Sexual Problems for Men with Neuropathy

This is another topic which has been covered before on the blog but recently a 50 year old man from Arkansas mailed and said that despite having both neuropathy and HIV for some years, his doctor had told him that his erectile disfunction was a result of his age and a lifetime of smoking, nothing more. This may perhaps be the case but some doctors need to realise that ED can definitely be a result of neuropathic complaints and not dismiss someone's concerns with a cliche. Losing their potency is a really big deal for many men and having a genuine medical reason for it can perversely, ease the blow. This article is from medicalxpress.com (see link below) and shows the link between ED and neuropathy revealed by the results of Spanish research in this area.

Erectile dysfunction study shows high prevalence of peripheral neuropathy
November 15, 2011

Spanish researchers have uncovered clear links between erectile dysfunction (ED) and peripheral neuropathy, according to a paper in the December issue of the urology journal BJUI.

"Up to now the impact of damaged nerves in the peripheral nervous system on ED has been underestimated" says lead author Dr Consuelo Valles-Antuña, from the Department of Neurophysiology at the Hospital Universitario Central de Asturias in Oviedo.

"However our study of 90 patients shows that men with more severe symptoms of peripheral neuropathy, which can be caused by disease, trauma or illness, had greater self-reported ED and required more aggressive treatment.

"Our findings underline the importance of clinicians carrying out neurophysiological tests on patients with ED, particularly in the pelvic area."

The research team, which included experts on both neurophysiology and urology, studied 90 consecutive patients with sexual problems recruited from the hospital's Department of Andrology.

ED was diagnosed using the five-item version of the International Index of Erectile Dysfunction (IIEF-5) and the occurrence of peripheral neuropathy was predicted using the Neuropathy Symptom Score.

A range of neurophysiology tests were carried out to assess the presence of large and small fibre peripheral neuropathy.

The researchers found that:

•The average age of the men in the study was 54 years of age. Ten per cent were under 40 and only two per cent were over 70.
•No significant correlation between IIEF-5 scores and increasing age was found. In fact, younger patients had lower (worse) IIEF-5 scores, which could be due to higher expectations or a higher number of organic risk factors.
•Just under a third of the patients (30 per cent) had cardiovascular disease, 16 per cent had neurogenic risk factors (relating to the nerves or nervous system) 16 per cent had diabetes and 11 per cent had no risk factors. Just over seven per cent had been diagnosed with mental health issues.
•Patients with more severe symptoms of peripheral neuropathy showed lower (worse) IIEF-5 scores and required more aggressive therapies.
•Neurophysiological exploration confirmed that just under 69 per cent of patients had neurological pathology. Of these, 61 per cent had some type of peripheral neuropathy and eight per cent had myelopathy - problems with their spinal chord.
•Just under 38 per cent of the patients had polyneuropathy, which occurs when a number of the peripheral nerves throughout the body malfunction simultaneously. Of these nine per cent had small fibre neuropathy, damage to the small unmyelinated peripheral nerve fibres, and just over 14 per cent had pudendal neuropathy, affecting the somatic nerve in the pelvic region.
•The findings of the sympathetic skin response tests underlined the importance of checking nerve problems in the pelvic area, as response alterations were much more common in the penis than hand or foot.
•No association between neurophysiological diagnosis and IIEF-5 scores was detected, but a statistical association was found between neuropathy and the Neuropathy Symptom Scores.
."To our knowledge, this is the first study to assess the whole peripheral nerve fibre spectrum in a non-selected group of patients with erectile dysfunction" says Dr Valles-Antuña.

http://medicalxpress.com/news/2011-11-erectile-dysfunction-high-prevalence-peripheral.html

MORE LEFT HANDED MEN ARE BORN DURING THE WINTER

Men born in November, December or January are more likely of being left-handed than during the rest of the year. While the genetic bases of handedness are still under debate, scientists at the Faculty of Psychology, University of Vienna, obtained indirect evidence of a hormonal mechanism promoting left-handedness among men.

Psychologist Ulrich Tran and his colleagues published their findings in the scientific journal Cortex.

Various manual tasks in everyday life require the use of the right hand or are optimized for right-handers. Around 90 percent of the general population is right-handed, only about 10 percent is left-handed. The study of Ulrich Tran, Stefan Stieger, and Martin Voracek comprised two large and independent samples of nearly 13,000 adults from Austria and Germany. As in modern genetic studies, where a discovery-and-replication-sample design is standard, the use of two samples allowed testing the replicability and robustness of findings within one-and-the-same study.

Overall, 7.5 percent of women and 8.8 percent of men were left-handed. "We were surprised to see that this imbalance was caused by more left-handed men being born specifically during November, December, and January. On a monthly average, 8.2 percent of left-handed men were born during the period February to October. During November to January, this number rose to 10.5 percent," according to Ulrich Tran, lead author of the study.

