvement. Conclusions: In addition to procedures that bring the meatus to a more terminal position, those that bring it more ventral can be performed without negatively affecting psychosexual adjustment. Hypospadias patients were reluctant to seek advice for problems and, therefore, they should be followed through adolescence.
Article
Introduction. A normal sexual response in the female depends on the integrity of afferent sensory input from the genital region. So far genital sensation has been investigated only during a non-excitatory state, and the sensory physiological changes, which occur during the sexual cycle in this region, are still obscured. Aim. To investigate the sensory status of the female genital region during sexual arousal and orgasm. Main Outcome Measures. Genital sensory thresholds measured by Quantitative Sensory Testing (vibratory and thermal) were compared in a non-excitatory vs. excitatory state in normal sexually functioning females. Methods. Eleven healthy female volunteers were recruited and attended three separate visits. During each session only one anatomical site, either clitoris or vagina was tested for either vibratory or thermal stimuli. A psychophysical method of limits was employed for threshold determination of warm or vibratory stimuli. In each session, all women were tested at baseline, immediately after arousal, after orgasm and three more measurements – 5, 10, and 20 minutes during the recovery state. Results. A significant decrease in clitoral vibratory sensation threshold was observed between the baseline and the arousal phases (P = 0.003). Comparison of vibratory sensation between baseline and following orgasm at the clitoral and vaginal region showed a significant difference (P < 0.001) for both regions. These changes were not significant for thermal threshold sensation at the clitoral region (P = 0.6). Conclusions. This is the first time that genital sensation has been measured during the excitatory phase of the female sexual cycle. This normative data may serve as a baseline for further investigations of the sensory input of the genital organs during intercourse in pathological states. Gruenwald I, Lowenstein L, Gartman I, and Vardi Y. Physiological changes in female genital sensation during sexual stimulation. J Sex Med 2007;4:390–394.
Article
Introduction. There are no psychometrically validated assessment tools designed to solely and specifically evaluate satisfaction with the quality of erections. Aim. To develop and psychometrically analyze the Quality of Erection Questionnaire (QEQ), a new patient-reported measure developed to evaluate men’s satisfaction with the quality of their erections. Methods. The questionnaire was developed through in-depth qualitative interviews of men with erectile dysfunction (ED) in the United States and Australia. An exploratory methodology study was conducted on 65 men with ED. Subsequently, the psychometric properties were confirmed in a larger dataset of 558 men with ED from two combined clinical trials. Main Outcome Measures. Identification of potential redundancy or outliers in items (Pearson inter-item correlations); exploratory factor analysis (unrotated and varimax rotated); internal consistency (Cronbach’s alpha); convergent validity (Pearson correlation coefficients between the QEQ total score and domain scores of the International Index of Erectile Function); known-groups validity (ability of the QEQ scores to differentiate between ED severity groups); test–retest reliability (Pearson correlation coefficient). Results. The QEQ demonstrated excellent convergent and known-groups validity. Additional analysis demonstrated high internal consistency (Cronbach’s alpha, 0.92). Item analysis demonstrated a unidimensional structure and suggested that satisfaction with hardness may be the key driver for satisfaction with overall quality of erections (r = 0.8). The smaller exploratory study demonstrated good test–retest reliability (r = 0.82). Conclusions. The QEQ is a six-item, patient-reported measure with a unidimensional structure, which produces a total score that may be transformed to a 0–100 scale. Psychometric analysis confirmed reliability and validity of the QEQ, which solely and specifically evaluates satisfaction of men with the quality of their erections. The QEQ is a potentially useful measure for monitoring and evaluating treatment in those who are bothered by, or concerned about, their erectile function. Porst H, Gilbert C, Collins S, Huang X, Symonds T, Stecher V, and Hvidsten K. Development and validation of the Quality of Erection Questionnaire. J Sex Med 2007;4:372–381.
Article
1. The discharge of impulses in afferent fibres dissected from the dorsal nerve of the penis of chloralose-anaesthetized rams was recorded electrophysiologically during controlled natural stimulation of the surgically exposed penis maintained at body temperature and mechanically stabilized in a plaster of Paris mould. 2. Fifty-eight slowly adapting mechanorecptor units were examined and their pressure, velocity and displacement thresholds were determined. Units often responded best to integumental stretch. Few had resting discharges. During a sustained perpendicularly applied displacement most units adapted to silence within 1.5 min. The units were classified into types from an analysis of their adapted impulse trains in response to a sustained mechanical stimulus. 3. Twenty-five mechanoreceptive units had rapidly adapting responses. Most units had typical rapid adapting characteristics and discharged impulses only during the dynamic phase of the application of the displacement. A subgroup had intermediate adapting characteristics, and discharged intermittently during steady displacement of the integument. 4. The mechanical sensitivity of most receptors altered when the temperature of the receptive field was changed with a positive correlation in eleven units, a negative correlation in six. Six slowly adapting units were thermally insensitive. Twelve rapidly adapting units were tested. Six had a positive thermal correlation and four a negative correlation. 5. The conduction velocities of axons of mechanoreceptor units in the dorsal nerve of the penis were in the Aalpha range (12--77 msec-1). 6. Two specific warm and five specific cold units were found. The conduction velocities of the axons supplying warm receptors were 45.4 msec-1 (one unit) and those for cold receptors were 7.5, 7.8, 30, 45.5, 48.7 msec-1. 7. No correlation could be found between the receptor submodality and the profuse receptor end bulb population demonstrated histologically.
