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Introduction There are numerous genital complaints in women cyclists, including pain, numbness, and edema of pelvic floor structures. Debate ensues about the best saddle design for protection of the pelvic floor. Aim To investigate the relationships between saddle design, seat pressures, and genital nerve function in female, competitive cyclists. Methods We previously compared genital sensation in healthy, premenopausal, competitive women bicyclists and runners. The 48 cyclists from our original study comprise the study group in this subanalysis. Main Outcome Measures Main outcome measures were: (i) genital vibratory thresholds (VTs) determined using the Medoc Vibratory Sensation Analyzer 3000 and (ii) saddle pressures as determined using a specially designed map sensor. Results More than half of the participants (54.8%) used traditional saddles, and the remainder (45.2%) rode with cut-out saddles. On bivariate analysis, use of traditional saddles was associated with lower mean perineal saddle pressures (MPSP) than riding on cut-out saddles. Peak perineal saddle pressures (PPSP) were also lower; however, the difference did not reach statistical significance. Saddle design did not affect mean or peak total saddle pressures (MTSP, PTSP). Saddle width was significantly associated with PPSP, MTSP, and PTSP but not with MPSP. Women riding cut-out saddles had, on average, a 4 and 11 kPa increase in MPSP and PPSP, respectively, compared with women using traditional saddles (P = 0.008 and P = 0.010), after adjustment for other variables. Use of wider saddles was associated with lower PPSP and MTSP after adjustment. Although an inverse correlation was seen between saddle pressures and VTs on bivariate analysis, these differences were not significant after adjusting for age. Conclusion Cut-out and narrower saddles negatively affect saddle pressures in female cyclists. Effects of saddle design on pudendal nerve sensory function were not apparent in this cross-sectional analysis. Longitudinal studies evaluating the long-term effects of saddle pressure on the integrity of the pudendal nerve, pelvic floor, and sexual function are warranted.

Introduction Clinical trials in male sexual dysfunction (MSD) are expanding. Consequently, there is a need for consensus standards in this area. Aim To develop an evidence-based, state-of-the-art consensus report on standards for clinical trials in MSD. Methods A literature review was performed examining clinical trials in erectile dysfunction (ED), premature ejaculation (PE), delayed/absent ejaculation, libido disorders/loss of desire, hypogonadism, and Peyronie's disease, focusing on publications published in the last 20 years. This manuscript represents the opinions of eight experts from seven countries developed in a consensus process. This document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. Main Outcome Measure Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Results According to experience and recent publications in dealing with clinical trials in sexual dysfunction, recommendations have been made for conducting trials in patients with ED, PE, delayed ejaculation, libido disorders, hypogonadism, and Peyronie's disease. Conclusions It is important that future clinical trials are conducted using standards upon which investigators can rely when reading manuscripts or conducting new trials in this field. Porst H, Vardi Y, Akkus E, Melman A, Park NC, Seftel AD, Teloken C, and Wyllie M. Standards for clinical trials in male sexual dysfunctions.

Introduction Blebbistatin (BLEB) is a small cell permeable molecule originally reported as a selective inhibitor of myosin II isoforms expressed by striated muscle and non-muscle cells (IC 50 = 0.5–5 µM) with poor inhibition of turkey gizzard smooth muscle (SM) myosin II (IC 50 ∼80 µM). However, recently it was found that BLEB can potently inhibit mammalian arterial SM (IC 50 ∼5 µM). Aim To investigate the effect of BLEB on corpus cavernosum SM (CCSM) tone and erectile function (EF). Methods CC tissue obtained from penile implant patients along with CC, aorta and bladder from adult male rats were used for BLEB organ bath studies. Intracavernosal BLEB was administered to rats and EF was assessed via intracavernous pressure (ICP). Main Outcome Measures Effects of BLEB on agonist-induced CCSM, aorta and bladder contraction in vitro and ICP in vivo. Results BLEB completely relaxed human CCSM pre-contracted with phenylephrine (PE) in a dose-dependent manner decreasing tension by 76.5% at 10 µM. BLEB pre-incubation attenuated PE-induced contraction of human CC by ∼85%. Human CC strips pre-contracted with endothelin-1 or KCl were almost completely relaxed by BLEB. Rat CCSM pre-contracted with PE showed BLEB relaxation comparable to human CCSM. BLEB inhibition was similar for rat aorta but slower for bladder. Both maximal ICP and ICP/mean arterial pressure were dose-dependently increased by BLEB intracavernous injections with full erection at 1 micromole. Conclusion Our novel data reveals that BLEB nearly completely relaxes rat and human CCSM pre-contracted with a variety of potent agonists and exhibits tissue selectivity. Coupled with our in vivo data in which nanomole doses of BLEB significantly increase ICP, our data substantiates an important role for the SM contractile apparatus in the molecular mechanism for EF and suggests the possibility of BLEB binding at myosin II as a therapeutic treatment for ED by targeting SM contractile pathways. Zhang X, Aydin M, Kuppam D, Melman A, and DiSanto ME. In vitro and in vivo relaxation of corpus cavernosum smooth muscle by the selective myosin II inhibitor, blebbistatin. J Sex Med 2009;6:2661–2671.

