An Exploratory Study on the Central Nervous Correlates of Sexual Excitation and Sexual Inhibition.

The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) measure sexual excitation and sexual inhibition proneness. We used SIS and SES scores of 62 heterosexual teleiophilic men (Mage 34.3, SD = 9.9) to predict brain activation levels during the presentation of male and female visual sexual stimuli in a magnetic resonance imaging (MRI) scanner. Statistical analyses revealed significant correlations. SES and SIS1 scores were positively associated with brain activation in various brain regions during the presentation of both male and female stimuli. SIS2 turned out to be a weaker predictor of brain activation, still revealing one significant correlation in the right lateral orbitofrontal cortex. Significant regions for SES and SIS1 were, among others, primary and supplementary motor areas, the caudate nucleus, the dorsal anterior cingulate cortex, anterior insula, and prefrontal areas. Our study can be seen as an exploratory investigation of SIS and SES with means of functional brain imaging. The results provide a promising contribution to the assertion of neurophysiological systems of sexual inhibition and excitation proneness.

Gray matter anomalies in pedophiles with and without a history of child sexual offending.

Pedophilia is a psychiatric disorder that is inter-related with but distinct from child sexual offending (CSO). Neural alterations reportedly contribute to both pedophilia and CSO, but until now, no study has distinguished the brain structural anomalies associated with pedophilia from those specifically associated with CSO in pedophilic men. Using high-resolution T1-weighted brain images and voxel-based morphometry, we analyzed the gray matter (GM) volume of the following 219 men recruited at four acquisition sites in Germany: 58 pedophiles with a history of CSO, 60 pedophiles without any history of CSO and 101 non-pedophilic, non-offending controls to control for the effects of age, education level, verbal IQ, sexual orientation and the acquisition site. Although there were no differences in the relative GM volume of the brain specifically associated with pedophilia, statistical parametric maps revealed a highly significant and CSO-related pattern of above vs below the 'normal' GM volume in the right temporal pole, with non-offending pedophiles exhibiting larger volumes than offending pedophiles. Moreover, regression analysis revealed that the lower GM volume of the dorsomedial prefrontal or anterior cingulate cortex was associated with a higher risk of re-offending in pedophilic child molesters. We believe our data provide the first evidence that CSO in pedophilia rather than pedophilia alone is associated with GM anomalies and thus shed new light on the results of previous studies on this topic. These results indicate the need for new neurobehavioral theories on pedophilia and CSO and may be potentially useful for treatment or prevention approaches that aim to reduce the risk of (re)offending in pedophilia.

[Sexual medicine in daily practice : Germany-wide questionnaire of urologists]. / Sexualmedizin im ärztlichen Alltag : Bundesweite Umfrage unter Ärzten in der Urologie.

BACKGROUND: Sexual-related problems are very prevalent. Physicians of different disciplines are frequently contacted by men with those problems. OBJECTIVES: The aim of this study was to investigate the situation of sexual medicine in daily practice and to evaluate German urologists' need for further training in this field with a focus on gender-specific differences. MATERIALS AND METHODS: A five-page questionnaire included questions about sexual medicine in daily practice. A focus was set on physicians dealing with sexual medicine in daily practice and their need for further training in this field. In April/Mai 2015, questionnaires were sent per mail to 5955 urologists, urology residents and andrologists throughout Germany. The questionnaire was developed based on previously published studies and a pretest was performed to evaluate comprehensibility. A χ2 test was performed to determine significant gender-specific differences; for this propose response options were dichotomised. P values ≤0.05 were considered significant. RESULTS: The response rate was 16.0%, representing 955 questionnaires. A total of 50 questionnaires from non-urologists were excluded, so 905 questionnaires were analysed. The mean age was 47.7 ± 10.4 years, 78.9% were male, 97.0% had studied in Germany, 86.7% were specialists and 37.7% had further qualification in andrology. CONCLUSION: Our results emphasize the need for further training in sexual medicine, especially for female physicians. This study underlines the demand for advanced qualification in sexual medicine.

[Dermatological diseases and sexuality. How to proceed?]. / Dermatologische Erkrankungen und Sexualität. Wie geht man vor?

A variety of dermatological diseases is associated with male or female sexual dysfunction. Some sexual disorders are caused organically; erectile dysfunction in men with systemic sclerosis may be due to penile vascular alterations and corporal fibrosis. Other dermatoses such as psoriasis are associated with risk factors (metabolic syndrome) for sexual disorders and may therefore indirectly induce erectile dysfunction. However, the majority of sexual dysfunctions in dermatological patients is caused by reduced self confidence and sexual self esteem leading to affected partnership and sexuality. Dermatologists should be trained in basic sexual medicine and ask their patients for sexual problems. They may not treat sexual disorders, but they should be identified as sympathetic physicians for these problems and should be able to refer the patient to specialists in sexual medicine.

