Cerebral activity zones on the background of neuromodulation of the intimate muscles and visual erotic stimulation in peroral and intracavernous induction of erection.
Schwarz, P.2, Kibets, Sergey*,3, Zhukov, O.1, Zubaraev, A.1, Krotenkova, M.2, Konovalov, R.2, 2 Federal Facility Research Institute of Neurology, Russian Academy of Medical Sciences, Moscow, Moscow Oblast, Russia3 Urology Department, 12th Medical Diagnostic Center, Russian Defence Ministry, Moscow, Moscow Oblast, Russia1 Russian State Medical University, Ultrasound Diagnosis Department, Moscow, Moscow Oblast, Russia
ABSTRACT- Objective: To determine the cerebral structures participating in the central regulation of the erectile function, and to evaluate the impact of certain vasoactive inducers of erection on these structures. Materials and methods: We examined a total of three patients (mean age 46 ± 10.5 years) with the generalized form of erectile dysfunction. In order to reveal any possible organic lesions and functional disorders in the cerebral structures responsible for realization of erection, the patients were subjected to functional magnetic resonance tomography (fMRT) of the brain using the tomograph Siemens Symphony Maestro class, with the magnetic field voltage of 1.5 teslas. The first stage of the studies included a series of tomograms taken in the patients at rest. The second stage was electrostimulation of the mm. ishiocavernosum, bulbocavernosum by modulated current using the Bio bravo device with an amplitude of 6 mA, frequency 30 Hz and pulse width 200 msec. The third stage was visual erotic photostimulation on the background of sildenafil citrate administered at a dose of 50 mg 1 hour before the study. The fourth stage consisted in the intracavernous test with prostaglandin E at a dose of 10 
g. Each stage of the study was accompanied by performing fMRT. Results: Carrying out the first session of fMRT revealed in one patient a 4-mm pathological focus in the brain trunk on the left, with no focal alterations in the cerebral tissue being detected in the rest of the patients. The second session of tomograms revealed excitation foci in the areas of the truncus cerebri, cerebellum, hypothalamus and temporal areas, being registered by the functional programme in stimulation of the intimate muscles participating in formation of the rigid erection phase. The third-session tomograms turned out to reveal excitation foci in the visual occipital, olfactory frontal and temporal areas, registered by the functional programme in erotic photostimulation by means of the patient-chosen picture. The stage-four tomograms revealed excitation foci most pronounced in the temporal regions responsible for inhibition of erection (in one patient), as well as in the hypothalamus, optic and olfactory cortex of the brain, registered by the functional programme after the intracavernous test. Discussion: Hence, we draw a conclusion that erectile dysfunction (ED) in one patient was probably caused by discoordination in the function of the cerebral zones responsible for erection activation and detumescence, in another one − an organic lesion to the cerebral trunk. The third patient showed a general decrease in the activity of the cerebral zones responsible for erection activation. Conclusions: With the insufficiently informative value of the standard procedure of examination of the patient with ED, the diagnostic algorithm should also include an additional method of neurovisualization, i.e. fMRT, making it possible to detect both organic and functional lesions to the cerebral areas responsible for realization of erection.
Key words: erection, visual erotic stimulation, induction of erection, vasoactive inducers of erection, neurovisualization