Introduction Stimulation of the cavernous nerve elicits increases in intracavernosal pressure (ICP) and visible penile erection (VPE) in rats. The observed penile erection can be characterized by the change in ICP and the ratio of ICP over blood pressure (BP; systemic blood pressure). Aim We evaluated correlations between ICP, BP, ICP/BP, and VPE, and the magnitude of the nerve stimulation required to elicit those responses in order to evaluate age-related changes in erectile function in a rodent model. Methods Nine young (3 months) and 10 old (18 months) rats were used. Under anesthesia cavernous nerve stimulation was performed at stimulation strengths ranging from 0.1 to 10 mA. Main Outcome Measures The ICP, BP, ICP/BP, and VPE responses to cavernous nerve stimulation were quantified and compared. Results Significant correlations were observed between ICP and ICP/BP in both young ( r 2 = 0.886) and old ( r 2 = 0.962) rats. If the ratio ICP/BP was taken as a metric of VPE and non-erection, then the threshold value for observing a VPE in the majority of animals was ≥0.5 in both young and old rats. However, higher current stimulation was required in the old than in the young animals to achieve erections. Moreover, both the maximal ICP and ICP/BP ratios achieved during erection were also lower in the old (85 ± 2 cmH 2 O and 0.6 ± 0.02, respectively) than young (106 ± 3 cmH 2 O and 0.75 ± 0.02, respectively) rats ( P Conclusion Old rats without obvious comorbidities were capable of penile erections, but those erections were accompanied by reduced ICP responses to cavernous nerve stimulation, implying apparently reduced penile rigidity. Taken together our current observations indicate that ICP, ICP/BP, and VPE provide useful metrics/indices of erectile capacity/function, and, moreover, that improved understanding of the inter-relationships among these parameters provides a frame work for further exploration of the mechanistic basis for age-related erectile dysfunction. Zhao W, Sato Y, Melman A, Andersson K-E, and Christ G. Metrics for evaluation of age-related changes in erectile capacity in a rodent model. J Sex Med 2009;6:1885–1892.

Bicycling is associated with neurological impairment and impotence in men. Similar deficits have not been confirmed in women.To evaluate the effects of bicycling on genital sensation and sexual function in women.Healthy, premenopausal, competitive women bicyclists and runners (controls) were compared.(1) Genital vibratory thresholds (VTs) were determined using the Medoc Vibratory Sensation Analyzer 3000. (2) Sexual function and sexually related distress were assessed by the Dennerstein Personal Experience Questionnaire (SPEQ) and the Female Sexual Distress Scale (FSDS).Forty-eight bicyclists and 22 controls were enrolled. The median age was 33 years. The bicyclists were older, had higher body mass indices (BMIs), were more diverse in their sexual orientation, and were more likely to have a current partner. Bicyclists rode an average of 28.3 +/- 19.7 miles/day (range 4-100), 3.8 +/- 1.5 days/week, for an average of 2.1 +/- 1.8 hours/ride. The mean number of years riding was 7.9 +/- 7.1 years (range 0.5-30). Controls ran an average of 4.65 +/- 2.1 miles/day (range 1.5-8) and 5.0 +/- 1.2 days/week. On bivariate analysis, bicyclists had significantly higher VTs than runners, indicating worse neurological function at all sites (P0.05). Multivariate analysis found significant correlations between higher VTs and bicycling at the left and right perineum, posterior vagina, left and right labia. Increasing VTs at the clitoris, anterior vagina, and urethra were associated with age. In bicyclists, there were no correlations between VTs and miles biked per week, duration of riding, or BMI. Composite SPEQ scores indicated normal sexual function in all sexually active subjects. Neither group suffered from sexually related distress.There is an association between bicycling and decreased genital sensation in competitive women bicyclists. Negative effects on sexual function and quality of life were not apparent in our young, healthy premenopausal cohort.