Article
Responses to vibrotactile stimuli were examined in men as a function of chronic exposure to either exogenous or endogenous androgens. Psychophysical techniques were used to evaluate thresholds to stimulus detection and perceived stimulus intensities in response to mild vibration applied to either the finger or the penis. Normal men were compared to the following groups: (a) untreated hypogonadal men, (b) androgen-replaced hypogonadal men, or (c) infertile men with androgen levels in the low normal range. Among the four groups, untreated hypogonadal men perceived vibrotactile stimuli as most intense and were slightly more sensitive to touch than were men with higher levels of androgen. Chronic treatment with testosterone enanthate was associated with a decline in the perceived intensity of vibrotactile stimuli in hypogonadal men. The lowest levels of sensitivity to tactile stimuli were observed in the infertile men.
Article
Year to year mean +/- 2 standard deviation values of the length and circumference of the penis from birth to 18 years have been determined on a population of white French children and adolescents of European origin. In addition, curves relating the length and the circumference of the penis with the testicular volume are reported. These curves appear to be useful for an appropriate evaluation of the size of the penis in the adolescents where large variations of the pubertal development are observed.
Article
Sixty-one single mechanoreceptive fibers were surgically isolated from the dorsal nerve of the penis in anesthetized, mature, and sexually intact male cats. Impulse activity was recorded extracellularly. Receptive fields on the glans penis were stimulated with an accurate computer controlled mechanostimulator. Thirty-four units were categorized as rapidly adapting (RA) based on the absence of a response to sustained skin displacement. The remaining were slowly adapting (SA) units responding to sustained displacement. Most of the SA units were located in the distal smooth glans whereas RA units predominated in the proximal spiny glans. Displacement thresholds were significantly lower for RA units. All units encoded indentation velocity although the SA units were better suited to discriminate slowly moving stimuli. In addition, SA units encoded sustained displacement amplitude. Male cats with a denervated glans penis display disoriented mounting behavior disabling intromission. The presence of distally located SA mechanoreceptors suggests they may be the primary penile proprioceptors, mediating, along with the RA mechanoreceptors, successful completion of intromission.
The sensory pathways innervating the male urethra were investigated by recording the sensory thresholds with electrical stimulation. Twenty-six male subjects (age 16 to 73 years) were included in the study. Ring-electrodes mounted on a Foley catheter were used for stimulation in proximal and distal urethra. Square wave pulses (duration 0.5 ms) were delivered with a constant current stimulator at different frequencies and the lowest intensity felt by the subject was defined as the threshold. The sensory thresholds were in the order of 0.5 to 5 mA and decreased with increasing stimulation frequency. All patients described a qualitative difference in the experienced sensation when comparing proximal and distal urethral stimulation. The reason for this is discussed. The possible use of this method as an adjunct to the urodynamic investigation in diagnosing neurogenic lesions is proposed.
Article
Many electrophysiologic tests have been performed and have proved useful for diagnosing sexual function. However, there have been limitations to the interpretation of the tests because of paucity of details concerning penile innervation. Therefore, electrophysiologic studies were performed in 3 patients with psychogenic impotence and in 15 patients with organic impotence to assess accurately the peripheral somatic innervation of the penis. The glans penis was innervated by the dorsal nerve of the penis. In some patients dual innervation was present at the ventral aspect of the glans penis by the dorsal nerve of the penis and the perineal nerve. The predominant innervation and fiber spectra of the glans by the dorsal nerve of the penis and the crucial role of the glans in sexual arousal and erectile function provide adequate rationale for the measurement of nerve conduction velocity of the dorsal nerve of the penis in sexual dysfunction.
Article
To determine the role of afferent input from the penis and copulatory experience on the ontogeny of reproductive behavior, 49 bulls were randomly assigned to the following groups: control; surgical penile deflection (penis deviation), which prevents intromission; penile neurectomy; or penis deviation plus neurectomy. Sexual performance tests were conducted at 3-month intervals from 9 to 24 months of age. Bulls deviated but not neurectomized mounted more frequently than bulls in the other groups. The low mount frequency for control bulls in tests in which copulation occurred was due to the sexually quiescent postejaculatory refractory period. Preventing control bulls from copulating by affixing cloth patches to females' perinea increased mount frequency to the level of deviated bulls. It is concluded that copulatory experience is not essential to the development and maintenance of normal mounting activity. However, sensory stimulation from the penis facilitates the expression of sexual behaviors.
