ArticleLiterature Review

The worldwide prevalence and epidemiology of erectile dysfunction

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Abstract

This paper: (i) describes the worldwide prevalence of erectile dysfunction (ED); (ii) presents age-specific incidence rates for ED in the US; (iii) summarizes some key epidemiologic correlates of ED in the general population; and (iv) considers the possibility that ED may be a biobehavioral marker (sentinel event) of subsequent cardiovascular disease in men. Clinical, anthropometric, life style and hormonal data are presented from the milestone Massachusetts Male Aging Study (MMAS), a large (over 1000) prospective cohort of randomly sampled community-dwelling, normally aging men. Newly updated population prevalence and (more importantly) age-specific incidence rates are reported. We also estimate the likely magnitude of ED that will accompany the worldwide globalization of aging. Key correlates (predictors) of incident ED, especially vasculogenic influences, are identified and discussed. In conclusion, ED is a common biobehavioral phenomenon and there are strong physiological and epidemiological reasons for considering it a major marker (or predictor) of subsequent cardiovascular disease in men. International Journal of Impotence Research (2000) 12, Suppl 4, S6-S11.

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... In addition, the global prevalence of erectile dysfunction is expected to reach 322 million cases by 2025. Owing to its widespread occurrence on a global scale, the prevalence of ED has gained significant recognition as a prominent health concern among the progressively thriving elderly demographic [20,21]. ...
... ED primarily affects men older than 40 years of age and as a result, ED is regarded as a major health problem for the increasingly healthy ageing population and the worldwide prevalence of ED has been predicted to reach 322 million cases by the year 2025 [20,21]. Several studies have explored the epidemiology of ED by considering different settings and populations and two milestone studies have provided valuable results in this setting: the Massachusetts Male Ageing Study (MMAS) and the European Male Ageing Study (EMAS). ...
Article
The global incidence of erectile dysfunction is increasingly becoming a significant health concern, as its frequency demonstrates a consistent upward trajectory each year. In recent years, FDA-approved drugs like silden-afil among others has been approved to treat this disorder however the drug is not without its own side effects. In a bid to develop alternative therapeutic option, scientists have now turned to traditional medicine in search of a treatment regimen. Africa is blessed with numerous medicinal plants used in the treatment and management of several diseases including erectile dysfunction. Due to limited access to modern medicine and high-quality medical facilities, a significant number of individuals in Africa continue to depend on traditional medicine as a means of addressing critical health issues. Perhaps one of the grossly explored medicinal properties of plants in Africa is for erectile function. Through years of extensive research in medicinal plants, several plants indigenous to Africa have been identified to show profound ability to mitigate erectile dysfunction. While previous reports have indeed corroborated the ability of this plant to abate erectile dysfunction, there is still a dearth of information regarding the mechanistic aspect of these plants. Hence, the current review aims to provide a comprehensive mechanistic perspective to the major African medicinal plant which have been reported to be effective in the treatment of erectile dysfunction.
... Estimates on the prevalence of ED range from 12 to 47% depending on age group but likely undervalue the true scale given expected under-reporting and differences in disease de nition and treatment threshold (2). Nonetheless, ED and its surgical treatment represent a signi cant proportion of patients in a typical urology practice (3). ...
... While one and two-piece implants are available, by far the most common implant utilized currently is the three-piece in atable prosthesis as it mimics a physiologic erection (3). Currently, there are two FDAapproved three-piece devices, the AMS 700™ series (Boston Scienti c, Massachusetts) and the Coloplast Titan® (Coloplast, Minnesota). ...
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We compare using a prospective data collection the likelihood of infection and short-term revision in inflatable penile prosthesis (IPP) placements when using AMS 700 TM CX series versus Coloplast Titan®. The study included the first-time IPP implantations using both implants performed between January 2017 and December 2019. The surgeon alternated the implants every other week, and the patients were divided into two cohorts based on implant company for comparison and study. Data were collected on patient demographics, implant characteristics, perioperative features, and complications. Follow-up was carried out at 6 weeks, 3 months, and then annually. A total of 542 patients underwent IPP implantations during the two years, 301 (56%) were performed using AMS 700 TM CX and 241 (44%) using Coloplast Titan®. There was only one (0.18%) case complicated by infection. Seven cases (1.3%) required revision, five had been done using AMS 700 TM CX implants. Overall, the most common reason for revision was tube fracture (n=3). Diabetes, case time, reservoir type, and reservoir location were not significant prognostic factors for revision (p>0.05). We concluded that regarding manufacturing companies the risk of infection is not affected. Diabetes and drain placement for three days did not increase the risk of infection or overall revision.
... This variation may be attributed to methodological differences and the diverse ages of study populations (2). The prevalence and incidence of ED tend to increase with age (3). For instance, ED affects 2% of men under the age of [40][41][42][43][44][45][46][47][48][49][50] and 40-50% of men older than 60-70 years. ...
Article
Objective: Childhood traumas (CT), particularly sexual abuse, are linked with sexual dysfunction and reduced sexual satisfaction. This study explores the association between CT, anxiety, and sexual satisfaction in individuals with erectile dysfunction (ED). Method: The study cohort consisted of 93 patients with ED and 95 control group volunteers. Participants completed self-report forms on demographic data and sexual histories, along with the Childhood Trauma Questionnaire (CTQ), the State and Trait Anxiety Inventory (STAI), and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Results: Forty participants from the ED groups also had a co-diagnosis of premature ejaculation (PE). Those with co-morbid PE were categorized as a separate group (ED + PE). Physical abuse, sexual abuse, and minimization as measured by the CTQ, along with impotence, infrequency, and dissatisfaction as measured by the GRISS, were significantly lower in the control group compared to the ED and ED + PE groups (p<0.001). Anxiety scores were significantly different between the ED + PE group and both the ED and control groups (p<0.001). A history of childhood sexual abuse was linked to avoidance behavior (p<0.05). Significant correlations were observed between emotional maltreatment and PE (p<0.05), impotence and minimization (p<0.001), impotence and psychical neglect (p<0.05), and tactile avoidance and emotional neglect (p<0.01). Conclusion: This study highlights the importance of CT, including types other than sexual abuse, in contributing to sexual dysfunction and diminished satisfaction.
... A penile prosthesis is typically placed for patients with erectile dysfunction (ED) unresponsive to medical management and in patients after reconstructive surgeries for penile malignancies, congenital anomalies, or trauma. Demand has seen a steady rise with prevalence expected to exceed 320 million by 2025 [58]. MRI is paramount for the evaluation of implant position, mechanical complications, and to detect early signs of infection [59]. ...
Article
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Penile MRI is a vital yet underutilized diagnostic tool that provides detailed information crucial for managing various penile pathologies. Due to its infrequent use, many radiology trainees lack confidence in interpreting these exams. This article reviews the anatomy, key technical considerations, and interpretive pearls for penile trauma, Peyronie’s disease, priapism, penile neoplasms, prosthesis evaluation, and a few miscellaneous conditions. Through illustrative case examples, this review aims to enhance the understanding and proficiency of radiologists in performing and interpreting penile MRI in these clinical scenarios.
... More than 30 million men in the United States and far more all over the world have erectile dysfunction (ED), which is a pervasive disorder and a most common disability. Very few are seeking medical attention, and even fewer have received minimal benefits from modern pharmaceutical based therapy [1]. ED is the incapability of the person for satisfactory sexual intercourse to achieve or maintain a penile erection [2]. ...
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Erectile dysfunction is a common disorder found in men, which occurs due to multiple factors such as psychogenic, hormonal imbalance, and neurovascular disturbances. The present investigation was undertaken to examine the effect of a Consciousness Energy Healing based DMEM medium on the Human Endothelial Hybrid Cell Line (EA. hy926) to evaluate the level of cyclic guanosine monophosphate (cGMP). The test item (DMEM medium) was divided into three parts, first part received a one-time Consciousness Energy Healing Treatment by a renowned Biofield Energy Healer, Alice Branton and was labeled as the one-time Biofield Energy Treated (BT-I) DMEM, while second part received the two-times the Biofield Energy Treatment and is denoted as BT-II DMEM. The third part did not receive any treatment and defined as the untreated DMEM group. The level of cGMP for the inhibition of PDE-5 enzyme was assessed using cGMP ELISA assay kit (colorimetric). Sildenafil citrate, used as positive control, which showed a significant increase of cGMP levels in Ea. hy926 cells. The one-time Biofield Energy Healing Treated DMEM (BT-I) showed 29.92% alteration, while the two-times Biofield Energy Healing Treated DMEM (BT-II) showed a significantly (p≤0.001) increased level of intracellular cGMP by 307.09% in Ea. hy926 cells compared to the untreated DMEM group. Overall, experimental data suggested that the two-times Biofield Treated DMEM showed a significantly improved level of cGMP compared with the one-time Biofield Treated DMEM group. Therefore, data indicated that the Biofield Energy Healing Treatment can be used to treat erectile dysfunction along with other sexual disorders such as orgasmic disorders, female sexual arousal disorder, fetishistic disorder, frotteuristic disorder, hypoactive sexual desire disorder, sex addiction, sexual masochism and sadism, vaginismus, voyeuristic disorder, premature or delayed ejaculation.
