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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... Erectile Dysfunction (ED) reduces the quality of life, and is associated with depression, increased anxiety and poor self-esteem in affected patients [3]. Despite these effects, ED seems to be a very sensitive issue and most individuals do not wish to have it discussed [3]. ...
... Erectile Dysfunction (ED) reduces the quality of life, and is associated with depression, increased anxiety and poor self-esteem in affected patients [3]. Despite these effects, ED seems to be a very sensitive issue and most individuals do not wish to have it discussed [3]. ED is underestimated in developing countries including Nigeria because it is not seen as a life threatening condition and may not be reported partly due to the stigma associated with it [4]. ...
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Introduction: Erectile dysfunction (ED) is the most common male sexual dysfunction all over the World. It is underestimated in developing countries including Nigeria because it is assumed not to be a life threatening condition which is associated with stigmatization and poor health seeking behavior. The Prevalence rate of ED among specific age groups has not been reported in most available local studies. This study was aimed at determining the prevalence rates of ED and the severity of ED among different age groups and patients’ awareness of its treatment. Methods: The study was a descriptive cross-sectional hospital based survey among men aged 18 years and above seen in the outpatient clinics of University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria. Self reported erectile dysfunction was obtained using proforma. The prevalence and severity of ED was obtained using International Index of Erectile Function-5 Questionnaire (IIEF-5). Results: A total of 378 subjects were recruited for this study with age range of 18-76 years. The prevalence of ED in this study using IIEF-5 was 66.4%. The prevalence of ED was noted to increase with increasing age as ED was more prevalent (59%) among men aged 60-79 year. ED was least common among the young subjects (15.7%) and the most severe ED found among the elderly There was a positive correlation between age and ED (rho =0.306). There was statistically significance association between ED and co-morbidities with hypertension accounting for 22.5% and diabetes 16.7%. The percentage of subjects aware of treatment for ED was 39.4% and 20.4% of the subjects had sought help from doctors. Only about a quarter (26.5%) of the subjects had their sexual challenges discussed with the doctor. Conclusion: ED is a common medical and social problem in our environment though still shrouded in secrecy. ED is more prevalent and severe among age 60-79 years. Awareness of treatment seeking behavior and the ability of the attending physicians to discuss with men about their sexual health remains quite poor in our environment.
... 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.
... Sexual dysfunction is a common disease that troubles 40% of women in the United States, and it is reported that 150 million men worldwide are affected by ED. 34,35 Due to a lack of international consensus on sexual dysfunction, however, the incidences or prevalence reported in different studies are different, and the epidemiological characteristics are unclear. 36 Many studies think that sexual dysfunction can be classified into 4 categories: (1) sexual desire disorders, (2) sexual arousal disorders (sexual arousal disorders in females and male ED), (3) orgasmic disorders (inhibited male or female orgasm and premature ejaculation in males), and (4) sexual pain disorders (dyspareunia and vaginismus). ...
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Introduction: The association between systemic sclerosis (SSc) and sexual dysfunction was controversial. Aim: To explore the impacts of SSc on sexual function, the prevalence of sexual dysfunction in patients with SSc and associated risk factors. Methods: A systematic review of all published studies was performed. Studies exploring the association between SSc and sexual function were retrieved from PubMed, Web of Science, and EBSCO. All retrieved papers were selected according to the inclusion and exclusion criteria. Main outcome measure: The impacts of SSc on sexual function, the prevalence of sexual dysfunction in males and females with SSc and associated risk factors. Results: A total 12 studies were included in this study. The prevalence of sexual dysfunction in SSc males and SSc females were 76.9-81.4% and 46.7-86.6%, respectively. But the direct impacts of SSc on sexual function were controversial. EULAR SSc activity score ≥3, the number of complications ≥2, and the presence of anticardiolipin antibody and anti U1 ribonucleoprotein antibody in males and resistive index (RI) and the systolic/diastolic (S/D) ratio of clitoral blood in females have potential to be SSc-specific risk factors for sexual dysfunction. Clinical implications: Clinicians need to pay more attention to the impacts of SSc on sexual function of patients especially in those with risk factors. Strengths & limitations: Systematically explored the prevalence of sexual dysfunction in SSc males and females, and the risk factors of sexual dysfunction for SSc were explored innovatively. However, there were some limitations in included studies prevented exploring the impacts of SSc on sexual function deeply. Conclusion: Sexual dysfunction may be an important symptom of SSc, many risk factors may be associated with sexual dysfunction in males and females with SSc. Gao R, Qing P, Sun X, et al. Prevalence of Sexual Dysfunction in People With Systemic Sclerosis and the Associated Risk Factors: A Systematic Review. Sex Med 2021;XX:XXXXXX.
... ED is common among both younger and older men in various settings [3,4] and is estimated to be experienced by 19.3% of the population [5] with higher incidence with increasing age [6]. ...
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Background: Erectile dysfunction (ED) is common and impacts psychosocial wellbeing negatively. Many do not seek medical attention and several barriers for healthcare seeking with ED exist. Little is known about the association between socioeconomic characteristics of the patient and barriers for healthcare-seeking for men bothered by ED. The objectives of the study were 1) to estimate the proportion of men bothered by ED, who do not contact the GP, 2) to analyse the frequencies of selected barriers for healthcare seeking and 3) to analyse associations between socioeconomic factors and barriers for contacting the GP. Methods: Data derive from a nationwide survey of symptom experiences among 100,000 randomly selected individuals aged 20 years and above. The questionnaire comprises, among other, questions about ED. This study focuses on men who reported bothersome ED and further reported, that they did not contact a GP regarding the symptom. Questions addressing barriers regarding GP contact included embarrassment, worrying about wasting the doctor's time, being too busy, and worrying about what the doctor might find. Information about socioeconomic characteristics was obtained from Statistics Denmark. Results: A total of 4072 men (18.3%) reported that they had experienced ED within the past four weeks. Of those, 2888 (70.9%) were categorized as having bothersome ED. In the group of men with bothersome ED 1802 (62.4%) did not contact the GP and 60.5% reported barriers for GP-contact. Of the reported barriers, the most frequent was 'being too embarrassed' (29.7%). In general, respondents in the older age groups were less likely to report embarrassment, business and worrying what the doctor might find. Respondents with highest attained educational level were less likely to report embarrassment and worrying. Conclusion: Nearly two third of the respondents with bothersome ED had not contacted their GP. More than half of those reported barriers towards GP contact with embarrassment as the most frequent barrier. In general, respondents in the older age groups and with high educational level were less likely to report barriers.
