functioning measured by the IIEF prior to commencing bicalutamide treatment.• Then, about five weeks later, patients were asked to prospectively provide information regarding their current sexual functioning while undergoing bicalutamide treatment. RESULTS• Overall IIEF scores as well as the Erectile Function, Orgasmic Function, Sexual Desire, and Overall Satisfaction subscales showed group, treatment, and group by treatment effects.• The Intercourse Satisfaction subscale showed group and group by treatment effects.• On most subscales, homosexual men showed lower functioning than heterosexual men, primarily in response to treatment with bicalutamide. CONCLUSIONS• Treatment with an anti-androgen in a clinical population of men undergoing therapy for prostate cancer affected homosexual men more than heterosexual men, although not all heterosexual men were un affected.• These results are discussed in the context of dual sexual natures, a concept recently developed in the sexual literature.• Furthermore, these findings reiterate the importance of incorporating such variables as sexual orientation into studies investigating medical treatments on sexual response. What's known on the subject? and What does the study add? A recent published paper regarding sexual and cognitive duality presents that androgens act synergic with female sexual pheromones while estrogens would act synergic with male sexual pheromones in normal potent men.The same authors found in this study that bicalutamide disfavours sexual function predominantly in homosexual rather than heterosexual men suffering with prostate cancer. The results of this study are interpreted alone in this article, the similarities and differences with results corresponding to younger and normal potent men following to be discussed recently in a review regarding psychosexual dualism.

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Normal sexual arousal and response suppose an integrated process involving both physiological and psychological processes. However, the current understanding of sexual arousal does not provide a coherent model that accounts for the integration of multiple physiological systems that subsequently generate a coordinated sexual response at both the spinal peripheral and cerebral central levels. Herein we suggest a model that involves both sympathetic and parasympathetic activation during sexual arousal via the two classes of gonadal hormones, androgens and oestrogens. We discuss the manner in which gonadal hormones may activate such a system, transforming pre-pubertal (non-erotic) genital stimulation to post-pubertal erogenization of stimulation and subsequent sexual arousal. Finally, we indicate that the different balance of androgens and oestrogens in men and women may generate asymmetric effects on each of the components of the autonomic nervous system, thereby explaining some of the differences in patterns of sexual arousal and the responses cycle across the sexes.

Human sexual response is a complex function involving many cerebral, spinal and peripheral aspects; the last are relatively known and benefit from good pharmacological control, as in the case of erectile dysfunction. Spinal cord sexual reflexes also have a good theoretical and experimental description. There is minimal understanding of the cerebral sexual processes (libido, sexual arousal, orgasm). The initial perspective was that the cerebral areas implied in sexuality exert descending stimulatory and inhibitory influences on spinal cord sexual centres/reflexes. This was a wrong supposition, which inhibited progress in this subject, with a considerable impact on a subject’s individual and social life. A new approach to sexual function arises from the idea that simple neurological structures can support only simple functions, while a more complex function requires correspondingly complex anatomical structures. For this reason the spinal cord would not be able to realise the integration of multiple (spinal and psychosensorial) stimuli into a unique and coherent ejaculation response. Consequently, all mechanisms implied in human sexuality would be cerebral processes, ejaculation reflexes ascending in evolution to the cerebral level. This new evolutionary concept was developed after 2001 in five distinct articles on the cerebral duality of sexual arousal, sexual hormones, ejaculation and serotonergic receptors. During this period other published results suggested a possible cerebral duality for sexual pheromones and libido in humans. All these dual physiological aspects are integrated in this review into one neurophysiological model, thus trying to further develop the new concepts of sexual function and perhaps relational behaviour. In conclusion, ejaculation is a dual cerebral process with arousal sensation (hormonally modulated) and libido perception (pheromonally modulated) as the afferent part. Two neurophysiological axes could exist in both men and women. In this assumption the mechanisms for libido and sexual arousal are not the only ones invoked, their correlations and implications are also suggested, perhaps critical aspects for further developments in the field.

Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice.