Hebephilia as a sexual disorder.

BACKGROUND: The term "hebephilia" describes the sexual preference for minors at an early pubertal body age. For most clinicians the definition of hebephilia is not obvious and not integrated as a separate category in the DSM-5. METHOD: N = 222 self-motivated applicants from the community for the therapy program of the Prevention Project Dunkelfeld in Berlin were assessed concerning their sexual preference towards minors. RESULTS: Approximately two-thirds (n = 153) showed a sexual interest in early pubertal minors (15 % exclusively; 85 % non-exclusively). Approximately 95 % reported having sexually abused children and/or having used child abusive images at least once in their lifetime. Hebephiles reported a significantly higher level of clinically relevant distress and personality characteristics, as well as more offense-supportive attitudes compared to normative samples. CONCLUSION: Hebephilia can be differentiated from pedophilia in terms of sexual interest for the body age of the minor. Associated personal distress, deviant personality characteristics as well as sexual behavior problems suggest that hebephilia can fulfill the criteria of a sexual disorder which should be considered in classification systems (DSM, ICD).

Human face processing is tuned to sexual age preferences.

Human faces can motivate nurturing behaviour or sexual behaviour when adults see a child or an adult face, respectively. This suggests that face processing is tuned to detecting age cues of sexual maturity to stimulate the appropriate reproductive behaviour: either caretaking or mating. In paedophilia, sexual attraction is directed to sexually immature children. Therefore, we hypothesized that brain networks that normally are tuned to mature faces of the preferred gender show an abnormal tuning to sexual immature faces in paedophilia. Here, we use functional magnetic resonance imaging (fMRI) to test directly for the existence of a network which is tuned to face cues of sexual maturity. During fMRI, participants sexually attracted to either adults or children were exposed to various face images. In individuals attracted to adults, adult faces activated several brain regions significantly more than child faces. These brain regions comprised areas known to be implicated in face processing, and sexual processing, including occipital areas, the ventrolateral prefrontal cortex and, subcortically, the putamen and nucleus caudatus. The same regions were activated in paedophiles, but with a reversed preferential response pattern.

[Hebephilia as a sexual disorder]. / Hebephilie als sexuelle Störung.

BACKGROUND: The term "hebephilia" describes the sexual preference for the body scheme of pubescent minors (Tanner stages 2 and 3). For most clinicians the definition of hebephilia as a sexual disorder is not obvious. METHOD: In all assessed males included in the Prevention Project Dunkelfeld at the Institute for Sexual Medicine at the Charité between 2005 and 2011, who met the inclusion criteria and showed no evidence for exclusion criteria (n=222), the existence of a hebephilia was examined. RESULTS: Approximately two thirds of the present sample (n=153) showed responsiveness for the body scheme of pubescent minors. Of these, only 15% were exclusively attracted by the pubescent body scheme and 85% were cases of mixed types. Concerning the clinical aspects of the sexual preference disorder, about 95% reported child sexual abuse and/or having used child abusive images at least once in their lifetime. Additionally, hebephiles reported a higher level of clinical/psychological stress and more distinct personality characteristics in relation to a comparative sample. In terms of risk factors, hebephiles showed more offense-supportive attitudes compared to a male comparative sample. CONCLUSION: Hebephilia is a sexual disorder, but cannot be independently coded in the presently valid classification systems (DSM-IV-TR and ICD-10). Plans to separately include this in future in the DSM-5 represent an important step from a sexological point of view.

[Motility disorders of the esophagus]. / Motilitätsstörungen des Ösophagus.

Motility disorders of the esophagus comprise a heterogeneous spectrum of diseases. Primary malformations of the esophagus are now amenable to improved surgical and gastroenterological therapies; however, they often lead to persistent long-term esophageal dysmotility. Achalasia originates from impaired relaxation of the gastroesophageal sphincter apparatus. Systemic diseases may give rise to secondary disorders of esophageal motility. A number of visceral neuromuscular disorders show an esophageal manifestation but aganglionosis rarely extends into the esophagus. The growing group of myopathies includes metabolic and mitochondrial disorders with increasing levels of genetic characterization and incipient emergence of therapeutic strategies. Esophagitis with an infectious etiology causes severe dysmotility particularly in immunocompromised patients. Immunologically mediated inflammatory processes involving the esophagus are increasingly better understood. Finally, rare tumors and tumor-like lesions may impair esophageal motor function.

T-cell co-stimulatory molecules: novel targets for the treatment of allergic airway disease.