... ED is a common medical condition that affects the sexual life of millions of men worldwide, the majority between the ages of 40 and 70 years (Lewis et al., 2010;McKinlay, 2000;NIH Consensus Conference, 1993;Shaeer & Shaeer, 2012). Various large-scale cross-sectional and longitudinal studies have indicated a worldwide prevalence of ED between 10 and 20% (Albersen, Mwamukonda, Shindel, & Lue, 2011). ...
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Sublingual apomorphine could be an option in patients with erectile dysfunction who cannot take phosphodiesterase type 5 inhibitors (e.g., using nitrates). We have completed a systematic review to evaluate the effects of sublingual apomorphine comparing with placebo for treating erectile dysfunction. The evidence searching process finished on 9 January 2019. We included nine randomized controlled trials (RCTs). Treatment length varied from 4 to 8 weeks and doses ranged from 2 to 6 mg. The percent of successful sexual intercourse attempts per ingested dose of apomorphine was evaluated in eight studies. All the studies found that apomorphine was better than placebo (6-27% more successful intercourse attempts than with placebo), but differences were not statistically significant in one study done in patients previously treated with radical prostatectomy. Regarding erectile function scores, three studies reported higher improvement on the erectile function scores for apomorphine. Differences with placebo were not clinically relevant in another two studies, one in which only diabetic patients were included and one in which only patients with radical prostatectomy were involved. Discontinuation of treatment due to adverse events was higher for apomorphine, particularly for higher doses. Available evidence suggests that sublingual apomorphine is more effective than placebo, except for patients previously treated with radical prostatectomy, and is generally well tolerated at doses of 2 or 3 mg. Nowadays, sublingual apomorphine is the only licensed oral drug for erectile dysfunction not absolutely contraindicated with nitrates use, and more RCTs should be performed to evaluate its effects and safety for treating ED.
... 5 In fact, ED is a highly prevalent problem, especially among the individuals who suffer from various chronic illnesses, leading to poor quality of life and well-being. 6,7 Erectile dysfunction is a multi-factorial condition where a large number of risk factors are involved in its pathophysiology, including aging, chronic illnesses (i.e., cardiovascular disease, hypertension, diabetes, hyperlipidemia), cigarette smoking, metabolic disorders, hypogonadism, urinary tract infection, surgical procedures, medications, sedentary lifestyle, and depression. [8][9][10][11] It was found also that the presence of metabolic syndrome had a significant correlation with lower International Index of Erectile Function-erectile dysfunction (IIEF-ED) scores, lower intercourse satisfaction scores, and lower total testosterone (p < 0.01), and the greater the number of components of metabolic syndrome, the higher the prevalence of ED. 12 Thus, early identification and treatment of metabolic syndrome risk factors, including diet and lifestyle interventions, might be helpful to prevent ED and secondary cardiovascular disease. ...
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Background and objective This study aimed to determine the validity of using a single-question self-report of erectile dysfunction (ED) as a screening tool among Saudi men with type 2 diabetes mellitus (T2DM).
... The role of poor sleep and the participation of sleep disorders in erectile dysfunction has gained prominence in recent studies. It is estimated that by 2025 over 300 million men will be affected [11,12]. ...
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Purpose of the Review We sought to produce a review of studies that examine how lack of sleep can modulate male sexual function, with a particular focus on recent findings about sleep apnea and erectile dysfunction (ED) and to examine novel therapeutic approaches proposed in the literature to provide literature on novel therapeutic approaches. Recent Findings Studies have shown that continuous positive airway pressure (CPAP), − used as standard therapy for obstructive sleep apnea (OSA) – is associated with a clinically significant improvement in the following sexual issues: erectile function, total erectile events, night penis stiffness, overall sexual satisfaction. Recent research has indicated that insufficient sleep, interrupted sleep, and sleep disorders affect sexual function. Sleep is fundamental for quality of life, but with the increasing pressures exerted by modern life there is a tendency for a reduction in sleep time. The resulting sleep debt can have a significant impact on health, including on sexual health. Summary Penile erection is essential for reproductive success and depends on the integration of psychological, vascular, endocrine, neurological, and myogenic mechanisms, triggered by a reflexive response or by psychogenic stimuli of central origin. During sleep, erections can occur through impulses sent through the descending pathway, via spinal medulla that activate the penile system reflex in healthy males from birth until old age, independent of the dream content. OSA is associated with an increased risk of ED and/or other urological disorders. Patients with severe OSA have low testosterone concentrations and a higher prevalence of ED.
... Accumulating data suggests that erectile dysfunction is highly prevalent in the general population. Although prevalence rates as high as 74% have been reported [21][22][23][24][25][26][27][28][29][30][31], data from large epidemiological studies around the world, the Cross-National Study, the MALES study, the Health Professionals Study, and the MATeS study, point towards an average prevalence of erectile dysfunction in the general population of around 15-20% [28,[32][33][34][35]36]. Of note, sexual dysfunction seems to be more frequent in women than in men in the general population [37]. ...
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: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.
... В возрасте 40-50 лет ЭД выявляется уже у 40% мужчин, в 50-60 лету 48-57%. Каждый третий мужчина старше 60 лет вообще не способен совершать половой акт [2,3]. По результатам анализа форм и распространенности ЭД в Российской Федерации с помощью опросника Международного индекса эректильной функции (МИЭФ-5) выявлено, что из 1225 мужчин в возрасте от 20 до 75 лет симптомы ЭД имели место у 1101 респондента. ...
... (Bacon et al., 2003). As per an estimate over 320 million people in the Westernized nations will be develop MSD by 2025 (McKinlay JB, 2000). ...
... Several studies reported that 10% of men older than 35 years experienced ED, and this percentage increased to 75% in men aged 70 and older. Therefore, it is estimated that there are more than 150 million men suffering from ED worldwide [4][5][6]. ...
