Perceptions of the living dead: An assessment of knowledge and opinions about whole body donation, its process, and willingness to become cadaveric donors in Pennsylvania.

Despite the many important uses for human cadavers, there is a relative shortage of bodies donated to the scientific community in the United States of America. The purpose of this study was to determine the community's perceptions regarding whole body donation and their willingness to become donors. Moreover, we aimed to investigate people's understanding of the process of whole body donation, and examine their opinions regarding its importance. Individuals in Erie, Pennsylvania were surveyed. Data were collected via a questionnaire, which was offered to friends and family members of patients in the waiting area of the UPMC Hamot Surgery Center. All participants were residents of Erie County. The questionnaire was designed to evaluate knowledge and opinions about whole body donation. A total of 123 people completed the survey. We found people were willing to become whole body donors and understood the importance of this giving act, but lacked understanding about the registration process and the use of donated bodies. Participants revealed the belief that they have the right to decide what is to be done with their bodies after death, but did not indicate specific negative repercussions of becoming whole body donors. In conclusion, our findings indicate that the shortage of cadaveric donors could be due to lack of understanding about whole body donation and the registration process.

Self-assessment of anatomy, sexual sensitivity, and function of the labia and vagina.

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.

Male circumcision decreases penile sensitivity as measured in a large cohort.

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.

Inhibitory effects of 405 nm irradiation on Chlamydia trachomatis growth and characterization of the ensuing inflammatory response in HeLa cells.

BACKGROUND: Chlamydia trachomatis is an intracellular bacterium that resides in the conjunctival and reproductive tract mucosae and is responsible for an array of acute and chronic diseases. A percentage of these infections persist even after use of antibiotics, suggesting the need for alternative treatments. Previous studies have demonstrated anti-bacterial effects using different wavelengths of visible light at varying energy densities, though only against extracellular bacteria. We investigated the effects of visible light (405 and 670 nm) irradiation via light emitting diode (LEDs) on chlamydial growth in endocervical epithelial cells, HeLa, during active and penicillin-induced persistent infections. Furthermore, we analyzed the effect of this photo treatment on the ensuing secretion of IL-6 and CCL2, two pro-inflammatory cytokines that have previously been identified as immunopathologic components associated with trichiasis in vivo. RESULTS: C. trachomatis-infected HeLa cells were treated with 405 or 670 nm irradiation at varying energy densities (0 - 20 J/cm2). Bacterial growth was assessed by quantitative real-time PCR analyzing the 16S: GAPDH ratio, while cell-free supernatants were examined for IL-6 and monocyte chemoattractant protein-1 (CCL2) production. Our results demonstrated a significant dose-dependent inhibitory effect on chlamydial growth during both active and persistent infections following 405 nm irradiation. Diminished bacterial load corresponded to lower IL-6 concentrations, but was not related to CCL2 levels. In vitro modeling of a persistent C. trachomatis infection induced by penicillin demonstrated significantly elevated IL-6 levels compared to C. trachomatis infection alone, though 405 nm irradiation had a minimal effect on this production. CONCLUSION: Together these results identify novel inhibitory effects of 405 nm violet light on the bacterial growth of intracellular bacterium C. trachomatis in vitro, which also coincides with diminished levels of the pro-inflammatory cytokine IL-6.

A retrospective observational study of enuresis, daytime voiding symptoms, and response to medical therapy in children with attention deficit hyperactivity disorder and autism spectrum disorder.