Article
Local anaesthesia (using lidocaine) of the penis, or of the vagina and cervix caused marked changes in the sexual behaviour of marmosets. Penile desensitization did not affect sexual arousal or erectile capacity. However, intromission latencies increased and 7 out of 10 males failed to intromit during some post-lidocaine tests. Females failed to show several behavioural patterns which normally occur during intromission (shrugging body movements, head turning and opening the mouth) or exhibited them at reduced frequencies after intra-vaginal application of lidocaine. The tendency of females to terminate mounts after ejaculation had occurred was also reduced with resultant increases in intromission duration in all cases. Desensitization of the females' external genitalia had no effect upon sexual behaviour. Co-ordination of copulatory behaviour in this primate species depends, in part, upon afferent stimuli from the penis and from the vagina or cervix.
Article
Application of the topical anesthetic pontocaine (tetracaine hydrochloride) to the penis and preputial sheath virtually abolished the display of penile reflexes by intact rats. When pontocaine was applied immediately following ejaculation in copula, however, normal genital reflexes were observed in the majority of rats, albeit with a prolonged latency to the first erection relative to the control test. These same animals were, nonetheless, unable to achieve intromission when returned to the mating arena despite repeated mounting attempts. These data suggest that sensory input to the genitalia is generally necessary for the display of penile reflexes in the rat. However, stimuli associated with copulation can override the suppressive effect of sensory loss of these reflexes, presumably due to removal of supraspinal inhibition.
Article
We studied the psychosexual adjustment, sexual behavior and genital appraisal of 9 to 18-year-old hypospadias patients. We interviewed 116 hypospadias patients and 88 comparison subjects in a semi-structured manner. Hypospadias patients had a more negative genital appraisal and anticipated more ridicule by a partner because of penile appearance than comparison subjects but they did not have a different sexual adjustment. No significant impact of medical treatment (surgical procedures, number of operations or age at final surgery) was noted. Many hypospadias patients (38.8%) desired functional or cosmetic penile improvement. In addition to procedures that bring the meatus to a more terminal position, those that bring it more ventral can be performed without negatively affecting psychosexual adjustment. Hypospadias patients were reluctant to seek advice for problems and, therefore, they should be followed through adolescence.
Article
We studied the degree of agreement between hypospadias patient and surgeon satisfaction with the cosmetic surgical result, and the relation between penile length, meatal position and patient satisfaction. Cosmetic and functional results in 35 boys with hypospadias were assessed, and a standardized questionnaire was completed by patients and surgeon. There was hardly any agreement between patient and surgeon satisfaction with patient penile appearance. Patients were less satisfied than the surgeon. No significant correlation was noted between penile satisfaction and penile length. Patients with a retracted meatus were less satisfied with the meatal position than those with a glanular meatus. Of the 35 patients 4 underwent repeat surgery after our study. Hypospadias surgeons should explicitly asked if patients are satisfied and they should follow patients through adolescence.
Article
To our knowledge no direct measurement of autonomic failure in the penis is currently available. Indirect techniques in clinical use, such as bulbocavernosus reflex, genital somatosensory evoked potentials and biothesiometry, all rely on large nerve fiber function. Since micturition and potency depend on small fibers of the peripheral system, tests of these fibers might be more relevant in the clinical diagnostic evaluation. We provide upper normal limits and demonstrate repeatability of small fiber mediated sensations of warm and cold sensory thresholds on penile skin. Penile warm and cold sensory thresholds were measured in 35 healthy volunteers (at 2 sessions in 27) via 2 methods. Upper normal values, expressed as 95% confidence limits for warm and cold thresholds, through methods of limits and levels as well as inter-session repeatability are given. Penile thermal thresholds are repeatable and can be used as a valid diagnostic tool to assess somatic small fiber function in patients with lower urinary tract disorders.
This article is a long-term follow-up to a classic case reported in pediatric, psychiatric, and sexological literature. The penis of an XY individual was accidentally ablated and he was subsequently raised as a female. Initially this individual was described as developing into a normally functioning female. The individual, however, was later found to reject this sex of rearing, switched at puberty to living as a male, and has successfully lived as such from that time to the present. The standard in instances of extensive penile damage to infants is to recommend rearing the male as a female. Subsequent cases should, however, be managed in light of this new evidence.
