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Introduction The recent availability of noninvasive pharmacological remedies for male sexual function triggered an exponential increase in the number of men requesting help in the sexuality area. Aim The Italian Society of Andrology explored requests for help, not included in formerly established clinical categories of sexual medicine. Methods A central board of 67 andrologists identified new areas of requests for help, instrumental for a web-based questionnaire, forwarded to 912 members of the Italian Society of Andrology. Results were submitted to an independent consensus development panel. Main Outcome Measures A questionnaire response rate of 30.8% was considered acceptable according to standard response rates of medical specialist samples. Results The Central Board interaction identified two new domains of requests for help: sexual distress and unconventional requests for pro-erectile medications. Web-based questionnaire results suggested that such domains account for 29% and 9% respectively of all requests for help already presented by male patients at sexual medicine clinics. The Independent Consensus Development Panel issued a final consensus document; herewith, the statement defining male sexual distress: A non-transitory condition and/or feeling of inadequacy such as to impair “sexual health” (WHO working definition). Inadequacy can originate both from physiological modifications of male sexual functions, and from diseases, dysfunctions, dysfunctional symptoms and dysmorphisms, both of andrological and non-andrological origin, which do not relate to “erectile dysfunction” (NIH Consensus Development Panel definition), but that might also induce erectile dysfunction. Sexual Distress can lead to a request for help which needs to be acknowledged . Conclusion The Italian Society of Andrology identified two new areas of requests for help concerning male sexual issues: sexual distress and unconventional requests for pro-erectile medications. These domains, which do not represent new diseases, nonetheless induce the sufferers to seek help and, accordingly, need to be acknowledged. Pescatori ES, Giammusso B, Piubello G, Gentile V, and Pirozzi Farina F. Journey into the realm of requests for help presented to sexual medicine specialists: Introducing male sexual distress.

Objective To evaluate spermatogenesis in patients with isolated GH deficiency and multiple pituitary hormone deficiencies. Design Treatment of isolated GH-deficient patients with recombinant human GH (weekly dose of 0.7 IU/kg) for 5.3 ± 0.4 (mean ± SD) years and cotreatment of multiple pituitary deficient patients with GH at the same dosage for 8.0 ± 0.4 years and hCG (2,000 IU, three times per week) and hMG (500 IU, two times per week) for 13.7 ± 1.1 months. Setting Endocrine Pediatric Unit. Patients Eight patients affected by isolated GH deficiency and seven by multiple pituitary hormone deficiencies. Main Outcome Measures Serum LH, FSH, and T, testicular volume, semen volume, density, count, and motility. Results Patients with isolated GH deficiency completed their pubertal development in 19.0 ± 3.5 months and patients with multiple pituitary hormone deficiencies in 13.7 ± 1.1 months. At the end of puberty, the two groups of patients had similar testicular volume, penis size, sperm concentration, motility, and morphology, although T levels and seminal volume were lower in isolated GH-deficient patients than in multiple pituitary deficient patients. Conclusions The two groups of patients, treated specifically for their identified hormonal deficiencies, in the end had similar satisfactory reproductive results.

Ten asthmatic patients receiving long term treatment with high dose of inhaled beclomethasone dipropionate (BDP) (750 to 2,250 micrograms/die, average 1,400 +/- 474 micrograms) underwent evaluation of hypothalamic-pituitary-adrenal (HPA) axis under basal conditions (serum cortisol and ACTH levels at 8.00 AM and 8.00 PM, 24-hours free urinary cortisol) and by means of pharmacological tests (short tetracosactide and Corticotrophin Releasing Factor Tests). Basal ACTH serum levels at 8.00 PM were lower than the normal values in all patients: three patients had reduced 24-hr free urinary cortisol and six subjects showed lower cortisol serum levels at 8.00 PM. A normal response to the short tetracosactide test was observed in all patients, whilst Corticotrophin Releasing Factor (CRF) induced an increase in ACTH and cortisol levels (expressed as delta AUC) that was significantly lower in the BPD treated patients compared with a control group of five healthy subjects (p0.05). Thus BPD, in high doses, may cause a partial inhibition of HPA axis. Our results show that determination of basal ACTH level and CRF test are more sensitive than serum cortisol levels and short tetracosactide test to evaluate a suppression of HPA axis in patients receiving long term inhaled high doses of BDP.

There has been increasing interest in recent years in patients complaining of erectile dysfunction. This has prompted research and the development of diagnostic procedures aimed at allowing increasingly rapid characterization of the type of impotence involved (psychogenic or organic) and thus the most effective treatment. In this preliminary study, we present our study methodology in patients with erectile dysfunction, emphasising in particular the diagnostic procedures best suited to revealing the presence of an organic cause in the pathogenesis of impotence.