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Epidemiology of erectile dysfunction
Abstract
This review of the current epidemiological literature on erectile dysfunction (ED) suggests that approximately 5-20% of men have moderate-to-severe ED. Different definitions of ED, age distributions and concomitant medical conditions, as well as methodological differences, may explain much of the variance in reported prevalence rates. Various chronic disorders are associated with elevated rates of ED including depression, diabetes, and cardiovascular and neurological diseases. Such disorders are more common in the elderly, which may partially explain the elevated prevalence of ED in men over 60 y of age. Currently, up to 70% of men with ED are not treated. However, so many men experience considerable distress from their condition, that the increasing awareness of ED as well as the availability of noninvasive treatments may result in a greater proportion of patients seeking treatment, and eventually regaining satisfaction with their sex life.
... Erectile dysfunction (ED) is a common [1-7], consequential [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], and clinically neglected [4,5,[27][28][29][30][31][32][33][34][35][36][37][38] sexual problem that is experienced by millions of men and their partners worldwide. The current research, which is part of the Strike Up A Conversation (S.U.A.C.) research program, examines the experience of communication about ED among men with ED, partners of men with ED, and physicians who treat ED. ...
... Urologists and general practitioners also, like the patients and their partners, relatively infrequently cited long duration of action (''lasts 24 hours'') as a critical characteristic of ED treatment. We note that from a sexological perspective [2][3][4], the attributes of therapy of ED nominated as most important by men with ED, partners of men with ED, and physicians make a great deal of sense. Research shows that for men with ED, intercourse generally occurs with very little advance notice [2][3][4], and in the context of unpredictable intercourse opportunities a therapy with an extended duration of action, during which intercourse may or may not occur, may appear less rational than one that simply lasts long enough for successful initiation and completion of intercourse and reliably improves erection quality. ...
... We note that from a sexological perspective [2][3][4], the attributes of therapy of ED nominated as most important by men with ED, partners of men with ED, and physicians make a great deal of sense. Research shows that for men with ED, intercourse generally occurs with very little advance notice [2][3][4], and in the context of unpredictable intercourse opportunities a therapy with an extended duration of action, during which intercourse may or may not occur, may appear less rational than one that simply lasts long enough for successful initiation and completion of intercourse and reliably improves erection quality. ...
Background: Erectile dysfunction (ED) is a common, consequential, and clinically neglected sexual problem. The current research is designed to study the experience of communication about ED among men with ED, partners of men with ED, and physicians who treat ED. Methods: Qualitative research with 10 men with ED, 10 female partners of men with ED, and 15 physicians who treat men with ED, was used to formulate questions pursued in quantitative research with larger samples of men with ED (n = 449), partners of men with ED (n = 429), and physicians who treat men with ED (n = 389), concerning communication about ED among men with this condition, partners, and physicians. Results: Men with ED and partners of men with ED reported strikingly similar perceptions of ED, positive responses to communicating about ED, and negative responses to failing to communicate about ED. Results concerning communication about ED with physicians, physician perspectives on communication about ED, preferred attributes of oral ED therapy, and correlates of phosphodiesterase (PDE5) inhibitor therapy use and non-use, are reported in Part II of this publication. Conclusions: These findings can be used to guide clinical counselling and public health education to facilitate communication about ED and treatment seeking for this condition where appropriate.
... Erectile dysfunction (ED) is a common [1-7], consequential [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], and clinically neglected [4,5,[27][28][29][30][31][32][33][34][35][36][37][38] sexual problem that is experienced by millions of men and their partners worldwide. The current research, which is part of the Strike Up A Conversation (S.U.A.C.) research program, examines the experience of communication about ED among men with ED, partners of men with ED, and physicians who treat ED. ...
... Urologists and general practitioners also, like the patients and their partners, relatively infrequently cited long duration of action (''lasts 24 hours'') as a critical characteristic of ED treatment. We note that from a sexological perspective [2][3][4], the attributes of therapy of ED nominated as most important by men with ED, partners of men with ED, and physicians make a great deal of sense. Research shows that for men with ED, intercourse generally occurs with very little advance notice [2][3][4], and in the context of unpredictable intercourse opportunities a therapy with an extended duration of action, during which intercourse may or may not occur, may appear less rational than one that simply lasts long enough for successful initiation and completion of intercourse and reliably improves erection quality. ...
... We note that from a sexological perspective [2][3][4], the attributes of therapy of ED nominated as most important by men with ED, partners of men with ED, and physicians make a great deal of sense. Research shows that for men with ED, intercourse generally occurs with very little advance notice [2][3][4], and in the context of unpredictable intercourse opportunities a therapy with an extended duration of action, during which intercourse may or may not occur, may appear less rational than one that simply lasts long enough for successful initiation and completion of intercourse and reliably improves erection quality. ...
Background: Erectile dysfunction (ED) is a common, consequential, and clinically neglected sexual problem. The current research is designed to study the experience of communication about ED among men with ED, partners of men with ED, and physicians who treat ED. Methods: Qualitative research with 10 men with ED, 10 female partners of men with ED, and 15 physicians who treat men with ED, was used to formulate questions pursued in quantitative research with larger samples of men with ED (n = 449), partners of men with ED (n = 429), and physicians who treat men with ED (n = 389), concerning communication about ED among men with this condition, partners, and physicians. Results: Men with ED and partners of men with ED reported strikingly similar perceptions of ED, positive responses to communicating about ED, and negative responses to failing to communicate about ED. Results concerning communication about ED with physicians, physician perspectives on communication about ED, preferred attributes of oral ED therapy, and correlates of phosphodiesterase (PDE5) inhibitor therapy use and non-use, are reported in Part II of this publication. Conclusions: These findings can be used to guide clinical counselling and public health education to facilitate communication about ED and treatment seeking for this condition where appropriate.
... Erectile dysfunction (ED), generally defined as the consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction [1][2][3], may significantly reduce quality of life [4] for as many as 30 million men in the United States [5] with 8-52% of men throughout the world experiencing some degree of ED symptoms depending on the specific population being evaluated [3,[5][6][7]. While historically labeled as a disease of older men, ED is experienced by men of all ages [11] with prior studies estimating 21% of men aged 30-79 and 22-39% of men aged 40 and above suffering from ED [7][8][9]. ...
... Erectile dysfunction (ED), generally defined as the consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction [1][2][3], may significantly reduce quality of life [4] for as many as 30 million men in the United States [5] with 8-52% of men throughout the world experiencing some degree of ED symptoms depending on the specific population being evaluated [3,[5][6][7]. While historically labeled as a disease of older men, ED is experienced by men of all ages [11] with prior studies estimating 21% of men aged 30-79 and 22-39% of men aged 40 and above suffering from ED [7][8][9]. ...
... While historically labeled as a disease of older men, ED is experienced by men of all ages [11] with prior studies estimating 21% of men aged 30-79 and 22-39% of men aged 40 and above suffering from ED [7][8][9]. ED is often more distressing to younger patients at the peak of their fertility when establishing an intimate relationship and starting a family are important goals [3,7,8,10]. ...
Purpose
To assess the efficacy of time-resolved MR angiography (MRA) in evaluating penile vasculature in patients with clinically suspected vascular anomalies contributing to their erectile dysfunction correlating with penile doppler ultrasound (PDUS) findings and clinical outcomes after surgical intervention.
Methods
Men (n = 26) with signs of early vascular shunting on PDUS underwent time-resolved, contrast-enhanced (0.1 mMol/kg gadobutrol at 1 ml/s followed by saline flush) 3-dimensional spoiled gradient echo T1-weighted MRA sequence performed over 3 min with 4.6 s frame rate after intracavernosal injection of an erectogenic agent. Additional T1- and T2-weighted sequences were performed for anatomic co-localization and tissue characterization. MRA images were evaluated for early filling of draining veins as well as arteriovenous malformations and fistulas and correlated with findings at surgery.
Results
29 MRA examinations on 26 patients (mean age 39 years) demonstrated abnormal early venous drainage (n = 22) as well as diminutive/delayed cavernosal enhancement (n = 3), incomplete tumescence (n = 2), and combined arterial inflow/venous outflow disease (n = 1). The MRA had a concordance of 85.2% at determining the presence, or lack thereof of a shunt/AVM when compared to PDUS.
Conclusions
Time-resolved MRA allows for both temporal and spatial resolution with visualization of both arterial and venous abnormalities which may be suggested with a screening PDUS examination. This technique allows us to provide detailed anatomic information prior to any surgical intervention.
... Since most of our patients were senile with age older than 65 years, we speculated that the vascular and endocrinological effects of obesity were diminished as other complex confounding factors, such as diabetes mellitus, neurological conditions, mood and depression, or psychology, could implicate erectile functions. [16] BMI, as a simple and straightforward evaluation tool for obesity, has been associated with mortality in big meta-analyses. Therefore, it is widely used as the current standard of measurement of obesity in clinical practice. ...
... Additionally, it confers a higher degree of cardiovascular risk due to higher atherothrombotic events. [16] Therefore, central obesity is regarded as a more precise indicator of body fat distribution than BMI. ...
... Different age strata and selection bias may also influence ED studies. [2] Moreover, different methodological methods have been used to elicit responses, which may also influence research. [2,7] To our knowledge, there are few studies on patients with organic ED who sought treatment. ...
... [2] Moreover, different methodological methods have been used to elicit responses, which may also influence research. [2,7] To our knowledge, there are few studies on patients with organic ED who sought treatment. Furthermore, previous studies almost exclusively focused on Caucasian populations, and there is still a paucity of data on Asian people. ...
... 8 This condition often impacts the quality of life (QoL) of the individual and his partner, creating psychological fear, loss of self-esteem, anxiety and depression. 9,10 In men, ED is described as "the persistent inability to attain and/or maintain penile erection sufficient for sexual intercourse". 11 An epidemiological review by Kubin et al 9 has suggested that 5% to 20% of adult men have moderate-to-severe ED. ...
... 3,19,20 These illnesses are more frequent in older males, 13 which could explain the higher prevalence of ED in men over 60 years old. 9 With the increment of longevity in high-income countries, it is estimated that by the year 2025, 322 million men will suffer from ED. 21 Penile erection is a neurovascular manifestation that is both modulated by hormonal (eg, testosterone levels) 22 and psychological factors. 23 Upon stimulus, occurs release of neurotransmitters, mostly NO, 24 primarily secreted by neurons and further by endothelium, which diffuses to the smooth muscle cells and conducts to relaxation of the vascular system that supplies the erectile tissue, causing increased blood flow into the penis. ...
Hypertension (HT) is a prevalent disease, which origin frequently remains undetermined. Antihypertensive treatment (AHT) has been linked with erectile dysfunction (ED), mainly in middle-aged and older males. On the other side, some drugs used in AHT seem to be themselves associated with ED as a secondary effect. This led to the search of coadjuvant therapies for hypertensive patients with ED, considering that both illnesses cause high physical, psychological and economic burden. While the association between AHT and ED has been approached several times, the direct association between blood pressure and ED remains unclear. This review aims to summarize the current knowledge on the relationship between HT, AHT and ED specifically in males with age ≥40 years.
... Different age strata and selection bias may also influence ED studies. [2] Moreover, different methodological methods have been used to elicit responses, which may also influence research. [2,7] To our knowledge, there are few studies on patients with organic ED who sought treatment. ...
... [2] Moreover, different methodological methods have been used to elicit responses, which may also influence research. [2,7] To our knowledge, there are few studies on patients with organic ED who sought treatment. Furthermore, previous studies almost exclusively focused on Caucasian populations, and there is still a paucity of data on Asian people. ...
... Existing literature reports a large variation in the estimated prevalence of ED, ranging from 5% to 52% [3,4]. This variation can be due to differences in study populations, research methods, and definitions of ED [5]. According to the Fourth International Consultation on Sexual Medicine, ED is defined as the 'consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction' [6]. ...
... neurogenic, endocrinological, vasculogenic, or drug-induced), psychogenic, or mixed causes [7]. Additionally, ED and cardiovascular disease (CVD) share many risk factors including advanced age, cigarette smoking, excessive alcohol consumption, a high body mass index (BMI), and sedentary behaviour [1,5,[7][8][9][10]. The association between these lifestyle factors and ED has mainly been studied in relatively small sample sizes. ...
Objective: To investigate associations between age, lifestyle and erectile dysfunction (ED) in the general population and to explore associations between age, lifestyle and contact with a general practitioner (GP) regarding ED.
Design: Cross-sectional web-based questionnaire study.
Setting: The general Danish population.
Subjects: A randomly selected sample of 48,910 men aged 20 years and older.
Main outcome measures: Prevalence of ED and probability of contacting a GP regarding ED. In logistic regression models we analysed associations between age, smoking status, alcohol consumption, body mass index (BMI), and self-rated physical fitness on both ED and GP contact.
Results: A total of 22,198 men (47.6%) completed the question regarding ED. The overall prevalence of ED was 19.3%, varying from 2.3% among men aged 20–29 years to 55.3% among men aged 80 years and above. 31.8% of men reporting ED had contacted a GP regarding ED. Increasing age, current or former smoking, complete alcohol abstinence or alcohol consumption above seven units per week, high BMI, and poor self-rated physical fitness were significantly associated with reporting ED. The proportion of GP contacts was significantly associated with age. Overall, no significant associations between lifestyle and healthcare seeking were observed, although lower odds of GP contact were found when physical fitness was rated as poor.
Conclusion: Reporting ED and GP contact were significantly associated with age. Furthermore, lifestyle was significantly associated with reporting ED, but largely not associated with healthcare seeking. These findings are important for future interventions aiming to improve diagnosis and treatment of ED.
• Key points
• Experiencing erectile dysfunction is frequent in the general population, especially among older men.
