Management of sexual dysfunctions in women.

The deeper understanding of female physiology changed the perspective used to evaluate sexual difficulties. Systems like: vascular, neurological, biochemical, and endocrine are investigated as their modifications for aging or medical conditions may alter the sexual responsivity of women. New data imply that pharmacological interventions may become suitable for women. Gonadal steroids influence mood, wellbeing, and genital physiology but evidence of actions is controversial. Hormone imbalance provokes symptoms that may also derive from other conditions. Clinicians must exclude dismetabolism, depression and family crisis before diagnosing gonadal problems. The female androgen insufficiency syndrome was defined in July 2001 as altered mood, memory and wellbeing, and loss of desire. Estrogen maintains wellbeing and healthy genitals, influencing mood and sexuality. Progesterone provokes tension and nervousness, causing premenstrual syndrome. Hormone replacement is indicated in the treatment of endocrine deficiency. In research projects women receiving one preparation containing androgen reported improvement of mood, and arousal. Sildenafil cures approximately 25% of sexually dysfunctional, menopausal patients; being more effective with hormone replacement therapy (HRT) and consistently active against the block of antidepressants on orgasm. Added to psychiatric regimens, sildenafil ameliorates excitement. Sex therapy helps patients change behavior, overcome anger, communicate needs and redefine sex. We strongly believe that such crucial aspects must be addressed in therapy, even when the etiology is organic.

The microvasculature of the corpus luteum in pregnant rabbit. A scanning electron microscopy study of corrosion casts.

The vascular network of pregnant rabbit ovaries was studied by means of scanning electron microscopy (SEM) of corrosion casts, in order to evaluate the morphofunctional changes of the microcirculation of corpus luteum (CL). Pregnant rabbit ovary showed an overwhelming vascularization. Ovarian hilus displayed an increase in the arterial spirallisation. The arterial spiral pattern was present along the entire vessel course, up to CL tissues. The CL of pregnancy was supplied by wide vascular plexuses (2-5 plexuses were found in each pregnant ovary) whose major axis was about 2 mm. Luteal capillaries showed a tortuous course and were arranged in a three-dimensional, wide and rounded-meshed network. Postcapillary venoconstrictions were present. The venous drainage appeared more developed then the arterial supply. Tight artero-venous contacts in hilar, juxtamedullar and medullar regions of the ovary were observed. These results clearly show that the morphofunctional expression of CL of pregnancy is greatly dependent on its hemodynamic control. In particular, the increase of spirallisation exhibited by the arteries during pregnancy is likely to be considered a significant functional change. The spirallisation likely is a device for reducing the blood pressure through the CL. The artero-venous contacts, also previously described in hCG stimulated (pseudopregnant) ovaries, may support a counter-current like system that may allow a veno-arterial exchange of small molecules through the wall of the facing vessels. In addition, in 10-day pregnant rabbit CL the consolidation of a well-developed capillary network was revealed, which is a sign that the CL of pregnancy reached the full morphofunctional maturation. Furthermore, the CL of 10-day pregnant rabbit did not present significant capillary permeabilization and dilation or angiogenic processes, aspects that were previously found in stimulated periovulatory ovaries. Indeed, changes of the arterial supply and venous drainage of the CL of pregnancy were demonstrated. This suggests that the control of the blood flow through the CL of pregnancy may be transferred from the local capillary microcirculation to the regional artero/venous circulation. This may be probably related to the significant increase of the ovarian blood flow necessary for the maintenance of CL endocrine functions during pregnancy.

On a complex arrangement of the vascular pedicle of the left kidney.

During the dissection of an 83 year-old male cadaver, we observed that the left renal vein passed behind the aorta to follow an oblique course before draining into the inferior vena cava. The left renal vein was connected to the left suprarenal, spermatic, lumbar ascending and azygos veins. The left spermatic vein, after collecting the suprarenal vein, crossed in front of the abdominal aorta to reach the inferior vena cava directly. Furthermore, the arterial pedicle of the left kidney was composed of two tortuous and intermingled vessels. Variations in the number and arrangement of the vessels terminating in the renal veins are not uncommon, but so complex a vascular arrangement as this has not to our knowledge been previously described. The ontogenetic explanation and clinico-surgical implications of such a variation are reviewed and discussed.