ABSTRACT
INTRODUCTION: Despite the interest for the brain correlates of male sexual arousal, few studies investigated neural mechanisms underlying psychogenic erectile dysfunction (ED). Although these studies showed several brain regions active in ED patients during visual erotic stimulation, the dynamics of inhibition of sexual response is still unclear. AIM: This study investigated the dynamics of brain regions involved in the psychogenic ED. METHODS: Functional magnetic resonance imaging (fMRI) and simultaneous penile tumescence (PT) were used to study brain activity evoked in 17 outpatients with psychogenic ED and 19 healthy controls during visual erotic stimulation. Patterns of brain activation related to different phases of sexual response in the two groups were compared. MAIN OUTCOME MEASURES: Simultaneous recording of blood oxygen level-dependent fMRI responses and PT during visual erotic stimulation. RESULTS: During visual erotic stimuli, a larger activation was observed for the patient group in the left superior parietal lobe, ventromedial prefrontal cortex, and posterior cingulate cortex, whereas the control group showed larger activation in the right middle insula and dorsal anterior cingulate cortex and hippocampus. Moreover, the left superior parietal lobe showed a larger activation in patients than controls especially during the later stage of sexual response. CONCLUSION: Our results suggest that, among regions more active in patient group, the left superior parietal lobe plays a crucial role in inhibition of sexual response. Previous studies showed that left superior parietal lobe is involved in monitoring of internal body representation. The larger activation of this region in patients during later stages of sexual response suggests a high monitoring of the internal body representation, possibly affecting the behavioral response. These findings provide insight on brain mechanisms involved in psychogenic ED.
Subject(s)
Brain Mapping , Erectile Dysfunction/physiopathology , Inhibition, Psychological , Parietal Lobe/physiopathology , Adult , Case-Control Studies , Emotions , Erotica/psychology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , PsychophysiologyABSTRACT
Retroperitoneal cysts are rare lesions, variable from asymptomatic cases with incidental discovery to case with acute or chronic abdominal discomfort. A 50-year-old female after a car crash refered chronic abdominal pain. An X-ray revealed the presence of sternal and multiple costal fractures. Abdominal ultrasonography (US) and computed tomography (CT) lead to the discovery of a retroperitoneal cyst too. As the patient was well after fractures solution, we decided to control the cyst in the time. In symptomatic cases surgery is the treatment of choice. The advent of laparoscopic surgery allows resection of these cysts to be achieved without full laparotomy.
