Gorm Wagner

The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.

OBJECTIVES To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. METHODS Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. RESULTS A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbachs alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. CONCLUSIONS The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.

Electrical activity of corpus cavernosum during flaccidity and erection of the human penis: a new diagnostic method?

We investigated 7 normal men and 1 diabetic patient with erectile dysfunction. Electromyography electrodes were placed in the corpus cavernosum of the penis and electrical activity was recorded during flaccidity. With sexual arousal the activity decreased and tumescence was initiated. During tumescence and full erection the electrical activity of the corpus cavernosum almost ceased but in the diabetic patient (neurogenic impotence) an increase was observed. This discoordination might be the cause of the erectile dysfunction. Recording the electrical activity of the corpus cavernosum in patients with suspected neurogenic erectile dysfunction could become clinically valuable, since this is the first test possible to study the function of the autonomic motor system that normally regulates penile function.

Insufficient penile erection due to abnormal drainage of cavernous bodies

Four men were referred for incomplete erection of the penis. All had abnormal venous outflow from the cavernous bodies: 1 iatrogenic fistula from the cavernous body to the glans, 1 congenital fistula from the cavernous body to the glans, 1 with several congenital large veins connecting the interior of the cavernous body to the outer veins, and 1 who suddenly lost the ability for erection was found to have a venous leak through scar tissue in the tunica albuginea. They were all operated on and the visible leaks closed. Three of them were functionally greatly improved.

Vasoactive intestinal polypeptide (vip) as a putative neurotransmitter in penile erection

The localization of vasoactive intestinal polypeptide (VIP) in the male genitourinary tract was investigated in the rabbit and man by means of radioimmunoassay and immunohistochemistry. In addition, the in vitro effect of VIP upon penile smooth muscle from man, the Vervet monkey, and the rabbit was investigated. Significant concentrations of VIP immunoreactivity were found in the human penis and all the organs of the rabbit genital tract apart from the testis. VIP immunoreactive nerve fibres were observed in the erectile tissue of the human and rabbit penis and in the other organs of the rabbit genital tract apart from the testis. Fibres were most abundant in association with blood vessels, in smooth muscle tissue, and subepithelially in glandular tissue. Strips of smooth muscle taken from the corpus cavernosum of Vervet monkey and man showed a dose-dependent relaxation in response to VIP at concentrations of 6 X 10(-8) mol X L-1 and 6 X 10(-7) mol X L-1. The data indicate that VIP may be an inhibitory neurotransmitter involved in the nervous control of penile erection.

Vasoactive intestinal polypeptide (VIP) provokes vaginal lubrication in normal women

The human vagina is known to be heavily innervated by vasoactive intestinal polypeptide (VIP) immunoreactive nerve fibres. In the present study we have examined the effect of VIP (900 pmol x kg-1 x h-1, IV during 30 min) on vaginal lubrication and blood flow in fourteen normal non-pregnant women. Vaginal blood flow was measured by the heat clearance technique and the vaginal lubrication quantified by the weight gain of preweighed filter papers placed on the surface of the vaginal wall for 30 min. Arterial blood pressure, pulse frequency and the concentration of VIP in peripheral blood were monitored. VIP (median concentrations of 200-300 pmol x l-1) induced a significant increase in vaginal blood flow accompanied by a 100% increase in vaginal lubrication (from 27 mg/cm2 to 53 mg/cm2). The VIP infusion lead to a significant increase in pulse frequency and a significant fall in diastolic arterial blood pressure. The findings suggest that VIP may participate in the control of the local physiological changes observed during sexual arousal: genital vasodilation and increase in vaginal lubrication.

Oxygen Tension of the Vaginal Surface during Sexual Stimulation in the Human

An oxygen electrode was maintained by suction on the vaginal wall in seven women. The basal value of pO2 was 9.3 mm Hg +/- 10.7 (mean +/- standard deviation) before clitoral self-stimulation was initiated. When stimulation took place the oxygen tension rose and peaked immediately after orgasm to 39.5 +/- 14.1 mm Hg. It then declined and fell to 20.1 +/- 13.8 mm Hg 10 minutes after the peak value. The changes correlate closely with changes in vaginal blood flow. The increased oxygen tension may be one of the factors that enhance of even initiate the motility of spermatozoa when deposited intravaginally.

Vasoactive intestinal polypeptide and the female genital tract: relationship to reproductive phase and delivery.