• • In this large-scale national survey, age and lifestyle were significantly associated with reporting erectile dysfunction.
• • Healthcare seeking with erectile dysfunction was significantly associated with age, but not with lifestyle.
• • Diagnosis and treatment of erectile dysfunction might be challenged when erectile dysfunction does not lead to healthcare seeking.
... Erectile dysfunction (ED) is the most common sexual problem, especially in older men. Although many studies have reported that the incidence and prevalence of ED increase with age, there are publications reporting that it is also commonly seen in young men [1][2][3]. The cases reported have varied significantly across studies. ...
... In Australia, ED is experienced by about one in five men over the age of 40 years [3]. The prevalence of ED with diabetes is much higher at 35%-75% [4][5][6][7][8][9][10]. In diabetes, hyperglycemia is considered the main factor for macro and microvascular complications, increasing sexual dysfunction through oxidative stress and impairing erectile and endothelial function. ...
Objective: To assess the treatment outcome of diabetic patients with erectile dysfunction who are prescribed an alternate daily high dose of tadalafil over a 120-day treatment period. Methods: This was a single-site, retrospective, observational study of 63 diabetic men with erectile dysfunction prescribed an alternate daily dose of 30mg of tadalafil between January 1, 2021, and December 31, 2021. Treatment outcomes accessed medication compliance, adverse drug reactions, and patient treatment satisfaction at 60- and 120-days treatment. Results: Mean age of patients was 58.3 years and included patients who suffered from comorbidities ranging from hypertension (54.0%), dyslipidemia (52.3%), and depression (9.5%). At 60 days in the study, 69.8% were satisfied and continued the treatment. However, at the end of the 120-treatment period, a low number of men (17.5%) were satisfied with the treatment and therefore did not remain on the treatment protocol. These patients reported a lack of medication dose efficacy (86.5%), non-compliance with treatment as prescribed (65.4%), and adverse drug reactions (30.8%) as reasons for discontinuing treatment. None of the identified patient demographics were significantly associated with 120-day continuous treatment. Similarly, the odds ratio derived from the logistic regression did not demonstrate an association between the selected variables and the outcome of 120-day continuous treatment retention. Conclusion: This retrospective case series study found that 82.5% of diabetic patients were not satisfied with treatment with alternate dosing of 30mg tadalafil to treat their ED at the end of the 120-day treatment period suggesting an alternative treatment plan.
... The organic causes may be vascular, traumatic, neurological, endocrine-induced, and drug-induced, while the psychogenic causes include depression, performance anxiety, and relationship problems [9]. Studies have also associated ED with common chronic disorders such as diabetes mellitus, lower urinary tract infections, and obesity as well as cardiovascular and neurological diseases [10,11]. Though the findings mentioned above had helped formulate some therapies that target the neurophysiology and the penile tissues, a large proportion of the affected did not respond to such therapies. ...
Background: The burden of erectile dysfunction (ED) is rising worldwide due to unresponsiveness of some affected individuals to existing drugs and treatment strategies. Fortunately, improvement in biological techniques has led to the understanding that some cases of the disorder may have a genetic etiology, which, when fully understood, may lead to improved treatment.
Objective: This review articulated established ED candidate genes and pathophysiology to assist researchers and medical practitioners to formulate effective drugs and treatment procedures.
Methods: The Google search engine was used to retrieve relevant information on the topic from reputable academic databases, including PubMed, Medline, Google Scholar, Scopus, and SpringerLink.
Results: The search discovered 10 ED candidate genes, which are SIM1, SLC6A4, 5-HTTLPR, TGFB1, DAT1, MC4R, NOS3, GNB3, AR, and MTHFR. Polymorphisms or mutations in these genes may disrupt erectile activities of the hypothalamus, neurotransmitters such as dopamine, serotonin, and nitric oxide as well as relaxation of penile tissues. Clinical presentations of ED include loss of erection, weak vaginal penetration, premature ejaculation, and anejaculation. Each gene has a distinct mechanism, which, if targeted in the affected may reverse the disorder or reduce the effects.
Conclusion: Some cases of ED are genetic, which, when fully understood, may give an insight into new treatment procedures or improve on the current ones. Medical practitioners are advised to formulate treatment procedures that target the affected gene (s) in individuals.
... Erectile dysfunction (ED), broadly defined as inability to achieve or maintain an erection sufficient for sexual intercourse 1 and has significant impact on quality of life in both physical and psychological dimensions, partners of men with ED may experience more poor quality of life than those partners who do not have ED. [2][3][4] ED is also marker for cardiovascular disease and correlated with general male health status regardless of etiology. 5 Compounding significant prevalence of ED and reduced quality of life, studies suggested that men often under-report because of embarrassment or lack of awareness. ...
Several factors may affect identification and treatment of erectile dysfunction by health care providers, this study evaluates prescribing pattern of PDE-5 inhibitors and assess effectiveness of Sildenafil and Tadalafil in patients with erectile dysfunction.
This is a descriptive and observational study, observed participants without providing any interventions, after fulfilling inclusion and exclusion criteria, patients were enrolled into study and informed written consent was obtained from all patients, data was obtained from medical records, analysed descriptively. International Index of Erectile Function (IIEF) Questionnaire is used in assessment of erectile dysfunction and treatment outcomes.
In our study, 80% of patients were prescribed with phosphodiesterase inhibitors and 20% received nutritional supplements. 80 percent of drugs were prescribed under generic name, subjects treated with Sildenafil/Tadalafil were found to be associated with higher mean scores for questions of International Index of Erectile Function (IIEF). Tadalafil scored high in terms of sexual desire domain.
PDE5 inhibitors represent major first-line oral therapy option for men with erectile dysfunction, shift of market from brand to generic products allows more freedom of choice, although multiple reports suggest general equivalency of four major PDE5 inhibitors, tadalafil suggested to be preferable.
... Prior studies which have utilized the IIEF in the setting of (CHD) reported rates of ED to be between 10-14% (15,16). However, when including studies that have included different assessment tools, rates of ED ranged from 10% up to 38% (17,18), with reported risk varying from the same as expected "normal" population rates to two times higher (19,20). In Australia, ED rates in young men have been reported to be lower than the rates we recorded in young men living with a Fontan circulation; Chew et al. (21) found that in a cohort of men aged 20-29 years the background rate of ED in the community was 16 and 8.7% in 30-39 year olds using the IIEF-5 questionnaire (a truncated version of the IIEF utilized in this study, with similar sensitivity and specificity). ...
Introduction: It is unknown if the Fontan circulation has an impact on sexual health in men. This study assessed self-reported sexual health and fertility in men with a Fontan circulation.
Aims: In this prospective, cross-sectional study, Australian men ≥18 years enrolled in the Fontan Registry of Australia and New Zealand were invited to complete the International Index of Erectile Function (IIEF), alongside questions assessing fertility. These data were compared to historical, age-matched controls.
Results: Of 227 eligible men, 54 completed the survey; of those 37 were sexually active and included in the final analysis. Mean age was 28 ± 3 years, age at Fontan was 5 ± 3 years. Fontan type was extra-cardiac conduit in 15 (41%), lateral tunnel in 12 (32%), and atriopulmonary connection (APC) in 10 (27%). Ventricular function was normal in 24 (83%), and all were New York Heart Association Class I (23 patients, 79%) and II (six patients, 21%). Nine participants (24%) had erectile dysfunction (IIEF-EF score ≤25). The severity was mild (IIEF 22–24) in six (16%), mild–moderate (IIEF 17–21) in two (5%), and moderate (IIEF 11–16) in one (3%). Baseline characteristics and current medication usage were similar in those with and without erectile dysfunction. Compared with historical control values, erectile function was not significantly impaired in the Fontan population ( p =0.76). Men with a Fontan circulation had decreased levels of sexual desire and overall satisfaction ( p < 0.001). There was no correlation between the presence of erectile dysfunction and any assessed parameter. Eleven (30%) of the cohort reported a pregnancy with a prior partner.
Conclusion: In our cohort, overall erectile function was comparable between men with a Fontan circulation and historical controls, however sexual desire and overall satisfaction were reduced. There was no correlation between study parameters and the presence of erectile dysfunction. The proportion of the cohort who had a prior pregnancy was congruent with population data.
... In Italia, la prevalenza media del disturbo si attesta al 12,8% [36]. Tuttavia, anche in questo caso il 70% dei pazienti non riceve consulenza medica [37]. ...
Sommario
Le patologie del sistema endocrino hanno un notevole impatto dal punto di vista epidemiologico sulla salute delle popolazioni. Esse sono in grado di alterare la qualità della vita dei pazienti affetti e sono responsabili di disabilità a lungo termine; si collocano al quinto posto tra le cause di morte. In questa revisione della letteratura abbiamo valutato la prevalenza e l’incidenza delle principali malattie endocrine nel mondo e in Italia per evidenziarne il reale impatto nella pratica clinica dell’endocrinologo.
... Probably psychogenic causes are depression, anxiety, and relationship problems [2]. Different chronic diseases like diabetes mellitus, cardiovascular disease, and depression are associated with a higher proportion of erectile dysfunction [3] where diabetic mellitus leads to be a major problem [4]. ...
Abstract
Background: Erectile dysfunction, which is defined as difficult to attain and maintain an erectile function enough to permit sufficient sexual performance, is accepted to be a big problem especially among diabetic patients. Objective To assess the Magnitude and factors contributing to Erectile Dysfunction Among Diabetic men attending the diabetic clinic in Debre Tabor Comprehensive and Specialized hospital, North West Ethiopia. Methods: Hospital based cross-sectional study was conducted on 362 participants in Debre Tabor Comprehensive and Specialized Hospital from August - December 2020 using systematic random sampling technique. Data were analyzed with SPSS Version 23. Binary and multivariable logistic regressions were done to identify factors which were contributing to erectile dysfunction. P-value < 0.05 and the corresponding 95% CI of odds ratios were considered to declare the result as statistically significant. Results: Three hundred sixty-two diabetes patients participating in the study with the mean age being 44.4 ± 14.47 (range: 18 - 78) years were interviewed. The majority (59.7% with CI: 54.4:64.6) of the diabetes patients suffered from erectile dysfunction and 13.3% (95% CI 17.8% - 26.8%) were found to have severe erectile dysfunction. Bi-variable analysis showed duration of diabetes (>10 years), type of diabetes (type II), physical exercise, drinking alcohol, BMI, blood glucose, and blood pressure were associated with erectile dysfunction at 5% level (p ≤ 0.05). Multiple logistic regression analysis revealed that duration of diabetes 10 years (AOR = 6.2, 95% CI: 2.78 - 13.85, p = 0.001), co-existing hypertension (AOR: 3.59, 95% CI: 1.58 - 8.19, p = 0.002), physically inactive (AOR = 2.87, 95% CI: 1.53 - 8.31, p = 0.003), unsafe level alcohol intake (AOR: 3.09; 95% CI 1.45 - 6.59*, p = 0.003) and raised blood glucose (AOR: 15.26, 95% CI: 7.82 - 29.77, p = 0.004) were independent risk factors but no association was found with other variables. Conclusion: The magnitude of erectile dysfunction in this study population was 59.7% and associated with the type of diabetes; duration of diabetic, physical exercise, alcohol drinking, increase in blood pressure, and elevated blood glucose level were independently correlated with erectile dysfunction.
... In Italy, the average prevalence of the disorder is about 12.8% (59). About 70% of them do not receive any treatment (60). The importance of identifying ED arises not only from the great psychological impact that it has but also from the significant clinical implications associated with it. ...
Endocrine diseases have a considerable impact on public health from an epidemiological point of view and because they may cause long-term disability, alteration of the quality-of-life of the affected patients, and are the fifth leading cause of death. In this extensive review of the literature, we have evaluated the prevalence of the different disorders of endocrine interest in the world and Italy, highlighting their epidemiological, clinical, and economic impact. © Copyright © 2021 Crafa, Calogero, Cannarella, Mongioi’, Condorelli, Greco, Aversa and La Vignera.
... A large portion of sexual dysfunctions are relative to impaired genital arousal. In men it is translated to erectile dysfunction, with prevalence estimated in range 5-20% [2], while in women prevalence estimates are as high as 28%, usually ranging between 8% and 15% [1]. Since the discovery of sildenafil in 1998, and later other phosphodiesterase type 5 inhibitors, the treatment of erectile dysfunction has seen a revolution, but issue stays open, as PDE5i are not always effective (efficacy around 65% [3], etiology-dependent), are contraindicated with significant cardiovascular conditions (a strong risk factor for ED), and with use of other medicaments such as nitric oxide donors. ...
... Both psychological and biological treatments are effective in managing ED among patients with DM. Even though treatments increased the level of sexual and life satisfaction, treatment-seeking behavior among men with ED is minimal [15][16][17][18]. Factors including but not limited to age, BMI, peripheral neuropathy, longer duration and mode of therapy had a significant association with ED [11,12]. ...
Background: Diabetes mellitus is the predominant risk factor for erectile dysfunction due to vascular and neurological complications. It affects the patient's quality of life by imposing psychological and emotional consequences including depression, anxiety, low self-esteem, and lack of self-confidence. Hence, this study aimed to scrutinize the prevalence of impotence and its associated factors among diabetic patients.
Methods: Institutional based cross-sectional study was employed on 330 systematically selected male diabetic patients in tertiary hospitals, Northern Ethiopia from March 2019 to January 2020. Data were collected using a structured questionnaire through face-to-face interviews, entered to Epi data version 4.4.2.1, and exported to SPSS version 25 for analysis. Binary logistic regression was used for analysis. Variables with p< 0.25 in the bi-variable analysis were fitted to multivariate analysis. Then, the adjusted odds ratio with 95% CI was used to report the association whereas statistical significances declared at P≤0.05. Finally, the findings were presented using texts and frequency tables.