The first two articles in this series discussed the fundamental concept of T-cell co-stimulation as a key event in the induction of any immune response, in addition to reviewing the current data on the role of co-stimulatory molecules for the induction and progression of allergic airway diseases. Based on these considerations, this final edition will delineate and discuss novel strategies for the prevention and/or therapy of allergic diseases based upon the modulation of co-stimulation.

T-cell co-stimulatory molecules: their role in allergic immune reactions.

The development of allergic diseases, such as allergic asthma, depends upon the initiation and maintenance of T-helper cell type-2-skewed allergen-specific immune reactions. Although it is clear that susceptibility to this process is under genetic and environmental control, the fine-tuning and regulation of the type-2 T-helper cell immune response is not yet fully understood. In this second article in the present series, current understanding regarding the involvement of T-cells and antigen-presenting cells is summarised, with emphasis on the interaction between these two types of immune regulatory cells by means of co-stimulatory molecules.

Master switches of T-cell activation and differentiation.

T-cells play a central role in allergic airway diseases such as bronchial asthma. The imbalance between allergen-specific pro-inflammatory and pro-allergic T-cell responses on one hand and regulatory or suppressive T-cell responses on the other may best explain the development of unwanted immune responses against environmental allergens, which lead to immunoglobulin E production and airway inflammation. A key role in the fine tuning of any T-cell response is provided by the engagement of so-called co-stimulatory molecules that are required for the full activation of T-cells and the recognition of antigens via the antigen-specific T-cell receptor. Many of these co-stimulatory molecules have been identified only recently, leading to a fundamental change in the overall understanding of T-cell regulation. Due to their pivotal impact on T-cell differentiation and control, co-stimulatory molecules are promising targets for therapeutic intervention in T-cell-regulated or -mediated immune disorders, including allergic diseases and asthma. In the present article, an attempt is made to summarise the current knowledge on the basic concept of co-stimulation, the presently known co-stimulatory molecules and their various functions on T-cell activation or suppression. The mini-series will be completed by two more articles describing the recent experimental studies and preliminary clinical findings regarding the role of co-stimulatory molecules in allergic disorders and bronchial asthma, and a discussion regarding the feasibility of co-stimulatory molecules as potential targets for the treatment of allergic airway disease. Although it is too early for any clinical implication or utilisation at this moment, the authors are convinced that a better understanding of co-stimulation in the context of allergic asthma will finally provide novel and promising approaches for treatment and prevention.

Prevalence of erectile dysfunction among middle-aged men in a metropolitan area in Germany.

The comparison of results of previous studies on the prevalence of erectile dysfunction is hampered due to differences in study design and research instruments including definitions used. The aim of the study was to determine the prevalence of erectile dysfunction/erectile disorder (ED) using different definitions. An epidemiological cross-sectional study was conducted between May and November 2002 in Berlin, Germany. A total of 6000 men between 40 and 79 years of age were randomly selected by the Berlin Office of Vital Statistics and were sent a questionnaire by mail. The prevalence of ED was determined using five different methods. A total of 1915 questionnaires were eligible for analysis. The five different definitions yielded age-adjusted ED prevalence rates between 18 and 48%. Age was strongly correlated with all five definitions (P<0.001). These results indicate the need for standardized criteria when conducting future studies on ED and may aid in designing public health and clinical management strategies.

[Influence of neurological diseases on partnership and sexuality. Particularly in view of multiple sclerosis and Parkinson's disease]. / Der Einfluss neurologischer Erkrankungen auf Partnerschaft und Sexualität. Unter besonderer Berücksichtigung der Multiplen Sklerose und des Morbus Parkinson.

A great number of neurological diseases exert a direct impact on sexuality, due to lesions in the central and peripheral nervous system and due to different neurological symptoms and their treatment (for example medication). The psychosocial basic needs for acceptance, intimacy, and security, which can be best fulfilled by sexual communication, attain essential importance in the situation of disease-induced helplessness. This implies that not only the experience of sexual pleasure and the functioning of reproduction can be influenced, but the partnership, too. A holistic treatment approach always requires the consideration of partnership aspects.

[Biopsychosocial understanding of human sexuality. Prerequisite for diagnostics and treatment in sexual medicine]. / Biopsychosoziales Verständnis menschlicher Geschlechtlichkeit. Vorausetzung für sexualmedizinische Diagnostik und Therapie.