... ED is a widespread health concern affecting men globally. It has been reported that up to 30 million men in the United States and 150 million men worldwide are estimated to be affected by ED [10,11] . It is estimated that by 2025 we will see up to 322 million men affected, with prevalence rates reaching up to 70% in men 70 years and above [12] . ...
Article
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Artificial intelligence (AI) is a complex combination of multidisciplinary machines and systems that can replicate human‐like cognitive tasks to execute capabilities such as pattern recognition, decision‐making, and problem‐solving. Dating back to the 2000s, AI has been utilized in the medical field, however the interest in this subject has sharply increased over the past several years. Erectile dysfunction (ED) is an increasingly pervasive issue as men age, affecting up to 150 million men worldwide. In the field of men's health, AI has been employed to assist physicians in the evaluation and management of ED. This article aims to summarize the ways in which AI has been utilized in the management of ED, as well as the considerations that must be made when implementing this technology. AI can be utilized for virtual health assistance to protect patient privacy and increase access to care. Augmented reality can aid surgeons in real‐time during operations, as well as be utilized to prepare physicians for situations that they may encounter in the operating room. Pharmaceutical companies can benefit from AI in the interpretation of data, analysis of chemical compounds and in drug development. Additionally, AI can be used to assist patients in post‐procedure recovery in the form of rehabilitation and post‐treatment monitoring. While the utilization of AI in men's health is an exciting venture, there are tremendous ethical and practical considerations that have limited its use in the management of ED.
... [3][4][5] Despite the high prevalence of ED, it is still underdiagnosed and undertreated. 6 It is alarming that many men with ED do not seek professional help or voice their concerns despite wishing to be treated. [7][8][9] In many cases, this is a result of cultural perceptions of sex and shame upon seeing a female physician. ...
Article
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Purpose: Erectile dysfunction (ED) is frequently undermanaged due to communication barriers, particularly among Asian men. We looked at how ED discussion and treatment were affected by the patient's prompt sheet and the Knowledge Translation Tools in the Management of Erectile Dysfunction (LASTED). Methods: We conducted a quasi-experimental study in a primary care clinic in Kedah, Malaysia involving 120 Asian men with diabetes. In the intervention group, patients were given a prompt sheet to indicate their intention to discuss or receive ED treatment, and physicians were provided with LASTED to assist with ED consultation. The control group patients received standard care from their physicians. Results: The intervention increased the initiation of ED discussion up to 66.7% compared with 8.3% in the control group. In the intervention group, 57.5% of patients were prescribed phosphodiesterase-5 inhibitors and men with ED of moderate severity were more likely to be prescribed oral ED medication. Use of the LASTED flipchart was associated with prescription of phosphodiesterase-5 inhibitors (P = .011) and patient satisfaction with ED consultation (P <.001). Conclusion: Our study suggests that using the LASTED flipchart and patient's prompt sheet together may encourage ED conversation and medication prescription particularly when working with Asian men who frequently view ED as a taboo subject.
... In 1995, 152 million men were affected, and according to studies, by 2025, this number will have increased to 322 million [3]. This increase is mainly due to the growing proportion of elderly people in the population [4,5] Recently, ED treatment has evolved considerably and has been revolutionized by the introduction of phosphodiesterase-5 inhibitors (PDE5i), which are considered the first-line therapy for ED. However, up to 50% of patients on PDE5is still have insufficient erections for intercourse or experience relevant side effects [6]. ...
Article
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Background Venous leak appears to be the most common cause of vasculogenic erectile dysfunction (ED), which can be treated with venous embolization. Traditionally, conventional cavernosography was used for the diagnosis and treatment planning of venous leak. Recently, computed tomography (CT) cavernosography was introduced as a novel cross-sectional imaging method proposed to be advantageous over conventional cavernosography. We created a novel management algorithm for diagnosing venous leak including CT cavernosography as an imaging modality. In order to provide a broader basis for our management algorithm, a systematic literature review was conducted. Main body In this article we systematically review relevant literature on using CT cavernosography for the diagnosis and treatment planning in ED patients with venous leak following the PRISMA selection process. Nine full-text articles were included in the review and assigned a level of evidence grade (all grade II). Two studies (2/9) compared the results of conventional cavernosography with those of CT cavernosography which was superior for site-specific venous leak identification (19.4% vs. 100%, respectively). CT cavernosography is a more detailed imaging method that is faster to perform, exposes the patient to less radiation, and requires less contrast material. In one study (1/9), CT cavernosography was used for diagnostic purposes only. Eight studies (8/9) cover both, diagnostic imaging and treatment planning including embolization (1/9) and sclerotherapy (2/9) of venous leak in patients with venogenic ED. Three studies (3/9) describe anatomical venous leak classifications that were established based on CT cavernosography findings for accurate mapping of superficial and/or deep venous leak and identification of mixed or more complex forms of venous leak present in up to 84% of patients. In addition to treatment planning, one study (1/9) used CT cavernosography also for follow-up imaging post treatment. Conclusion CT cavernosography is superior to conventional cavernosography for diagnosis and treatment planning in patients with ED caused by venous leak (grade II levels of evidence). Consequently, CT cavernosography should be included in management algorithms for ED patients with suspected venous leak.
... General satisfaction score was found to be 8 (5.3-9) in the male patient group and 8 (8-10) in the control group and sexual satisfaction score was found to be 10 (7)(8)(9)(10)(11)(12) in the male patient group and 13 (10.3-14) in the control group. (Table 2b) There was no signi cant difference between marital status, hypertension status, smoking and alcohol consumption with respect to erectile function score among the male patients (Table 2a). ...
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In this study, it is aimed to investigate the prevalence of sexual disorders in patients in stage 2–5 stage chronic kidney disease and its relationship with laboratory parameters, including demographic, clinical and especially metabolic acidosis. This is a cross-sectional study consisting of 110 predialysis patients with chronic kidney disease and 110 healthy controls admitted to nephrology out-patient clinics. IIEF (International Index of Erectile Function) and FSFI (Female Sexual Function Index) questionnaire was applied to the patients and control group. The relationship between demographic, clinical and various biochemical parameters, sexual dysfunction in the patient group was assessed. Sexual dysfunction was detected in 76% of the female patients and 31.4% of the control group.FSFI total. Subscale scores of the patients were significantly lower than the control group. In male patients and controls, the frequency of erectile dysfunction was 56.7% and 33.3% respectively. The erectile function, sexual satisfaction and overall satisfaction scores of the IIEF scale were significantly lower than the control group. Female patients reported %40 regular menstrual cycles. Advanced age was associated with loss of libido in female patients, while erectile dysfunction was associated with loss of libido, orgasmic disturbance and sexual dissatisfaction in male patients. Low Glomerular filtration rate(GFR), high calcium(Ca) levels, increased CRP, anemia and metabolic acidosis in both genders. Testosterone deficiency in male patients were associated with sexual dysfunction. In multiple regression analysis, eGFR was the only independent variable associated with sexual dysfunction. The increase in Parathormone (PTH) and Prolactin levels was related to the loss of libido in both genders. Sexual dysfunction is widely observed in male and female patients with chronic kidney disease. There is a need for public awareness of sexual dysfunction, as well as specific studies to better characterize, assess, understand and treat. Clinical Implications:. Despite common neglect,sexual disorders in chronic kidney disease can be optimized with simple precautions Strengths&Limitations: This study contributes to the literature in sexual dysfunction about female CKD patients. Another prospective study should enstrength the findings. Conclusion: Metabolic acidosis and low eGFR seem to be the most important risk factors contributing sexual disorders in CKD patients.
... ED defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual activity has a prevalence of 20 million in Europe and 30 million in the United States. It is estimated at approximately 150 million worldwide [32,33]. ED is mainly caused by organic causes such as vascular, hormonal, and neurogenic etiologies. ...
Article
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Purpose: Cardiovascular disease (CVD) is one of the leading causes of death, accounting for one-third of all deaths worldwide. Patients with CVD are three times more likely to complain of sexual dysfunction than healthy people. Causes of sexual dysfunction in patients with CVD include physical/mental changes and drug side effects. The prevalence of sexual dysfunction in patients with CVD has been estimated to be up to 89%. Ordinary treatments such as pharmacotherapy cannot effectively reduce sexual problems. Therefore, sexual rehabilitation has a broad spectrum, including exercise therapy such as pelvic floor muscle treatment, appropriate counseling, a multidisciplinary approach, and partner rehabilitation. In this study, systematic review and meta-analysis was performed to investigate the effect of sexual rehabilitation on sexual problems in patients with CVD. Materials and methods: Comprehensive literature searches were conducted using MEDLINE, Cochrane Library electronic database, and EMBASE through June 2022. Questionnaire scores at the end point as outcomes of the study were recorded as were standardized mean difference (SMD) with their 95% confidence intervals (CIs). Meta-regression analysis was conducted for each moderator. We performed a risk of bias evaluation for included studies using the RoB 2 tool. Results: The overall SMD in the meta-analysis for sexual rehabilitation versus no-sexual rehabilitation was 0.430 (95% CI, 0.226-0.633). There was a statistical difference between groups. SMD changes were 0.674 (95% CI, 0.308-1.039) at one month and 0.320 (95% CI, 0.074-0.565) at six months. The regression analysis with all variables (number of patients, study duration, and questionnaire types) revealed no significance. Conclusions: This study indicates that sexual rehabilitation is an effective method with high therapeutic potential for sexual dysfunction of patients with CVD. However, for clinical application, well-designed studies with many patients should be conducted in the future and the standardization of rehabilitation protocols is required.