Results: This study was conducted on 330 male diabetic patients with an overall response rate of 97.1%. The prevalence of erectile dysfunction among men with diabetes mellitus was found to be 87%. Having average monthly income above poverty line [AOR=5.6; 95%CI: 2.08-15.08], long duration on diabetic follow-up [AHR=1.67; 95% CI: 1.40-2.00], not engaging in daily physical exercise [AOR=4.73; 95%CI: 1.83-12.23], and using oral medications for diabetes mellitus [AHR= 6.27; 95% CI: 2.01-19.58] were significantly associated with erectile dysfunction among male diabetic patients.
Conclusion: Erectile dysfunction is highly prevalent among diabetic patients. Moreover, prolonged diabetic follow-up, family monthly-income above the poverty line, using oral hypoglycemic agents, and lack of daily physical exercise were independent risk factors of impotence. Thus, it is advisable to conduct universal screening for this population group with open discussion during diabetic visits to enable timely detection and management.
... Furthermore, about 30% of ED men seek professional help ending in 11% only who actually receive treatment. 9,10 Our current research studied the epidemiological factors of ED and demonstrated different patterns of ...
Objectives
We aimed to study the risk factors of erectile dysfunction (ED) and different patterns of phosphodiestrase type 5 inhibitors (PDE5is) usage among Egyptian patients.
Patients and methods
One thousand five hundred consecutive Egyptian patients complaining of ED were included in this cross-sectional study from July (2014) to October (2015). Patients were requested to answer the international index of erectile function questionnaire (IIEF-5). Statistical differences between groups were tested using Chi square test and Spearman's rho correlation coefficient for qualitative variables.
Results
Remarkably, significant associations between IIEF scores and aging and diabetes mellitus (DM) and hypertension (HTN) and ischaemic heart disease (IHD) and hyperlipidaemia were shown in the studied patients (p < .0001, p < .0001, p < .0001, p < .0001, p < .0001, respectively). Eventually, our study showed significant correlations between different age groups and morning erection and lower urinary tract symptoms and HTN and IHD and DM where the severity of ED was directly proportional to the absence or decreased strength of morning erection with aging and the increased incidence of LUTS and HTN and IHD and DM with aging (p < .0001; p = .001; p < .0001; p < .0001; p < .0001, respectively).
Conclusion
Our study demonstrated that aging; DM, HTN and hyperlipidaemia are potential major risk factors of ED in Egypt for further validation. In addition, most of the participants used PDE5is without prior medical consultation together with concomitant administration of illicit drugs.
... Erectile dysfunction (ED), the inability to achieve and/or maintain an erection sufficient for satisfactory sexual intercourse is traditionally considered an age dependent male dysfunctional disorder, resulting from the physiological changes associated with the aging process [1]. Previous surveys demonstrated an age associated 3-fold increased probability of ED in men between ages 20-60 [2]. However, in recent multinational studies, the prevalence of ED in young men (under 40) has been shown to be as high as 30% [3]. ...
... Development of drugs to treat ED is considered as one of the modern medical topics in the "aging" society. Approximately 5-20% of men in the world suffer from moderate-to-severe ED [66]. Drugs affecting NO pathway such as the case of PDE5 inhibitor have been discovered by chance through performing medical treatments for diseases regulating blood pressures [67]. ...
Male penis is required to become erect during copulation. In the upper (dorsal) part of penis, the erectile tissue termed corpus cavernosum (CC) plays fundamental roles for erection by regulating the inner blood flow. When blood flows into the CC, the microvascular complex termed sinusoidal space is reported to expand during erection. A novel in vitro explant system to analyze the dynamic erectile responses during contraction/relaxation is established. The current data show regulatory contraction/relaxation processes induced by phenylephrine (PE) and nitric oxide (NO) donor mimicking dynamic erectile responses by in vitro CC explants. Two photon excitation microscopy (TPEM) observation shows the synchronous movement of sinusoidal space and the entire CC. By taking advantages of the CC explant system, tadalafil (cialis) was shown to increase sinusoidal relaxation. Histopathological changes have been generally reported associating with erection in several pathological conditions. Various stressed statuses have been suggested to occur in the erectile responses by previous studies. The current CC explant model enables to analyze such conditions through directly manipulating CC in the repeated contraction/relaxation processes. Expression of oxidative stress marker and contraction related genes, Hif1a, Gpx1, RhoA, Rock was significantly increased in such repeated contraction/relaxation. Altogether, it is suggested that the system is valuable for analyzing structural changes and physiological responses to several regulators in the field of penile medicine.
... Erectile dysfunction (ED) is a highly age-dependent disorder, and recent epidemiologic studies suggest that ap-proximately 5% to 35% of men aged 40 to 70 years have experienced different levels of ED [1]. The focus on diabetes mellitus (DM) as an important cause of ED has increased recently. ...
Purpose:
To investigate potential target genes associated with the diabetic condition in mouse cavernous endothelial cells (MCECs) for the treatment of diabetes-induced erectile dysfunction (ED).
Materials and methods:
Mouse cavernous tissue was embedded into Matrigel, and sprouted cells were subcultivated for other studies. To mimic diabetic conditions, MCECs were exposed to normal-glucose (NG, 5 mmoL) or high-glucose (HG, 30 mmoL) conditions for 72 hours. An RNA-sequencing assay was performed to evaluate gene expression profiling, and RT-PCR was used to validate the sequencing data.
Results:
We isolated MCECs exposed to the two glucose conditions. MCECs showed well-organized tubes and dynamic migration in the NG condition, whereas tube formation and migration were significantly decreased in the HG condition. RNA-sequencing analysis showed that MCECs had different gene profiles in the NG and HG conditions. Among the significantly changed genes, which we classified into 14 major gene categories, we identified that aging-related (9.22%) and angiogenesis-related (9.06%) genes were changed the most. Thirteen genes from the two gene categories showed consistent changes on the RNA-sequencing assay, and these findings were validated by RT-PCR.
Conclusions:
Our gene expression profiling studies showed that Cyp1a1, Gclm, Igfbp5, Nqo1, Il6, Cxcl5, Olr1, Ctgf, Hbegf, Serpine1, Cyr61, Angptl4, and Loxl2 may play a critical role in diabetes-induced ED through aging and angiogenesis signaling. Additional research is necessary to help us understand the potential mechanisms by which these genes influence diabetes-induced ED.
... ED has been estimated to affect approximately 5%-20% of men. Differences in the definitions of ED, as well as methodological differences, may explain the variety in reported prevalence rates [2]. The Multinational Men's Attitudes to Life Events and Sexuality study identified the overall prevalence of ED to be 16% and found the prevalence to be 20% in the United States. ...
There are only two three-piece inflatable penile prostheses (IPP) available to patients in the American market: the AMS (American Medical Systems) 700TM series (Boston Scientific, Massachusetts) and the Coloplast Titan® series (Coloplast, Minnesota), and data comparing the two are scant. The aim of our study was to summarize the current scientific evidence comparing the two. A systematic literature review was conducted on PubMed. A 10-year filter was placed to include only studies published after Coloplast launched the Titan Touch® release pump. Eligibility criteria included articles discussing specifically the AMS 700TM and Coloplast Titan® models. Further searches for studies on patient/partner satisfaction were conducted. Abstracts were reviewed to include studies focusing specifically on the models we are studying and studies on patient satisfaction using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. The Coloplast device demonstrated slightly greater resistance to the stimulated forces of penetration and gravity. Coloplast implants coated with vancomycin/gentamicin had the highest infection rate followed by the AMS penile prosthesis and the rifampin/gentamicin coating had the lowest infection rate. Prosthesis durability and survival were similar between both brands. Overall satisfaction was high but comparisons are inconsistent. The literature is inconclusive about which device is superior. We suggest randomized, multicenter, prospective studies to help further elucidate the highlights of each product.
... Erectile dysfunction is clinically defined as the inability to attain or maintain a penile erection "sufficient for satisfactory sexual performance." 1 Estimates of erectile dysfunction prevalence vary widely because of heterogeneity in definitions and survey methods, but as with many other chronic diseases, erectile dysfunction is highly age-dependent. 2 In the United States, erectile dysfunction has been self-reported in about 15% of men ages 40-59, 45% of those in their 60s, and 70% of those 70 or older. 3 Among 1290 men ages 40-70 years in the Massachusetts Male Ageing Study (MMAS), 52% reported erectile dysfunction. ...
Vasculogenic erectile dysfunction has been aptly called the “canary in the coal mine” for cardiovascular disease as it almost always precedes other manifestations of atherosclerotic cardiovascular disease, including myocardial infarction and stroke. It is common, associated with the presence of modifiable cardiovascular risk factors, and impacted by diet and lifestyle choices. This concise review provides an update on the use of dietary and other lifestyle interventions to improve vasculogenic erectile dysfunction and atherosclerotic cardiovascular disease.
... Even if the risk of erectile dysfunction increases with age for all men, it appears to be higher among diabetic men. 2 Researches confirmed that higher rates of ED are related with different types of chronic illnesses such as diabetes mellitus (DM), cardiovascular disease and depression, where DM appears to be a major determinant. 3,4 In the United States, the Massachusetts Male Aging Study had shown that the risk of ED is increased by age, lower education, diabetes, heart disease, and hypertension. ...
Background: Erectile dysfunction is currently one of the most common sexual dysfunctions
worldwide affecting the quality of life of men of all ages, but it is usually underestimated
because it is not a life threatening condition.
Purpose: This study aims to determine the prevalence of erectile dysfunction and the
possible correlates among diabetic men in Dessie Referral Hospital, North Central
Ethiopia.
Methods: An institution-based cross-sectional study was conducted among diabetic men
aged greater than 18 years, at Dessie Referral Hospital. Systematic random sampling
technique was used to select study participants. A pre-tested and structured questionnaire
was used to collect the data. Data were entered in Epi Info version 7 and analyzed using
SPSS version 21. Logistic regression was applied to identify association between explanatory
variables and the outcome variable. An adjusted odds ratio with 95% confidence interval and
p-value less than 0.05 was computed to determine the level of significance.
Results: Overall, the prevalence of erectile dysfunction (ED) in this study was 58.5% at
95% CI (0.548–0.622), and specifically 10.5%, 40.9%, 6.8% respondents had mild, moderate
and severe erectile dysfunction, respectively. Age, duration of diabetes diagnosis, types of
medication, types of complication and body mass index were significant unadjusted factors
associated with erectile dysfunction, but following adjustment only age [AOR=5.5 (95% CI
2.06–14.744), duration of diabetes [AOR=20,(95% CI 5.663–75.0096) and types of medication
[AOR=2.106 (95% CI 1.112–3.988) have independently statistically significant association
with erectile dysfunction.
Conclusion: This study showed that ED is high. Age, duration of diabetes mellitus and type
of medication are independently associated with erectile dysfunction. Health policymakers
need to consider including the training of health personnel to consider the relevant risk
factors during the physical, social and psychological assessment of patients, and clinicians
should pay attention to the sexual history of their client.
Keywords: diabetes, erectile dysfunction, Dessie
... The process of healthcare seeking in general is influenced by a mixture of physical, social and psychological factors [8] where some factors are drivers and other are barriers. It has been shown that most men experiencing ED do not seek medical attention and that several barriers for healthcare seeking with ED are present [9]. Common barriers for healthcare seeking with ED reported in the literature are infrequent occurrence or lack of importance for the individual [10]. ...
Background:
Erectile dysfunction (ED) is common and impacts psychosocial wellbeing negatively. Many do not seek medical attention and several barriers for healthcare seeking with ED exist. Little is known about the association between socioeconomic characteristics of the patient and barriers for healthcare-seeking for men bothered by ED. The objectives of the study were 1) to estimate the proportion of men bothered by ED, who do not contact the GP, 2) to analyse the frequencies of selected barriers for healthcare seeking and 3) to analyse associations between socioeconomic factors and barriers for contacting the GP.
Methods:
Data derive from a nationwide survey of symptom experiences among 100,000 randomly selected individuals aged 20 years and above. The questionnaire comprises, among other, questions about ED. This study focuses on men who reported bothersome ED and further reported, that they did not contact a GP regarding the symptom. Questions addressing barriers regarding GP contact included embarrassment, worrying about wasting the doctor's time, being too busy, and worrying about what the doctor might find. Information about socioeconomic characteristics was obtained from Statistics Denmark.
Results:
A total of 4072 men (18.3%) reported that they had experienced ED within the past four weeks. Of those, 2888 (70.9%) were categorized as having bothersome ED. In the group of men with bothersome ED 1802 (62.4%) did not contact the GP and 60.5% reported barriers for GP-contact. Of the reported barriers, the most frequent was 'being too embarrassed' (29.7%). In general, respondents in the older age groups were less likely to report embarrassment, business and worrying what the doctor might find. Respondents with highest attained educational level were less likely to report embarrassment and worrying.
Conclusion:
Nearly two third of the respondents with bothersome ED had not contacted their GP. More than half of those reported barriers towards GP contact with embarrassment as the most frequent barrier. In general, respondents in the older age groups and with high educational level were less likely to report barriers.
... [11] Furthermore, it is a depending on majorly observed more common chronic disordered such as cardiovascular, neurological, and diabetes in older age men's. [12] It may be the partial reason for prevalence in older males. In addition, it is more common in the obese age group and more specifically in the existence of hypertension, diabetes, dyslipidemia, etc. [13,14] Hence, the prevalence and incidence of ED problems are highly correlated with the known risk factors, aging factors, and comorbidities. ...