INTRODUCTION: Children with attention deficit hyperactivity disorder (ADHD) show an increased prevalence of enuresis and other daytime voiding symptoms (DVS). There is also some evidence toward an increased prevalence of enuresis among children with autism spectrum disorder (ASD), but with no data available with respect to DVS or response to medical treatment. The aim of this study was to assess enuresis and DVS, along with treatment outcomes, in children with ASD, to aid urological management. METHODS: A retrospective observational study on the incidence of enuresis and other DVS in 671 children with/without ADHD/ASD was performed. Symptomatic improvement ≥50% was required to be considered positive. Complete resolution of symptoms for 3 months after cessation of treatment was considered cure. RESULTS: Symptomatic improvement with desmopressin or anticholinergic treatment was seen in 76% of patients without ADHD/ASD, 85% of patients with ADHD, and 100% of patients with ASD. Cure was seen in 61% of patients without ADHD/ASD, 48% of patients with ADHD, and 50% patients with ASD. Mean time to cure was 9 months in those without ADHD/ASD (N = 319), 10 months in those with ADHD (N = 62), and 8 months in those with ASD (N = 10) (P = 0.69). CONCLUSION: Despite the small sample size of patients with ASD, our data show a favorable trend toward efficacy of desmopressin and anticholinergic therapy in these children with enuresis and DVS.

Immunocytochemical characterization of pacinian-like corpuscles in the labia minora of prepubertal girls.

STUDY OBJECTIVE: To better understand the precise role of sensory corpuscles within the female external genitalia. DESIGN: After IRB approval, waste tissue samples were obtained from 10 normal girls (aged 2-9 years) who underwent surgery for labial fusion. Immunocytochemistry against protein gene product 9.5 (PGP 9.5), neuron-specific enolase (NSE), vasoactive intestinal peptide (VIP), 5-hydroxytryptamine transporter (5HTT), 5-hydroxytryptamine receptor 1A (5HT1A), Neuronal Peptide Y (NPY), neuronal nitric oxide synthase (nNOS), and estrogen receptors (ER) α and ß was performed. RESULTS: Pacinian-like corpuscles were identified in epithelium of labia minora of prepubertal girls. A central structure composed of an axon surrounded by a central core, outer core, external capsule, surrounded by encapsulated stroma, and a subsidiary innervation in the outer aspect of the corpuscle stroma stained for PGP 9.5 in the outer core and layers of the external capsule, NSE positive cells in layers of the outer core, 5HTT in stroma of the corpuscle and cells located in layers of the outer core, 5HT1A in cells of outer core, NPY in stroma of the corpuscle, and nNOS in external core and external capsule of the central structure. ERα was present in stroma, external core, and external capsule, and ERß in stroma of the corpuscle with subsidiary innervation in the stroma positive to PGP 9.5, VIP, and NPY. CONCLUSION: PGP 9.5, NSE, ERα, nNOS, and 5HTT immunoreaction detected in the outer core and external capsule could indicate these areas may play an important role in the functional aspects of the Pacinian-like corpuscle.

Obstructive ejaculatory duct calculi in a patient with bladder augmentation and myelomeningocele.

Symptomatic ejaculatory duct (ED) calculi, typically composed of uric acid, carbonate apatite and calcium phosphate, or calcium phosphate in the form of hydroxyapatite, are rare occurrences. We report a case of bilateral, large ED calculi in a patient with spina bifida myelomeningocele and an augmented neurogenic bladder. A 25-year-old Caucasian male, not compliant with his urological management, presented with abdominal pain, difficulty in self-catheterization, nausea and vomiting. Two of eight large struvite calculi, which blocked the urethra, were identified at the right ED. After endoscopic calculi removal, further management included bladder irrigation and infection control modalities. This case highlights the importance of clean intermittent catheterization, bladder irrigation, and routine urologic management necessary for patients with myelodysplasia and neurogenic bladder. It is the first recorded case to demonstrate the augmented bladder as an initiator of ejaculatory duct calculi in patients with an open bladder neck and spastic external sphincter.

Pyospermia in an adult cohort with persistent lower urinary tract symptoms and a history of ablated posterior urethral valve.