... 1 ED is highly prevalent, affecting more than 150 million men worldwide. 2 In Portugal, most recent surveys indicate a prevalence between 5 -28% depending on the definition. 3 As the male population ages and awareness of the problem increases, it is expected that the prevalence will at least double in forthcoming years. ...
Article
Introdução: A disfunção erétil é uma doença com elevada prevalência existindo crescente interesse na sua terapêutica endovascular. Devido à complexidade do sistema arterial pélvico masculino, o conhecimento anatómico é fundamental. Avaliou-se a aplicabilidade da classificação de Yamaki na avaliação de doentes com disfunção erétil arteriogénica usando a Angiografia Tomográfica Computorizada e a Angiografia Digital de Subtração.Métodos: Análise retrospetiva dos achados imagiológicos de Angiografia Tomográfica Computorizada e Angiografia Digital de Subtração em 21 doentes do sexo masculino, com suspeita de disfunção erétil arteriogénica, que foram submetidos a embolização pélvica seletiva numa única instituição. A função erétil foi avaliada através do IIEF-5. O padrão de bifurcação da Artéria Ilíaca Interna foi caracterizado de acordo com a classificação de Yamaki. O diagnóstico da disfunção erétil arteriogénica foi feita baseado na presença de lesões ateroscleróticas da Artéria Ilíaca Interna e da Artéria Pudenda Interna.Resultados: A idade média foi de 67,2 anos; a média do IIEF foi 10,6 pontos. A Angiografia Tomográfica Computorizada e a Angiografia Digital de Subtração permitiram a classificação de todos os 42 lados pélvicos de acordo com a classificação de Yamaki. Vinte e quatro lados pélvicos foram classificados como Grupo A (57%), nove como Grupo B (21,5%) e nove como Grupo C (21,5%). A Angiografia Digital de Subtração detectou 19 Artérias Pudendas Internas anormais (lesões ateroscleróticas) (45%). A Angiografia Tomográfica Computorizada detectou 24 Artérias Pudendas Internas anormais (57%).Conclusão: Os achados por Angiografia Tomográfica Computorizada e Angiografia Digital de Subtração incluem estenoses e oclusões da Artéria Ilíaca Interna e da Artéria Pudenda Interna. A classificação de Yamaki tem reprodutibilidade radiológica e permite o reconhecimento da Artéria Pudenda Interna em doentes com disfunção erétil arteriogénica.
... The inability to generate or sustain an adequate penile erection for satisfying sexual performance is referred to as erectile dysfunction (ED), a traditional male sexual dysfunction that increases with men's age (NIH Consensus Conference, 1993). As a global problem, it is predicted that there will be 322 million cases of ED by 2025 (Ayta et al., 1999;McKinlay, 2000). The causes of ED are numerous and could be organic (e.g., vascular and neurogenic), psychogenic (e.g., excessive performance anxiety), or mixed (Salonia et al., 2020). ...
Article
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Background: The causal relationship between depression and erectile dysfunction (ED) is still uncertain. Objectives: To identify the genetically predicted causality of depression on ED through Mendelian randomization (MR). Materials and methods: A comprehensive GWAS meta-analysis comprising 807,553 Europeans provided single-nucleotide polymorphism (SNP) information for depression, and another genome-wide association analysis involving 223,805 European ancestries measured SNPs for ED. The inverse variance weighted (IVW) method was used as the primary MR analysis method to evaluate causal effects. In addition, the maximum likelihood method, MR-Egger, weighted median, robust adjusted contour score (MR.RAPS), and MR pleiotropic residual and outlier (MR-PRESSO) methods were used as supplements for sensitivity analysis. Results: According to the IVW analysis, depression significantly increases the incidence of ED (odds ratio [OR] = 1.68, 95% confidence interval [CI] = 1.38–2.05, p < 0.001). In sensitivity analyses, the ORs for the maximum likelihood method, MR-Egger, weighted median, MR.RAPS, and MR-PRESSO are 1.70 (95% CI = 1.39–2.08, p < 0 .001), 1.94 (95% CI = 0.63–6.01, p > 0 .05), 1.59 (95% CI = 1.21–2.10, p < 0 .001), 1 .70 (95% CI = 1.39–2.08, p < 0 .001), and 1.68 (95% CI = 1.40–2.04, p < 0 .001). There is no clear indication of potential heterogeneity or pleiotropy (p for the MR-Egger intercept = 0.804; p for the global test = 0.594; and p for Cochran’s Q statistics >0.05). Conclusion: Genetically predicted depression plays a potentially causal role in the occurrence of ED.
... Erectile dysfunction is the most common form of male sexual dysfunction, which affects about 30 million men in the United States [1] and is expected to impact over 300 million men worldwide by the year 2025 [2]. Prostate Cancer is one of the leading causes of cancer death in men in the US. ...
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Background Inclusion of ethnic/racial minorities in clinical trials is essential to fully assess therapeutic efficacy. It is well-known that populations respond dissimilarly to interventions. Our objective is to analyze the inclusion of minority men in clinical trials for erectile dysfunction (ED). Methods We searched ClinicalTrials.gov for the disease keyword: “Erectile Dysfunction (ED)” and used “Prostate Cancer” for comparison. Completed trials which reported demographic data were included for analysis. Literature was reviewed to determine the prevalence of ED and prostate cancer (PC) among Hispanic, Black, White, and Asian men. The proportion of individuals of each group that participated in trials is divided by the proportion of each group in the disease population to calculate the “Participation to Prevalence Ratio” (PPR). PPRs between 0.8-1.2 indicates adequate representation, <0.8 is under-representation and >1.2 is over-representation. Results A total of 312 trials were assessed: 289 for prostate cancer and 23 for ED. Hispanic men comprised 11.8% of ED trial participants and 4.61% of prostate cancer trial participants, yet represented 18% of ED patients and 7.3% of PC patients. Black/African-American (AA) men accounted for 10.2% of ED trial participants and 9.4% of PC trial participants, but comprise 16% of ED patients, and 16.3% of PC patients. Hispanic and AA men are under-represented in trials for ED and Prostate Cancer (Hispanic ED PPR = 0.66; Hispanic PC PPR = 0.63; AA ED PPR = 0.42; AA PC PPR = 0.58). Conclusion Our analysis shows that both Hispanic and AA men are underrepresented in both ED and PC clinical trials.
... Erectile dysfunction (ED) in a man can be diagnosed when during almost all occasions of sexual activity (75-100% on average), at least one of the following three symptoms occurs: (1) marked difficulty in obtaining an erection during sexual activity, (2) marked difficulty in maintaining an erection until completion of sexual activity, (3) marked decrease in erectile rigidity [25]. The incidence of ED in the general population ranges from 10-15% in men aged 40-49 to 50-70% in men aged 60-79 years [29,30] Risk factors include age, cardiovascular diseases, diabetes, obesity, smoking, and depression [31,32]. The incidence of ED in the cancer patient population may be around 29% at the time of diagnosis and 43% after treatment, but it is strongly dependent on the type of cancer and may be up to 80-90% for prostate, anus or colorectal cancers [33]. ...
Article
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Sexual dysfunction is common in patients with advanced cancer, although it is frequently belittled, and thus consistently underdiagnosed and untreated. Opioid analgesics remain fundamen- tal and are widely used in cancer pain treatment. However, they affect sexual functions primarily due to their action on the hypothalamus–pituitary–gonadal axis. Other mechanisms such as the impact on the central and peripheral nervous systems are also possible. The opioid-induced sexual dysfunction includes erectile dysfunction, lack of desire and arousal, orgasmic disorder, and lowered overall sexual satisfaction. Around half of the individuals taking opioids chronically may be affected by sexual dysfunction. The relative risk of sexual dysfunction in patients on chronic opioid therapy and opioid addicts increased two-fold in a large meta-analysis. Opioids differ in their potential to induce sexual dysfunctions. Partial agonists and short-acting opioids may likely cause sexual dysfunction to a lesser extent. Few pharmaceutical therapies proved effective: testosterone replacement therapy, PDE5 inhibitors, bupropion, trazodone, opioid antagonists, and plant-derived medicines such as Rosa damascena and ginseng. Non-pharmacological options, such as psychosexual or physical therapies, should also be considered. However, the evidence is scarce and projected primarily from non-cancer populations, including opioid addicts. Further research is necessary to explore the problem of sexuality in cancer patients and the role of opioids in inducing sexual dysfunction.
... Male sexual dysfunction can affect men of all age groups, but the incidence increases with age. Over 152 million men were affected with SD in 1995, and it is estimated that by 2025 the incidence count will increase to >320 million worldwide (McKinlay, 2000;Ayta et al., 1999). ...