A man’s aptitude to acquire and continue an erection is frequently equated with masculinity
and virility and can greatly influence men’s confidence. The sexual healthiness is a significant
determinant of the worth of life. Erectile dysfunction (ED) as the inability to have or sustain a
penile erection long enough to have momentous sexual intercourse with a partner. As per the
literature, it is revealed that the millions of men populations are suffering from ED and there is
an extreme need to overcome the ED. The various natural traditional herbs, synthetic pioneered
chemical entities/potentials are preferred to treat ED. The present review discusses ED therapy
including drug selection, application site, and choice of formulation. Moreover, this review
updates the various pharmaceutical formulation such as liposomes, ethosomes, transfersomes,
nanoemulsion, self-nano-emulsifying drug delivery system, solid dispersion, penetrosomes, solid
lipid nanoparticles, and nanostructured lipid carriers development in ED therapy through the oral
route, topical and nasal route, etc., which are helpful for researchers to develop new nanocarriers
based formulations.
... Erectile dysfunction consists of insufficiency to maintain a penile erection to the degree of sexual satisfaction. The different types of erectile dysfunction can derive from psychological, neurogenic, vascular, smooth muscle, and skeletal muscle components, with vascular etiology, mostly familiar with cardiovascular diseases or failure, which is present in up to 58% of the patients with erectile dysfunction [1]. A contributing factor which lies within erectile dysfunction is priapism. ...
The contents of irregularities in the physiology of the vascular wall have been closely associated with erectile dysfunction. Understanding the components of the vascular wall under optimal conditions highlights the aspects to take note of during distress. Under conditions of erectile dysfunction, overlapping relationships are observed with irregularities of the vascular homeostasis. The purpose of this review is to analyze the relevance of the vascular wall towards erectile dysfunction, discussing the fundamental aspects that surround the understanding of the vascular wall such as the core biology, neurotransmission activity, biochemistry, essential pathways, and physiology that partake during synthesis and homeostasis of the vascular wall, as well as the autophagy, which contributes to regulatory steps within the vascular wall. The correlations between oxidative stress, atherosclerosis, and endothelial dysfunction overlap with conditions observed within erectile dysfunction. A fundamental concept which partakes in erectile dysfunction is priapism, the insufficiency of returning to the flaccid state.
... The prevalence of ED reported in epidemiological data vary depending on patient age group and definition used. In the United States, it has been reported that ED affects 52% of men aged 40 to 70 years and more than 70% in men older than 70 years [2][3][4]. In the past, ED was considered a purely psychogenic disorder; however, current evidence suggests that the pathogenesis of ED is related to a multitude of factors. ...
Currently, several treatments exist for the improvement of erectile dysfunction (ED). These include medical therapies such as
phosphodiesterase type 5 inhibitors (PDE5-Is), invasive methods such as intracavernosal injection therapy of vaso-active substances,
vacuum erection devices, and penile prosthesis implants. However, the percentage of patients that are unresponsive
to available treatments and who drop out from treatments remains high. Current evidence reveals that the pathogenesis of
ED is related to multiple factors including underlying comorbidities, previous surgery, and psychological factors. Diverse approaches
using novel molecular pathways or new technologies have been tested as potential therapeutic options for difficultto-
treat ED populations. Melanocortin receptor agonist, a centrally acting agent, showed promising results by initiating erection
without sexual stimulation in non-responders to PDE5-Is. Recent clinical and pre-clinical studies using human tissues
suggested that new peripherally acting agents including the Max-K channel activator, guanylate cyclase activator, and nitric
oxide donor could be potential therapies either as a monotherapy or in combination with PDE5-Is in ED patients. According
to several clinical trials, regeneration therapy using stem cells showed favorable data in men with diabetic or post-prostatectomy
ED. Low-intensity shock wave therapy also demonstrated promising results in patients with vasculogenic ED. There are
growing evidences which suggest the efficacy of these emerging therapies, though most of the therapies still need to be validated
by well-designed clinical trials. It is expected that, should their long-term safety and efficacy be proven, the emerging
treatments can meet the needs of patients hitherto unresponsive to or unsatisfied by current therapies for ED.
... Researches confirmed that inability to get maximum erection of the penis related with different types of illnesses. However, living with the DM has been reported as the main cause for ED [3,4]. ...
... Accumulating data suggests that erectile dysfunction is highly prevalent in the general population. Although prevalence rates as high as 74% have been reported [21][22][23][24][25][26][27][28][29][30][31], data from large epidemiological studies around the world, the Cross-National Study, the MALES study, the Health Professionals Study, and the MATeS study, point towards an average prevalence of erectile dysfunction in the general population of around 15-20% [28,[32][33][34][35]36]. Of note, sexual dysfunction seems to be more frequent in women than in men in the general population [37]. ...
: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.
... is phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. In the general male population, the prevalence of ED has increased to approximately 20%, but less than 30% of patients seek treatment [18]. Due to factors such as Chinese traditional culture, cognitional differences of the patients and their spouses, most men often show sorrow and anxiety about the disease and misconceive this disease. ...
It is an interesting clinical phenomenon that when evaluating the erectile function of men with erectile dysfunction by couples, respectively, using the erectile hardness model, there will exist the evaluation difference between men and their female partners. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. To explore the influencing factors associated with this clinical phenomenon, we conducted this interesting, observational, and cross-sectional field survey. We enrolled 385 couples from the andrology clinics of the first affiliated hospital of Anhui Medical University from December 2017 to December 2018. The demographic data of couples, the medical history, sexuality and the characteristics of ED, and anxiety and depression of the couples were collected through face-to-face interview and questionnaires. The couples were divided into two groups containing 238 couples and 147 couples, respectively. We divided couples into difference group including couples which have inconsistent evaluation results from touching the erectile hardness model and no difference group including couples which have consistent evaluation results from touching the erectile hardness model, respectively. The difference group where the couples share different evaluation results reported higher erectile hardness grade from men than from their female partners (male > female: 73.11% vs. male < female: 26.89%). The scores of IIEF-5 in difference group and no difference group are 13.43 ± 5.75 and 16.82 ± 8.23, respectively. The average grades evaluated from men and women in difference group are 2.79 ± 0.85 and 2.45 ± 0.63, respectively. The average grades evaluated from couples in no difference group are 3.02 ± 0.45. Through statistical comparison and logistic regression analysis, duration of ED > 16 months, seeking treatment from female, negative communication state, and depression from men are the relevant factors accounting for the different evaluation results. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. As for couples with these risk factors, we cannot focus only on the oral medication which only restores the penile erectile function. More importantly, we must combine the sexual counseling and sexual knowledge education with the drug treatment. When the two treatments are tightly integrated, not only the penile erection but also the gap of couples can be restored which is the best result of the ED treatment.
1. Introduction
Erectile dysfunction (ED), defined as the persistent inability to attain and/or maintain an erection sufficient for sexual performance for at least six months, is one of the most common diseases in males [1]. ED is a complicated interaction between the etiology of vascular, neurogenic, hormonal, psychogenic, iatrogenic, and anatomic causes, which plays an important role in the occurrence of ED [2].
Several large epidemiological studies have shown a high prevalence and incidence of ED worldwide. In the Men’s Attitude to Life Events and Sexuality Study, which included 20 to 75-year-old men from 8 countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil), the ED prevalence, assessed by International Index of Erectile Function (IIEF), ranged from 22% in the United States to 10% in Spain [3]. In a study surveying the prevalence of ED among type 2 diabetic Chinese men, among subjects with ED, the most prevalent was mild ED (28.9%), followed by mild-to-moderate (27.9%), moderate (13.4%), and severe (9%) ED [4]. A project launched for estimating the likely worldwide increase in the prevalence of ED in the next 25 years projected that ED will affect 322 million by 2025 [5]. It is evident that ED has become a measurable health disorder for men globally that requires medical and public health attention.
ED has biological, psychological, and social effects on the patients and their sexual partners [6]. A study conducted in China concluded that the prevalence of anxiety and depression were 79.82% and 79.56% in Chinese ED patients and the prevalence and severities of anxiety and depression increased as the ED severity increased [7]. The effects of ED on the partners are strikingly similar to the effects on the patient. When erectile dysfunction occurs in a man, his female partner will suspect her attractiveness and worry that he is potent with other people. These anxious thoughts influence their confidence and lead to anxiety and depression [6]. In conclusion, ED can cause frustration, anxiety, and depression for couples, potentially resulting in separation and/or divorce with the progress of illness. The vicious cycle of anxiety and erectile dysfunction encompasses the entire relationship between the patient and the partner. With the development of this vicious circle, the couples will decrease the frequency of intercourse, time together, and communication [8]. In addition, the Female Experience of Men’s Attitudes to Life Events and Sexuality study showed that women engaged less frequently in sexual activity after their partner developed ED and that their sex life was less satisfactory when the ED of their partner was severe. Similar results had been reported by other authors [9]. A research found that compared to the general population, the quality of life in people with ED was known to be decreased to on average 10% [10]. It concluded that ED not only harms the health of men but also damages the harmonious relationship between couples.
The emergence of phosphodiesterase type 5 inhibitor in 1998 dramatically altered the treatment landscape for erectile dysfunction [11]. This targeted treatment is convenient for patients and physicians. The clinical efficacy of nonselective treatment for ED can reach 60%–80% [12]. On the contrary, high rates of treatment discontinuation were present in several studies, ranging from 14% to 57% [13–16]. Higher PDE5 discontinuation rates were found in other studies, reaching 80.4% [17]. It is clear that there is a significant disparity between efficacy and continuation rates. Exploring this “disparity phenomenon,” we hypothesized that sexual dysfunction typically involves both physiological and psychological aspects, and such medications, although they improve penile neurovascular response, do not address the complex psychological and relationship issues that often accompany a sexual problem. Without exploring the relational issues that result from ED, the treatment efficacy would be limited.
In our daily male outpatient work, we found an interesting phenomenon: when using the erectile hardness measurement model for evaluating and comparing the erectile function of the men in the past six months, the couple who came to the male outpatient for ED came to a different conclusion. More often, the women’s response to erectile hardness is more objective and real than the patient himself. This phenomenon reflects the problem of communication and cognition between husband and wife in ED patients. In the general male population, the prevalence of ED has increased to approximately 20%, but less than 30% of patients seek treatment [18]. Due to factors such as Chinese traditional culture, cognitional differences of the patients and their spouses, most men often show sorrow and anxiety about the disease and misconceive this disease. This makes the male patients in the face of the doctor only emphasize the organic factors of their erectile dysfunction, avoiding the related effects of the disease on the sexual partner and both sides. This will cause the doctor to ignore the effect of the ED on the patient’s relationship, and the treatment to the patient’s erectile function is limited to the use of drugs. However, except in ideal circumstances when these psychosocial forces are not present, dispensing a tablet to reverse these powerful forces is not likely to succeed [19]. Consequently, the exploration of the influencing factor of the aforementioned details will be helpful to the exploration of the psychological factors owing to the illness itself and to attach sexual counseling and sexual education to the drug therapy to improving the treatment efficacy of ED.
The purpose of this paper is to explore the factors influencing the differences in the evaluation of the penile hardness model between husband and wife. We explore relevant factors from multiple perspectives including duration of ED, duration of relationship, frequency of sexual intercourse, the main reason for treatment of ED, the state of communication, and the psychological burdens of the couples. Moreover, we want to inform andrologists that when treating ED patients with such risk factors, combined drug therapy, sexual counseling, and sex education will achieve better therapeutic goals.
2. Methods
2.1. Patient Selection
Patients who were referred to the Department of Andrology, the First Affiliated Hospital of Anhui Medical University (Hefei, China), for the erectile dysfunction from December 2017 to December 2018, were enrolled in this study. This study was reviewed and approved by the Anhui Medical University Research Subject Review Board. Informed consent was obtained from all patients before study. To be enrolled in the study, all subjects had to meet the following criteria: (a) males and their female partner aged ≥18 years; (b) the couples comprehend and speak Chinese; and (c) males having ED for more than six months with a regular heterosexual relation (at least once per week). Exclusion criteria were as follows: take medicine that could affect erectile function, the presence of a severe psychopathological disorder, and suffering from premature ejaculation (according to ISSM definition of PE). Subjects’ medical and sexual histories were carefully evaluated by an experienced clinician.
2.2. Study Design
Before the official investigation begins, a presurvey was given to a small sample (n = 30) to modify the originally designed items to ensure that the questionnaire was comprehensive and easily understood owing to several subjective and sensitive personal questions included in the study. This survey was conducted with three steps. Firstly, a question was asked to men with ED (diagnosed with IIEF-5) and their female partner, such as “based on the previous six months, which one of the models was similar to you or your partner erectile hardness.” Then, they answered the question by the evaluation model of erectile hardness (see Figure 1). This model made by the Pfizer Inc. (Pfizer Inc., New York, NY) was the visual and tactile version of the standardized Erectile Hardness Score (EHS) tool [20]. It was originally validated and standardized in order to evaluate the efficacy of sildenafil citrate in recovering EF [21]. Its four grades represent four states of the penile, respectively, when stimulated by the sex. The dark blue penis model of the tool (score 4 at the EHS) mirrors the sentence “penis completely hard and fully rigid.” The blue penis model of the tool (score 3 at the EHS), in turn, mirrors the sentence “penis hard enough for penetration but not completely hard.” The light blue penis model of the tool (score 2 at the EHS) mirrors the sentence “penis is hard but not hard for penetration.” The light gray penis model of the tool (score 1 at the EHS) mirrors the sentence “penis is large but not hard.” Secondly, a face to face interview was conducted to collect a detailed medical history of the patients, including the duration of relationship, the cause of disease, the duration of disease, the frequency of sexual intercourse, the main reason of treatment, and the use of erectile-related drugs. Additionally, the state of couple communication includes active communication behavior and negative communication behavior [22]. Thirdly, we make two questionnaires intended for men and women to collect some information. Here, a detailed interpretation of the questionnaires follows. The first part of the two questionnaires is the same, mainly including some demographic characteristics: age, BMI, life style (smoking status and exercise status), characters, educational status, occupational status, and residence. The NEO-PI-R was used to assess the personality of the couples [23]. The second part of the questionnaire intended for men is the 5 items of International Index for Erectile Function used to measure the sexual dysfunction of the men [24]. The third part of the questionnaire attended for the couples contains the Zung self-rating anxiety/depression scales [25, 26]. The reliability of these instruments (NEO-PI-R, the Zung self-rating anxiety/depression scales, and IIEF-5) was assessed with Cronbach’s alpha coefficient. The internal consistencies of the NEO-PI-R, the Zung self-rating anxiety/depression scales, and IIEF-5 were 0.84, 0.80, 0.81, and 0.79, respectively.