PURPOSE: To assess for the presence of lower urinary tract symptoms and abnormal semen parameters in adults with a history of PUV. MATERIALS AND METHODS: The study involved 29 male patients, aged 17-51 (mean 21.5 years), with a history of PUV. Ten had more severe symptoms of frequency, urgency and enuresis, and agreed to detailed study. Medical history, urine analysis, ultrasonography and voiding cystourethrogram were completed for all. Magnetic resonance imaging of the bladder, prostate, seminal vesicles and ejaculatory ducts, ultrasonography of the prostate, as well as semen analysis and culture, and measurement of serum levels of follicle-stimulating hormone, luteinizing hormone and testosterone were performed on the 10/29 patients with severe symptoms. RESULTS: Of the 8/10 patients who provided acceptable semen culture data, 88% (7/8) showed significant bacterial growth and pyospermia. On semen analysis, 3/8 patients had profound decreases in sperm count, 6/8 < 50% motility and 4/8 ≤ 30% normal forms. pH range for semen was 7.2-7.8 (mean 7.45). For all 10 patients, follicle-stimulating and luteinizing hormone values were within normal range. Elongation of the prostate was the only radiologic variant of the sex accessory structures. CONCLUSION: A significant finding of pyospermia and bacterial growth in semen culture is reported in a subpopulation of young men with a history of PUV and severe lower urinary tract symptoms. This may have an impact on fertility.

Detection of RXFP1 receptors in skin biopsies from children with congenital adrenal hyperplasia: a preliminary report.

OBJECTIVE: Relaxin may potentiate the effect of topical estrogen treatment to eradicate post-incisional scarring in congenital adrenal hyperplasia (CAH) patients undergoing genitoplasty. The aim of this study was to determine whether CAH skin is capable of responding to relaxin. PATIENTS AND METHODS: Skin biopsies were obtained from four female CAH patients (aged 2-9 years; Prader 4-5, salt-wasting, 21-hydroxylase deficiency, Caucasian) during routine genitoplasty surgery and screened for relaxin receptors. All received corticosteroid and mineralocorticoid replacement therapy. Specimens were sectioned, mounted and screened for the presence of the putative H2 relaxin receptor using conventional two-antibody immunohistochemistry. Tissue controls were processed concurrently. RESULTS: Tissue controls evidenced appropriate staining. Biopsies from CAH patients stained positively for RXFP1 expression while some variation between specimens was evident. Staining occurred adjacent to the basement membrane of the epithelium, localized to germinative basal keratinocytes. CONCLUSION: Based on a limited patient sample, germinative keratinocytes in CAH patients appear competent to respond to relaxin perhaps topically applied. Given that relaxin downregulates collagen accretion and upregulates collagenases, its use may potentiate the effects of estradiol and abrogate post-incisional wound scarring. More research is needed to confirm or refute this thesis.

Development and validation of the pregnancy and infant orientation questionnaire.

The purpose of this study was the construction, scaling, and scale validation of a self-report questionnaire assessing biographical information and motivation for pregnancy and infant care in men and women with disorders of sex development or other gender variations of potential clinical relevance. The overall design of the questionnaire and the initial item pool were derived from related clinical and research experience. Collection of pilot data and, where appropriate, scale construction (via principal components analyses) were based on Canadian convenience samples of heterosexual (HET) and non-HET men and women (N = 414). A sample of gender-dysphoric (GDYS) men and women (n = 45) was added for validity analysis. Validation of the resulting scales was based on the demonstration of expected scale differences between HET men and women, as well as between HET, non-HET, and GDYS men and between HET, non-HET, and GDYS women, and was successful with one exception. This study concludes that this new questionnaire, in addition to its descriptive sections, provides several distinct scales related to desires for child bearing and child rearing and has good psychometric properties.

Adequacy of sanitization and storage of catheters for intermittent use after washing and microwave sterilization.

