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Objective: to assess the sexual function in men with idiopathic Parkinson's disease., Patients and Methods: a cross-sectional study was performed in 35 men, mean age 68 ± 9 years, with idiopathic Parkinson's disease followed in a single urological department. The 15 questions International Index of the Erectile Function was sent by postal mail., Results: the answer's rate was 42.9% (15 patients). The mean age of the responders was 68.7 ± 10.0 years. Mean duration of the disease was 10.4 ± 6.8 years. Sexual dysfunction was the second cause for consultation in urology. Despite a sustained sexual desire, patients had an altered sexual function with low erectile function, orgasmic function, intercourse satisfaction and total satisfaction scores. According to the Cappelleri's classification, the erectile dysfunction was severe in 54% of the cases and moderate in 26.6%. Age, institutionalization and overactive bladder symptoms were associated with erectile, orgasmic function and intercourse satisfaction alteration, sexual desire alteration, intercourse and global satisfaction alteration, respectively., Conclusion: men with idiopathic Parkinson's disease had a severe sexual dysfunction. The sexual desire was usually maintained but all the other domains were severely altered., (2010 Elsevier Masson SAS. All rights reserved.)

Introduction: Post radical prostatectomy potency rates, quantified on the basis of physician survey, have ranged up to 80%. Physician derived potency data, however, may not be representative of true post-prostatectomy potency rates or more importantly may not accurately portray patients' post-operative sexual satisfaction. We conducted a pilot study combining physician derived and patient derived subjective data with objective measures of erectile function., Materials and Methods: Eleven men, mean age of 59 years, who were treated with nerve sparing radical retropubic prostatectomy formed the study group. Initially, the patients responded to a physician directed telephone survey on sexual status. Potency was then objectively assessed utilizing Rigiscan testing on two consecutive evenings. Lastly, the patients completed a validated short questionnaire directed to obtain a patients' subjective perception of sexual function., Results: All the patients responded to the first part of the study by informing the physician that they were sexually active or potent after radical prostatectomy. Of these 11 patients, however, only 2 (18%) were mostly satisfied with their sex life according to the quality of life questionnaire. Rigiscan testing revealed that 8 of the 11 patients had nocturnal erections which were adequate for vaginal penetration. Of the 5 patients who stated that they were mostly dissatisfied with their sexual functioning, 3 had objective evidence of adequate erectile ability as documented by Rigiscan. Three of the four patients who were ambivalent with respect to their sexual function also demonstrated objective evidence of normal erectile activity., Conclusion: Although a patient may inform his care provider that he is sexually active or potent, he may not be satisfied with his present level of sexual functioning. In addition, we observed that some dissatisfied patients do have normal Rigiscan patterns indicating that a percentage of patients who are not happy with their level of sexual function after radical prostatectomy may have a psychogenic component to their problem.

This paper defines the main goals of the first consultation of an impotent patient, and describes the practical procedure. First of all, the first consultation must include a thorough history-taking which will make it possible in many cases to have a fairly objective idea of the degree of organic involvement. The most important questions are about the possible occurrence of regular rigid erections in situations that are neither coital nor sexual. Their occurrence rules out any organic involvement almost with certainty, and allows abstaining from additional examinations, or keeping them within minimum limits. Their absence is compatible with an organic involvement, but is not specific for this, and leads to further exploration. The first consultation is also the occasion of a first human contact, and its quality will often influence the prognosis. Besides being sufficient to cure some patients, this first contact is a major condition for the compliance with the therapeutic advice that will be given later on.

"Venous incompetence" is thought to be an organic cause of impotence. Its diagnosis is usually based upon Artificial Erection Test (AET); now, the reliability of this procedure is contested. We tested it in 9 controls, 13 psychogenic impotent patients and 65 impotent patients presenting "venous incompetence" according AET (maintenance flow rate needed for erection--MFR greater than 75 ml/min). Organicity of impotence was evaluated by Nocturnal Penile Tumescence monitoring and by the results of a sex-therapy. AET reproducibility was tested in 24 cases. The interest to perform an intracavernous injection of 80 mg papaverine before AET was tested in 18 impotent patients. Our results confirm that MFR is the most reliable criterion for interpreting AET. But 15% of the impotent patients with a MFR greater than 120 ml/min, 32% of those with a MFR greater than or equal to 80 ml/min and 66% of those with a MFR between 80 and 120 ml/min were in fact psychogenic patients. Moreover, we found "excessive" MFR in 3 of the 13 psychogenic patients and one of the normal controls (160 ml/min). In 50% of our patients, AET results were not reproducible. Injecting papaverine before AET significantly reduces MFR, but false positive results do still exist. Some recent physiopathologic data suggest that AET performed after papaverine injection might logically be disturbed by stress. These data should incite to be cautious when interpreting AET results, and results of "venous incompetence" surgery.