Sexual medicine is a subdiscipline of clinical medicine that deals with human sexuality and disorders. Sexuality eludes a unilateral definition. As a biologically, psychologically, and socially determined experience dimension of the human being, its individual form depends on biological factors and developments in the person's life. Moreover, sexuality exhibits different dimensions--lust, reproduction, and relationship--that are indeed closely interrelated. For this reason, directing therapy at only one of these dimensions is not adequate. All human beings are programmed toward fulfillment of elementary biopsychosocial needs such as acceptance, closeness, warmth, and security. If these basic needs are shortchanged in terms of fulfillment, all sorts of restrictions in the quality of life ensue, even to the point of resultant disorders of sexual function. Treatment then approaches the roots when it does not center on the sexual dysfunction but rather on the underlying frustrated relationship of the partners. Syndyastic sexual therapy is an important treatment method in sexual medicine.

[Sex therapy for male sexual dysfunction]. / Sexualtherapie bei sexuellen Funktionsstörungen des Mannes.

A high prevalence and incidence of sexual dysfunctions as well as the availability of orally effective medications cause a rising interest in professional help. In diagnosing and treating sexual disorders, a holistic, biopsychosocial understanding of sexuality and a thorough analysis of the specific needs of the couple are of the utmost importance. Furthermore, the typical physician-patient relationship has to be transformed into a physician-couple relationship wherever possible. Sex therapy, then, focuses on the universal psychosocial fundamental needs and their relevance for the complaints of the couple. In this way the main focus of attention is shifted from the sexual dysfunction to the communicative meaning of sexuality within the relationship and to the quality of the partnership as a whole. Thus the sexual problem is put into a new perspective and sexual functions are relieved from the pressure of performance anxiety. Simultaneously intimacy and mutual satisfaction are promoted. The possibility of obtaining an additional qualification in sexual medicine (since 1997 in postgraduate, curricular trainings) is offering new opportunities for urologists to integrate aspects of sexual medicine into their clinical practice and thus to propose a more extensive form of therapy to their patients. This paper reflects the process of this integration, illustrating it with respective case reports; it stresses the necessity of a holistic approach to the treatment of sexual dysfunctions, also in regard to the economic advantages of a biopsychosocially oriented sex therapy.

Coevolution of male and female reproductive traits in a simultaneously hermaphroditic land snail.

Inter- and intraspecific studies in gonochoristic animals reveal a covariation between sperm characteristics and the size of the female reproductive tract, indicating a rapid evolutionary divergence, which is consistent with the theory of post-copulatory sexual selection. Simultaneous hermaphrodites differ from species with separate sexes (gonochorists) in that they possess both functional male and female reproductive organs at the same time. We investigated whether in hermaphroditic animals intraspecific variation in reproductive traits results from divergent coevolution, by quantifying the variation in male and female traits among six natural populations of the snail Arianta arbustorum and examining the covariation in interacting traits. There was a significant among-population variation in spermatophore volume, number of sperm transferred and sperm length, as well as in volume of the sperm storage organ (spermatheca) and number of tubules, but not in spermatheca length. We found a positive association between sperm number transferred and spermatheca volume. This result suggests that the same post-copulatory mechanisms as in gonochorists drive the correlated evolution of reproductive characters in hermaphrodites.

Co-stimulatory molecules as potential targets for therapeutic intervention in allergic airway disease.

Airway inflammation is a characteristic feature of allergic asthma. Central to the initiation and progression of the inflammatory process are allergen-specific T lymphocytes that attract eosinophils, mast cells, and B cells to the airways by the secretion of specific cytokines. The direction of T cell responses is influenced by co-stimulatory signals that modulate the antigen-specific signal delivered by the T cell receptor. In addition to the prototypic co-stimulatory molecule, CD28, a number of newly identified co-stimulatory molecules and their ligands have now been characterized. Over the past 5 years, the role of these molecules in the pathophysiology of allergen-mediated sensitization and airway inflammation has been extensively studied in animal models of allergic asthma. The aim of this review is to provide a detailed overview on recent studies in mice and preliminary findings in man and to discuss the potential therapeutic and preventive treatment strategies offered by interactions with co-stimulatory molecules for patients with allergic airway diseases.

[Anaphylactoid reaction in occult systemic mastocytosis. A rare dermatologic emergency ]. / Anaphylaktoide Reaktionen bei okkulter systemischer Mastozytose Ein seltener dermatologischer Notfall.

With the occurrence of unclear consciousness conditions primarily internal or neurological causes are considered. Of a systemic mastocytosis one thinks only rarely, which can accompany without or with slight clinically visible skin changes. In the following we report on a patient who has repeated unclear shock conditions and required resuscitation several times without a recognizable cause, with whom a systemic mastocytosis could be proven. Clinically very discrete lesions of mastocytosis were recognizable from the skin. Only an increased tryptase level referred to being present an occult systemic mastocytosis. The diagnostics, potential triggers and therapy of this disease are to be discussed on the basis the available case.