A hormonal cause during embryonic development

"Presumably, the relative darkness during the period November to January is not directly connected to this birth seasonality of handedness. We assume that the relative brightness during the period May to July, half a year before, is its distal cause," explains Ulrich Tran. A theory, brought forth in the 1980s by US neurologists Norman Geschwind and Albert Galaburda, posits that testosterone delays the maturation of the left brain hemisphere during embryonic development. The left brain hemisphere is dominant among right-handers, the right brain hemisphere is dominant among left-handers. Intrauterine testosterone levels are higher in the male fetus, because of its own testosterone secretion, than in the female fetus. However, the testosterone level of the mother and external factors may also affect intrauterine testosterone levels. Specifically, more daylight may increase testosterone levels, making a seasonality effect plausible.

Previous studies on the subject provided mixed and inconsistent evidence. There was no clear indication which season has an effect, and whether seasonality affects men, women or both sexes equally. According to the current findings, there is a small, but robust and replicable, effect of birth seasonality on handedness, affecting only men. These results are consistent with a hormonal basis of handedness, corroborating thus an old and controversial theory. However, the exact way of causation needs to be investigated in future studies.

MEN WHO EXERCISE LESS MORE LIKELY TO WAKE UP TO URINATE

Men who are physically active are at lower risk of nocturia (waking up at night to urinate), according to a study led by a Loyola University Chicago Stritch School of Medicine researcher

The study by Kate Wolin, ScD, and colleagues is published online ahead of print in Medicine & Science in Sports & Exercise, the official journal of the American College of Sports Medicine.

Nocturia is the most common and bothersome lower urinary tract symptom in men. It can be due to an enlarged prostate known as benign prostatic hyperplasia (BPH) -- as the prostate enlarges, it can squeeze down on the urethra. Other causes include overproduction of urine, low bladder capacity and sleep disturbances. Nocturia increases with age, and is estimated to occur in more than 50 percent of men 45 and older.

Wolin and colleagues analyzed data from a large, ongoing clinical trial called the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). Men ages 55 to 74 were eligible for the trial. The study included questions on BPH-related outcomes, including enlarged prostate, elevated PSA levels and nocturia. PLCO also asked men about physical activity and other lifestyle factors.

Wolin's analysis included 28,404 men in the PLCO trial who had BPH outcomes before enrolling in the study (prevalent group) and 4,710 men who had newly developed BPH (incident group).

Among men in the incident group, those who were physically active one or more hours per week were 13 percent less likely to report nocturia and 34 percent less likely to report severe nocturia then men who reported no physical activity. (Nocturia was defined as waking two or more times during the night to urinate; severe nocturia was defined as waking three or more times to urinate.)

"Combined with other management strategies, physical activity may provide a strategy for the management of BPH-related outcomes, particularly nocturia," Wolin and colleagues wrote.

There are several possible mechanisms by which physical activity can protect against nocturia, including reducing body size, improving sleep, decreasing sympathetic nervous system activity and lowering levels of systemic inflammation.

Future studies should explore physical activity as a potential symptom-management strategy, "with particular attention to the dose of physical activity necessary and the mechanisms that might underlie the association," Wolin and colleagues wrote.

Do Women Deal With Pain Better Than Men

Today's fascinating article comes from health.com (see link below) and discusses the reasons why women react to to pain differently to men. Women have long claimed that they can suffer pain with more fortitude than men but are there reasons for that and is it true? It's a useful discussion, especially when applied to how the sexes cope with neuropathic pain. If women truly feel pain more intensely, yet deal with it better, are there any lessons to be learned? Is there something in the female physiology that facilitates this?

How Women's Pain Differs from Men's

Women feel pain more intensely—and in higher numbers—than men, but it's not exactly clear why

Women have been saying for years that if men were responsible for giving birth, the human race would have died out long ago because guys couldn't take the pain.

It's a clever dig—because, well, it's impossible to prove. But in fact, lab experiments suggest that women are more—not less—sensitive to pain than men.

"Contrary to popular opinion, it is very clear that women have a lower pain threshold and tolerance than men," says Roger Fillingim, PhD, a pain expert and professor of community dentistry and behavioral science at the University of Florida, in Gainesville. When study volunteers are exposed to an increasingly painful stimulus (such as a heat source) in experiments, Fillingim says, "women say 'stop' sooner."

This may explain in part why chronic pain conditions such as arthritis and migraine are more common among women, in some cases dramatically so. Fibromyalgia—a chronic condition marked by widespread pain, as well as fatigue and other symptoms—affects seven times as many women as men, for instance.