... Data from the United States suggest that ED affects more than 75% of men over 70 years of age [5], while other studies suggest that more than 40% of men over 60 years of age are likely to have ED [6]. ED is associated with a number of chronic disorders that are more common in older men, such as diabetes and cardiovascular or neurological disease [7], and this may at least partly explain the increased prevalence in older men. In addition, ED is a common comorbidity in obese men, particularly in the presence of other cardiovascular risk factors such as diabetes, dyslipidemia, or hypertension [8,9]. ...
Erectile dysfunction (ED), defined as the inability to initiate or maintain an erection sufficient for satisfactory sexual intercourse, is common, particularly in men aged ≥50 years. Existing treatments have significant limitations, and there remains a need for a fast-acting (to facilitate spontaneity during intercourse) and well tolerated local therapy. Topical glyceryl trinitrate (GTN) may meet this need because GTN undergoes rapid metabolism in penile smooth muscle and endothelial cells to produce nitric oxide, which plays a key role in the development of erection. This paper describes the rationale for the development of MED2005, a topical GTN formulation using DermaSys® technology, which is undergoing clinical trials for the treatment of ED. Pharmacokinetic studies have shown that MED2005 provides rapid delivery of GTN following application to the glans penis, and a Phase 2(a) trial in men with ED showed that MED2005 produced significant improvements in erectile function, compared with placebo. MED2005 was well tolerated in this trial, with only 21 cases of headache in 1003 intercourse attempts. It is anticipated that MED2005 will provide an effective therapy for ED, with a fast onset of action, good local tolerability, and fewer contraindications than phosphodiesterase 5 inhibitors, the current cornerstone of ED therapy.
... Erectile dysfunction (ED) is a very common symptom affecting 15%-25% of men in the general population and achieving a prevalence of up to 70% in elderly men. 1 Despite its widespread distribution and its great impact on the quality of men' and couple's life, 2 it is estimated that only 30% of men with ED consult a physician for this problem. 3 Several reasons could explain this low consultation rate. ...
Background:
Despite the well-known influence of psychological and situational factors on erectile dysfunction (ED), the influence of the physician's gender on the andrological work-up has never been investigated so far.
Objectives:
To investigate physician's gender influence on the erectile dysfunction (ED) diagnostic workup.
Materials and methods:
Cross-sectional study with retrospective data collection. We evaluate a consecutive series of ED patients: 95 at the University of Modena and Reggio Emilia (UNIMORE) and 1808 at the University of Florence (UNIFI). In the UNIMORE cohort (Cohort 1), intracavernousal injection (ICI) test was performed in case of suspected vascular pathogenic component. In the UNIFI cohort (Cohort 2), patients were evaluated by Structured Interview on Erectile Dysfunction (SIEDY) and ANDROTEST. Both cohorts were divided in 2 groups according to the gender of the physician who performed the ICI test or the structured interview.
Results:
In Cohort 1, patients who had the ICI test performed by a female physician had a significantly higher probability of obtaining a better ICI test response. In Cohort 2, patients interviewed by female physician more frequently reported to have a conflictual couple relationship and a reduced frequency of climax in their partners. However, they reported less difficulties in achieving and maintaining erection, higher frequency of autoeroticism, lower occurrence of ED during masturbation and lower impairment in morning erections.
Conclusions:
Physician's gender affects the results obtained during the ED diagnostic workup. Men interviewed by a female physician describe a less severe ED probably as attempt to defend their own virility. On the other hand, the presence of a male physician during ICI test is associated to a worse response suggesting a possible unconscious competition.
... Worldwide epidemiological surveys show that approximately between 5 to 35% of men exhibit from moderate to severe Erectile Dysfunction (ED) (Araujo et al. 2000;Martin et al. 2014;Klein et al. 2005). ED has a profound negative impact on the quality of a man's socio-sexual life, and may result in fear, anxiety, loss of self-image, selfconfidence and depression (Kubin et al. 2003). The causes of ED can be organic or psychogenic (Wyllie 2005). ...
Objectives
According to the DSM-5, in men, the inability to achieve or sustain an erection for satisfactory sexual activity can be of organic or psychological nature. The risk factors for Psychogenic Erectile Dysfunction (PED) include exposure to episodic, acute or chronic stressors, dysfunctional lifestyle factors and relationship patterns, anxiety, mood and personality disorders, neurotic or submissive temperamental traits. We hypothesized that worsening socioeconomic condition may lead to PED, and that depression and temperament (harm avoidance) may act as mediators or moderators of this relationship.Methods
Eighty-four patients with psychogenic erectile dysfunction and fifty healthy control subjects participated in a retrospective study that investigated stressful events (e.g., lifestyle factors) potentially associated with PED and our hypothesized mechanism linking stress, depression, temperament, and erectile dysfunction.ResultsIn our clinical sample, loss of economic resources was a risk factor for PED and its effects were statistically mediated by depression, especially among individuals who scored high in harm avoidance.Conclusions
Our findings are consistent with the rank theory of depression and emphasize the importance of an evolutionary approach to understanding clinical conditions such as psychogenic erectile dysfunction.
... 17 while there are strong psychosocial correlates; there is an increasing recognition of its relationship to clinical co-morbidities that indicate an organic basis in the majority of presentations. 18 As more epidemiological data accrue, information is emerging regarding the extent and impact of risk factors associated with ED 19 There are, however, a number of traditional (increasing age, high LDL-cholesterol, low HDLcholesterol, hypertension, diabetes mellitus, smoking), underlying (obesity, sedentary lifestyle, atherogenic diet) and emerging (insulin resistance/metabolic syndrome) risk factors that are shared between Erectile Dysfunction and cardiovascular disease. [20][21][22][23][24][25][26][27] In some West African Countries including Nigeria, though there are many studies on Health related quality of life (HRQOL), 28-30 data on the impact of erectile dysfunction on quality of life (QOL) of patients with this disorder are scarce in the medical literature 31 . ...
Erectile dysfunction is a major family health concern. It is a highly prevalent and often under-reported condition and has considerable negative impact on quality of life of men who have it and on their family. The present study was a cross- sectional study designed to assess the impact of erectile dysfunction on Health –related quality of life (HRQOL) among adult patients attending the general outpatient clinic of the University of Uyo Teaching Hospital between January and March 2009. Four hundred (400) eligible participants were recruited through systematic random sampling technique and were administered a semi-structured questionnaire after a signed consent had been obtained from them.
The questionnaire evaluated their socio-demographic characteristics, their reactions to erectile dysfunction (ED) as well as their Health-related quality of life (HRQOL).
The mean age of the participants was 42.6 years with a standard deviation of 4.1 years.
The result obtained showed that the overall prevalence of erectile dysfunction in this study was 41.5 percent. The prevalence and severity of erectile dysfunction were more among respondents between 50 and 70 years of age. This was statistically significant (P < 0.001) when compared with respondents between 20 and 49 years of age.
Erectile dysfunction (ED) was also more prevalent among those who were currently married than among those who were single, divorced, separated or widowed (not currently married), (P < 0.001). Rural dwellers reported more prevalent erectile dysfunction than urban residents (P < 0.001). ED was also more prevalent among hypertensive participants than non-hypertensive participants (P < 0.001), and also among diabetes mellitus than non-diabetes mellitus participants (P < 0.001).
Respondents who were using such medications as sulphonylureas, metformin, diuretics and angiotensin converting enzyme inhibitors reported more prevalent erectile dysfunction (ED) than non-users.
Participants in this study who had erectile dysfunction also reported more profound impairment in the overall quality of life (P< 0.001) and general health satisfaction domains
(P < 0.001) of their health-related quality of life compared to participants who did not have erectile dysfunction. Moreover, participants who had erectile dysfunction also reported more significant impairment in the psychological (P< 0.001) and social relationships domains (P<0.001) of their health-related quality of life than in the physical (P>0.950) and environment domains (P> 0.070) compared to those without erectile dysfunction.
There is therefore need for greater awareness on the part of physicians to routinely assess the sexual health status of their adult male patients who present with undifferentiated medical problems at the general outpatient clinic. This is important since sexual health is an integral part of patients’ overall health, which has been recognized to encompass aspects of physical, emotional, mental and social well-being. Such an approach will holistically address the overall health care needs of adult male patients and also foster a trusting relationship between physicians, patients and patients’ families with consequent improvement in the overall quality of life of such patients.
Background:
Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and assess for any associated factors in a large multi-institutional penile implant cohort.
Materials and Methods:
A retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis (IPP)implantation at 2 high volume implant centers was conducted. Cases were defined as ‘complex’ if they involved revision, salvage with removal/replacement, or were performed with concurrent penile, scrotal or intra-abdominal surgeries. The incidence of scrotal hematoma among primary and complex IPP recipients was measured and modifiable and innate risk factors associated with hematoma formation within the two cohorts were tracked.
Results:
Of 246 men who underwent IPP, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although patients in the complex group had comparable drain outputs to non-hematoma patients on POD0 (66.8cc vs 49.6, p=0.488) and POD1 (20.0cc vs 40.3, p=0.114), hematomas in the complex group had a higher propensity for OR evacuation (p=0.03). Difference in duration of temporary device inflation between 2 and 4 weeks did not contribute to hematoma formation. Postoperative hematoma formation in complex cases (5/52, 9.6%) trended towards a higher incidence than primary cases (7/194, 3.1%) (HR=2.61, p=0.072).
Conclusions:
Complex IPP surgery performed for revision or with ancillary procedures are more likely to result in clinically significant hematomas that require surgical management, suggesting a need for heightened caution in managing these individuals.
Introduction
Erectile dysfunction (ED) is a substantial cause of dissatisfaction among many men. This discontentment has led to the emergence of various drug treatment options for this problem.
Objectives
Unfortunately, due to various interactions, contraindications, and side effects, systemic therapies such as phosphodiesterase-5 inhibitors (including sildenafil, tadalafil, vardenafil, avanafil, etc.) are not welcomed in many patients. These problems have led researchers to look for other ways to reduce these complications.
Methods
This article holistically reviews the efficacy of topical prostaglandins and their role in treating ED. We sought to provide a comprehensive overview of recent findings on the current topic by using the extensive literature search to identify the latest scientific reports on the topic.
Results
In this regard, topical and transdermal treatments can be suitable alternatives. In diverse studies, prostaglandins, remarkably PGE1 (also known as alprostadil), have been suggested to be an acceptable candidate for topical treatment.
Conclusion
Numerous formulations of PGE1 have been used to treat patients so far. Still, in general, with the evolution of classical formulation methods toward modern techniques (such as using nanocarriers and skin permeability enhancers), the probability of treatment success also increases.
Hamzehnejadi M, Tavakoli MR, Homayoun F et al. Prostaglandins as a Topical Therapy for Erectile Dysfunction: A Comprehensive Review. Sex Med Rev 2022;10:764–781.
Chronic kidney disease (CKD) is frequently accompanied by reproductive health challenges in females and males alike. Progression of CKD is associated with escalating impairment of the hypothalamic-pituitary-gonadal axis, which facilitates evolving ovarian, testicular, and sexual dysfunction. Common clinical reproductive health complications in CKD include abnormal menstruation, impaired sexual health, and reduced fertility. Though sex-specific factors, such as sex hormones and gonadal function, have a strong influence on reproductive health outcomes in CKD, a person's gender and gendered experience also have important implications. Institutionalized gender, gendered perceptions of health, and health care-seeking behaviors, as well as adherence to medical care, all have critical effects on reproductive health in CKD. This review endeavors to explore the implications of both sex and gender on overall reproductive health in individuals living with CKD.
Plants and their derived molecules have been traditionally used to manage numerous pathological complications, including male erectile dysfunction (ED). Mimosa pudica Linn. commonly referred to as the touch-me-not plant, and its extract are important sources of new lead molecules in drug discovery research. The main goal of this study was to predict highly effective molecules from M. pudica Linn. for reaching and maintaining penile erection before and during sexual intercourse through in silico molecular docking and dynamics simulation tools. A total of 28 bioactive molecules were identified from this target plant through public repositories, and their chemical structures were drawn using Chemsketch software. Graph theoretical network principles were applied to identify the ideal target (phosphodiesterase type 5) and rebuild the network to visualize the responsible signaling genes, proteins, and enzymes. The 28 identified bioactive molecules were
docked against the phosphodiesterase type 5 (PDE5) enzyme and compared with the standard PDE5 inhibitor (sildenafil). Pharmacokinetics (ADME), toxicity, and several physicochemical properties of bioactive molecules were assessed to confirm their drug-likeness property. Molecular dynamics (MD) simulation modeling was performed to investigate the stability of PDE5–ligand complexes. Four bioactive molecules (Bufadienolide (−12.30 kcal mol−1
), Stigmasterol (−11.40 kcal mol−1), Isovitexin (−11.20 kcal mol−1
), and Apigetrin (−11.20 kcal mol−1)) showed the top binding affinities with the PDE5 enzyme, much more powerful than the standard PDE5 inhibitor (−9.80 kcal mol−1). The four top binding bioactive molecules were further validated for a stable binding affinity with the PDE5
enzyme and conformation during the MD simulation period as compared to the apoprotein and standard PDE5 inhibitor complexes. Further, the four top binding bioactive molecules demonstrated
significant drug-likeness characteristics with lower toxicity profiles. According to the findings, the four top binding molecules may be used as potent and safe PDE5 inhibitors and could potentially be
used in the treatment of ED.