Article
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Article
Our aim was to ascertain whether the short-term results and the frequency of complications of corrective surgery in hypospadias correlate with patients' opinions on their sexual life and voiding ability as adults, as well as to establish what kind of problems underlie dissatisfaction with the result of surgery. Between 1963 and 1975, 64 hypospadias patients, had been operated and their treatment completed in the Division of Paediatric Surgery at Tampere University Hospital. Their patient records were analyzed retrospectively, and a detailed questionnaire was mailed to 61 of them. 43 (70.5%) patients returned the questionnaire. Of the respondees, 62.8% expressed satisfaction with the result of the operation. Among those who were satisfied, 22.2% had had complications after the operation, whereas 57.1% of those expressing dissatisfaction with the result had had complications (p < 0.05). Satisfied subjects had fewer problems in voiding and erection than those who were unsatisfied. They were also more often satisfied with the appearance of their penis and their sexual life. Fifteen patients would have preferred a longer follow-up. There is a correlation between the frequency of complications following hypospadias surgery and long-term results. Good short-term results also predict good long-term ones. There is no straight correlation between the presence of voiding abnormalities and overall satisfaction with the result. It seems that the overall appearance as perceived by the patient and patients' satisfaction with their sexual function are more important. This study shows that the 1-stage methods currently used, represented here by the Mathieu technique, give superior results compared to older methods, at least partly because complications occur less often.
Article
The integrity of the dorsal nerve of the penis is crucial for normal erectile and ejaculatory function. To our knowledge a description of this nerve along the phallus has not been formally described. We illustrate the distribution of the dorsal nerve of the penis to the penile shaft, anterior urethra and glans. Neuroanatomical dissections were performed on 28 cadaver penis specimens. Electrodiagnostic testing was conducted on 10 healthy male subjects to confirm the anatomical findings. The dorsal nerve of the penis consists of 2 populations of axons, one to innervate the penile shaft and urethra, and the other to innervate the glans. Stimulation of the urethra resulted in responses recorded in the main trunk of the dorsal nerve of the penis and stimulation of the nerve evoked responses within the urethra. Bulbocavernosus muscle contraction was elicited following urethral stimulation. Urethral innervation by the dorsal nerve of the penis supports the view that urethral afferent impulses are a component of reflex ejaculatory activity. The pattern of glanular innervation by the dorsal nerve of the penis identifies the glans as a sensory end organ for sexual reflexes. The undulating character of the dorsal nerve of the penis is a mechanism by which the nerve can accommodate to significant changes in penile length with erection. Electrodiagnostic studies of the dorsal nerve of the penis should be modified to consider the anatomical findings.
Article
To determine the distribution of the dorsal nerve of the penis (DNP), the principal somatosensory nerve innervating the phallus, along the penile shaft and within the glans penis. The DNP was dissected in human autopsy specimens, using low magnification, following the course of the nerve from the symphysis pubis into the glans penis. The shaft and glans were innervated by separate populations of axons. The lateral and ventral portions of the penile shaft were innervated by branches arcading from the dorsal midline radiating toward the ventral surface. These branches were very variable and some were seen to penetrate the corpus spongiosum. The axons innervating the glans were constant in a dorsal, midline location along most of the penile shaft, and once within the glans, there was abundant branching. Undulations in the nerves were noted along the penile shaft. The lateral arcading branches of the DNP provide a sensory pathway on the ventral and lateral penile shaft, and the termination of the fibres at the corpus spongiosum is consistent with pudendal innervation of the penile urethra. The distinct pattern of innervation of the glans emphasizes the role of the glans as a sensory structure. These findings may aid in planning penile surgical procedures.
Article
We demonstrate the innervation of the glans penis through nerve blockade and electrophysiological tests. The study was conducted in 14 healthy, sexually potent volunteers. The dorsal nerves of the penis were anesthetized bilaterally with lidocaine. Electrophysiological testing was performed by stimulating the dorsal nerve of the penis at the penile base distal to the block and recording action potentials at the glans. Dorsal nerve of the penis block resulted in anesthesia of the dorsal, lateral and glanular aspects of the penis. The ventral surface, including the frenulum, was intact to pinprick sensation. Dorsal nerve of the penis stimulation resulted in responses from the corona, dorsal and ventral mid glans, and penile shaft. Frenular responses were less consistently obtained. The most common recorded pattern was a monophasic waveform representing the arrival of a standing potential at a nerve terminal. Latencies were progressively longer with increasing distance from the point of stimulation with the longest latencies measured at the frenulum. Amplitudes of the responses decreased with increasing distance from the point of stimulation. The dorsal nerve of the penis innervates the glans, including the frenulum which is also innervated by a branch of the perineal nerve. Branches of the dorsal nerve of the penis extend through the glans ventrolaterally. Electrical representation of glanular innervation reveals the glans to be filled with nerve endings supporting its function as a sensory structure.