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Background Stenoses of internal pudendal arteries (IPAs) appear to be related to erectile dysfunction (ED). Nevertheless, the correlation between the severity of ED and stenosis of the IPAs is not well established. Objectives To evaluate angiographic findings of IPAs in patients with suspected coronary artery disease (CAD) and to assess the correlation between the severity of ED and IPA stenosis. Materials and methods Ninety-one patients who were scheduled for cardiac angiogram (CAG) because of suspected CAD participated. ED was assessed using the International Index of Erectile Function (IIEF) questionnaire. Erectile function (EF) domain scoring was used to assess the severity of ED: severe (EF score = 1–10); moderate (11–16); mild-moderate (17–21); mild (22–25); and no ED (26–30). Angiography was performed in bilateral common, internal iliac, and IPAs and the location and extent of stenoses were measured. We divided patients according to those with maximum stenosis of less than 50% (Group I) and those with more than 50% (Group II), regardless of direction. Results We diagnosed 88 patients (88/91, 96.70%) with ED. There was no correlation between increasing age and severity of ED (r = - 0.063, p = 0.555). There were 72 patients in Group I and 19 in Group II. In Group I, 62 patients were diagnosed with ED even though there was no stenosis. There was no significant correlation between the severity of ED and the extent of stenosis in IPAs (r = -0.118, p = 0.265). Conclusions There was no significant correlation between the severity of ED and the extent of stenosis of IPAs. We believe that this is because the progression of ED is induced by endothelial cell dysfunction, not by mechanical obstruction leading to blood flow reduction.
... It is estimated that by 2025, there will be more than 300 million ED patients worldwide. 1 The data show that the total prevalence of ED in China is 26.1%, while that in men over 40 years old is as high as 40.2%. ED seriously affects quality of life in men and is an important hidden danger to social stability. ...
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Introduction Phenotype switch refers to the process in which smooth muscle cells change from contractile type to synthetic type and acquire the ability of proliferation. Phenotypic transformation involves many changes of cell function, such as collagen deposition and fibrosis, which affect the normal erectile function of penis. Aim To investigate the role of miR-195-5p in regulating the Phenotype switch of the corpus cavernosum smooth muscle (CCSM) cells. Methods A small mother against decapentaplegic 7(Smad7) virus vector and a miR-195-5p mimics or an si-Smad7 viral vector and a miR-195-5p inhibitor were transfected into CCSM cells. The cells were obtained by primary culture of rat corpus cavernosum smooth muscle tissue. Real-time polymerase chain reaction (PCR) experiments, Western blotting, hematoxylin-eosin (HE) staining, transwell experiments, MTT assays, and flow cytometry were used to detect miR-195-5p, Smad7, phenotype switch markers of CCSM cells and related protein expression, as well as changes in cell morphology, migration, proliferation and apoptosis. Main Outcome Measure To study the regulation of miR-195-5p in CCSM cells by overexpression and silencing strategies. Results Overexpressed miR-195-5p promoted the transformation of CCSM cells from a contractile type to a synthetic type. Meanwhile, the migration ability and proliferation ability of CCSM cells increased, and the apoptosis rate decreased. The expression-silencing of miR-195-5p gave rise to the opposite effect. The results of the rescue experiment demonstrated that overexpressed Smad7 rescued the inhibitory of the switch of the CCSM cell phenotype from the contractile type to the synthesis type caused by overexpression of miR-195-5p alone. Moreover, the enhancement effect of the migration ability and proliferation ability of CCSM cells was also eliminated, and the apoptosis rate was increased. Silencing miR-195-5p and Smad7 at the same time resulted in the opposite effect. Conclusion miR-195-5p may regulate the phenotype switch of CCSM cells by targeting Smad7. Zhang J, Zhang X, Zhang J, et al. miR-195-5p Regulates the Phenotype Switch of CCSM Cells by Targeting Smad7. Sex Med 2021;9:100349.
... In fact, the women partners of patients with PE often report lower sexual satisfaction, and higher personal distress and interpersonal difficulty (56). The other sexual dysfunction with great psychophysical impact is represented by ED, with an incidence of 12.4/1,000 cases per year in men aged 40-49 years, 29.8/1,000 in men aged 50-59 years, and 46.4/1,000 in men aged 60-69 years (57). The prevalence is about 20% in men younger than 30 years, 25% in men of 30-39 years, 40% in 40-49 years, 60% in 50-59 years, 80% in 60-69 years, and 90% in men older than 70 years (58). ...
Article
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Endocrine diseases have a considerable impact on public health from an epidemiological point of view and because they may cause long-term disability, alteration of the quality-of-life of the affected patients, and are the fifth leading cause of death. In this extensive review of the literature, we have evaluated the prevalence of the different disorders of endocrine interest in the world and Italy, highlighting their epidemiological, clinical, and economic impact. © Copyright © 2021 Crafa, Calogero, Cannarella, Mongioi’, Condorelli, Greco, Aversa and La Vignera.
... Prostate cancer (PC) is a common malignancy and its associated treatments often result in various complications including male sexual dysfunction [1,2]. Similar to the higher incidence of PC with age, older males are more likely to report erectile dysfunction (ED) too [1,3]. There is a strong association between ED and cardiovascular disease (CVD) [4,5] since they share similar risk factors and pathophysiologic mechanisms [6,7]. ...
Article
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Prostate cancer (PC) and its associated treatments can cause significant cardiovascular and sexual dysfunctions. While structured exercise interventions can induce positive outcomes in males with PC, there are limited data on its effects on cardiovascular health, erectile function, or the combination of these outcomes. It has been proposed that positive changes in biomarkers of cardiovascular health through physical exercise programs, can result in cardiovascular remodelling and improve penile haemodynamic and erectile function recovery in those with metabolic syndrome and/or cardiovascular diseases, although the data is accruing in males who are diagnosed and/or treated for PC. While the results of this review article support structured physical exercise interventions to effectively prevent and mitigate the development of both sexual and cardiovascular dysfunctions in males with PC, appropriate caution should be maintained and future clinical research should focus on the development of standardised and evidence-based exercise guidelines in the setting of PC survivorship.
... The landmark MMAS revealed a prevalence of mild to moderate ED in 52% of men aged 40-70 years [Feldman et al., 1994], whereas the European Male Ageing Study (EMAS) found an average ED prevalence of 30% in men at ages 40-79 years [Corona et al., 2010]. Although there are regional differences, it was estimated that ED affected 152 million men worldwide in 1995 and was predicted to increase to 322 million men globally by 2025 (using the lowest United Nations population projections) [Ayta et al., 1999;McKinlay, 2000]. ...
