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Partial or complete impotence is common in uremia. It is not clear whether the impotence is organic or psychogenic in nature and whether uremia itself or the state of chronic illness is responsible for it. We examined these questions, by psychiatric interviews and nocturnal penile tumescence (NPT), in 50 normal subjects, 48 patients with chronic uremia, including 23 patients treated with maintenance dialysis, and 22 patients with chronic illness and normal renal function. About 40 to 50% of patients with uremia, but not those with chronic illness and normal renal function, complained of erectile dysfunction and reported a significant decrease in frequency of intercourse. There were no significant differences between patients with uremia prior to initiation of therapy and those treated with maintenance hemodialysis. NPT declines after 40 years of age. In all age groups, NPT was significantly (P less than 0.01) lower in uremics than in normals or those with chronic illness. There was no correlation between erectile complaints, frequency of intercourse or NPT, and the presence or absence of depression. The frequency of intercourse correlated significantly (r = 0.68, P less than 0.01) with NPT in patients with uremia. Data indicate that 50% of male patients with uremia have partial or complete impotence, which is most probably organic in nature and is related to uremia or its metabolic or hormonal consequences rather than to the state of chronic illness.

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The relationship between abnormalities in nocturnal penile tumescence (NPT) and autonomic function, measured by the Valsalva maneuver, was evaluated in 25 uremic patients and 22 normal subjects. NPT in uremic patients (45 ± 6.8 min/night) was lower (p < 0.01) than in normals (85 ± 10.4 min/night). Valsalva ratio in uremics (1.58 ± 0.07) was also lower (p < 0.01) than in normal subjects (2.05 ± 0.11). NPT and Valsalva ratio were significantly correlated in uremic patients (r = 0.62, p < 0.01). The 12 uremic patients with abnormal Valsalva maneuver had NPT of 22 ± 5.2 min/night, a value lower (p < 0.01) than that (67 ± 8.7 min/night) observed in the 13 uremic patients with normal Valsalva maneuver. There was also a significant correlation (r = 0.56, p < 0.05) between the Valsalva ratio and the frequency of intercourse per month in the uremic patients, who had steady and active sexual partners. The data suggest that a dysfunction of the autonomic nervous system may be an important factor in the genesis of erectile abnormalities in patients with uremia.

SUMMARY To determine whether basal blood pressure or pressor responses to stress are related to sympathetic nerve tone or to psychological factors in hypertensives, 15 hypertensives and 13 normotensives were studied by means of a self-administered questionnaire, Isometric handgrip exercise (IHE), and the mental stress of serial subtraction. Plasma norepinephrine (NE), epinephrine (E), blood pressure (BP) and heart rate (HR) were measured before and at the end of IHE and mental stress. A greater number of hypertensives had suppressed anger (p < 0.01) and scored higher on anxiety trait (p < 0.01) and depression (p < 0.

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