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Male sexual dysfunction (MSD) is considered taboo among people worldwide. In males, it comprises very complex physiological processes, including loss of libido, erectile dysfunction, premature ejaculation, delayed ejaculation, or no ejaculation, etc. Very little attention has been paid to male sexual health due to certain cultural beliefs that hold people from seeking medical attention at times of need. Issues related to sexual health should be recognized and addressed properly. Although several guidelines are available for the same, they are limited in scope. Health care practitioners need to be trained adequately in treating conditions related to sexual health, especially in men. New policies should be implemented for affordable healthcare and financial insurance for such treatments. Every window of opportunity should be utilized to spread awareness about the utility and benefits of modern non pharmacological, medical and surgical strategies for MSD.
... This figure is higher in the aged and patients with diabetes and end-stage renal disease. [3][4][5] ED exerts substantial adverse effects on patients, leading to poor mental state and quality of life. It was observed by Liu et al. 6 that ED patients had a 2.92-fold risk of depression than their non-ED counterparts. ...
Article
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Sleep has attracted extensive attention due to its significance in health. However, its association with erectile dysfunction (ED) is insufficiently investigated. To investigate the potential causal links between sleep traits (insomnia, sleep duration, and chronotype) and ED, this study was performed. The single-nucleotide polymorphisms (SNPs) associated with insomnia, sleep duration, and chronotype were retrieved from previous genome-wide association studies (GWAS). A conventional two-sample Mendelian randomization (MR) was used to estimate the causal links between sleep traits and ED. The summary statistics of ED were from individuals of European ancestry (6175 cases vs 217 630 controls). As shown by the random effect inverse-variance-weighting (IVW) estimator, genetically predicted insomnia was causally associated with a 1.15-fold risk of ED (95% confidence interval: 1.07-1.23, P < 0.001). Sleep duration and morningness were not causally associated with ED, as indicated by the IVW (all P > 0.05). These findings were consistent with the results of sensitivity analyses. Based on genetic data, this study provides causal evidence that genetically predicted insomnia increases the risk of ED, whereas sleep duration and chronotype do not.
... Erectile dysfunction (ED) and the-drug (Sildenafil Citrate) are commonly known, in public as Viagra or Revatio that causes serious histopathological side effects at overdosed or misused" [1]. "Every medicine which is intended to work in a particular part of the body to make positive changes may affect other parts of the body unintentionally" [2,3]. "There are many substances which alter the human sociosexual response cycle either negatively, positively or both. ...
Article
Biochemical parameters are biomarkers used in evaluating the functionality of some bodily organs such as liver, kidneys and the heart. This study aimed at assessing the effects of Vino Gano Ginger And Herbal Liqueur on the Biochemical Parameters of the male Wistar rats. A total of 25 adult male Wistar rats weighing between 115.3 -248.6 g were used for experiment. They were divided into four groups [4 in each group] based on the body weight and different dosage of Vino Gano Ginger and Herb Liqueur were administered to the rats of various groups. Nine [9] out the 24 was used to determine the Sub- acute test to basses toxicity and mortality using Lorke (1983) method. The animals were separated into four [4] groups; control and three treatment groups that received [5 ml/kg, 10 ml/kg and 15 ml/kg] of Vino Gano Ginger and Herb Liquor orally for 4 weeks. The experimental animals were weighed weekly and at the end of the 4th week, they were sacrificed and blood samples were collected for Biochemical Analysis. Results showed significant elevation in mean AST, ALT, ALP, Urea, Creatinine, Total Cholesterol and LDH of the Wistars treated with [5 ml/kg, 10 ml/kg and 15 ml/kg] of the Vino Gano Ginger and Herb Liqueur (p<0.05). A significant Total Protein reduction was recognized of the Wistar rats treated with Vino Gano Ginger and Herb Liqueur. There was slight increase in Albumin in the treatment group 1 [5 ml/kg] but reduction was recorded in treatment groups II and III [10 ml/kg and 15ml/kg]. In conclusion, continues intake of Vino Gano Ginger and Herb Liqueur will pose reno-toxic effect, Myocardial infarction, Cholestasis, Sarcopenia, leukemia and other life treating conditions.
... Erectile dysfunction (ED), a type of sexual dysfunction that is global (1), negatively influences self-esteem and sexual quality of life in males. Research examining erectile dysfunction has revealed that inhibiting the phosphodiesterase type 5 enzyme can increase the concentration of cyclic guanosine monophosphate (cGMP) in the penile cavernosa, resulting in the smooth muscle relaxation that is associated with penile erection (2). ...
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Purpose This study aimed to evaluate two modes of Rigiscan for predicting tadalafil response, and to identify which Rigiscan variables are the most efficient at making these predictions. Methods All patients received at least two rounds of nocturnal penile tumescence and rigidity (NPTR) testing and/or audiovisual sexual stimulation (AVSS), then completed the International Index of Erectile Function-5 (IIEF-5) questionnaire, followed by oral 5 mg tadalafil daily for 4 weeks. After a 4-week washout period, all respondents underwent an the IIEF-5 questionnaire again. ED patients were then categorized into tadalafil responders and tadalafil non-responders, who were then further divided into cured patients and uncured patients. Results When predicting tadalafil responders, the area under the curve (AUC) of NPTR was superior to that of AVSS (0.68~0.84 VS 0.69~0.73), and the predicted optimal cut-off values were DOEE60≥17.75 min in NPTR, compared to other parameters regardless of AVSS or NPTR (P<0.05). When predicting which patients would be cured, the AUC of AVSS was superior to NPTR parameters (0.77~0.81 vs 0.61~0.76), and the determined best diagnostic cut-off values were DOEE≥4.125min in AVSS, compared to other parameters regardless of AVSS or NPTR (P < 0.05). Conclusion Rigiscan was able to predict the efficacy of daily tadalafil accurately and efficiently. Its diagnostic value was at maximum when DOEE60 ≥17.75 min of NPTR in tadalafil responders and DOEE ≥ 4.125 min of AVSS in cured patients.
... Erectile dysfunction (ED) affects up to 30 million people in the United States (US) [1]. It is especially prevalent in the aging population, affecting between 26% and 76% of this group [2,3]. ...
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The aim of this study was to investigate the association between socioeconomic status and erectile dysfunction. Data were obtained from the National Health and Nutrition Examination Survey, a nationally representative survey of the United States population. Socioeconomic status was estimated using the poverty income ratio, a ratio of family income to established poverty levels. Erectile function was assessed from a single survey question and was divided into two groups: normal (always and usually able to maintain an erection) and erectile dysfunction (sometimes or never able to maintain an erection). Multivariable logistic regression, using a multi-model approach, was used to characterize the interplay between well-established risk factors for erectile dysfunction and socioeconomic status. Our final cohort included 3679 respondents, representative of 81,255,155 subjects with a mean age of 44.4 [SE, 0.365]. Multivariable logistic regression showed that low-income respondents were significantly more likely to report erectile dysfunction [adjusted odds ratio (AOR) = 1.95, 95% CI 1.28–2.96; p = 0.003] compared to higher-income respondents. This study suggests that low socioeconomic status may be associated with erectile dysfunction in a large, nationally representative sample.
... It is estimated that nearly one-half of men older than 40 years have some degree of ED. While in 1995, ED affected over 152 million men worldwide, it is projected that by 2025, more than 320 million patients will be afflicted with the largest projected increases in the developing world [3][4] . The overall prevalence of ED has been reported to be 16-25 per cent in the general population depending on the cohort of study and the definition of ED being applied [5] . ...
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Ayurveda is a science of life which believes in treating body, mind and soul for ensuring a complete state of health. Sexuality has fascinated the people in all walks of life from ancient time to present. The male sexual dysfunction includes all nature of disturbances of coital performance and sexual congress in male. This condition has been decoratively described as "Klaibya" in Ayurvedic classics and "Erectile Dysfunction" in modern texts. On the basis of the cause, six types of Klaibya are mentioned by Acharya Sushruta and four types of Klaibya are mentioned by Acharya Charaka in Ayurvedic classics. On the basis of the cause, two types of Erectile Dysfunctions are mentioned in modern medical science. The disease Klaibya is a multifactorial ailment, mainly including Bahu Do-shavastha as a whole and Shukrakshaya in definite, Mano Dosha, and Shukravaha Sroto Dusti. The Basti administered through the Uttara Marga (Mutra and Shukra Marga in male) and having the Sreshtha Guna (superior qualities) is known as Uttara Basti. Uttara Basti is one among the Panchakarma is capable of performing all sorts of actions like Shodhana, Samana and Bramhana etc. By virtue of the specific type and drugs utilised it effectively overcomes the aggravated Vata. It specially ameliorates the Bahu Dosavastha due to its Shodhana action.
... Erectile dysfunction (ED) is defined as the inability of the penis to reach or maintain sufficient rigidity to complete satisfactory sexual intercourse [1]. ED is a common male disease, and there are hundreds of millions of men worldwide with varying degrees of ED [2,3]. ED has a close relationship with diabetes mellitus, the incidence of ED in male diabetic patients is as high as 75% [4], and the symptoms in these patients appear earlier and are more severe. ...