The article discusses and presents the peculiarities of the relationship between the emotional intelligence of the individuals and anxiety due to the pandemic strict regime.
Silent information regulator 2-related enzyme 1 (SIRT1) is an aging-related protein activated with aging. Herein, we evaluated the role of SIRT1 in aging-related erectile dysfunction. The expression of SIRT1 was modulated in aged Sprague-Dawley rats following intragastric administration of resveratrol (Res; 5 mg kg-1), niacinamide (NAM; 500 mg kg-1) or Res (5 mg kg-1) + tadalafil (Tad; phosphodiesterase-5 [PDE5] inhibitor; 5 mg kg-1) for 8 weeks. Then, we determined erectile function by the ratio of intracavernosal pressure (ICP)/mean systemic arterial pressure (MAP). Cavernosal tissues were extracted to evaluate histological changes, cell apoptosis, nitric oxide (NO)/cyclic guanosine monophosphate (cGMP), the superoxide dismutase (SOD)/3,4-methylenedioxyamphetamine (MDA) level, and the expression of SIRT1, p53, and forkhead box O3 (FOXO3a) using immunohistochemistry, terminal deoxynucleotidyl transferase (TdT)-mediated 2'-deoxyuridine 5'-triphosphate (dUTP) nick-end labeling (TUNEL), enzyme-linked immunosorbent assays, and western blot analysis. Compared with the control, Res treatment significantly improved erectile function, reflected by an increased content of smooth muscle and endothelium, NO/cGMP and SOD activity, and reduced cell apoptosis and MDA levels. The effect of Res was improved by adding Tad. In addition, the protein expression of SIRT1 was increased in the Res group, accompanied by decreased p53 and FOXO3a levels. In addition, inhibition of SIRT1 by NAM treatment resulted in adverse results compared with Res treatment. SIRT1 activation ameliorated aging-related erectile dysfunction, supporting the potential of SIRT1 as a target for erectile dysfunction treatment.
Purpose
Erectile dysfunction (ED) is one of the increasing diseases with aging society. The basis of ED derived from local penile abnormality is poorly understood because of the complex three‐dimensional (3D) distribution of sinusoids in corpus cavernosum (CC). Understanding the 3D histological structure of penis is thus necessary. Analyses on the status of regulatory signals for such abnormality are also performed.
Methods
To analyze the 3D structure of sinusoid, 3D reconstruction from serial sections of murine CC were performed. Histological analyses between young (2 months old) and aged (14 months old) CC were performed. As for chondrogenic signaling status of aged CC, SOX9 and RBPJK staining was examined.
Results
Sinusoids prominently developed in the outer regions of CC adjacent to tunica albuginea. Aged CC samples contained ectopic chondrocytes in such regions. Associating with the appearance of chondrocytes, the expression of SOX9, chondrogenic regulator, was upregulated. The expression of RBPJK, one of the Notch signal regulators, was downregulated in the aged CC.
Conclusions
Prominent sinusoids distribute in the outer region of CC which may possess important roles for erection. A possibility of ectopic chondrogenesis induced by alteration of SOX9/Notch signaling with aging is indicated.
The aim of this study was to assess the relationship between serum folic acid (FA) levels and erectile dysfunction (ED) through a meta‐analysis. A research was conducted in MEDLINE via PubMed, Cochrane Library, EMBASE and Web of Science up to 22 November 2020 to identify studies related to FA and ED. Two authors independently screened the literature, evaluated methodological quality and extracted the data. We used RevMan5.3 and STATA 14.0 for meta‐analysis. A total of six studies including 1,842 participants were included, and the results showed that the FA levels in the non‐ED group were significantly higher than those in the ED group (MD = 3.37, 95% CI 1.49–5.52, p = 0.004). Subgroup analysis indicated that with the increase in ED severity, the difference in FA levels between groups was more obvious (MD: 1.99 vs. 4.63 vs. 5.63). The differences in FA levels between groups seem more significant in the younger group (MD = 4.87, 95% CI 2.58–6.89, p < 0.001) than in the older group (MD = 3.15, 95% CI 2.21–4.08, p < 0.001). In conclusion, FA deficiency is closely related to ED, and the degree of FA deficiency may reflect the severity of ED. In addition, the association seems to be more pronounced in the younger group.
In this study, we examined the adverse consequences of prolonged treatment with sildenafil and/or clomipramine (CLO) on the hepatic, cardiac and testicular tissues of rats. Additionally, we investigated the potential effects of treatment discontinuation. To this end, 60 adult male rats were randomly assigned into six groups and were orally treated with 4.5 mg sildenafil /kg BW (SLD) and 9 mg/ kg BW (SHD), 2.25 mg CLO/kg BW (CLO), 4.5 mg sildenafil/kg BW + 2.25 mg CLO/kg BW (SLD‐CLO) and 9 mg sildenafil/kg BW + 2.25 mg CLO/kg BW (SHD‐CLO) while the control rats received 0.5 ml distilled water for 8 weeks. Then, five rats from each group were sacrificed and the other five rats were left untreated for another four weeks to recover from the drug treatment. Long‐term administration of sildenafil and/or CLO led to oxidative stress, inflammation and structural changes in the liver, heart and testis, reduction in sperm count and motility, an increase in abnormalities, and a reduction in serum testosterone, FSH and LH levels. All tested parameters returned to the normal state following the four‐week discontinuation of sildenafil. Additionally, all the alterations caused by long‐term administration of CLO, SLD‐CLO and SHD‐CLO were significantly improved during the recovery period.
Objective:
To review the evidence suggesting a significant association between gout and erectile dysfunction (ED) and evaluate possible underlying pathways that may explain this relationship.
Methods:
English medical literature was searched from January 1, 2010, to January 1, 2020, for randomized or quasi-randomized controlled trials, cross-sectional studies, case-cohort studies, or meta-analysis evaluating the relationship between gout and ED.
Results:
All nine gout studies included in the study found a significant association between gout and ED. ED pathophysiology in gout involves hyperuricemia, increased reactive oxygen species, decreased nitric oxide synthesis, and low-grade inflammation.
Conclusion:
The findings of this review suggest that the effect of urate-lowering therapy on the incidence of ED in gout patients should be studied. Additionally, we propose that all gout patients should be assessed for ED.
Background
Udenafil, a recently discovered drug used for erectile dysfunction treatment, has been widely prescribed and its effect on human systems has been extensively studied. However, there is little research on the human metabolites of udenafil. Three metabolites have been identified in rats.
Objective
Herein, highly sensitive and accurate liquid chromatography–quadrupole time-of-flight tandem mass spectrometry (LC-Q-TOF-MS/MS) was conducted to identify new udenafil metabolites.
Methods
Human liver microsomes were incubated with udenafil for in vitro samples, and rat urine and faeces samples were collected from udenafil-administered rats for in vivo samples. Each sample was deproteinated with acetonitrile and extracted by solid phase extraction. The purified samples were separated and analyzed by LC-Q-TOF-MS, and some metabolite candidates were reanalyzed for further structural analysis using LC-Q-TOF-MS/MS.
Results
Eleven and three metabolites were identified in the in vitro and in vivo samples, respectively, and were found to be hydrolyzed, oxidized, or demethylated forms of udenafil or its metabolites. The error of the metabolic analysis was −8.7 to 7.6 ppm, indicating the high accuracy of the method.
Conclusion
These metabolic results could be useful for further investigation of udenafil and new phosphodiesterase-5 inhibitors.
Die Einteilung von Störungen in die Gruppe der sexuellen Funktionsstörungen basiert auf dem sexuellen Reaktionszyklus von Masters und Johnson (1966), ein für die Zeit der Veröffentlichung bahnbrechendes Modell, das die sexuelle Reaktion von Menschen in vier Phasen unterteilt. Diese sind die Erregungsphase, die Plateauphase, die Orgasmusphase und die Rückbildungsphase und bilden einen idealtypischen linearen, zeitlichen Ablauf ab. In diesem Kapitel werden die verzögerte Ejakulation, die Erektionsstörungen, die weibliche Orgasmusstörung, die Störung des sexuellen Interesses bei der Frau, die Genito-Pelvine Schmerz-Penetrationsstörung, die Störung mit verminderter sexueller Appetenz beim Mann und die vorzeitige Ejakulation besprochen.
This paper is based on the findings of a study carried out on the determinants of sexual functionality among men who utilize sex enhancing drugs (SEDs). The study was submitted as a thesis in partial fulfillment for the award of a degree of Master of Public Health Maseno University in the year 2019. The research design was cross sectional. Data for this study was collected using socio-demographic and International Index for Erectile Function (IIEF) questionnaires from a sample of 67 men above the age of 18 who were sampled purposively. The results from descriptive analysis indicated that 55% of the study participants are aged between 30 and 49 years, 64% are educated to secondary school and above, 68% have an occupation, 71% are non-smokers, 40% ride a bicycle, 91% are physically active and 30% have co-morbidity. On sexual functionality, 95% have some level of erectile dysfunction, at 85% a similar number have varying levels of orgasmic dysfunction and sexual desire. 98% have some level of intercourse dysfunction. The study demonstrate that the determinants of sexual functionality include age, marital status, education, alcohol consumption, bicycle riding, physical activity and co-morbidity. The study identifies socio-demographic factors, lifestyle and co-morbidity as risk factors to sexual functionality. It recommends that sexual functionality be given deserving public health attention.
Inflatable penile prosthesis (IPP) is an effective treatment for erectile dysfunction refractory to nonsurgical management. The infrapubic approach for IPP placement is less frequently employed than the penoscrotal approach, with only about 25% of IPPs placed via this method. Underutilization of the infrapubic method may be due to fear of injuring the penile dorsal neurovascular bundle, perceived difficulties of scrotal pump placement through a distant location, or insufficient distal corporal exposure. However, this approach appears to result in favorable operative times, faster time to device activation, equivalent postoperative satisfaction and quality of life, and similar complication rates. We provide a contemporary review of literature published before May 2019 regarding the infrapubic approach for IPP placement, technical considerations, and postoperative expectations.
Context
Patients with prostate cancer and their physicians need knowledge of
treatment options and their potential complications, but limited data on complications
are available in unselected population-based cohorts of patients.Objective
To measure changes in urinary and sexual function in men who have undergone
radical prostatectomy for clinically localized prostate cancer.Design
The Prostate Cancer Outcomes Study, a population-based longitudinal
cohort study with up to 24 months of follow-up.Setting
Population-based cancer registries in 6 geographic regions of the United
States.Participants
A total of 1291 black, white, and Hispanic men aged 39 to 79 years who
were diagnosed as having primary prostate cancer between October 1, 1994,
and October 31, 1995, and who underwent radical prostatectomy within 6 months
of diagnosis for clinically localized disease.Main Outcome Measures
Distribution of and change in urinary and sexual function measures reported
by patients at baseline and 6, 12, and 24 months after diagnosis.Results
At 18 or more months following radical prostatectomy, 8.4% of men were
incontinent and 59.9% were impotent. Among men who were potent before surgery,
the proportion of men reporting impotence at 18 or more months after surgery
varied according to whether the procedure was nerve sparing (65.6% of non–nerve-sparing,
58.6% of unilateral, and 56.0% of bilateral nerve–sparing). At 18 or
more months after surgery, 41.9% reported that their sexual performance was
a moderate-to-large problem. Both sexual and urinary function varied by age
(39.0% of men aged <60 years vs 15.3%-21.7% of older men were potent at ≥18
months [P<.001]; 13.8% of men aged 75-79 years
vs 0.7%-3.6% of younger men experienced the highest level of incontinence
at ≥18 months [P = .03]), and sexual function
also varied by race (38.4% of black men reported firm erections at ≥18
months vs 25.9% of Hispanic and 21.3% of white men; P
= .001).Conclusions
Our study suggests that radical prostatectomy is associated with significant
erectile dysfunction and some decline in urinary function. These results may
be particularly helpful to community-based physicians and their patients with
prostate cancer who face difficult treatment decisions.
Prostate cancer is the most frequently diagnosed solid tumor in US men.
An estimated 179,300 men will be diagnosed as having the disease in 1999,1 and in more than 70% of these patients, the disease
will be clinically localized.2 Treatment options
for men with tumors confined to the prostate who have at least a 10-year life
expectancy include radical prostatectomy, external beam radiation, brachytherapy,
or expectant management. Each of these approaches is associated with a different
spectrum of morbidity and effects on quality of life, which may be short-term
or long-term.
To make informed choices about treatment alternatives, patients with
prostate cancer and their physicians need accurate information to assess the
potential and pattern of complications associated with each option. Numerous
investigators have assessed urinary and sexual function 1 or more years after
radical prostatectomy, with rates of incontinence ranging from 4% to 40% and
impotence from 29% to 75%.3- 12
These findings reflect the experiences of patients from selected clinical
practices,3- 5,7- 9,12
a health maintenance organization,10 and Medicare
recipients.6,11 Differences in
patient mix, study size, and data collection methods may explain the wide
range of results.
Limited data are available to describe the outcome experiences of unselected
population-based patients. We report results from the multicenter Prostate
Cancer Outcomes Study (PCOS), which has completed longitudinal assessments
of functional status in a large community-based cohort of patients with prostate
cancer treated with radical prostatectomy for clinically localized disease.
