Brain magnetic resonance imaging in exploring the central neurophysiological mechanisms of penile erection: Progress in studies / 中华男科学杂志

Previous studies have found that penile erection is not only dependent on the peripheral nervous and vascular systems, but also controlled by the central nervous system. Some brain regions are responsible for promoting and suppressing penile erection, respectively. Studies on the brain functions showed both activation and inactivation of the brain regions when receiving sexual stimulation, and those on the brain structure of ED patients revealed atrophy of the gray matter structure and abnormal connection of the white matter fibers. In addition, abnormal connections within emotional, cognitive and default and salience networks were found in patients with psychogenic ED. This article reviews the brain MRI-based studies on the central neurophysiological mechanisms of penile erection, aiming to gain a deeper insight into human neurophysiological mechanisms of the neural circuits controlling erectile function.

Correlation of abnormal topological properties of the white matter fibers connecting the left amygdale with psychogenic erectile dysfunction / 中华男科学杂志

Objective@#To explore the topological properties of the degree and strength of nodes in the binary and weighted brain white matter networks of the patients with psychogenic erectile dysfunction (pED) and analyze the changes of myelin integrity, number and length of the white matter fibers in the topological space.@*METHODS@#Diffusion tensor imaging data were obtained from 21 patients with pED and 24 healthy controls matched in sex, age, and years of education and subjected to preprocessing. The whole cerebral cortex was divided into 90 regions, followed by fiber tracking, construction of the binary and weighted white matter networks, and calculation of the node degrees and connectivity strengths in different brain regions. The property values were compared between the two groups using the two-sample t-test, the results were corrected by multiple testing correction, and the correlation of the property values with the erectile function of the patients was subjected to Pearson's correlation analysis.@*RESULTS@#Compared with the healthy controls, the pED patients showed significantly decreased node degree of the left triangular part of inferior frontal gyrus (IFG) (7.54±1.44 vs 5.95±1.28, t = －3.88, corrected P = 0.02), medial orbital part of superior frontal gyrus (SFG) (10.08±3.60 vs 6.29±3.30, t = －3.67, corrected P = 0.02), and amygdala (6.50±2.11 vs 4.29±1.31, t = －4.16, corrected P = 0.01) in the binary networks, as well as the connectivity strength of the left triangular part of IFG (2.50±0.68 vs 1.72±0.50, t = －4.35, corrected P = 0.01), medial orbital part of SFG (3.17±0.97 vs 2.08±1.10, t = －3.53, corrected P = 0.03), and amygdala (1.80±0.69 vs 1.11±0.39, t = －4.03, corrected P = 0.01) in the fractional anisotropy (FA) weighted networks. The node degree of the left amygdala was negatively correlated with the total score (r = －0.47,P = 0.04), second item score (r = －0.46, P = 0.03), and third item score of IIEF-5 (r = －0.45, P = 0.04) in the pED patients.@*CONCLUSIONS@#The myelin integrity of the white matter fibers in the left frontal lobe and amygdale is impaired in pED patients, which leads to the aberrant generation, processing and regulation of their emotions. The decreased pivotal role and importance of the white matter fibers connecting the left amygdale may be associated with pED.

Resolution of erectile dysfunction after an andrological visit in a selected population of patients affected by psychogenic erectile dysfunction / 亚洲男科学杂志(英文版)

The aim of this study was to ascertain whether some patients with psychogenic erectile dysfunction (PED) who chose psychotherapy spontaneously improved their sexual function immediately after diagnosis. Two hundred eighty-five patients with PED were retrospectively studied. Complete resolution of PED was analyzed regarding age, primary or secondary PED, marital status, domestic status, prevailing attitude of the female partner to the dysfunction, duration of their partnership, social status, duration of PED, International Index of Erectile Function score, and prevailing attitude of the patient after a diagnosis of PED. The data were analyzed using post-hoc tests. PED was resolved in 32.3% of the patients immediately after diagnosis. These patients were older, more frequently affected by secondary ED, more frequently living with their partner, and more frequently resigned or happy with the diagnosis of PED than the patients who did not resolve their PED. A nonchalant or cooperative female attitude to PED improved the possibility of PED resolution. The other variables did not influence PED resolution. Our data showed that a clear-cut diagnosis of psychogenic erectile deficiency and some psychosocial factors were critical for the management of some patients with PED.