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Purpose: To determine whether microRNA could be a therapy target of erectile dysfunction (ED) and the underlying mechanisms. Materials and methods: Eight-week-old fasting male SD rats were intraperitoneally injected with streptozotocin to construct diabetic rat models. Diabetic ED rats were treated with miRNA-92a inhibitor. The cavernous nerves were electrically stimulated to measure the intracavernous pressure and mean arterial pressure of rats in each group. After the detection, the penile cavernous tissues are properly stored for subsequent experiments. Rat aortic endothelial cells were used in in vitro studies. Results: The expression of miR-92a was significantly increased in the corpus cavernosum of Streptozocin (STZ)-induced diabetic rats and injection of miR-92a antagomir into the corpus cavernosum of diabetic rats significantly increased eNOS/NO/cGMP signaling pathway activities, cavernous endothelial cell proliferation, endothelial cell-cell junction protein expression and decreased the levels of oxidative stress. These changes restored erectile function in STZ-induced diabetic rats. Moreover, in vitro study demonstrated that the miR-92a expression increased significantly in endothelial cells treated with high glucose, inhibiting AMPK/eNOS and AMPK/Nrf2/HO-1 signaling pathways in rat aortic endothelial cells via targeting Prkaa2, causing endothelial dysfunction and overactive oxidative stress, miR-92a inhibitor can improve the above parameters. Conclusions: miRNA-92a inhibitor could exert an inhibition role on oxidative stress and endothelial dysfunction to improve diabetic ED effectively.
... This highlights the fact that age is one of the major risk factors for the development of ED. Numerous studies show that the prevalence of ED increases with older age [39,41]. Shamloul et al. describe an increasing prevalence leading from 2-9% for men between 40 and 49 years to a prevalence of 50% to 100% for men over 70 years of age [42]. ...
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Background: Sexual dysfunctions (SD) are common but underreported in Parkinson's disease (PD) and have negative impacts on the quality of life (QoL) and partnership. Methods: We analyzed the data set from the PRISM study for demographics of SD and their influence on quality of life and partnership. Results: 449/861 (52.1%) PD patients reported SD, with male patients being affected more often and having a longer course of disease. The most common SD in men was erectile dysfunction (ED) (n = 152), while women's most frequent complaints were orgasm dysfunction (n = 84) and reduced libido (n = 81). Hypersexual SDs were reported significantly more often by men. Spousal caregivers of patients reporting inability to relax and enjoy sex and reduced libido indicated a negative influence on the relationship in general. Negative effects on the sexual relationship were reported significantly more often for patients with ED, difficulties with sexual arousal, inability to relax and enjoy sex, and reduced libido. Hypersexual dysfunctions showed no effect on the relationship. Conclusion: SD is a common but underreported problem in the treatment of patients with PD. Due to the negative influence on the relationship and QoL of patients and caregivers, SD should be assessed routinely.
... The inability to attain and maintain penile erection sufficient for sexual satisfaction is the hallmark of erectile dysfunction (ED;Hui et al., 2020) and it is projected that the global prevalence of ED will reach 322 million by 2025 (Shiferaw et al., 2020). ED results from a number of factors which could be psychological, hormonal, arterial impairment, or neurological (McKinlay, 2000). The erectogenic process begins with sexual stimulation which leads to activation of nitric oxide synthase (NOS) and consequent conversion of l-arginine to nitric oxide (NO). ...
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The use of lemon (Citrus limon) and lime (Citrus aurantifolia) juices for the treatment of erectile dysfunction (ED) is fast becoming common practice, even though there is dearth of information on the effect of such functional food and drug combination in the management of ED. This study evaluated the effect of lemon and lime juices on the erectogenic properties of sildenafil. ED was induced with L‐NAME (40 mg/kg body weight). The rats were divided into 11 groups (n = 6) and given various doses of the test samples. Immediately after the sexual behavior studies, the animals were sacrificed and the penile and brain tissues were isolated. The results revealed that lime and lemon juices improved sexual behavior in rats by improving NO production and inhibiting the activities of PDE‐5, arginase, ACE, MAO, ATPdase, AMPdase, and activated antioxidant enzymes. Furthermore, lime at 1.0 ml/kg significantly improved the therapeutic properties of sildenafil. While, lemon (0.5 and 1.0 ml/kg) and lime (0.5 ml/kg) did not show any synergistic effect. This study revealed that lime and lemon juices could improve erectile function and combining lime juice with sildenafil could be very effective in the management of ED. Practical applications The therapeutic management of erectile dysfunction has involved maximizing NO production through the modulation of macromolecules such as phosphodiesterase‐5 and arginase with the use of drugs such as sildenafil. Combining such drugs with functional foods such as lime and lemon juices is becoming common practice. However, there is dearth of report on the effect of lime and lemon juices on the erectogenic potentials of sildenafil. The present study shows that combining 1 ml/kg lime juice (got from 2 lime fruits) with sildenafil will boost the erectogenic properties of the drug. While combining lime (0.5 ml/kg) and lemon (0.5 and 1.0 ml/kg) juices with the drug did not have any synergistic effect.
... It is estimated that the worldwide prevalence of erectile dysfunction will likely increase to 322 million men by 2025 [7]. These results also explain the increase in interest over the years in Google trend searches for many terms such as prosthetic surgical treatment (+1.7%), for prostaglandins (+0.7%), for traction (+0.6%), and for shock wave therapy (+1.8%) [8]. ...
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Interest in the role of dietary patterns has been consistently emerging in recent years due to much research that has documented the impact of metabolism on erectile dysfunction (ED) and/or benign prostatic hyperplasia (BPH). We conducted a non-systematic review of English articles published from 1964 to September 2021. The search terms were: (“dietary patterns” OR “diet”) AND/OR (“erectile dysfunction”) AND/OR (“benign prostatic hyperplasia”). In the present review, we have highlighted how the association between dietary patterns and two of the most frequent pathologies in urology, namely erectile dysfunction and benign prostatic hyperplasia, is present in the literature. The data suggested that a diet that is more adherent to the Mediterranean diet or that emphasizes the presence of vegetables, fruits, nuts, legumes, and fish or other sources of long-chain (n-3) fats, in addition to reduced content of red meat, may have a beneficial role on erectile function. At the same time, the same beneficial effects can be transferred to BPH as a result of the indirect regulatory effects on prostatic growth and smooth muscle tone, thus determining an improvement in symptoms. Certainly, in-depth studies and translational medicine are needed to confirm these encouraging data.
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Erectile Dysfunction (ED) is a form of sexual dysfunction in males that imposes significant health and financial burdens globally. Despite its high prevalence, diagnosing ED remains challenging due to the limitations of current diagnostic methods and patients’ reluctance to seek medical help. Currently, some studies have used machine learning techniques for developing ED prediction models, but the performance and interpretability of existing models need to be further improved. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) for the years 2001 to 2004, adhering to the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement. After excluding male respondents who did not meet the study criteria, a total of 3,869 participants were included. Gradient boosting decision tree (GBDT) algorithms (XGBoost, CatBoost, LightGBM) were used to develop the ED prediction model. Data preprocessing, feature selection, model evaluation, and interpretability analysis were performed to ensure the reliability and effectiveness of the model. The model evaluation results revealed that the AUC values are XGBoost: 0.887 ± 0.016; LightGBM: 0.879 ± 0.016; CatBoost: 0.871 ± 0.019. The F1-Scores are XGBoost: 0.695 ± 0.023; LightGBM: 0.681 ± 0.025; CatBoost: 0.681 ± 0.025. The Recall values are XGBoost: 0.789 ± 0.026; LightGBM: 0.739 ± 0.030; CatBoost: 0.711 ± 0.030. These results confirmed that the XGBoost model is the best-performing ED prediction model in this study. Interpretability analysis results of the XGBoost model showed that age, obesity, cardiovascular risk factors, prostate-related diseases, and socioeconomic status are key features for predicting ED, playing a significant role in the ED mechanism. Therefore, we believe the ED prediction model trained in this study has strong predictive performance and high interpretability. This model can help to expand the diagnostic options for ED, improve the diagnosis rate of ED, and assist doctors in early intervention for patients with ED, ultimately improving patient prognosis.
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A cross-sectional study incorporating quantitative and qualitative analyses was conducted between 2020 and 2022, to evaluate the perception of quality of life and self-esteem in men with erectile dysfunction (ED), exploring factors associated with these psychological constructs. General and sexual-specific quality of life, self-esteem, and confidence, were measured in men with ED in Spain, using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, Sexual Life Quality Questionnaire (SLQQ), and Self-Esteem and Relationship (SEAR) questionnaire. Comprehensive interviews were conducted to deepen the understanding of how ED impacts various aspects of life. 353 men participated in the quantitative phase and 21 in the qualitative phase. 54.9% of participants rated their general quality of life as good or very good. No association was found between the perceived quality of global life and the quality of erection or severity of ED. The median SLQQ score was 33.75 (IQR 22.5), and the median SEAR subscale self-esteem score was 37.5 (IQR 25). It was found that the duration of ED and the frequency of sexual activity influenced self-esteem and confidence in men with ED. In the qualitative assessment, the subjects considered that ED did not influence aspects of their life unrelated to sexual health.