PURPOSE: Clean intermittent catheterization is used to treat neurogenic bladders and it can be adequate to maintain sterile urine. Typically polyvinylchloride, individually packaged catheters are used but they are not intended for repeat use by the manufacturer. Antibacterial soap alone or combined with microwave heating was advocated to decrease pathogens and bacterial residue, which could inoculate the bladder from a colonized catheter. We assessed the efficacy of catheter sanitizing and storage for reuse. MATERIALS AND METHODS: Catheters were inoculated with a 24-hour broth culture of Escherichia coli and washed in antibacterial soap, washed and microwaved or immediately packaged (positive controls) and stored for 1, 3 and 7 days, respectively. Common packaging was used, including paper towels, sealable plastic bags or sealable rigid plastic containers. Each condition was assessed in triplicate via culture of the entire catheter contents, yielding a total of 27 catheters per sanitization method. RESULTS: Antibacterial wash alone failed to sanitize 67% of catheters (6 of 9 with 2 of 3 positive per container) on day 1, 22% (2 of 9 with all positive catheters in a paper towel) on day 3 and 44% (4 of 9 with 1 in a paper towel and 3 in a plastic container) on day 7. For combined antibacterial wash and microwave heating the positive rate was 0% (0 of 9 catheters) on day 1, 22% (2 of 9 in a plastic container) on day 3 and 56% (5 of 9 with 3 in a paper towel, 1 in a plastic bag and 1 in a plastic container) on day 7. Positive untreated controls showed viable organisms throughout the test period. CONCLUSIONS: Overall 44% of catheters (12 of 27) washed with antibacterial soap yielded E. coli vs 26% (7 of 27) with combined antibacterial soap-microwave treatment. The latter is a more effective but not an absolute way to sanitize catheters for intermittent use. Longer storage time increased the risk of E. coli growth on the catheters.

Giant condyloma with demise secondary to meningococcemia in an infant boy.

Human papilloma virus (HPV) is the most common sexually transmitted disease among adults in the USA; however, the presence of HPV in infants is rare. Condyloma acuminata, a cutaneous, fungating lesion caused by HPV, has a generally mild course that often resolves spontaneously or can be managed both medically and surgically. Typical treatments for condyloma include imiquimoid cream, podofilox gel, podophyllin resin, cryotherapy, laser surgery, tangential shave excision, and electrocautery. Rapidly progressing condyloma acuminata followed by a fatal course of Neisseria meningitis in an infant is an extremely rare presentation that merits further investigation into possible immunologic etiology. A 7-month-old circumcised Caucasian boy presented with a rapidly progressing giant penile condyloma acuminatum. This is the youngest documented case of this type. Refractory to medical and surgical treatments, this otherwise apparently healthy child was referred to pediatric immunology. Normal complete blood count led to deferment, suggesting further medical and surgical treatment. Five days after such treatment, the baby presented with progressive systemic rash, fever and tachycardia. The patient died from meningococcemia. This case serves as a warning concerning the course of condyloma in infants. Immunologic investigation may be critically important in young patients refractory to designated treatments for condyloma.

Relaxin's involvement in extracellular matrix homeostasis.

Burgeoning evidence suggests that the hormone relaxin modulates collagen in the extracellular matrix of diverse tissues. In separate lines of study, we provide further substantiation of this hypothesis. Immunofluorescence was used to probe isolated fibroblasts derived from volar oblique ligament explant culture for vimentin, actin, RXFP1, and estrogen receptor beta. Ligaments were obtained as surgical waste from thumb reconstruction patients. Four specimens have been examined to date. Cells derived from these patients expressed vimentin and actin, consistent with fibroblast morphology. Putative fibroblasts derived from two of three female patients expressed RXFP1 receptors; the solitary male was negative. Given the small sample, however, the data are considered preliminary. Immunohistochemistry was used on frozen sections from 26 skin biopsies obtained from children undergoing genitoplasty. A subset of samples was also probed for transforming growth factor (TGF-beta1) and TGF-beta3. Appropriate controls were used. Finally, a subset of patient blood was assayed for relaxin by using an enzyme-linked immunosorbent assay-based method. The results showed RXFP1 receptor expression in the cells that populate the basement membrane in 96% of patients, regardless of gender. Most tissue expressed TGF-beta. Finally, serology suggested that relaxin was detectable in these children. Our two lines of research provide additional evidence for the diverse tissue tropism of relaxin. In particular, connective tissues as diverse as ligaments and basal lamina keratinocytes express RXFP1. These data lend support to our contention that relaxin affects ligament integrity and wound healing.