Exactly why women feel pain more intensely—and in higher numbers—than men remains a mystery. It's not simply that women aren't as "tough." Pain is a complex phenomenon, and how a person responds to it involves physical, psychological, and even cultural factors.

"Women experience more pain then men," Fillingim says. "We know a lot of different whys, but we don't have a single answer."

Questions remain, but the female body and mind do appear to process pain differently than a man's. And these differences can affect every aspect of pain, from the physical sensation itself to how women cope with chronic pain and what treatments are likely to be most effective for them.

Different bodies, different pain
Sex hormones may be responsible for much of the difference in how women and men experience pain, experts say.

Estrogen levels, which fluctuate according to the menstrual cycle and also dwindle as a woman enters menopause, have been linked to changes in how a woman feels pain, says Jennifer F. Kelly, PhD, a clinical psychologist at the Atlanta Center for Behavioral Medicine.

The relationship appears to be complicated, however. Some studies have shown that women are more sensitive to pain when their estrogen levels are low (during menstruation, for instance), while others have shown the exact opposite. It's still unclear whether estrogen makes pain better or worse, Fillingim says.

Psychological factors also likely play a role in gender-based pain differences. More so than men, who are apt to focus on the immediate physical sensation of pain, women tend to think about the consequences pain will have on their lives, Kelly says.

"If a man hits his hand, his hand hurts," Kelly says. "But if a woman hits her hand, she focuses on the emotional aspects...and how it is going to impact day-to-day functions. Women tend to experience more pain as a result, possibly because the emotions associated with pain are usually negative."

While this may sound like a cliche straight out of Men Are from Mars, Women Are from Venus, it's backed up by studies that have used brain scans to identify the regions of the brain that respond to pain. When women and men receive the same pain stimulus, women show more activity in the emotional centers of their brains, while in men the cognitive and analytical areas of the brain tend `to light up.

Other health conditions—most notably depression—may magnify the emotional response to pain. Women are more likely to be diagnosed with depression, which is a risk factor for chronic pain conditions, says Kelly, who gave a presentation on gender and pain at a recent meeting of the American Psychological Association in San Diego.

How women cope
Strategies for coping with chronic pain also differ between the sexes. These differences are potentially important, since how a person copes with pain can actually influence how much pain they feel.

For instance, women are more likely than men to turn to friends, family, and other sources of social support to talk through how their pain is affecting them, Fillingim says. That's generally a good thing, but some studies suggest that women are also more likely to exaggerate their chronic pain and the negative consequences it has on their lives.

This excessively pessimistic or melodramatic thinking—"catastrophizing," some pain experts call it—can backfire and make pain worse. It tends to elicit hostility from spouses, family, and friends (rather than support), and it's linked to higher levels of pain and depression.

The roles that women play in their families—as well as in society more broadly—can also shape how they cope with chronic pain, says Carmen R. Green, MD, a professor of anesthesiology and ob-gyn at the University of Michigan, in Ann Arbor. In some cases, expectations for women's behavior and their responsibilities can actually lead them to downplay their pain and try to fight through it—the opposite of catastrophizing. "Women will always take care of their kids, so it appears that they are functioning better because they have no choice," Dr. Green says.

In some ways, women cope with pain more constructively than men do, Dr. Green says. "Women enter the health care arena sooner than men, which may be a positive coping step, and they tend to have a more varied and larger social networks," she says. The latter means they may have more shoulders to lean on when their pain is acting up.

Finding the right pain treatmentDespite the many differences in pain between genders, treatments aren't always tailored to women and men. And women in particular are at risk for having their pain poorly assessed and undertreated, Kelly says. (It probably doesn't help that the majority of pain physicians are men.)Pain medications often have disparate effects—and side effects—in women and men, according to Kelly. "Physicians working with females have to be aware that women have more side effects from medications, and have to work with them differently and find something that can be a benefit with the least amount of side effects across the board," she says.

Doctors prescribe pain medicine based on how the drugs are metabolized by a 150-pound man, Dr. Green adds. "We have to do more clinical trials on women to see if age—and whether they are pre, peri-, or post-menopausal—affects how they respond to medications to treat their pain," she says.

In many cases, non-medical treatments such as cognitive behavior therapy may be especially beneficial for women, Kelly says. This brief, focused therapy addresses coping skills and seeks to change the thought patterns associated with pain (such as catastrophizing) and the impact they have on a person's quality of life.

"We need to teach women to be good advocates for themselves about their pain and how it impacts their life, so that they can see their doctor and say 'This is where it hurts', 'This is what makes it feel better,' 'This is what I can do' and 'This is what I can't do," Kelly says.

http://www.health.com/health/condition-article/0,,20424823_3,00.html