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Erectile dysfunction (ED) is an extremely prevalent condition which significantly impacts quality of life. The rapid increase of ED in recent decades suggests the existence of unidentified environmental risk factors contributing to this condition. Endocrine Disrupting Chemicals (EDCs) are one likely candidate, given that development and function of the erectile tissues are hormonally dependent. We use the estrogenic-EDC diethylstilbestrol (DES) to model how widespread estrogenic-EDC exposure may impact erectile function in humans. Here we show that male mice chronically exposed to DES exhibit abnormal contractility of the erectile tissue, indicative of ED. The treatment did not affect systemic testosterone production yet significantly increased estrogen receptor α (Esr1) expression in the primary erectile tissue, suggesting EDCs directly impact erectile function. In response, we isolated the erectile tissue from mice and briefly incubated them with the estrogenic-EDCs DES or genistein (a phytoestrogen). These acute-direct exposures similarly caused a significant reduction in erectile tissue contractility, again indicative of ED. Overall, these findings demonstrate a direct link between estrogenic EDCs and erectile dysfunction and show that both chronic and acute estrogenic exposures are likely risk factors for this condition.
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The study was performed to assess the impact of Biofield Treated test item (DMEM medium) on Human Endothelial Hybrid Cell Line (EA. hy926) for the expression of cyclic guanosine monophosphate (cGMP). The test item was divided into three parts. The first part was received one-time Consciousness Energy Treatment by a renowned Biofield Energy Healer, Mahendra Kumar Trivedi and labeled as BT-I, while second part received two-times Biofield Treatment and is denoted as BT-II. The third part did not receive any types of treatment and denoted as untreated DMEM. The level of intracellular cGMP in the BT-I and BT-II groups showed a significantly (p≤0.001) increased by 296.06% and 339.37%, respectively in Ea. hy926 cells compared to the untreated DMEM group. These results suggest that BT-II group showed a significant improved the level of cGMP with respect to the BT-I group. Therefore, the Biofield Energy Healing Treatment can be used to treat the erectile dysfunction patients along with other associated disorders such as orgasmic disorders, frotteuristic disorder, female sexual arousal disorder, vaginismus, fetishistic disorder, sex addiction, hypoactive sexual desire disorder, premature or delayed ejaculation.
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Background Phosphodiesterase type 5 inhibitors (PDE5Is) are generally well tolerated but have been associated with uncommon and significant adverse events (AEs). Aim This study aims to investigate and compare the characteristics of AEs associated with PDE5Is used for erectile dysfunction and identify any safety signals in a postmarketing surveillance database between 2010 and 2021. Methods A descriptive analysis was conducted for all AEs reported to the Food and Drug Administration Adverse Event Reporting System for 4 PDE5Is—avanafil, sildenafil, tadalafil, and vardenafil—indicated for erectile dysfunction between January 2010 and December 2021. The frequency of the most reported AEs and outcomes were identified. A disproportionality analysis based on proportional reporting ratio (PRR) and reporting odds ratio (ROR) was conducted for the most common and clinically important AEs to identify signals to gain insights into potential differences in safety profiles. Outcomes The outcome measures of the study are frequency of reported AEs and outcomes following AE. Results A total of 29 236 AEs were reported for PDE5Is during the study period. The most reported AE was “drug ineffective” with 7115 reports (24.3%). Eight safety signals were detected across the 4 drugs. Key signals were sexual disorders (PRR, 3.13 [95% CI, 2.69-3.65]; ROR, 3.24 [95% CI, 2.77-3.79]) and death (PRR, 3.17 [2.5-4.01]; ROR, 3.211 [2.52-4.06]) for sildenafil, priapism (PRR, 3.63 [2.11-6.24]; ROR, 3.64 [2.12-6.26]) for tadalafil, and drug administration error (PRR, 2.54 [1.84-3.52]; ROR, 2.6 [1.86-3.63]) for vardenafil. The most reported outcomes were other serious events with 6685 events (67.2%) and hospitalization with 1939 events (19.5%). Clinical Implications The commonly reported AEs and detected signals may guide clinicians in treatment decision making for men with erectile dysfunction. Strengths and Limitations This is the first comprehensive report and disproportionality analysis on all types of AEs associated with PDE5Is used for erectile dysfunction in the United States. The findings should be interpreted cautiously due to limitations in the Adverse Event Reporting System, which includes self-reports, duplicate and incomplete reports, and biases in reporting and selection. Therefore, establishing a causal relationship between the reported AEs and the use of PDE5Is is uncertain, and the data may be confounded by other medications and indications. Conclusion PDE5Is demonstrate significantly increased risks of reporting certain clinically important AEs. While these events are not common, it is imperative to continually monitor PDE5I use at the levels of primary care to national surveillance to ensure safe utilization.
Article
Background: The purpose of this research was to explore the mechanistic protective cardiovascular effects of phosphodiesterase-5 inhibitors (PDE5i) in men with erectile dysfunction. Erectile dysfunction and endothelial dysfunction both precede clinical atherosclerosis. Studies have shown that treatment for erectile dysfunction with PDE-5i decreased death, heart failure, myocardial infarction, and revascularization in men with erectile dysfunction who had previous myocardial infarction, and cardiovascular events. Methods: A pilot study that recruited 5 men with erectile dysfunction without cardiovascular disease. Endothelial function (flow mediated percent change of the diameter of the brachial artery [FMD %]), erectile dysfunction grade, high sensitivity C reactive protein, and body mass index were measured before and 3 months after starting treatment with Cialis, 5 mg daily. Pearson's analysis was performed to study a correlation between the change in erectile dysfunction and the change in endothelial function. Results: A significant correlation was found between changes in FMD% and changes in erectile dysfunction following the administration of Cialis (P=0.010; Pearson correlation coefficient = 0.959). No change was observed in C reactive protein or weight. Conclusions: Erectile dysfunction and endothelial dysfunction are risk factors for cardiovascular disease. Our study showed that PDE5i improved endothelial function and erectile dysfunction (with a significant correlation). Improving endothelial function could be the mechanism that leads to a reduction in cardiovascular events and death in men with erectile dysfunction treated with PDE5i.
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Erectile dysfunction is more common than realised and can be the first indication of systemic disease. Penile prosthesis is a low‐risk intervention with high patient satisfaction, previously deemed an endstage form of management. However, improvements in the devices and a recent American Association of Urology recommendation could change that.
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Background: Penile duplex Doppler ultrasound in combination with intra-cavernous injection of vasoactive agents (PDDU-ICI) is the most accepted tool for diagnosis of arteriogenic erectile dysfunction (AED), but is invasive, time consuming and at risk of side effects. Objectives: The purpose of this pilot study is to evaluate the potential of transrectal color Doppler ultrasound (TR-CDU) of the common penile arteries as a non-invasive method for the diagnosis of AED. Materials and methods: A consecutive series of 61 men consulting for erectile dysfunction (ED) and 20 controls underwent TR-CDU examination, aged from 40 to 80 years. Sonographic parameters were correlated with the International Index of Erectile Function, short form (IIEF-5). Sensitivity and specificity were calculated and the areas under the receiver operating characteristic curves (AUC) were compared to evaluate the diagnostic performance. Results: Receiver operating characteristic curve analysis showed no significant results for IIEF-5 score ⩾21 in relation to the Doppler parameters. However, we found a good diagnostic performance for patients with ED grading from moderate to severe at IIEF-5. In this cohort, we found that mean peak systolic velocity >15.8 cm/s predicted IIEF-5 ⩾17 (AUC = 0.73, p = 0.002) with 61.5% sensitivity and 85.7% specificity. Mean end diastolic velocity >1.46 cm/s predicted IIEF-5 ⩾17 (AUC = 0.68, p = 0.02) with 80.7% sensitivity and 52.4% specificity. Mean resistance index ⩽0.72 predicted IIEF-5 ⩾17 (AUC = 0.71, p = 0.004) with 46.2% sensitivity and 95.2% specificity. Mean pulsatility index ⩽1.41 predicted IIEF-5 ⩾17 (AUC = 0.75, p = 0.0005) with 48.5% sensitivity and 95.14% specificity. Conclusions: TR-CDU proved to be a feasible and non-invasive procedure, easily repeatable and not time consuming, overcoming the limits of PDDU-ICI. Diagnostic accuracy seems to be promising in discriminating patients with normal erectile function or mild dysfunction from those with moderate to severe ED. However, these findings need to be verified in future controlled randomized clinical trials.
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Case: Phosphodiesterase type-5 enzyme (PDE5) inhibitors are well tolerated and used to treat erectile dysfunction. We report a case of prosthetic knee effusions associated with PDE5 inhibitor use in a 65-year-old man after total knee arthroplasty (TKA). PDE5 inhibitor treatment was stopped, and the patient had no further episodes of painful effusions. Conclusion: This report describes a previously unknown adverse effect of PDE5 inhibitor use in a prosthetic joint after TKA. We hope to encourage physicians managing patients after joint replacement to be aware of the association between PDE5 inhibitor use and recurrent joint effusions to improve postoperative outcomes.