Recently, vasoactive intestinal polypeptide (VIP) has been localized in nerve fibers in the human female genital tract. In the present investigation, the effect and concentration of VIP was studied in uterine tissue from pregnant and nonpregnant women, and the plasma concentration of VIP was measured in relationship to diurnal rhythm, intake of food, menstrual cycle, pregnancy, labor, age, and sexual arousal. In vitro VIP inhibited the contractions of the nonpregnant but not of the pregnant uterus. The median concentration of VIP in myometrium from pregnant women (less than 0.1 pmole/gm) was significantly lower than that in myometrium from nonpregnant women (1.6 pmoles/gm). The venous plasma concentrations of VIP during labor (10.5 to 13.0 pmoles/L) were significantly higher than those during pregnancy (2.0 to 5.0 pmoles/L) and the menstrual cycle of VIP increased significantly during sexual arousal, from 4.0 to 8.5 pmoles/L. The median arterial and venous concentrations in the umbilical cord (12.5 and 14.5 pmoles/L, respectively) were significantly higher than the concentration in maternal peripheral venous blood (5.2 pmoles/L). The plasma concentrations of VIP were not related to intake of food, diurnal rhythm, menstrual cycle, or age. The conclusion is that the function of VIP may be related to pregnancy, delivery, and sexual stimulation.

Vaginal Physiology During Menstruation

We studied 18 young healthy women on the second, fourth, and 14th day of their menstrual cycle. Vaginal fluid was collected for measurement of oxygen and carbon dioxide tension (PO2 and PCO2) and specimens were collected for bacteriologic examination. The vaginal pH was measured at four different sites and the redox potential was measured in the top of the vagina. Staphylococcus aureus was found in three women. The PO2 ranged from 0 to 77 mm Hg on day 2; 0 to 76 mm Hg on day 4; and 0 to 53 mm Hg on day 14. The mean PCO2 (+/- SE) was 46 +/- 2 mm Hg on day 2; 62 +/- 4.5 mm Hg on day 4; and 50.6 +/- 8.5 mm Hg on day 14. The mean vaginal pH (+/- SE) was significantly higher on day 2 (6.6 +/- 0.3) compared with day 4 (5.3 +/- 0.3) and day 14 (4.2 +/- 0.2). The redox potential was significantly higher on day 14 compared with day 2 and day 4. No differences were found in values of women who took birth control pills and those of the women who did not.

Standardized Evaluation of Erectile Dysfunction in 95 Consecutive Patients

We investigated 95 patients referred for erectile dysfunction by penile blood pressure measurement, the intracavernous papaverine test and Doppler investigation of the penile arteries. Furthermore, penile cutaneous perception threshold, bulbocavernosus reflex latency and somatosensory cortical evoked potentials of the pudendal nerve were measured. In selected cases cavernosometry, cavernosography and corpus cavernosum electromyography were performed. Doppler investigation of the cavernous arteries after papaverine injection was more reliable than penile blood pressure measurement in the diagnosis of arteriogenic erectile dysfunction. Decreased sensibility of the penis may be the sole factor responsible for inability to sustain an erection. Erectile dysfunction may be provoked by impaired function of the pudendal nerve. Penile cutaneous perception threshold measurement and corpus cavernosum electromyography are mandatory in the evaluation of neurogenic etiology. Cavernosometry and cavernosography are reliable methods in the determination of abnormal drainage from the corpus cavernosum.

Tampon-induced changes in vaginal oxygen and carbon dioxide tensions

Vaginal oxygen and carbon dioxide tensions were measured continuously in a group of normal young women on the second day of menstruation during a 90-minute period. PO2 averaged 3 mm Hg (+/- 11 SD) and PCO2 averaged 64 mm Hg (+/- 13 SD). The value rose to that of atmospheric air when a tampon was inserted and gradually fell, giving a mean value of 112 mm Hg (+/- 18 SD) during the following 90 minutes; preinsertion values were reached in about 8 hours. Carbon dioxide rose rapidly to almost preinsertion values (mean value of 50 mm Hg +/- 12 SD) during the 90-minute period and remained steady at this level during extended periods. As in vitro studies have indicated an oxygen-dependent production of a toxin-like protein from Staphylococcus aureus, it is suggested that intravaginal tampons may be a risk factor in the development of toxic shock syndrome by supplying oxygen, thus changing the vaginal microenvironment from anaerobic to aerobic.