Article
Erectile function is usually assessed by neurophysiologic tests such as the bulbocavernosus reflex or pudendal nerve somatosensory evoked potentials. These tests investigate only large nerve fibers, although erection depends on autonomic nerve fibers, which are of small diameter. Warm and cold sensory fibers have similar calibers as the autonomic nerve fibers, and their integrity can be reliably evaluated by the measurement of thermal sensory thresholds. We studied penile thermal sensory testing in parallel with standard electrophysiologic tests to assess their sensitivity in the diagnosis of penile neuropathy. Twenty-five normal male subjects without erectile dysfunction or evidence of diffuse neuropathy (group 1) and 35 diabetic patients who complained of impotence (group 2) were studied. Erectile function was quantitated using the erectile dysfunction symptom score. Warm, cold, and vibratory sensory thresholds were assessed on the dorsal aspect of the penis. In addition, penile sympathetic skin responses and pudendal nerve somatosensory evoked potentials were recorded. We found a significant difference between the two groups in the erectile dysfunction symptom score (P <0.0001), cold threshold (P = 0.0007), and warm threshold (P = 0.0025), but not for the other parameters. The erectile dysfunction symptom score correlated with the penile warm and cold thresholds (P = 0.0006 and 0.002, respectively). Thermal thresholds assess small nerve fiber damage, which can indirectly reflect autonomic disturbances, particularly in the context of a diffuse neuropathy such as diabetic polyneuropathy. Penile thermal sensory testing correlated strongly with the clinical evaluation of erectile function and is a new and promising tool for the diagnosis of neurogenic impotence.
Article
In recent years, gender has become a hotly debated issue in regard to two clinical syndrome categories: Intersexuality, i.e., individuals with ambiguities of the genitalia, and Gender Identity Disorder (GID), i.e., individuals who have normal genitalia but desire gender change. The intersex controversy focuses on the assignment of gender and related issues of psychosocial and medical management. The GID debate centers on the question whether GID should be considered a mental disorder or be removed from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA, DSM-IV, 1994) and declared a normal variant in analogy to the 1973 decision of the APA on homosexuality (Bayer, 1987)). The GID debate extends to intersexuality, because if intersex patients have significant gender identity problems, DSM-IV classifies them as GID Not Otherwise Specified (GIDNOS) which implies a mental-disorder status. In the current paper, however, we will leave the GID part of the debate aside and concentrate on the question of gender assignment and related issues in intersexuality.
Article
To define the scrotal nerve origin and distribution with respect to surrounding structures in male human fetuses, by using neuronal-specific markers and three-dimensional (3D) imaging techniques, as the developmental neuroanatomy of the human scrotum has not been studied in detail and an explicit description of nerve derivation and distribution in the human scrotum is germane to genital reconstructive surgery. Sixteen normal human fetal penile specimens at 17.5-38 weeks of gestation were studied. Specimens were fixed in formalin, embedded in paraffin wax, serially sectioned at 6 micro m and stained with the neuronal marker S-100. All of the specimens contained the whole penis and scrotum from glans to anal verge. The gestational age of the fetuses was determined by fetal heel-to-toe length. 3D-computer reconstruction of serial sections allowed a detailed analysis of the neuroanatomy of the fetal penis and scrotum. The nerves innervating the ventral side of the proximal penis and scrotum originated mainly from the perineal nerves arising from pudendal nerves. The nerves travelling along the ventral side of penis coalesced at the penoscrotal area to be directed into the interscrotal septum. At the penoscrotal junction, nerves on both sides of the ventral penis shifted to the interscrotal septum in a triangular fashion. The interscrotal septum was densely occupied by nerve fibres. Nerves were distributed horizontally to both hemiscrotal walls through this interscrotal septum. Both hemiscrota seem primarily to be innervated separately. The interscrotal septum has a dense innervation. Both hemiscrota were innervated mainly by horizontally distributed nerve fibres arising from the interscrotal septum. Any procedure violating the penoscrotal and interscrotal septal area may jeopardize scrotal innervation.