Article
The detection and identification of phosphodiesterase type 5 enzyme (PDE-5) inhibitors in dietary supplements poses an analytical challenge due to the large number of analogs and isomers currently available and the continued introduction of novel analogs. The use of trapped ion mobility spectrometry (TIMS) in conjunction with liquid chromatography (LC) and electrospray ionization tandem mass spectrometry (MS/MS) was explored for the analysis of two groups of isomeric PDE-5 inhibitor analogs using a 5-minute method. Of the eight compounds studied, six were resolved by a combination of LC and TIMS; the two remaining isomers were distinguished by one or more unique product ions in the MS/MS spectrum. The results revealed that separation by LC corresponded to differences in substitution on the piperazine moiety of the PDE-5 inhibitors, while separation by TIMS corresponded to the position of a nitrogen atom in the fused ring region of the molecules. Samples prepared by spiking mixtures of varying amounts of the Group 2 isomers into a representative dietary supplement matrix were analyzed and concentrations determined from the mobility-adjusted extracted ion chromatograms exhibited relative standard deviations of 6.0 % or less for 17 of 20 measurements and recoveries between 80 % and 120 % for all measurements. Quantitative measurements from a short LC gradient were possible due to the reduced chemical background associated with the TIMS separation of co-eluting matrix compounds, which enabled acquisition of rapid and qualitatively relevant broadband collision induced dissociation spectra that didn't require precursor ion isolation; the reduced chemical background permits non-targeted detection of novel analogs and eliminates the need for a separate method for quantitative measurement.
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Wide-ranging and inclusive, this text provides an invaluable review of an expansive selection of topics in human evolution, variation and adaptability for professionals and students in biological anthropology, evolutionary biology, medical sciences and psychology. The chapters are organized around four broad themes, with sections devoted to phenotypic and genetic variation within and between human populations, reproductive physiology and behavior, growth and development, and human health from evolutionary and ecological perspectives. An introductory section provides readers with the historical, theoretical and methodological foundations needed to understand the more complex ideas presented later. Two hundred discussion questions provide starting points for class debate and assignments to test student understanding.
Chapter
Wide-ranging and inclusive, this text provides an invaluable review of an expansive selection of topics in human evolution, variation and adaptability for professionals and students in biological anthropology, evolutionary biology, medical sciences and psychology. The chapters are organized around four broad themes, with sections devoted to phenotypic and genetic variation within and between human populations, reproductive physiology and behavior, growth and development, and human health from evolutionary and ecological perspectives. An introductory section provides readers with the historical, theoretical and methodological foundations needed to understand the more complex ideas presented later. Two hundred discussion questions provide starting points for class debate and assignments to test student understanding.
Chapter
Wide-ranging and inclusive, this text provides an invaluable review of an expansive selection of topics in human evolution, variation and adaptability for professionals and students in biological anthropology, evolutionary biology, medical sciences and psychology. The chapters are organized around four broad themes, with sections devoted to phenotypic and genetic variation within and between human populations, reproductive physiology and behavior, growth and development, and human health from evolutionary and ecological perspectives. An introductory section provides readers with the historical, theoretical and methodological foundations needed to understand the more complex ideas presented later. Two hundred discussion questions provide starting points for class debate and assignments to test student understanding.
Chapter
Wide-ranging and inclusive, this text provides an invaluable review of an expansive selection of topics in human evolution, variation and adaptability for professionals and students in biological anthropology, evolutionary biology, medical sciences and psychology. The chapters are organized around four broad themes, with sections devoted to phenotypic and genetic variation within and between human populations, reproductive physiology and behavior, growth and development, and human health from evolutionary and ecological perspectives. An introductory section provides readers with the historical, theoretical and methodological foundations needed to understand the more complex ideas presented later. Two hundred discussion questions provide starting points for class debate and assignments to test student understanding.
Chapter
Wide-ranging and inclusive, this text provides an invaluable review of an expansive selection of topics in human evolution, variation and adaptability for professionals and students in biological anthropology, evolutionary biology, medical sciences and psychology. The chapters are organized around four broad themes, with sections devoted to phenotypic and genetic variation within and between human populations, reproductive physiology and behavior, growth and development, and human health from evolutionary and ecological perspectives. An introductory section provides readers with the historical, theoretical and methodological foundations needed to understand the more complex ideas presented later. Two hundred discussion questions provide starting points for class debate and assignments to test student understanding.
Article
Background A consecutive series of 177 male patients, with high energy pelvic ring injuries, were treated operatively in our institution. The purpose of this study was to evaluate long-term sexual and urological dysfunction in these patients using validated disease specific patient reported outcome measures (PROMs), and identify if sexual and urological dysfunction is detectable from generic outcome scores used in the assessment of pelvic ring injury at a minimum of 10 years follow-up (range 10–22). Methods Surviving patients were contacted to complete validated PROMs to examine genitourinary and global functional outcome. Fifty-two male participants, had a mean age of 44-years-old (range,16–69) and ISS of 17 at time of injury. Mean duration follow-up of 15 years. The primary outcome measures were the Sexual Health Inventory for Men (SHIM) and the Modular Questionnaire for Male Lower Urinary Tract Symptoms (MLUTS). Secondary outcomes were the EQ-5D and Short Form 36. Responses were tested for correlation between generic and disease-specific PROMs and analyzed for association with genitourinary injury and age as risk factors of poor outcome. Results Genitourinary injuries occurred in 7 patients (13%), and ten patients (19%) had documented neurological dysfunction following injury. Satisfactory general functional outcome was reported with EQ-5D-3L VAS score of 71. However, 80% report some level of sexual dysfunction with 37% reporting it as severe. MLUTS mean symptom score was 9 (range, 0 – 26) and bothersomeness score was 21 (range, 0–90). There was poor correlation between urological and sexual dysfunction scores and between the disease specific and generic scores. Conclusion In operatively treated pelvic ring injuries, validated disease specific PROMs, (SHIM and MLUTs) identified a significant impact to both sexual and urological patient health, with 37% reporting severe sexual dysfunction. Longstanding sexual and/or urological dysfunction can be a source of significant psychological impact that this study has shown is not identifiable using generic PROMs; EQ-5D-3L and SF-36. To gain a holistic understanding of the functional outcome of patients following a pelvic injury, urological and sexual dysfunction must not be overlooked.
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The present chapter deals with the effect of lifestyles and lifestyle intervention for male fertility. It addresses negative effects of excessive training load, unhealthy eating, and other detrimental lifestyles like smoking, alcohol, and recreational drug use. Also highlighted and discussed is exposure to endocrine disruptors, substances that interfere with the proper functioning of the hormonal system and therefore may alter human reproductive potential. The chapter also highlights the beneficial effects of healthy interventions, either for natural conception or conception through assisted reproductive techniques. Furthermore, it addresses some basic nutrition concepts with regards nutrients that are considered important for optimal fertility and also in aiding to avoid excessive damage associated to sports practice.
Chapter
Placement of a prosthetic penile implant is the gold standard treatment for men with erectile dysfunction (ED) refractory to other treatments. The procedure has inherent risks and carries increased medicolegal liability compared to other treatments for ED. Surgeons – including urologists – are faced with a greater burden of legal challenges compared to other medical disciplines. While some medical malpractice cases are predicated on factors outside a surgeon’s control, there are steps that a surgeon can take to minimize liability when placing a penile implant. The surgeon must determine that a patient is an appropriate surgical candidate and that he and his partner can execute an applicable informed consent and thorough documentation of preoperative counseling and consenting. Issues concerning inappropriate surgical technique are most likely to lead to payout. The onus is on the surgeon to ensure appropriate training and technical skill when performing this potentially litigious procedure. Attentive and timely patient follow-up is critical. The court normally will not find fault with the surgeon after an intraoperative or postoperative complication, so long as it has not been caused by gross negligence and is addressed in a prompt and reasonable manner according to the current standard of care.
Article
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.
Article
This paper examines the physiologic and epidemiologic evidence for a widely discussed syndrome termed either 'mid-life crisis', 'male menopause', 'male climacteric', or increasingly, 'andropause'. The paper is divided into 2 parts: (1) a review of evidence from physiologic studies conducted over the last decade that examine endocrine function in aging males; (2) a description of the salient features of an ongoing multidisciplinary epidemiologic study (the Massachusetts Male Aging Study) of a sample of approximately 1700 men aged 40-69 yr, randomly sampled from the general population. This study is markedly different in size and content from studies conducted to date. Preliminary findings suggest that age per se may be a relatively unimportant contributor to endocrine variability and that anthropometrics and life style phenomena may be at least as important.
Article
To develop a brief questionnaire to measure male sexual function. An initial set of questions was refined and reduced through cognitive testing and two serial validation studies. In each study, men were recruited from a sexual dysfunction clinic and a general medicine practice to complete the instrument. Test-retest reliabilities, internal consistencies, and construct validities were examined. The final instrument covers sexual drive (two items), erection (three items), ejaculation (two items), perceptions of problems in each area (three items), and overall satisfaction (one item). Psychometric performance was generally very satisfactory, although self-assessments of ejaculate volume are problematic. Translations have been developed and pilot tested in a number of languages. The Brief Sexual Function Inventory may be useful for measuring male sexual function in practice and research.