Long-term vaginal sequelae secondary to pediatric pelvic fracture.

BACKGROUND: Pediatric pelvic fractures often appear radiographically benign despite significant injury to viscera. Vaginal injuries are rare, and therefore require a high index of suspicion. CASE: A 26-year-old female patient who sustained a pelvic fracture in a motorcycle accident at the age of 10 presented with vaginal stenosis precluding sexual intercourse. Patient menstruated through a fistula in the distal vaginal vault. Radiographic and dye studies showed almost complete vaginal obstruction with heterotopic ossification. An extensive 30-year review of the literature was conducted looking for documented cases of vaginal injuries secondary to pelvic injury. SUMMARY AND CONCLUSION: This is the only recorded case of a long-term vaginal complication with subsequent heterotopic ossification secondary to pelvic fracture. Preventing debilitating long-term sequelae from vaginal injuries requires close patient follow-up and age-appropriate assessments.

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

OBJECTIVE: 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). SUBJECTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Mesorchial testicular torsion: case report and a review of the literature.

Testicular torsion can be extravaginal, intravaginal, or mesorchial. Mesorchial torsion is less well defined and has an atypical presentation. Here we present the case of a 13-year-old with severe, intermittent right scrotal pain, erythema, and a large hydrocele. Color Doppler ultrasound examination showed epididymal enlargement and normal flow. Weeks after presentation, serial color Doppler ultrasound examinations showed epididymal enlargement and decreased perfusion. A literature review for testicular torsion etiology and clinical and radiologic findings documents this as the only recorded case of mesorchial testicular torsion with clinical and radiologic findings. Atypical pain, if persistent, requires careful reassessment, radiologic studies, and surgical exploration.

Clitoral sexual arousal: neuronal tracing study from the clitoris through the spinal tracts.

PURPOSE: Although genital tactile stimulation is regarded as a precursor to sexual arousal and a recognized initiator of central nervous system arousal, specific afferent neural pathways transmit sensory stimuli of arousal, beginning at the epithelial level on the clitoris and following the course of arousal stimuli through the central nervous system. Limited knowledge exists of the pathway from the cutaneous receptors of nerves originating in the epithelial tissue of the clitoris and continuing to spinal cord afferents. Such information may contribute to an understanding of sexual arousal, particularly in female vertebrates. We further defined the neural pathways and mechanisms responsible for arousal originating in the epithelium of the clitoris as well as related neural pathways to the spinal cord in a murine model. MATERIALS AND METHODS: We performed a comprehensive review of the published relevant clinical and histological material from human and nonhuman vertebrate studies. In 29 adult female C57B1/6 mice the distribution of pelvic nerves and vessels was mapped. Gross dissection of 4 female mice was facilitated by resin injection of the vascular system in 2. Neuronal tracing was performed in 25 mice that received clitoral injection of wheat germ agglutinin-horseradish peroxidase into the clitoris and were sacrificed after 72 to 96 hours. The spinal cord and periclitoral tissue were removed and fixed. Immunohistochemistry was performed. RESULTS: Gross anatomy of the mouse clitoris showed that pudendal and hypogastric nerves have a major role in the innervation of the external genitalia. Neuronal tracing revealed that the greatest nerve density was noted in the L5/6 spinal cord. The distribution extended from S1 to L2 with no labeling seen in the L3 spinal cord. Wheat germ agglutinin-horseradish peroxidase labeling was seen caudal in levels S1 through L4 and rostral in L2. CONCLUSIONS: Understanding the neuroanatomy of the clitoris using a murine model may provide a valuable tool for the study of sexual arousal disorders and the further understanding of sexual function related to neural pathologies and trauma.

Oestrogen receptors and their relation to neural receptive tissue of the labia minora.