Article
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Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of erectile tissues in the penis and/or disruptions in adulthood that impact sexual stimuli, neural pathways, molecular changes, and endocrine signalling that are required to drive erection. Sexual stimulation activates the parasympathetic system which causes nerve terminals in the penis to release nitric oxide (NO). As a result, the penile blood vessels dilate, allowing the penis to engorge with blood. This expansion subsequently compresses the veins surrounding the erectile tissue, restricting venous outflow. As a result, the blood pressure localised in the penis increases dramatically to produce a rigid erection, a process known as tumescence. The sympathetic pathway releases noradrenaline (NA) which causes detumescence: the reversion of the penis to the flaccid state. Androgen signalling is critical for erectile function through its role in penis development and in regulating the physiological processes driving erection in the adult. Interestingly, estrogen signalling is also implicated in penis development and potentially in processes which regulate erectile function during adulthood. Given that endocrine signalling has a prominent role in erectile function, it is likely that exposure to endocrine disrupting chemicals (EDCs) is a risk factor for ED, although this is an under-researched field. Thus, our review provides a detailed description of the underlying biology of erectile function with a focus on the role of endocrine signalling, exploring the potential link between EDCs and ED based on animal and human studies.
... [3] ED is a very common male health problem, defined as the inability to achieve and maintain sufficient erections to achieve satisfactory sexual intercourse, affecting nearly a third of men over the age of 50. [4] ED can have harmful effects on mental health, interpersonal relationships, and a wide range of psychosocial domains. [5] A variety of ED-related risk factors have been identified, such as cigarette smoking, diabetes mellitus, cardiovascular events, chronic kidney disease, metabolic syndrome, and depression. ...
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Background: Erectile dysfunction (ED) and osteoporosis are both common health problems and have similar risk factors. Recent studies have found that people with ED have a higher risk of osteoporosis.We aimed to systematically assess osteoporosis risk in patients with ED. Methods: A systematically research was carried out in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to June 4, 2020, to identify articles related to ED and osteoporosis. The 2 researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. All analyses were done using RevMan5.3 and Stata14. Results: A total of 4 studies involving 22,312 participants were included. The meta-analysis results showed that the risk of osteoporosis in the ED group was significantly higher than that in the non-ED group [odds ratio (OR) = 2.66, 95% confidence interval (95% CI) 1.42 to 4.98, P = .002, I2 = 68%]. Interestingly, compared with older participants, the increased risk of osteoporosis in ED patients seemed to be more pronounced in younger participants. Despite the lack of data for meta-analysis, more than half of the literature mentioned this tendency. We found the source of heterogeneity through sensitivity analysis, and there was no significant effect on the results before and after the removal of this literature, indicating that our results were robust. No obvious publication bias was found through Egger method (P = .672). Conclusion: People with ED have a higher risk of osteoporosis, especially among younger males. Because the assessment of osteoporosis is economical and noninvasive, ED patients should be evaluated by bone mineral density or men with osteoporosis should be further assessed for erectile function.
... Erectile dysfunction is a highly prevalent pathology in the entire male population, with a tendency to increase in the frequency of presentation as age increases. [1][2][3] The treatment of erectile dysfunction typically focuses on obtaining an erection through pharmacological or even surgical mechanisms. However, since 2010, shock waves have been evaluated as a new therapeutic option due to a large amount of evidence from cohort studies, controlled clinical trials, and meta-analysis [4][5][6][7][8][9] suggesting that this type of wave generates benefits in some groups of patients with this disease and showing how the waves could act on the physiopathology of the dysfunction. ...
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Introduction: Radial waves are used to treat erectile dysfunction; however, they are different than focal waves, and their mechanism of action or effect on improving this condition is not known. Aim: To evaluate the effect of radial waves at the cellular level and their effectiveness at the clinical level for the treatment of erectile dysfunction. Methods: Systematic literature review. Electronic database searches and manual searches were performed to identify (i) clinical trials or cohort studies evaluating the effectiveness of radial waves in men with erectile dysfunction and (ii) preclinical trials in animal models or cell cultures in which the production of nitric oxide or endothelial growth factor was evaluated. Study quality was assessed, and data were extracted from each study. A narrative synthesis of the results was performed given the high heterogeneity between the selected studies. Main outcomes measures: Nitric oxide production, endothelial growth factor expression, and changes in the Erection Hardness Score (EHS) and the International Index of Erectile Function (IIEF) Questionnaire score. Results: Four studies in animal models and 1 randomized clinical trial in men with erectile dysfunction and kidney transplantation were identified that met the selection criteria. Preclinical studies in animals suggest that radial waves increase cellular apoptosis in penile tissue, while vascular endothelial growth factor expression increases in brain tissue. In men with erectile dysfunction, no differences were found between radial wave therapy and placebo therapy in the mean IIEF score (15.6 ± 6.1 vs 16.6 ± 5.4 at 1 month after treatment), EHS (2.5 ± 0.85 vs 2.4 ± 0.7 at 1 month after treatment), or penile Doppler parameters. Conclusions: No quality evidence was found to support the use of radial waves in humans for the treatment of erectile dysfunction. In animal models and at the cellular level, the results are contradictory. More research is needed. Sandoval-Salinas C, Saffon JP, Corredor HA, et al. Are Radial Pressure Waves Effective in Treating Erectile Dysfunction? A Systematic Review of Preclinical and Clinical Studies. Sex Med 2021;XX:XXXXXX.
... It is also an early warning sign of many physical diseases, such as stroke, tumors, Parkinson's disease, and spinal cord disease, etc. (3). Estimates suggest that ED affects approximately 150 million men worldwide, and the rates of ED are expected to double by the year 2025 (4,5). In view of the current trend, the research and treatment of ED is very important and meaningful. ...
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This meta-analysis was performed to assess the efficacy and safety of taking tadalafil 5 mg once-daily for at least 6 months in the treatment of erectile dysfunction (ED). Based on databases: MEDLINE, EMBASE and Cochrane Controlled Trials Register, this analysis was performed to collect randomized controlled trials (RCTs) of tadalafil 5mg once-daily in treating ED over 6 months. Reviewers also investigated the references of each literature. The meta-analysis covered a total of 1,596 patients in six RCTs. The tadalafil group performed a better effect in terms of the international index of erectile function-erectile function (IIEF) domain (P=0.005) for the treatment of ED compared with the placebo group. Safety assessments including discontinuations due to adverse events (AEs) (P=0.31) and treatment-emergent AEs (P=0.06) indicated that the tadalafil group had a better tolerate. The analysis elucidates that the dose of 5 mg per day of tadalafil showed a good effect after the treatment of at least 6 months relative to the control group with fewer side effects.