Article
The mechanism of human erection requires the coordination of an intact neuronal system that includes the cavernous, perineal, and dorsal nerves of the penis. We defined the communication of these 3 nerves that travel under the pubic arch using specific neuronal immunohistochemical staining and 3-dimensional reconstruction imaging technique. A total of 18 normal human fetal penile specimens at 17.5 to 32 weeks of gestation were studied by immunohistochemical techniques. Serial sections were stained with antibodies raised against the neuronal markers S-100, and neuronal nitric oxide synthase (nNOS), vesicular acetylcholine transporter (VAChT), calcitonin gene-related peptide and substance P. The continuation of the dorsal neurovascular bundle of the prostate was documented under the pubic arch. Two distinct nerve bundles were identified superior to the urethra and medial to the origin of the crural bodies. Nerve bundles were observed to join the corporeal bodies at the penile hilum. Proximal to the penile hilum the dorsal nerves stained only for S-100 and VAChT. From the junction of the crural bodies at the hilum to the glans penis dorsal nerve fibers stained positive for S-100, VAChT and nNOS. Calcitonin gene-related peptide and substance P demonstrated positive staining at the distal nerves, particularly at the glans. In contrast, the whole course of the cavernous nerve stained for S-100 and nNOS. Under the pubic arch at the penile hilum the cavernous nerves were found to convey nNOS positive branches to the dorsal nerve to transform its immunoreactivity to nNOS positive. Proximal nNOS negative perineal nerves were shown to stain positive for nNOS distal on the penis. Interaction between nNOS positive dorsal nerve branches and perineal nerves was at the cavernous-spongiosal junction, where the bulbospongiosus muscle terminates. At penile hilum, where the corporeal bodies start to separate, the cavernous nerve sends nNOS positive fibers to join the dorsal nerve of the penis, thereby, changing the functional characteristics of the distal penile dorsal nerve. Similarly the nNOS negative, ventrally located perineal nerve originating from the pudendal nerve becomes nNOS reactive at the cavernous-spongiosal junction. These 2 examples of redundant neuronal wiring in the penis may impact erectile function, especially during reconstructive surgery.
Article
We assessed sexual behavior and sexual function in adults operated on for hypospadias. Long-term psychosexual adjustment was assessed with a standardized questionnaire which was mailed to 57 patients with hypospadias older than 18 years and 60 age matched normal control subjects. A total of 37 patients with hypospadias and 39 controls participated. Self-reported strength of libido on a scale of 1 to 5 was shown to be similar in the 2 groups. Patients with hypospadias did not have problems in achieving erection and average self-rated quality of erection ranging from 1 to 5 was the same as that of controls (mean value 4.5). Patients with hypospadias noted curvature in a downward direction in a significantly higher proportion compared to controls (40% vs 18%, respectively). There were 13 patients with hypospadias who had ejaculation difficulties, of whom 6 had spraying and 7 had only dribbling of ejaculate. Patients with hypospadias masturbated significantly less often, were significantly less sexually active and had a smaller total number of sexual partners compared to control subjects. Control subjects were significantly more completely satisfied with their sexual life compared to patients with hypospadias (76.92% vs 51.35%, respectively). Sexual function of patients who underwent surgery for hypospadias in general is not affected. However, there is clearly a difference in certain aspects of sexual behavior between patients with hypospadias and controls. Followup and adequate counselling of patients who underwent surgery for hypospadias in adult life is necessary.
Article
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency results in increased adrenal androgen secretion. When the deficiency is severe, the result is the salt losing (SL) form, and when the deficiency is partial, the result is the simple virilizing (SV) form of CAH. We documented long-term satisfaction with gender, cosmetic appearance and function of the genitalia, and surgical management practices in a group of women with CAH due to 21-hydroxylase deficiency. Psychosexual and surgical outcome were assessed in 41 women with CAH using an interview, a written questionnaire and a physical examination. When appropriate, outcome measures were compared to those in unaffected control women. Women in the SL group were more likely to question their female gender and report sexual concerns, and less likely to have sexual relations with a partner than those with the SV form or control women. Overall women with CAH were moderately satisfied with the cosmetic appearance of the genitalia but the SL group reported worse genital function than the SV group. Physician rated appearance of the genitalia was better than ratings provided by patients and women with the SL form were judged to have a worse cosmetic outcome of genital reconstruction than women with the SV form. The most common response concerning the optimal timing for genital reconstruction was during infancy and early childhood, although a number of women favored waiting until later for these procedures or did not respond to this question. Women with the SV form reported greater satisfaction and fewer concerns regarding their psychosexual and surgical outcome than women with the SL form.
Article
To assess the perceptions of healthy women of their genital anatomy and sexual sensitivity, and to provide suggestions for genitoplasty based on this information, as the success of genitoplasty has historically relied upon the surgeon's perception of the patient's anatomy and function, rather than the patient's perception of outcome in terms of appearance and erotic sensitivity. Fifty healthy, sexually active, adult women (aged 20-56 years) with no history of genital surgery completed the female version of the Self-Assessment of Genital Anatomy and Sexual Function. This self- report questionnaire comprises written text and images enabling women to rate the appearance, size and position of clitoris and vagina, as well as the intensity of orgasm and effort required for achieving orgasm in specified areas around the clitoris and within the vagina. Anatomical locations were compared for these ratings by repeated-measures analysis of variance. Anatomically, 46% of women described their clitoris as 'moderate-sized and raised', 42% as 'small and raised', and 78% reported that their vaginal opening was adequate for sexual penetration. The women reported the strongest orgasm and least effort to obtain an orgasm with stimulation of the area on and above the clitoris. For vaginal sensitivity, scores for orgasm intensity increased, and for orgasm effort decreased, with increasing vaginal depth, and they indicated less sexual sensitivity for the vagina than for the external genitalia. The skin above the clitoris, and the clitoris itself, appeared to be the most sexually sensitive. During genitoplasty, attention to preserving skin-flap integrity in this area seems appropriate.