What’s known on the subject? and What does the study add? Classically, sensation is the first stage in the functioning of the senses while perception would correspond to interpretation of sensations. This paper explains and argues that sensation and perception are actually two distinct and parallel internal mental stimuli, which are competitive with the two distinct and parallel internal erogenous stimuli: libido and sexual arousal. Both mental and sexual functions use the same somatic peripheral afferents and also perhaps a common autonomic hypothalomic processor. The dual theory of sexuality is a work in progress that tries to put together all the significant physiological aspects described on this subject, the most recent published article discussing about the hormonal and pheromonal neuromodulation of somatic peripheral afferents. But sexuality and cognition shares common somatic peripheral afferents, so that a good understanding of sexual mechanisms supposes also a good knowledge of the essential psychological mechanisms/neuromodulators. Current psychological approaches could be limited to two general tendencies. Some authors consider that cerebral neuronal connexions generate a unitary network substrate that – increasing in its complexity – becomes compatible with our complex mental function. Others suggest that such a complex cerebral function correspond actually to a system based on subsystems, represented by distinct neuronal units (not necessarily complexes) that interact each other. Starting from basic somatic/sexual neurophysiological elements and general accepted psychological aspects, the discussion gave sense to the last point of view, namely that genesis of a new function is the result of cooperation between distinct structural and functional units. Contrary to the classical concepts, this paper sows the fact that mental perception corresponds actually (in term of touch/tangibility) to the internal representation of an external object while sensations realize an internal representation of the external characteristics of environmental object. As a conclusion, sexuality and cognition are two distinct autonomic/dual functions, interrelated at both cerebral and peripheral level. Peripheral interference implies intervention of some specific (mental and sexual) neuromodulators, making external information act as internal mental or internal sexual stimuli. Central cerebral interferences are also clinically and pharmacologically documented, specific neuromodulators being taken into account. Supplementary studies would be necessary to complete psychosexual dualism, presenting the association between image and perception for the genesis of visual perception or between image and sensation for the genesis of visual sensations, complex (mental or sexual) stimuli that suppose a synergic action between distinct neuromodulators. This central synergism supposes a peripheral synergism between left visual field and right nostril, aspects that will be discussed largely in a future article.

Recent attempts to find effective pharmacological treatments for premature ejaculation (PE) have spurred significant interest in the causes of, consequences of, and existing therapies for this common male sexual dysfunction. The recurring tendency in science and medicine, however, to dichotomise causes of such problems into either biological or psychological is not only counterproductive, it is misguided. Ejaculatory response should be viewed as a system of integrated and inseparable hardwired and softwired central and peripheral responses, some being readily modifiable, others not. Such a view argues that treatment of PE aimed at multiple levels of functioning will be self-enhancing and ultimately more effective in producing positive therapeutic outcomes than strategies relying solely on either psychological or biological approaches.

Androgenetic alopecia (AGA) is a benign condition with variable psychosocial impact, with some individuals adapting well while others needing therapeutic support. Although 5α-reductase inhibitors like finasteride and dutasteride have proven effective in ameliorating AGA, their use/selection is currently a subject of debate. Areas covered: Treatment of AGA with 5α-reductase inhibitors lead to variable adverse effects and relatively unstable results (therapeutic efficacy ending with treatment cessation), so the choice of optimal therapy is not straightforward. This paper presents a general perspective regarding AGA based on studies listed in PubMed, to better understand/appreciate the opportunity for long term use of medication for a biological condition having non-life threatening implications. Studies focussed on adverse effects suggest that finasteride should be used with caution in AGA, due to considerable and persistent side effects induced in some men. In contrast, efficacy data indicate that dutasteride (a stronger inhibitor) presents superior therapeutic results compared to finasteride. Expert opinion: This paper argues that finasteride should be preferred to dutasteride in the treatment of AGA. Thus, finasteride preserves important physiological roles of dihydrotestosterone (unrelated to AGA) and, in addition, its adverse effects seem to be (at least in part) predictable.