... 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.
... 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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PurposeThis 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.ResultsWhen 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 a common [1-7], consequential [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], and clinically neglected [4,5,[27][28][29][30][31][32][33][34][35][36][37][38] sexual problem that is experienced by millions of men and their partners worldwide. The current research, which is part of the Strike Up A Conversation (S.U.A.C.) research program, examines the experience of communication about ED among men with ED, partners of men with ED, and physicians who treat ED. ...
Article
Background: Erectile dysfunction (ED) is a common, consequential, and clinically neglected sexual problem. The current research is designed to study the experience of communication about ED among men with ED, partners of men with ED, and physicians who treat ED. Methods: Qualitative research with 10 men with ED, 10 female partners of men with ED, and 15 physicians who treat men with ED, was used to formulate questions pursued in quantitative research with larger samples of men with ED (n = 449), partners of men with ED (n = 429), and physicians who treat men with ED (n = 389), concerning communication about ED among men with this condition, partners, and physicians. Results: Men with ED and partners of men with ED reported strikingly similar perceptions of ED, positive responses to communicating about ED, and negative responses to failing to communicate about ED. Results concerning communication about ED with physicians, physician perspectives on communication about ED, preferred attributes of oral ED therapy, and correlates of phosphodiesterase (PDE5) inhibitor therapy use and non-use, are reported in Part II of this publication. Conclusions: These findings can be used to guide clinical counselling and public health education to facilitate communication about ED and treatment seeking for this condition where appropriate.
... 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.
... 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.
... 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]. ...
... Several factors are responsible for erectile dysfunction, including psychological factors [4,5,6] physiological factors (hormonal, hypertension, diabetes) [7,8,9]. More than 150 million men are affected worldwide [10]and its prevalence is estimated to more than 300 million people in 2025 [11,3] with a large increase in developing countries, particularly in Africa, Asia and South America [12]. In Côte d'Ivoire, the prevalence of men affected by erectile dysfunction is unknown. ...
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In Côte d'Ivoire, the market of aphrodisiacs of natural origin has been significantly growing over the last decades. The objective of this study was to evaluate the cytotoxicity of the most employed by Ivorian men, called Aphro. For that, Caco-2/TC7 enterocytes and Vero ATCC cells kidney epithelial cells grown in DMEM medium were exposed to Aphro at concentrations ranging from 216 to 864 µg/mL. Lactate dehydrogenase (LDH) released upon cell death was assayed after 1, 2 and 24h of exposure. In parallel, the effect of Apho was evaluated in differentiated confluent cells by measurements of the trans-epithelial electrical resistance. A time course and significant dose response related increase of LDH was measured in the culture medium of Caco-2/TC7 and Vero ATCC cells exposed to the aphrodisiac. The trans-epithelial electrical resistance of the Caco-2/TC7 cell monolayers also showed a significant decrease from 1400 Ω*cm2 at the onset of the experiment to 450 Ω*cm2 after 24 h of treatment. Cell detachment and structural disorganization were observed in both cell lines. This study reveals the strong cytotoxicity of Aphro extract on both cell lines.
... negli uomini di età compresa tra 50 e 59 anni, 46,4/1.000 negli uomini di età compresa tra 60 e 69 anni [34]. La prevalenza è di circa il 20% nella fascia di età al di sotto dei 30 anni, 25% tra 30 e 39 anni, 40% tra 40 e 49 anni, 60% tra 50 e 59 anni, 80% tra 60 e 69 anni e 90% nei maschi di età >70 anni [35]. ...
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Sommario Le patologie del sistema endocrino hanno un notevole impatto dal punto di vista epidemiologico sulla salute delle popolazioni. Esse sono in grado di alterare la qualità della vita dei pazienti affetti e sono responsabili di disabilità a lungo termine; si collocano al quinto posto tra le cause di morte. In questa revisione della letteratura abbiamo valutato la prevalenza e l’incidenza delle principali malattie endocrine nel mondo e in Italia per evidenziarne il reale impatto nella pratica clinica dell’endocrinologo.
... 1 ED is currently one of the most common sexual dysfunctions in men worldwide. 2 ED is the chief complaint of more than 50% of all men treated for sexual disorder. The severity of presentation may range from a partial decrease in penile rigidity to a complete erectile failure. ...
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Background Erectile dysfunction (ED) is one of the most common psychosexual disorders in clinical practice, and it results in significant distress, interpersonal impairments, poor quality of life, and marital disharmony. However, there is limited research on ED in India. Therefore, this study aimed to assess the sociodemographic and clinical profile of patients presenting with ED. Method Cross-sectional evaluation of patients with ED presenting to the psychosexual outpatient department (OPD) of psychiatry department in a tertiary care hospital was done on structured clinical pro forma, Mini-International Neuropsychiatric Interview, International Index of Erectile Function-5, Arizona Sexual Experience, Hamilton rating scale for depression, and Hamilton rating scale for anxiety. Results The sample included 102 patients. The mean age was 33.38 years. The majority of the patients were married (81.4%), Hindu (82.4%), residing in a rural area (60.8%), and belonging to a nuclear family (62.7%). The majority of the patients had a moderate level of ED (50%) followed by mild-to-moderate ED (26.5%) and severe ED (23.5%). Premature ejaculation (46.1%) and depression (28.4%) were the most common sexual and psychiatric comorbidities. Obesity was common (62.7%), and only a minority had other metabolic dysfunction, namely dyslipidemia (7.8%), diabetes (5.9%), and hypertension (4.9%). Tobacco dependence and alcohol dependence were present in 37.3% and 6.9% cases, respectively. Conclusion Young adults with moderate-to-severe ED were present for treatment at a tertiary center. Comorbidities of other sexual disorders, psychiatric disorders, and substance use are commonly encountered in such patients. Promotion of early help-seeking should be encouraged. Clinicians should thoroughly assess even the young patients for other sexual, psychiatric, and medical comorbidities.