Article
To evaluate penile sensory thresholds in neonatally circumcised and uncircumcised men. We evaluated 125 patients, 62 uncircumcised men and 63 neonatally circumcised men. All patients completed the Erectile Function domain of the International Index of Erectile Function questionnaire. Of the 125 patients, 29 (International Index of Erectile Function score of between 25 and 30) were placed in the functional group, and 96 in the dysfunctional group. The patients were tested on the dorsal midline glans of the penis (foreskin retracted). Quantitative somatosensory testing was performed and included vibration, pressure, spatial perception, and warm and cold thermal thresholds. In the functional group, t-test analysis demonstrated a significant (P <0.001) difference, with worse vibration and better pressure sensation for uncircumcised men. When controlling for age, hypertension, and diabetes, all t-test significance was lost. In the dysfunctional group, circumcised men (49 +/- 16 years) were significantly younger (P <0.01) than uncircumcised men (56 +/- 13 years). For the dysfunctional group, t-test analysis also demonstrated worse vibration sensation for uncircumcised men (P <0.01). Again, when controlling for age, hypertension, and diabetes, all t-test significance was lost. We present a comparative analysis of uncircumcised and circumcised men using a battery of quantitative somatosensory tests that evaluate the spectrum of small to large axon nerve fiber function. Our study controlled for factors, including age, erectile function status, diabetes, and hypertension, that have been shown to alter neurologic testing. In our study of neonatally circumcised men, we demonstrated that circumcision status does not significantly alter the quantitative somatosensory testing results at the glans penis.
Article
To assess the effects of pictures on health communications. Peer reviewed studies in health education, psychology, education, and marketing journals were reviewed. There was no limit placed on the time periods searched. Pictures closely linked to written or spoken text can, when compared to text alone, markedly increase attention to and recall of health education information. Pictures can also improve comprehension when they show relationships among ideas or when they show spatial relationships. Pictures can change adherence to health instructions, but emotional response to pictures affects whether they increase or decrease target behaviors. All patients can benefit, but patients with low literacy skills are especially likely to benefit. Patients with very low literacy skills can be helped by spoken directions plus pictures to take home as reminders or by pictures plus very simply worded captions. Practice implications: Educators should: (1) ask "how can I use pictures to support key points?", (2) minimize distracting details in pictures, (3) use simple language in conjunction with pictures, (4) closely link pictures to text and/or captions, (5) include people from the intended audience in designing pictures, (6) have health professionals plan the pictures, not artists, and (7) evaluate pictures' effects by comparing response to materials with and without pictures.
Article
Urinary and sexual functions were assessed in post-pubescent boys who had undergone 2-stage hypospadias repair in infancy for severe hypospadias with chordee. A total of 44 boys who had undergone 2-stage hypospadias repair from 1985 to 1993 and who were at least 13 years old were contacted. Of the 44 boys 27 (61%) with an average age of 15.4 years (range 13 to 21) responded. Meatal locations were midshaft in 14 cases, penoscrotal in 9 and perineal in 4. Four boys had bifid scrotum and 5 had intersex disorders. Intramuscular testosterone was administered preoperatively to 15 (56%) boys. A Nesbit procedure was performed in 18 boys (67%). Average patient age at stage 2 repair was 2.3 years. Mean followup was 12.7 years (range 10.7 to 17.2). Additional surgery was performed for diverticuli in 5 cases, fistula in 3 and minor strictures in 4. Of the 27 patients 25 presented for examination and 2 responded to questionnaire only. All patients had normal meatal position, normal glanular anatomy, a well-defined coronal sulcus, normal cylindrical shafts without extra skin and well-defined penoscrotal junctions. Ten boys (40%) had minor spraying of stream, all stood to void and 10 (40%) milked the urethra after voiding. None had chordee. Twenty patients were able to ejaculate and 9 (42.9%) had to milk the ejaculate. Two patients (7.7%) had minor pain with erection. All subjects were satisfied with urinary, erectile and ejaculatory functions, and 23 (92%) were pleased with appearance. The 2-stage approach for severe hypospadias results in excellent function, cosmesis and patient satisfaction after puberty, with no chordee. Minor voiding and ejaculatory problems are to be expected. Late complications are rare. The use of extragenital skin to either primarily repair or salvage a "cripple" has not been necessary.