Article
We provide current, normative data on the prevalence of impotence, and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study. The Massachusetts Male Aging Study was a community based, random sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject's home. A self-administered sexual activity questionnaire was used to characterize erectile potency. The combined prevalence of minimal, moderate and complete impotence was 52%. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. Subject age was the variable most strongly associated with impotence. After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension. We conclude that impotence is a major health concern in light of the high prevalence, is strongly associated with age, has multiple determinants, including some risk factors for vascular disease, and may be due partly to modifiable para-aging phenomena.
Article
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Article
To project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health-policy consequences using the recent developments in the UK as a case study. Using the United Nations projected male population distributions by quinquennial age groups for 2025, the prevalence rates for ED were applied from the Massachusetts Male Aging Study (MMAS) to calculate the likely incidence of ED. The MMAS has the advantage of being the first study to provide population-based rates rather than rates based on clinical samples. All the projections were age-adjusted. It is estimated that in 1995 there were over 152 million men worldwide who experienced ED; the projections for 2025 show a prevalence of approximately 322 million with ED, an increase of nearly 170 million men. The largest projected increases were in the developing world, i.e. Africa, Asia and South America. The likely worldwide increase in the prevalence of ED (associated with rapidly ageing populations) combined with newly available and highly publicized medical treatments, will raise challenging policy issues in nearly all countries. Already under-funded national health systems will be confronted with unanticipated resource requests and challenges to existing government funding priorities. The projected trends represent a serious challenge for healthcare policy makers to develop and implement policies to prevent or alleviate ED.
Article
We estimated the incidence of erectile dysfunction in men 40 to 69 years old at study entry during an average 8.8-year followup, and determined how risk varied with age, socioeconomic status and medical conditions. Data from a randomly sampled population based longitudinal study of Massachusetts men were analyzed. A total of 1,709 men completed the baseline interview during 1987 to 1989 and 1,156 survivors completed followup from 1995 to 1997. The analysis sample consisted of 847 men without erectile dysfunction at baseline and with complete followup information. Erectile dysfunction was assessed by discriminant analysis of 13 questions from a self-administered sexual function questionnaire and a single global self-rating question. The crude incidence rate for erectile dysfunction was 25.9 cases per 1,000 man-years (95% confidence interval [CI] 22.5 to 29.9). The annual incidence rate increased with each decade of age and was 12.4 cases per 1,000 man-years (95% CI 9.0 to 16.9), 29.8 (24.0 to 37.0) and 46.4 (36.9 to 58.4) for men 40 to 49, 50 to 59 and 60 to 69 years old, respectively. The age adjusted risk of erectile dysfunction was higher for men with lower education, diabetes, heart disease and hypertension. Population projections for men 40 to 69 years old suggest that 17,781 new cases of erectile dysfunction in Massachusetts and 617,715 in the United States (white males only) are expected annually. Although prevalence estimates and cross-sectional correlates of erectile dysfunction have recently been established, incidence estimates were lacking. Incidence is necessary to assess risk, and plan treatment and prevention strategies. The risk of erectile dysfunction was about 26 cases per 1,000 men annually, and increased with age, lower education, diabetes, heart disease and hypertension.
Article
Erectile dysfunction (ED) is the subject of a vast clinical literature, but little information has been gathered from random samples of the general public. The Massachusetts Male Aging Study (MMAS) addressed this important aspect of men's health. The MMAS was conducted in two waves, with baseline data collection in 1987-1989 and follow-up in 1995-1997. Subsequent to the baseline MMAS survey, a consensus developed that subjective measures are optimal for defining ED. Unfortunately, the baseline questionnaire did not ask subjects directly about their erectile functioning. Thus, we previously assigned the MMAS subjects a degree of impotence at baseline using a series of related questions, employing a discriminant formula constructed from a separate sample of urology clinic patients. At follow-up the men classified themselves directly in addition to answering the original series of related questions. In the present article, we report the results of a new discriminant function, based on the MMAS men at follow-up. We also compare the two methods and discuss our reasons for preferring the internally calibrated method.
Article
Erectile dysfunction (ED), a wide spread and troublesome condition among middle-aged men, is partly vascular in origin. In the Massachusetts Male Aging Study, a random-sample cohort study, we investigated the relationship between baseline risk factors for coronary heart disease and subsequent ED, on the premise that subclinical arterial insufficiency might be manifested as ED. Men ages 40-70, selected from state census lists, were interviewed in 1987-1989 and reinterviewed in 1995-1997. Data were collected and blood was drawn in participants' homes. ED was assessed from responses to a privately self-administered questionnaire. Analysis was restricted to 513 men with no ED at baseline and no diabetes, heart disease, or related medications at either time. Cigarette smoking at baseline almost doubled the likelihood of moderate or complete ED at followup (24% vs. 14%, adjusted for age and covariates, P = 0.01). Cigar smoking and passive exposure to cigarette smoke also significantly predicted incident ED, as did overweight (body-mass index > or =28 kg/m(2)) and a composite coronary risk score. Weaker prospective associations were seen for hypertension and dietary intake of cholesterol and unsaturated fat. Erectile dysfunction and coronary heart disease share some behaviorally modifiable determinants in men who, like our sample, are free of manifest ED or predisposing illness. Open questions include whether modification of coronary risk factors can prevent ED and whether ED may serve as a sentinel event for coronary disease.
Article
To prospectively examine whether changes in smoking, heavy alcohol consumption, sedentary lifestyle, and obesity are associated with the risk of erectile dysfunction. Data were collected as part of a cohort study of a random sample of men 40 to 70 years old, selected from street listings in the Boston Metropolitan Area, Massachusetts. In-home interviews were completed by 1709 men at baseline in 1987 to 1989 and 1156 men at follow-up in 1995 to 1997 (average follow-up 8.8 years). Analyses included 593 men without erectile dysfunction at baseline, who were free of prostate cancer, and had not been treated for heart disease or diabetes. The incidence of moderate to complete erectile dysfunction was determined by discriminant analysis of responses to a self-administered sexual function questionnaire. Obesity status was associated with erectile dysfunction (P = 0.006), with baseline obesity predicting a higher risk regardless of follow-up weight loss. Physical activity status was associated with erectile dysfunction (P = 0.01), with the highest risk among men who remained sedentary and the lowest among those who remained active or initiated physical activity. Changes in smoking and alcohol consumption were not associated with the incidence of erectile dysfunction (P >0.3). Midlife changes may be too late to reverse the effects of smoking, obesity, and alcohol consumption on erectile dysfunction. In contrast, physical activity may reduce the risk of erectile dysfunction even if initiated in midlife. Early adoption of healthy lifestyles may be the best approach to reducing the burden of erectile dysfunction on the health and well-being of older men.
Article
A concise, reliable means of assessing erectile dysfunction (ED) in large, multidisciplinary population-based studies is needed. A single, direct question for self-assessed ED was assessed in the population-based sample of the Massachusetts Male Aging Study (MMAS). Of the 1156 respondents to the 1995-97 MMAS follow-up evaluation, 505 were randomly selected to complete either the International Index of Erectile Function (IIEF) (n = 254), or the Brief Male Sexual Function Inventory (BMSFI) (n = 251), in addition to the single question self-assessment. The proportion not classified due to missing data was MMAS-9%, BMSFI-8%, and IIEF-18%. The single question correlated well with these other measures (r = 0.71-0.78, P < 0.001). Prevalence was similar to that based on the IIEF, agreement was moderate (kappa = 0.56-0.58), and associations with previously identified risk factors were similar for each classification. Thus, the MMAS single question may be a practical tool for population-based studies where detailed clinical measures of ED are impractical.
  • Rj Krane
  • I Goldstein
  • Is De Tejada
Krane RJ, Goldstein I, de Tejada IS. Impotence. New Engl J Med 1989; 321: 1648 ± 1659.
Erectile dysfunction and coronary risk: prospective results from the MMAS
  • Ha Feldman
13 Feldman HA et al. Erectile dysfunction and coronary risk: prospective results from the MMAS. Prev Med 2000; 30: 328 ± 338.
Medical and psychological in¯uences on erectile dysfunction Ð results from a community study
  • J B Mckinlay
McKinlay JB. Medical and psychological in¯uences on erectile dysfunction Ð results from a community study. The 9th
Sexual Behavior in the Human Male WB Saunders: Philadelphia Human Sexual Response
  • Ac Kinsey
  • Wb Pomeroy
  • Ce Martin
  • Wh Masters
  • Ve Johnson
10 Kinsey AC, Pomeroy WB, Martin CE. Sexual Behavior in the Human Male. WB Saunders: Philadelphia, 1948. 11 Masters WH, Johnson VE. Human Sexual Response. Little Brown: Boston, MA, 1966. 12 NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83 ± 90.
  • R J Krane
  • I Goldstein
  • I S De Tejada
  • Impotence
Krane RJ, Goldstein I, de Tejada IS. Impotence. New Engl J Med 1989; 321: 1648 ± 1659.
Human Sexual Response
  • W H Masters
  • V E Johnson
Masters WH, Johnson VE. Human Sexual Response. Little Brown: Boston, MA, 1966.
NIH Consensus Development Panel on Impotence
NIH Consensus Development Panel on Impotence. JAMA 1993; 270: 83 ± 90.