... Erectile dysfunction (ED) is a common [1-7], consequential [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26], and clinically neglected [4,5,[27][28][29][30][31][32][33][34][35][36][37][38] sexual problem that is experienced by millions of men and their partners worldwide. The current research, which is part of the Strike Up A Conversation (S.U.A.C.) research program, examines the experience of communication about ED among men with ED, partners of men with ED, and physicians who treat ED. ...
Article
Background: Erectile dysfunction (ED) is a common, consequential, and clinically neglected sexual problem. The current research is designed to study the experience of communication about ED among men with ED, partners of men with ED, and physicians who treat ED. Methods: Qualitative research with 10 men with ED, 10 female partners of men with ED, and 15 physicians who treat men with ED, was used to formulate questions pursued in quantitative research with larger samples of men with ED (n = 449), partners of men with ED (n = 429), and physicians who treat men with ED (n = 389), concerning communication about ED among men with this condition, partners, and physicians. Results: Men with ED and partners of men with ED reported strikingly similar perceptions of ED, positive responses to communicating about ED, and negative responses to failing to communicate about ED. Results concerning communication about ED with physicians, physician perspectives on communication about ED, preferred attributes of oral ED therapy, and correlates of phosphodiesterase (PDE5) inhibitor therapy use and non-use, are reported in Part II of this publication. Conclusions: These findings can be used to guide clinical counselling and public health education to facilitate communication about ED and treatment seeking for this condition where appropriate.
... Erectile dysfunction (ED) is a common condition that affects up to 40% of men by the age of 70, and roughly 30 million men in the United States (US) [1,2]. ED can have a detrimental impact upon a wide range of psychosocial domains, interpersonal relationships, and overall mental health [3]. ...
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To determine the relationship between popular diets and erectile function we queried the National Health and Nutrition Examination Survey, a cross-sectional dataset, between 2001 and 2004. All men aged 18–85 who answered the prostate and dietary questionnaires were included. Diets were categorized as Mediterranean, low-fat, low-carbohydrate, or nonrestrictive. Multivariable models were created to determine the relationship between erectile function and each diet. Among 4027 men, 649 (16.1%) met criteria for a low-fat diet, 1085 (26.9%) for a Mediterranean diet, and 0 (0%) for a low-carbohydrate diet. 1999 men (49.6%) had some degree of erectile dysfunction. Men with nonrestrictive diets were more likely to endorse normal erectile function compared with those adhering to the Mediterranean or low-fat diets (both p < 0.05) on univariable analysis. Multivariable analysis controlling for age, comorbidities, activity level, and body mass index showed no differences in erectile function among men adhering to a low-fat, Mediterranean diet, or nonrestrictive diet. There was no association between specific diets and erectile function. While additional prospective research is required to corroborate these findings, these data support the notion that individualized diets should be tailored toward goals of weight loss and reduction of comorbidity.
Article
Erectile dysfunction (ED) significantly deteriorates the quality of life of patients with Parkinson's disease (PD). Until recently, treatment of ED received insufficient attention. Management of ED in patients with PD requires an integrated and multidisciplinary approach. Pharmacotherapy with apomorphine or sildenafil (or other inhibitors of phosphodiesterase-5) has shown encouraging results in most patients with PD and ED. This review of literature addresses problems of ED in patients with PD.
Article
Background: Oxidative stress is a significant contributor to the poor treatment efficacy on erectile dysfunction induced by diabetes mellitus (DMED). Thus, understanding the mechanism underlying oxidative stress will aid in the identification of novel therapeutic targets. Aim: To define the role of Janus kinase 2 (JAK2) in mediating oxidative stress in the corpus cavernosum smooth muscle cells (CCSMCs) and to investigate the therapeutic effect of monomeric berberine (BB), which inhibits JAK2, in the pathogenesis of DMED. Methods: Streptozotocin was used to establish type I diabetic rat models and apomorphine tests were conducted to determine DMED rats. Eighteen DMED rats were divided into the DMED group and the DMED+BB group, whereas another 10 age-matched rats formed the control group. CCSMCs were isolated from the corpus cavernosum of rats and were treated with the JAK2 inhibitor alpha cyanano-(3,4-hydroxyl)N-benzophenylamine (AG490) and/or BB. Outcomes: Metabolic parameters; erectile function; histologic and molecular alterations. Results: Erectile function was impaired and excessive oxidative stress was found in the DMED group. Excessive oxidative stress led to decreased expression level of phosphorylated endothelial nitric oxide synthase at serine 1177/endothelial nitric oxide synthase and increased expression level of Ras homolog gene family and Rho kinase 1/2. Meanwhile, the relative expression ratio of phosphorylated JAK2/JAK2 was significantly greater in the DMED group than that in the other groups. In vitro, oxidative stress was significantly reduced along with reduced intracellular calcium upon treatment with the JAK2 inhibitor, AG490. Moreover, the CCSMCs treated with BB showed changes similar to those upon treatment with AG490. In vivo experiments also confirmed that the erectile function of the DMED+BB group was improved, accompanied by decreased phosphorylated JAK2/JAK2 and decreased oxidative stress. Clinical translation: JAK2 can be used as a therapeutic target and BB can be used as a potential drug for the clinical treatment of DMED. Strengths and limitations: This study examines the promoting effect of JAK2 on oxidative stress occurrence in the corpus cavernosum and on the development of DMED in both animal experiments and cell experiments, as well evaluates the inhibitory effect of BB on JAK2 and its therapeutic effect on DMED. The main limitation of our current study is the lack of an appropriate means for activating JAK2. Conclusions: JAK2 can induce DMED by enhancing oxidative stress and BB can play a role in treating DMED by inhibiting JAK2 and reducing oxidative stress. Our study provides an option and an idea for further studies on the pathogenesis and treatment of DMED. Song J, Tang Z, Li H, et al. Role of JAK2 in the Pathogenesis of Diabetic Erectile Dysfunction and an Intervention With Berberine. J Sex Med 2019;XX:XXX-XXX.