Article
The present study aimed to contribute to the design of effective health education information. Based on cognitive-psychological theory, pictures were expected to improve understanding of two existing textual instructions for using asthma devices (inhaler chamber and peak flow meter). From an analysis of the affordances and constraints of both devices this effect was expected to be stronger with the inhaler chamber than with the peak flow meter. To test this, both instructions were systematically illustrated with seven line-drawings visualizing the actions. In two separate randomized controlled trials with in total 99 participants from the general public, the original text-only versions were compared to the text-picture versions of the same instruction. Dependent variables were participants' recall of the instructions and the quality of their performance with the instruction observed from video-recordings. Conform expectations, the results showed significant positive effects of pictures on recall and performance in both instructions, especially with the inhaler chamber. Thus, pictures may contribute to a better comprehension and use of medical devices that are inherently less clear. Health educators may optimize instruction design by careful analysis of the device with instruction and observational testing with potential users.
Article
The aim of this study was to explore the relationships between the short- and long-term results of hypospadias repair and identify the factors that could affect the long-term results of hypospadias repair. Between 1982 and 1988, 142 patients were operated for hypospadias and completed their treatment at Tongji Hospital (Wuhan, China). Their records were analyzed retrospectively, and a detailed questionnaire was mailed to them. One hundred two patients returned the questionnaire. Patients in the proximal hypospadias group, those using Denis-Browne technique, and those with early complications were markedly dissatisfied with the overall results of hypospadias repair and penile appearance. Moreover, their dissatisfaction grew with the number of operations they had. Thirty-nine (95.1%) of 41 patients using the Denis-Browne technique had voiding problems. Forty-nine (48%) of 102 patients felt inhibited in seeking girlfriends or sexual contacts. Moreover, there was a positive correlation between the level of sexual inhibition and operation times. A highly positive correlation was found between the age at the time hypospadias surgery was completed and the extent of being sexually inhibited. The patients in proximal hypospadias group had more erection and ejaculation problems. The short-term results of hypospadias repair could affect the long-term results significantly, and good short-term results also predict long-term ones. The types of hypospadias, procedures, and complications have significant influences on predicting the long-term results of hypospadias repairs.
Article
To better understand the genital changes that occur during the female sexual response, using a gross anatomical and histological study of the vascular tissue of the vulva, supplemented with magnetic resonance imaging (MRI). Seven cadaveric vulvectomy specimens were used; they were serially sectioned in coronal, sagittal, and axial planes, and stained with haematoxylin and eosin. Selected blocks were stained with elastic Masson's trichrome. Axial MR images were taken of two healthy women with intact sexual functioning using a gadolinium-based blood-pool contrast agent. A 1.5 T system was used for all MRI studies, with images taken at baseline and during sexual arousal while viewing an erotic videotape. There are five vascular compartments of the female external genitalia, found in the clitoris, clitoral bulbs, labia minora, urethra, and vestibule/vagina. Of these five compartments, two distinct types of vascular tissue were identified, i.e. erectile and non-erectile/specialized genital. The erectile tissue compartments had the greatest change in blood volume during sexual arousal, as assessed by MRI. The vulva contains a substantial amount of vascular tissue. These specialized tissues show a variable, but unified response to sexual arousal.
Article
Even if performed early in life, hypospadias surgery may have a significant impact on self-esteem and sexual behavior in adolescence. We evaluated the long-term cosmetic and sexual outcomes of hypospadias surgery performed in childhood. A detailed questionnaire was mailed to 33 patients with hypospadias who were 18 to 26 years old and had undergone the first operation at age 6 years or younger. It was also mailed to 50 age matched controls. A total of 22 patients (66.7%) and 38 controls (76.0%) returned the questionnaire. Mean age in the hypospadias and control groups was 20.6 and 21.0 years, respectively. Eight of the 22 patients had mild hypospadias and 11 had severe hypospadias. Severity was unknown in 3 patients. Age at the first and final operations was 31 to 75 (mean 46) and 35 to 81 months (mean 53). The number of operation was 1 in 10 patients, 2 in 10 and 3 in 2. The rate of dissatisfaction with penile appearance was slightly higher in the hypospadias group than in the control group (40.9% vs 34.2%). The single reason for dissatisfaction in the hypospadias group was inadequate penile size, whereas in the control group penile size, phimosis and curvature were the major reasons for dissatisfaction (69.2%, 46.2% and 23.1%, respectively). Experience with masturbation (100% and 97.4%) and sexual intercourse (52.4% and 55.3%), and mean age at first masturbation (13.4 and 13.0 years) and first sexual intercourse (16.6 and 17.3 years) were similar in the hypospadias and control groups, respectively. Although patients with hypospadias had a slightly higher rate of dissatisfaction with penile size, their sexual behavior was not different from that in control subjects.
Article
To map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations. Adult male volunteers with no history of penile pathology or diabetes were evaluated with a Semmes-Weinstein monofilament touch-test to map the fine-touch pressure thresholds of the penis. Circumcised and uncircumcised men were compared using mixed models for repeated data, controlling for age, type of underwear worn, time since last ejaculation, ethnicity, country of birth, and level of education. The glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity. There were significant differences in pressure thresholds by location on the penis (P < 0.001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis. The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.