OBJECTIVE: To assess the cellular distributions of oestrogen receptors alpha and beta (ER alpha and ER beta) and neuronal nitric oxide synthase (nNOS) in the labia minora, as knowledge about ER type and function may clarify the role of oestrogens in vaginal scar formation and improve outcomes in female genital surgery. SUBJECTS AND METHODS: Labial samples were taken from 10 girls (aged 2-9 years) who underwent surgery for labial fusion. The waste tissue strips obtained were used for immunohistochemical identification of ER alpha and ER beta, and nNOS in the labia minora. RESULTS: There was ER alpha nuclear staining in the stroma of the labia minora close to the clitoris, and basal and suprabasal in the epidermal cells membrane restricted to superficial sections of the labia minora. ER beta was found in the stroma of the labia minora closer to the clitoris and in superficial sections, in the basal epidermal cells membrane and apocrine glandular epithelial cells membrane. There was also ER beta cell membrane staining in the basal and suprabasal epithelial cells and fibroblasts in the lamina propria. CONCLUSIONS: Established ER presence allows the consideration of the introitus of the vagina as a target for oestrogen therapy in various clinical and surgical situations. Continuing elucidation of the immunohistochemistry of this external genital tissue might assist in the development of molecular tools to treat genital abnormalities. Details of this immunohistochemistry may also advance the understanding of the effects of sexual differentiation on the brain and other organ systems.

Clitoral sexual arousal: an immunocytochemical and innervation study of the clitoris.

OBJECTIVE: To further define neural pathways and mechanisms responsible for the arousing properties of the epithelium of the clitoris as well as related neural pathways associated with sexual arousal in a murine model. MATERIALS AND METHODS: Adult female C57B1/6 mice were used for gross dissection, facilitated by resin injection of the vascular system, and silver staining, and immunostaining for S-100 and neuronal nitric oxide synthase (nNOS). We also comprehensively reviewed relevant published clinical and histological material from both human and non-human vertebrate studies. RESULTS: The distal innervation consists of three nerve bundles: one related to the perineal region, one through the corpus cavernosum, and the third between the dorsal part of the clitoris and the urethra. Communicating nerve fibres were identified between the perineal, the corpus cavernous nerve (CN) and the dorsal nerve of the clitoris. Immunostaining for nNOS showed that the CN sends nNOS-positive fibres to join the dorsal nerve of the clitoris. In the same distal area of the clitoris, the connecting branches between the perineal nerve and the dorsal nerve of the clitoris are also nNOS positive. CONCLUSIONS: A rich network of nerve bundles and terminal branches were identified and associated with nNOS immunostaining in the cavernosal tissue of the body of clitoris. NO control of vasodilatation and neuronal signalling between the CN and the dorsal nerve of the clitoris could contribute to the engorgement and subsidence of clitoral tissue. This supports the initiation of sexual arousal by tactile stimuli. The distribution pattern of the general and peptidergic innervation in the murine clitoris is similar to that of the penis.

Imaging and examination strategies of normal male and female sex development and anatomy.

Over recent years a variety of new details on the developmental biology of sexual differentiation has been discovered. Moreover, important advances have been made in imaging and examination strategies for urogenital organs, and these have added new knowledge to our understanding of the 'normal' anatomy of the sexes. Both aspects contribute to the comprehension of phenotypic sex development, but they are not commonly presented in the same context. This will be attempted in this chapter, which aims to link discoveries in developmental biology to anatomical details shown by modern examination techniques. A review of the literature concerning the link between sexual development and imaging of urogenital organs was performed. Genes, proteins and pathways related to sexual differentiation were related to some organotypic features revealed by clinical examination techniques. Early 'organotypic' patterns can be identified in prostatic, urethral and genital development and followed into postnatal life. New imaging and endoscopy techniques allow for detailed descriptive anatomical studies, hopefully resulting in a broader understanding of sex development and a better genotype-phenotype correlation in defined disorders. Clinical description relying on imaging techniques should be related to knowledge of the genetic and endocrine factors influencing sex development in a specific and stepwise manner.