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies published in the 10 years since an earlier review by Spector and Carey (Arch. Sex. Behav. 19(4): 389–408, 1990). Community samples indicate a current prevalence of 0%–3% for male orgasmic disorder, 0%–5% for erectile disorder, and 0%–3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7%–10% for female orgasmic disorder and 4%–5% for premature ejaculation. Stable community estimates of the current prevalence of other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies has been conducted since the earlier review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings.
A consecutive series of 413 impotent men and 109 References rated their satisfaction with life as a whole and with seven different domains of life along a six graded scale ranging from very satisfied to very dissatisfied. In a subsample of impotent men treated with PGE1 these self-ratings were repeated applying the concept that dissatisfaction reflects an aspirations/achievement gap and successful treatment leads not only to increased sexual well-being but also to increased satisfaction with life as a whole. Regardless of the etiology of impotence pre-treatment level of sexual satisfaction was very low. In assumedly psychogenically impotent men levels of satisfaction with life as a whole, partnership and family life were also low. Using factor analytic technique satisfaction with sexual life was found to be a powerful predictor for satisfaction with life as a whole. In successfully PGE1-treated men pre-treatment decreased levels of satisfaction were significantly increased and generally normalization occurred.
From a representative sample of 2460 Danish citizens, ages 18 to 88, anonymous answers were obtained to a 317-item quality-of-life (QL) questionnaire, which included five questions on sexuality. Among the respondents in the sample, 1.2% reported they were bisexual and 0.9% homosexual. Although sexual problems were found in all age groups, lack of a suitable sex partner and inability to achieve orgasm were more common among the young and erectile dysfunction more common among the old. Most frequent problems among the women were reduced sexual desire (11.2%) and the lack of a suitable sex partner (4.9%), and among the men, the lack of a suitable sex partner (7.3%) and erectile dysfunction (5.4%). The QL of persons with sexual problems was from 1.2 to 19.1% lower than the population mean (as expressed in terms of this mean). The intermediate sized covariation between sexual problems and the QL suggests that such problems can be symptoms of a reduced QL rather than medical problems to be tackled through medical intervention or sex therapy proper. Implications for a quality-of-life-sensitive clinical practice are discussed.
Our objective was to analyze the prevalence and risk factors for erectile dysfunction (ED) in men with diabetes in Italy in a cross-sectional study.
Eligible for the study were men aged 20-69 years with a diagnosis of IDDM or NIDDM who were observed on randomly selected days in 178 diabetes centers in Italy. ED was defined as a failure to achieve and maintain an erection sufficient for satisfactory sexual performance.
Of the 9,868 diabetic men interviewed, 3,534 (35.8%) reported ED. The prevalence increased with age, from 4.6% in men aged 20-29 to 45.5% in those aged > or =60 years (test for trend, P = 0.0001). After taking into account the confounding role of age, men with NIDDM reported ED less frequently than did men with IDDM (odds ratio [OR], 0.7; 95% CI 0.6-0.8). In comparison with men reporting diabetes lasting < or =5 years, the ORs for ED were 1.3 and 2.0 for subjects with diabetes lasting 6-10 and 11-30 years, respectively. In comparison with men with good metabolic control, the ORs for ED were 1.7 and 2.3 in men with fair and poor control, respectively. A history of diabetes-related arterial, retinal, or renal diseases and neuropathy was associated with an increased risk of ED. Finally, in comparison with never-smokers, the ORs for ED were 1.5 (95% CI 1.3-1.6) for current smokers and 1.4 (95% CI 1.3-1.6) for ex-smokers. The OR increased with number of cigarettes smoked per day: in comparison with men smoking <12 cigarettes per day, the OR was 1.5 (95% CI 1.3-1.7) for those smoking > or =30 cigarettes day.
The study offers a quantitative estimate of the prevalence of ED and of its main risk factors in Italian men with diabetes.
Although erectile dysfunction is frequently seen in patients with manifestations of arteriosclerotic disease, the independent contribution of serum cholesterol in predicting erectile dysfunction is unclear. The aim of this study was to examine the relation between serum cholesterol and erectile dysfunction. Medical histories, physical examinations, and blood tests were obtained at Cooper Clinic, Dallas, Texas, from 3,250 men aged 26–83 years (mean, 51 years) without erectile dysfunction at their first visit, who had one more clinic visit, all between 1987 and 1991. These men were followed 6–48 months after the first clinic visit (mean, 22 months). Erectile dysfunction was reported in 71 men (2.2%) during follow-up. Every mmol/liter of increase in total cholesterol was associated with 1.32 times the risk of erectile dysfunction (95% confidence interval 1.04–1.68), while every mmol/liter of increase in high density lipoprotein cholesterol was associated with 0.38 times the risk (95% confidence interval 0.18–0.80). Men with a high density lipoprotein cholesterol measurement over 1.55 mmol/liter (60 m/dl) had 0.30 times the risk (95% confidence interval 0.09–1.03) as did men with less than 0.78 mmol/liter (30 mg/dl). Men with total cholesterol over 6.21 mmol/liter (240 mg/dl) had 1.83 times the risk (95% confidence interval 1.00–3.37) as did men with less than 4.65 mmol/liter (180 mg/dl). Those differences remained essentially unchanged after adjustment for other potential confounders. The authors conclude that a high level of total cholesterol and a low level of high density lipoprotein cholesterol are important risk factors for erectile dysfunction. Am J Epidemiol 1994;140:930–7.
The book concentrates on presenting the results of the national survey study in 1992. The central aim was to establish the changes in Finnish sex during the last 20 years (Sex life of Finns 1974, in Finnish language by Kai Sievers, Osmo Koskelainen and Kimmo Leppo). Our models were also Hans Zetterberg's ja Alfred Kinsey's sex studies in Sweden (1967) and USA (in the 1940s).
The research which has assessed the incidence and prevalence of sexual dysfunctions is reviewed. Twenty-three studies are evaluated. Studies completed with community samples indicate a current prevalence of 5-10% for inhibited female orgasm, 4-9% for male erectile disorder, 4-10% for inhibited male orgasm, and 36-38% for premature ejaculation. Stable community estimates with regard to the current prevalence of female sexual arousal disorder, vaginismus, and dyspareunia are not available. Recent studies completed with clinical samples suggest an increase in the frequency of orgasmic and erectile dysfunction and a decrease in premature ejaculation as presenting problems. Desire disorders have increased as presenting problems in sex clinics, with recent data indicating that males outnumber females. Methodological limitations of these studies are identified and suggestions for future research are offered.
The research which has assessed the incidence and prevalence of sexual dysfunctions is reviewed. Twenty-three studies are evaluated. Studies completed with community samples indicate a current prevalence of 5-10% for inhibited female orgasm, 4-9% for male erectile disorder, 4-10% for inhibited male orgasm, and 36-38% for premature ejaculation. Stable community estimates with regard to the current prevalence of female sexual arousal disorder, vaginismus, and dyspareunia are not available. Recent studies completed with clinical samples suggest an increase in the frequency of orgasmic and erectile dysfunction and a decrease in premature ejaculation as presenting problems. Desire disorders have increased as presenting problems in sex clinics, with recent data indicating that males outnumber females. Methodological limitations of these studies are identified and suggestions for future research are offered.
During the last two decades, significant advances have been made in the understanding of male sexual dysfunction. Concomitantly, a marked increase in both clinical and research activity in the field of male erectile dysfunction has led to a better evaluation and more treatment options. The prevalence and incidence are dependent on the definitions used, the diagnostic tolls, and the treatment options. Using standard definitions as suggested by the NIH Consensus Conference and improving our diagnostic and treatment options will have a major impact on the epidemiology of ED. A summary of the risk factors for ED is presented in Table 3. Still more epidemiologic research is essential to further understand the distribution as well as the prevalence of ED in certain ethnic groups, chronic conditions, and as a result of surgery and trauma. These studies will help us improve our diagnostic skills as well as our therapeutic options.
Medical literature concerning sexual dysfunction associated with antidepressant drug therapy in men is reviewed. Available information consists mainly of individual case reports or small series of cases. A complicating factor in understanding this area is the lack of sufficient information concerning sexual dysfunction associated with depression. Both erectile dysfunction and ejaculatory problems have been reported with the use of the clinically available antidepressants. No single agent seems to be implicated more frequently than the other drugs. Changes in libido have also been reported. The authors found no reported cases of priapism, which has been reported as a side effect of antipsychotic therapy.
Background: Coverage of sildenafil by health insurance plans is a contentious issue. Objective: To evaluate the cost-effectiveness of sildenafil treatment for erectile dysfunction. Design: A Markov decision model to estimate the incremental cost-effectiveness of sildenafil compared with no drug therapy. Data Sources: Values for the efficacy and safety of sildenafil and quality-of-life utilities were obtained from the published medical literature. Base-case values were chosen to bias against sildenafil use. Target Population: Men 60 years of age with erectile dysfunction. Time Horizon: Lifetime. Perspective: Societal and third-party payer. Intervention: Sildenafil or no treatment in identical hypothetical cohorts. Outcome Measures: Cost per quality-adjusted life-year (QALY) gained. Results of Base-Case Analysis: The cost per QALY gained for sildenafil treatment compared with no therapy was $11 290 from the societal perspective and $11 230 from the third-party payer perspective. Results of Sensitivity Analysis: From the societal perspective, the cost per QALY gained associated with sildenafil was less than $50 000 if treatment-related morbidity was less than 0.8% per year, mortality was less than 0.55% per year, treatment was successful in more than 40.2% of patients, or sildenafil cost less than $244 per month. The results were sensitive to variation of erectile dysfunction utilities, but cost per QALY gained was less than $50 000 if successful treatment increased utility values by 0.05 or more on a scale of 0 (death) to 1 (perfect health). Conclusions: In an analysis biased against use of sildenafil, the cost-effectiveness of sildenafil treatment compared favorably with that of accepted therapies for other medical conditions.
One thousand one hundred eighty men in a medical outpatient clinic were screened as to the presence of impotence. Four hundred one men (34%) were impotent, and of those, 188 (47%) chose to be examined for their problem. After a comprehensive evaluation the following diagnoses were obtained: medication effect, 25%; psychogenic, 14%; neurological, 7%; urologic, 6%; primary hypogonadism, 10%; secondary hypogonadism, 9%; diabetes mellitus, 9%; hypothyroidism, 5%; hyperthyroidism, 1%; hyperprolactinemia, 4%; miscellaneous, 4%; and unknown causes, 7%. The mean age of the impotent patients was 59.4 years, and the prevalence of alcoholism was 7%. Luteinizing hormone, follicle-stimulating hormone, testosterone, thyroxine, triiodothyronine (T3), T3 resin uptake, and prolactin studies were necessary to diagnose individual cases. We conclude that erectile dysfunction is a common and often overlooked problem in middle-aged men followed in a medical clinic.
(JAMA 1983;249:1736-1740)
• Little is known about sexual behavior among the elderly living in the community. Questions about sexual activity and its correlates were included in a clinic examination whose participants were identified by a household survey of a probability of Washtenaw County, Michigan, elderly, aged 60 years and over, on the medical, epidemiological, and social aspects of aging. Estimates of proportions based on responses at the clinic examination were also projected to the demographics of the household survey. The estimated proportions of individuals who are sexually active are 73.8% for married men and 55.8% for married women; among unmarried men and women the proportions are 31.1% and 5.3%, respectively. The levels decrease significantly with age in both genders. The estimated proportion of married men with erectile impotence is 35.3%. Significant associations were observed between having problems with mobility and the lack of sexual activity in both genders. The prevalence of impotency was significantly associated with a history of heart attack, urinary Incontinence, and the use of sedatives. The consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.
(Arch Intern Med. 1990;150:197-200)
Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies published in the 10 years since an earlier review by Spector and Carey (Arch. Sex. Behav. 19(4): 389–408, 1990). Community samples indicate a current prevalence of 0%–3% for male orgasmic disorder, 0%–5% for erectile disorder, and 0%–3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7%–10% for female orgasmic disorder and 4%–5% for premature ejaculation. Stable community estimates of the current prevalence of other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies has been conducted since the earlier review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings.
After a review of the literature and of our own data base this article specifies: the nosology of erectile dysfunction (ED) defined as an inability to achieve enough rigidityfora satisfactory intercourse. This lack of firmness is frequently associated with a loss of libido (37%), performance anxiety (37%), and premature ejaculation (40%). The prevalence of ED in the overall French population, age 18 to 70 years is 39% (11% presenting permanent ED defined as a rate of failure to perform of 50%). This rate increases with age to 52 and 25% respectively. A quantification of the symptomatology is proposed scoring three different aspects of sexual activity during intercourse, erectile activity in absence of intercourse, patient's satisfaction, and partner satisfaction. Figures of normal subjects and patients with ED are presented.
Purpose: With the changing age structure of the population in the Western industrial nations, age-correlated illnesses like erectile dysfunction are becoming increasingly important. At this time no questionnaire is available that has been validated in the German language and with German-speaking patients. Hence, we developed and validated a questionnaire (Cologne assessment of erectile dysfunction “KEED”) with patients of the Department of Urology, University of Cologne. The questionnaire was developed to register symptoms of erectile dysfunction. Material and Methods: It was given to 125 patients who where transferred to our outpatient clinic between November 1997 to February 1998. The men were examined in accordance with their specific symptoms. In this way clinical diagnosis was matched with the subjective patient information. Calculation of an E.D.-Score was made possible by the specific design of the questionnaire. Sensitivity, specifictiy and positive predictive value of the total sum values were computed. The average age of the patients was 56.3 years. Results: 105 of the 125 patients (85 %) answered the questions completely and correctly. With the sum values of the E.D.-Score, an ideal cut-off value of 17 with a sensitivity of 0.97, specificity of 0.93 and a positive predictive value of 0.98 was computed. The answer about contentment with sexual intercourse showed a positive correlation from 0,74. Conclusions: The “Cologne assessment of erectile dysfunction” (KEED) is the first in German and with German-speaking patients validated questionnaire. It offers the possibility of exact monitoring the symptoms of erectile dysfunction. Consequently, it represents a suitable instrument for epidemiological investigations in German-speaking populations. For clinical use “KEED” offers, by the separate assessment of erectile function and impairment of quality of life, the possitbility of a better judgement of the therapy necessity and success.