Article
Background While phosphodiesterase type-5 inhibitors (PDE5Is) are highly effective for the treatment of erectile dysfunction (ED) and well tolerated, updated data on prescription patterns have been limited in real-world settings. Aim To describe men in the United States who are prescribed PDE5Is for ED treatment and to evaluate patterns of initiation, switching, and treatment overlap. Methods This retrospective claims study used MarketScan Commercial and Medicare Supplement Databases from January 1, 2010, to December 31, 2015, to identify initial PDE5I claims (index date) for sildenafil, tadalafil, and/or vardenafil. Adults aged ≥18 years with ED were identified between July 1, 2010, and December 31, 2014, allowing for a 6-month preindex and 12-month follow-up period from the index date. Outcomes Outcomes included patient demographics and treatment-related patterns after treatment initiation. Results A total of 106,206 identified patients met all inclusion criteria. Of these, 51,694, 40,193, and 14,319 had initial claims for sildenafil, tadalafil, and vardenafil, respectively. Mean age was 50.35 years, and comorbidities included dyslipidemia (44.17%), hypertension (43.09%), diabetes (15.32%), and depression (10.61%). More patients (48.67%) initiated on sildenafil than tadalafil (37.85%) or vardenafil (13.48%). Rate of switching was lower in the 60 days after the end of day supply of the initial prescription in the sildenafil cohort (2.71%) compared with the tadalafil (2.81%) and vardenafil (3.88%) cohorts (P < .001 for sildenafil vs tadalafil or vardenafil). Treatment overlap was lower in the sildenafil cohort (0.35%) than in the tadalafil (0.75%) and vardenafil (0.62%) groups (P < .001 for sildenafil vs tadalafil or vardenafil). Clinical Implications These findings provide insight into updated patterns of PDE5I prescriptions in the United States and may aid in clinical decision-making. Strengths & Limitations Strengths include the large sample size, long data coverage period, and the real-world nature of the study. Limitations include the retrospective study design, use of data collected with a primary focus of claims, and lack of further details regarding reasons that drive switching. Actual rates of ED and impact on prescription patterns may be underestimated because the claims database only captured patients electing to visit a health-care provider. Conclusion Among men with ED in the United States, rates of switching and treatment overlap were low for all PDE5Is but were found to be the lowest for sildenafil compared with tadalafil and vardenafil. Mulhall JP, Chopra I, Patel D, et al. Phosphodiesterase Type-5 Inhibitor Prescription Patterns in the United States Among Men With Erectile Dysfunction: An Update. J Sex Med 2020;XX:XXX–XXX.
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INTRODUCTION: Twitter is a social network based on "tweets," short messages of up to 280 characters. Social media has been investigated in health care research to ascertain positive or negative feelings associated with several conditions but never in sexual medicine. AIM: To assess perceptions related to erectile dysfunction (ED) and premature ejaculation (PE) among Twitter users. METHODS: Data collection was performed on a daily basis between May 24-October 9, 2018 (138 days) via an automated script. Data collection was then performed after data cleaning. The statistical software R and the rtweet packages were used in both phases. RESULTS: We collected 11,000 unique tweets for PE and 30,546 unique tweets for ED. After data cleaning, we analyzed 7,020 tweets on PE and 22,648 tweets on ED by analyzing the most recurring words and the clusters describing word associations. The most popular words for ED were "Treatment," "Health," and "Viagra," whereas "Sex," "Sexual," and "Cure" were the top 3 for PE. Word clusters suggest the presence of some recurring themes, such as medical terms being grouped together. Additionally, tweets reflect the general feelings triggered by specific events, such as pieces of news pertaining to sexual dysfunctions. CLINICAL IMPLICATIONS: Tweets on sexual dysfunctions are posted every day, with more tweets on ED than on PE. Treatment is among the chief topics discussed for both conditions, although health concerns differ between PE and DE tweets. STRENGTH AND LIMITATIONS: This is the first analysis conducted on Tweets in the field of andrology and sexual medicine. A significant number of tweets were collected and analyzed. However, quantitative assessment of the sentiment was not feasible. CONCLUSION: Sexual dysfunctions are openly discussed on social media, and Twitter analysis could help understand the needs and interests of the general population on these themes. Sansone A, Cignarelli A, Ciocca G, et al. The Sentiment Analysis of Tweets as a New Tool to Measure Public Perception of Male Erectile and Ejaculatory Dysfunctions.
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association between Lower Urinary Tract Symptoms (LUTS) and sexual dysfunction especially Erectile Dysfunction (ED). LUTS, either alone or in combination with ED, represents a considerable problem for ageing men. An understanding of correlation between LUTS and ED in these ageing men will be useful in their routine care. Aim: To determine the incidence of ED and its correlation with LUTS in adult male patients attending the Urology clinic in a Tertiary Care Hospital. Materials and Methods: This was a cross-sectional study of 110 consecutive patients with LUTS recruited from the urological clinic. The data were collected, while ED and LUTS were assessed with the 5-Item Version of the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaire forms respectively. Findings were subjected to linear regression and Pearson’s chi-square tests, using Statistical Package for Social Sciences version 17. Results: The mean age of patients was 65.8±7.95 years. The incidence of ED among LUTS patients was 63.6%. There was positive correlation between ED scores and voiding phase, filling-storage phase and total LUTS scores. The severity of ED and graded LUTS score revealed no significant association between the severity of ED and that of voiding phase and filling-storage phase LUTS. Conversely, severity of ED was significantly related to the severity of total LUTS score. Conclusion: ED is common amongst adult patients with LUTS. Its severity worsens with worsening LUTS. The management of patients with LUTS should therefore involve evaluation and treatment for ED. This calls for increased awareness of these conditions to both the doctor and the patient.
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In this paper, I trace the changing characterisation of health and consider the evolution of health within a shifting paradigmatic landscape. I argue that understanding health now encompasses the importance of wellbeing as a key determinant of longer-term good health. I use the case study of body modification and body art to explore this further. I argue that, while body modification and body art, as a means of self-expression and empowerment, is relatively easy to access, there are critical gaps in the regulatory framework that may undermine the notion of wellbeing and individual choice. I critique the Court of Appeal’s decision in R v BM, [2018] EWCA Crim 560 which raises particular public interest concerns, but conclude that it is a missed opportunity in relation to how the law understands the promotion of ‘self’ within a model of wellbeing.