We provide a comprehensive review of the empirical literature regarding the prevalence of erectile disorder among men with diabetes mellitus. Estimates have varied from 7–85%, depending on sample characteristics. The average rate of erectile disorder in diabetic men (35%) was more than triple that of healthy controls (11%). Closer investigation of controlled research reveals only a slight difference in the prevalence of erectile disorder between men with diabetes and men with other chronic medical illnesses (26% versus 20%; p = .054). Overall, based on results of the 23 prevalence studies published since 1958, we suggest that 26–35% of diabetic men will develop erectile disorder. This estimated range counters the conventional view that erectile disorder is inevitable for men diagnosed with diabetes. Methodological limitations of extant research include inadequate study design (absence of appropriate control groups, use of cross‐sectional rather than longitudinal designs, failure to control for type of diabetes and other confounds), imprecise diagnostic criteria, and overreliance on self‐report measures. Future researchers need to assess the prevalence of distinct types of erectile disorder (e.g., lifelong versus acquired, generalized versus situational) among men with insulin‐dependent (Type I) diabetes and non‐insulin‐dependent (Type II) diabetes using accepted diagnostic criteria, a multivariate assessment strategy, and longitudinal designs. Although extant research has contributed to an understanding of erectile disorder among diabetic men, methodological improvements are necessary to provide more reliable and useful information.
Levels of satisfaction with life as a whole (happiness) and with eight different domains were investigated using mailed questionnaires in four age cohorts (25-, 35-, 45- and 55-year-olds) of men and women. With a few exceptions (vocational and financial satisfaction) levels of global and domain-specific satisfaction were not age-dependent and few gender differences were found. The generally high levels of satisfaction correspond well to those found in the USA and in Germany. Satisfaction with expressive (emotion-related) domains was greater in women than in men, and the provider items - satisfaction with vocational and financial situation -were influenced by age. The eight domains formed three meaningful factors: the first characterized satisfaction derived from expressive goals; the second from spare-time goals; and the third factor was instrumental (performance-related), characterizing satisfaction derived from provider goals. The three factors predicted gross level of happiness (happy/not happy) for 82% of subjects with complete answers, all three factors being significant predictors.
Background
Sexual function can be altered in patients by many neurological disorders affecting the cerebrum, the brain stem, the spinal cord, the spinal roots or the peripheral nerves. It can also be prominently affected in patients with an underlying undiagnosed neurological disease. Traditionally, practising neurologists have not paid much attention to sexual dysfunction in their patients, partly because therapeutic possibilities were scant. Sexual dysfunction, however, is observed in many neurological disorders, and may arise as a primary neurogenic disorder. Although not as obviously limiting as, for instance, paresis and pain, it is most disruptive for patients' lives. With emerging awareness of the primary importance of quality of life as the most important indicator of good patient management, and with the advent of more effective treatment of sexual dysfunction, it is no longer acceptable to ignore this very important dimension of life.In this review we will present the anatomical and physiological basis of the sexual response, the clinical approach to patients with sexual dysfunction, the characteristics of symptoms in neurological disorders, how to take a case history, diagnostic procedures and the treatment possibilities.
A massive survey of sexual lifestyles has been conducted in France (Nature 1992, 360, 407–409) in response to the spread of the AIDS epidemic. This survey was applied to 20 055 people aged 18–69 years and was focused on a detailed description of sexual practices and means of protection against AIDS contamination. Questions concerning sexual dysfunctions were included in an additional questionnaire. This article examines the most common male sexual dysfunction, premature ejaculation (PE) and its association with erectile dysfunction (ED). The prevalence rate of PE reported “often” was 11% (ED reported “often”: 7%). The prevalence rate of PE reported “often” or “sometimes” or “quite seldom” was 65% (ED: 47%). With regard to the association of PE with ED, 26% of men aged 18–24 reported neither PE, nor ED, 11% reported only ED, 41% only PE, and 22% both PE and ED; 4% of men aged 60–69 reported neither PE nor ED, 27% reported only ED, 28% only PE, and 41% both PE and ED. I discuss these prevalence rates and I propose a typology of PE.
The purpose of this prospective study was to evaluate the sexual function of patients with benign prostatic hyperplasia (BPH) before and after transurethral resection of the prostate (TURP). The sexual functions of 155 patients with BPH were evaluated before TURP and 6 and 12 months afterwards. The mean age of the patients was 69 years (range 49-86 years). The only significant change in sexual function after TURP was improvement in early morning erections (P < 0.01). Sixty-eight per cent of the patients were satisfied with their sex life before TURP, 69% after 6 months and 67% after 12 months. The corresponding percentages of patients satisfied with their libido were 60%, 59% and 54%. Only 26% of the patients had completely satisfactory erections before TURP, while 22% had them 6 months later and 24% 12 months later. The proportion of fully impotent patients was 11% before the procedure, 13% after 6 months and 16% after 12 months. In 84% of the patients ejaculation was retrograde 6 months and 12 months after TURP. We conclude that TURP does not affect the sexual function of patients with BPH, with the exception of retrograde ejaculation.
Objective: This paper examined the economic cost of male erectile dysfunction (ED) for a hypothetical managed-care (MC) model.
Design and Setting: A prevalence-based cost-of-illness approach was used to estimate the direct medical cost for ED treatment. A treatment plan algorithm was developed from a MC perspective to model the initial treatment selection of various patient groups [vacuum erection device, intracavernosal injection (ICI) therapy, transurethral alprostadil suppository, sildenafil, testosterone replacement therapy, penile prosthesis] and their therapy outcomes during a 3-year period. Overall cost was based on 1998 US dollars. Total direct medical cost of ED considered in this model included the cost of initial physician consultation and evaluation, the cost incurred by patients from various treatment groups (pharmacological and surgical options), as well as the cost related to patients’ follow-up for treatment within the 3-year period. Consideration for therapy switches made by patients who failed initial therapy was included as part of the clinical assumptions for this model. Treatment response and expected outcomes (dropouts) were considered for the various treatment options.
Participants: A total of 100 000 enrolled members were included in the study.
Main outcome measures and results: The total cost of ED was $US3 204 792 for the 3-year period in the hypothetical MC plan. The treatment portion accounted for approximately 80% of the total cost while the cost of medical services and diagnostic tests were minimal in comparison. The 3 year total cost of nonsurgical treatment was $US2 473 045. Costs associated with each treatment alternative were $US81 866 (testosterone transdermal patch), $US51 930 (vacuum erection device), $US384 624 (ICI therapy), $US226 483 (transurethral alprostadil suppository) and $US1 728 142 (sildenafil citrate). Results from the model showed a noticeable trend of decreasing cost patterns over time and reflected the attrition observed for many of the standard medical therapies for ED.
Conclusions: Sildenafil and the vacuum erection device should be considered as first-line management strategies for ED whereas ICI therapy, transurethral alprostadil suppository and penile prosthesis implant should be reserved for second- or third-line therapy. Because costs associated with switches related to successive treatment failures can be high, treatment considerations should, therefore, focus on achieving long term patient satisfaction. The patient’s preferred treatment choice, using goal-directed therapy during the initial consultation and evaluation visit, should be used.
Objective
To present the pattern of self-report and diagnosis of erectile dysfunction in the US over the time period 1990 through 1998 and examine whether the introduction of sildenafil in March 1998 influenced these findings.
Study design and methods
Retrospective database analysis. Data from the National Ambulatory Medical Care Survey (NAMCS) for the years 1990 through 1998 were used. Data from office-based physician-patient encounters for which either a complaint of erectile dysfunction as one of the reasons for requesting an encounter [National Center for Health Statistics (NCHS) code 1160.3] or a diagnosis of erectile dysfunction [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 302.72 or 607.84] was documented were extracted for men aged ≥40 years. National estimates per year were derived for: (i) the number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an encounter and the number of office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented; (ii) the rate per 1000 office-based physician-patient encounters for which a complaint of erectile dysfunction as a reason for requesting the encounter was documented and the rate per 1000 office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented; and (iii) the rate per 1000 US male population aged ≥40 years with a complaint of erectile dysfunction as a reason for requesting an encounter and the rate per 1000 US male population aged ≥40 years with a diagnosis of erectile dysfunction.
Results
The number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented increased from 764 682 in 1990 to 1 273 730 in 1998. The number of office-based physician-patient encounters with a recorded diagnosis of erectile dysfunction more than doubled over the time period examined, from 647 418 in 1990 to 1 495 793 in 1998. Office-based encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an appointment increased from 5.7 per 1000 in 1990 to 7.0 per 1000 in 1998; the rate of diagnosis of erectile dysfunction increased from 4.8 per 1000 in 1990 to 8.2 per 1000 in 1998. The population-adjusted rate of complaint of erectile dysfunction increased from 17.5 per 1000 in 1990 to 24.2 per 1000 in 1998; the rate of diagnosis increased from 14.9 per 1000 in 1990 to 28.4 per 1000 in 1998. In 1998, 2 142 776 office-based physician-patient encounters documented the prescribing of sildenafil; of these, 41% were for patients with a recorded diagnosis of erectile dysfunction.
Conclusions
The introduction of sildenafil was found not to have influenced the established upward trend in the documented rate of self-report of erectile dysfunction or the diagnosis of erectile dysfunction. However, the prescribing of sildenafil appears to offer greater insight into the actual magnitude of the problem erectile dysfunction represents in the US. Findings suggest there is a reluctance on the part of patients to discuss concerns about erectile dysfunction with their physician and a reluctance on the part of physicians to document patients’ expressed concerns regarding erectile dysfunction and/or to record a diagnosis of erectile dysfunction.
Little is known about sexual behavior among the elderly living in the community. Questions about sexual activity and its correlates were included in a clinic examination whose participants were identified by a household survey of a probability of Washtenaw County, Michigan, elderly, aged 60 years and over, on the medical, epidemiological, and social aspects of aging. Estimates of proportions based on responses at the clinic examination were also projected to the demographics of the household survey. The estimated proportions of individuals who are sexually active are 73.8% for married men and 55.8% for married women; among unmarried men and women the proportions are 31.1% and 5.3%, respectively. The levels decrease significantly with age in both genders. The estimated proportion of married men with erectile impotence is 35.3%. Significant associations were observed between having problems with mobility and the lack of sexual activity in both genders. The prevalence of impotency was significantly associated with a history of heart attack, urinary incontinence, and the use of sedatives. The consumption of at least one cup of coffee per day was significantly associated with a higher prevalence of sexual activity in women and with a higher potency rate in men.
The distribution of four main arterial risk factors (ARF) (diabetes, smoking, hyperlipidaemia (HLP), and hypertension) was investigated in 440 impotent men (mean age 46.8) in whom the penile blood-pressure index (PBPI) (ie, the ratio of the lowest systolic pressure in one of the four main arteries of the penis to the systolic pressure in the arm) was measured. In 222 the cause (organic or functional) of impotence was sought by further investigations, such as cavernosonography. 80% of this subgroup had organic impairment of erection. In 53% of these there was evidence of an arterial lesion. Smoking (64%), diabetes (30%), and HLP (34%) were all significantly more common in the 440 impotent men than in the general male population of a similar age. Whenever two or more ARFs were present mean PBPI was significantly lower. The frequency of organic impotence increased from 49% in the absence of any ARF to 100% in patients with 3 or 4 ARFs. It is concluded that increase in the frequency of impotence with age is mainly related to arteriosclerotic changes for the arteries of the penis and that the ARF and PBPI should be evaluated first in any patient complaining of impotence.
Medical literature concerning sexual dysfunction associated with antidepressant drug therapy in men is reviewed. Available information consists mainly of individual case reports or small series of cases. A complicating factor in understanding this area is the lack of sufficient information concerning sexual dysfunction associated with depression. Both erectile dysfunction and ejaculatory problems have been reported with the use of the clinically available antidepressants. No single agent seems to be implicated more frequently than the other drugs. Changes in libido have also been reported. The authors found no reported cases of priapism, which has been reported as a side effect of antipsychotic therapy.
In 49 male survivors of one myocardial infarction (MI) aspects of sexual function before and after the vascular catastrophe were investigated by means of structured interviews. In additionally 13 subjects penile blood pressure and flow were measured. In 63% of the subjects sexual function had deteriorated to some extent after the MI. The level of general sexual satisfaction decreased in 45%, and changes were associated with changes in sexual function. Stigmatization was associated with sexual dysfunctions. The findings indicate that both biologic and psychosocial factors are influential on the emergence of sexual dysfunction and, therefore, frustration.
One thousand one hundred eighty men in a medical outpatient clinic were screened as to the presence of impotence. Four hundred one men (34%) were impotent, and of those, 188 (47%) chose to be examined for their problem. After a comprehensive evaluation the following diagnoses were obtained: medication effect, 25%; psychogenic, 14%; neurological, 7%; urologic, 6%; primary hypogonadism, 10%; secondary hypogonadism, 9%; diabetes mellitus, 9%; hypothyroidism, 5%; hyperthyroidism, 1%; hyperprolactinemia, 4%; miscellaneous, 4%; and unknown causes, 7%. The mean age of the impotent patients was 59.4 years, and the prevalence of alcoholism was 7%. Luteinizing hormone, follicle-stimulating hormone, testosterone, thyroxine, triiodothyronine (T3), T3 resin uptake, and prolactin studies were necessary to diagnose individual cases. We conclude that erectile dysfunction is a common and often overlooked problem in middle-aged men followed in a medical clinic.