Article
Erectile dysfunction is a common problem in primary care. Martin Steggall and colleagues discuss what needs to be assessed and the treatment options available Erectile dysfunction (ED) is defined as the inability of a man to get and maintain an erection that is sufficient for sexual intercourse, and is a common problem. ED commonly has a profound negative impact on quality of life in the patient and his partner, which can result in changes to sexual self-confidence. This article outlines strategies for identifying and managing ED in primary care, outlining what needs to be assessed and the various treatment options available to manage the condition.
Article
Background Arteriogenic erectile dysfunction is a common disease oftentimes not satisfactory treatable with medical therapy. Aim To assess the safety and clinical success rate of endovascular revascularization of erection-related arteries with the angiolite BTK stent in patients with arteriogenic erectile dysfunction. Methods A total of 100 consecutive men (61.8 ± 10 years) with atherosclerotic lesions in erection-related arteries agreed to participate and were included into a single-center all-comers registry. Endovascular therapy with angiolite BTK drug-eluting stents was performed on a total of 211 lesions. Patients received a baseline International Index of Erectile Function (IIEF)-15 questionnaire at first presentation and 3 and 12 months after stenting. An improvement by 4 points in the erectile function domain consisting of 6 questions (IIEF-6) was defined as minimal clinically important difference. A total of 24 patients with 52 stented arterial lesions underwent angiographic follow-up of the initially treated arterial side during secondary revascularization of the contralateral side (angiographic sub-study). Outcome Clinical improvement of erections in 100 patients undergoing endovascular revascularization of erection-related arteries. Results No major adverse events occurred during endovascular revascularization or within 30 days thereafter. Technical success was achieved in all lesions and procedural success in all patients. At 1 year, 55 of 97 patients (56.7%) improved by at least 4 points in IIEF-6 score and thus achieved a clinically relevant improvement of erectile function.In the angiographic sub-study, arterial patency and binary restenosis were observed in 46 of 52 (88.5%) and in 8 of 52 (15.4%), respectively, after a mean follow-up of 9.6 ± 5.8 months. Clinical Implications In patients with arteriogenic erectile dysfunction, endovascular therapy with a novel thin-strut sirolimus eluting stent is a safe and feasible treatment option. Strengths & Limitations This real-world arterial revascularization registry included patients with a multitude of risk factors for ED, thereby representing the heterogeneity in patients in the clinical practice, which is one of its strengths but also one of its weaknesses. Another strength was the focus being laid on analyzing outcomes of patients with arteriogenic ED using only a single endovascular device. Further studies are warranted to better define subgroups of patients with impaired clinical outcomes. Conclusion Within the present all-comers registry, endovascular therapy of erectile dysfunction with the angiolite BTK stent was shown to be a safe and feasible treatment option resulting in clinical improvement rates comparable to earlier clinical trials although also showing that further research is warranted to define patient subgroups with particular benefits of endovascular therapy. Schönhofen J, Räber L, Knöchel J, et al. Endovascular Therapy for Arteriogenic Erectile Dysfunction With a Novel Sirolimus-Eluting Stent. J Sex Med 2020;XX:XXX–XXX.
Article
Erectile dysfunction (ED) is defined as the inability of a man to get and maintain an erection that is sufficient for sexual intercourse, and is a common problem. ED commonly has a profound negative impact on quality of life in the patient and his partner, which can result in changes to sexual self-confidence. This article outlines strategies for identifying and managing ED in primary care, outlining what needs to be assessed and the various treatment options available to manage the condition.
Article
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.
Article
Context Penile prosthesis is a durable and effective treatment for erectile dysfunction (ED). Even as other treatment options for ED have been brought to market, penile prosthetic surgery remains a mainstay for urologists treating ED. No systematic study has yet summarized the global trends in penile prosthetic surgery. Objective To systematically review studies of trends in penile prosthetic surgery to determine global movements in implantation rates, malleable versus inflatable prosthetic surgery, inpatient versus outpatient implantation surgery, proportion of men with ED undergoing penile prosthetic surgery, and prosthetic cost. Evidence acquisition A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing trends in penile prosthetic surgeries and costs associated with penile prosthetic device and inclusive surgical costs. Evidence synthesis Twenty-seven studies were identified during the systematic review, comprising 447,204 penile prosthetic surgeries reported from 1988 to 2019. A trend analysis demonstrates that rates of penile prosthetic surgery declined dramatically in the late 1980s and early 1990s, but have demonstrated modest growth since the mid-2000s. Outpatient inflatable penile prosthetic surgery has strongly trended upward. Costs of penile prosthetic device have matched the rate of inflation, but inclusive surgical cost has radically outpaced inflation. Growth has mainly been seen in the USA, with a more modest global growth. Conclusions Penile prosthesis remains a viable option for the treatment of ED. Trends such as outpatient surgery and inflatable penile prosthesis placement may be driving the recent steady growth of penile prosthetic surgeries, but surging inclusive surgical cost may present a barrier for some patients without insurance coverage. Patient summary Penile prostheses continue to be an important treatment for erectile dysfunction. While the volume of penile prosthetic surgeries dropped when phosphidiesterase-5 inhibitors became available, prosthetic surgery is becoming more patient centric, as seen by increases in inflatable prosthetic placement and outpatient surgery.
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.
Chapter
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.
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.
Article
The goal of this study was to investigate the association between serum oestradiol levels and clinically significant erectile dysfunction in a cohort of men presenting for andrological evaluation. Retrospective review was conducted of patients that presented to a urologist with practice in andrology over an 18‐month period. Patients completed the Male Sexual Health Questionnaire and had serum total testosterone and oestradiol measurements prior to 10:30 a.m. via immunoassay. t Tests, chi‐square tests and multivariate logistic regression were used to compare clinical characteristics between those with adequate erectile function (erection scale score > 2) vs. clinically significant erectile dysfunction (erection scale score ≤ 2). Among 256 patients, average age was 49 years (SD 15), average serum oestradiol was 22.3 pg/ml (SD 10.6), and average serum total testosterone was 465.9 pg/ml (SD 206.3). On multivariate logistic regression, serum oestradiol was associated with clinically significant erectile dysfunction (OR 1.52 per SD increase, 95% CI 1.11–2.09, p = 0.009) when controlling for serum total testosterone, age, body mass index and smoking status. These results warrant future studies on the utility of measuring serum oestradiol in patients with erectile dysfunction and the use of aromatase inhibitors in patients with erectile dysfunction and elevated serum oestradiol.
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
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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
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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
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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
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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.